18865 POST THIS CARD NEAR FRONT OF BUILDING
_ � PERMIT NUMBEfl
. 'CITY Or CUPERTINO 18865
INSPECTION DIVISION
' JOB INSPECTION REC_ORMj,�,
"PERMIT EXPIRATION"
.0 IT# T#
'JOB ADDRESS ,. ,
'/ �l .r PERMIT EXPIRES IF'WORK
ownER CONTRACTo l✓ e"Ay'v - - IS NOT STARTED.WITHIN,-
INSPECTION
ITHIN,-INSPEC ON DATE INSPECTOR INSPECTION RECORD 180 DAYSOFPERMIT ISSU-
ANCE OR'180 DAYS FROM
FOUNDATION .NOTE: , '' LASTCAL LED'INSPECTION.
LIFER ALL GRADING'AND DRAINAGE SHALL BE INSTALLED 1.
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CIT'OF -P MIT vAuoanoN
CUPERTINO STANDARDS. _
GARAGESLABS— = -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - - .,`�( -
1 UNDERGROUND /SLAB ' ':"
PLUMBING' -
ELECTRICAL .K»�L/ A � SSUANCI.DATE
MECHANICAL - - .. U Ibtt� RLD' ELECT PLG.. c+T
na.
C-1 ❑ "El
DO NOT POUR FLOOR.UNTIL ABOVE HAS BEEN SIGNED '•"^'? j/Iq' BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION - SIFT.
PLUMBING. . • - .+ J r;, �'
MECHANICAL I •/ -��� �•
P I11 TD'"
ELECTRICAL -
FRAMING _
sroRles -TYPE consrR.
- INSULATION - •
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROOF ` NOTE:NO FINAL INSP.SHALL BE MADE BEFORE S°,FrF UIOII AREA TOTALACREAGE
DIAPHRAGM THE.CONSTRUCTION TAX ISTAID
• TLID
OINGUSE ,
' RES 'IND- -CON PR O"',
ROOF'SHEATHING
❑ ❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL No.
ROUGH t SAN.#
' PLUMBING . - ELECT.ENERGY
TUBS 8 SHOWER•PAN r PLUMBING ENERGY TRACT No. PARCEL No.
MECHANICAL MECH.ENERGY
ACC.DATE ACC.FILE NO
ELECTRICAL" BUILDING ENERGY „
FRAMING _� ELECT:FINAL TEST
'ZONING ENG-SITE NO.
INSULATION PLUMBING"'
GAS TEST IV GAS
_ 'FIRE SPRINK' ENERGY T 24
MECHANICAL - '
'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y [:] N❑ ❑ �❑
EXTERIOR'SHEAR ELECTRICAL RELEASE FI�ooD�NE A,L u.c.
V❑ ,' N❑ V ❑ N❑'.
INTERIOR SHEAR �. � .FIRE DEPT. -
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH'. . BUILDING
.INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
. . GAS-
NO.TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING,252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE,JOBADDRESS WHEN.PHONING.
% = SEEPERMIT FOR EXPIRATION DATE' MECHANICAL
IMPORTANT! coNsT.TAX
PLEASE READ REVERSE SIDE BEFORE'- _ TOTAL h�((�
CALLING FOR FINAL INSPECTION.
OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION -PERMIT NUMBER
nool ss- 1••, APPLICATION & PERMIT - 4 1
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I oo OO6[J .
DINNER V -1 _v rls�f - ' PLAN CHECK VALIDATION
NAME
//1���Jn1 C TY. ELECTRIC PERMIT FEECo
(Rw�.[,� PHONE y �J
NAME OUTLETS
OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00 -
ADRESCTORs
DPPLIANCES-RESIDENTIAL - • 4.00 '
CONTRAS WJ
55I Ac
jcCoc yc, PHONE Z. PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.N0.
OR .PANELS (OVER 200 AMP) 20.00
•( ENGINEER ` `
vgaf uc.No. ���0 .SIGNS TRANS: 3.00
ARCH,OR ENG. ,, n '
ADDRESS �zT.-/ • SPECIAL CIRCUIT - 5.00 ERMIT VALIDATIOfi
SS3 SSC EMP.METER OR POLE INS. 20.00
APPLIC
ADDRESS ANTS MOTORS SEE FEE SCH.
SERVICE CHANGE r k'AWLJr"20.00 -
0¢ i l
Foo LICENSED CONFRACTORS DECLARATION h ,r ,..nn
a u 1 hereby affirm that I am licensed under provisions of ChapTnr 9 •N'^N U 150
H Q y (commencing with Section 7000)of Division 3 of the Business and BLOC. ELEGTNCE DFLG. CM.
H as z Professions Code,and my liceme is in full for
O,as - License Classes Lie,Number
o F° Dale-_-_ , /mss/l�[_ Contractor ---�� r 1 D7• f'R^f711 ❑ ❑ ❑
Q y f F (�I
T w a OWNI!R-B LDER DECLARATION �36BUILDING PERMIT
o a - INFORMATION
w ; LL N I hereby affirm that I am exempt from the Contractor's License MISC.— 'REFER TO ORD
u. 0 a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
r - PERMIT ISSUANCE - 10.00
,A - Code:Any city or county which requires a peril to construct,alter, //��• /j
QQ ¢Qimprove.demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC..NO. ELEC. OQ'�d
o u requires the applicant for such permit to file a signed statement that - - TOTAL PERMIT TO
n w m'y he is licensed pursuant to the,provisions of the Contractor's License,
>
Law(Chapter 9(commencingwith Section 7000)of Division 3 afthe - /
Business and Professions Code)of that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �r��"/"
¢ r$ - the basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN III (EA.) 5.00
of not more than five hundred dollars($5001.1: -
. 0 I,as owner of the property,or my employees with wages as - BACK F COW PROTECT. DEVICE 4:00
their Sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
—
intended or.offered for Sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:-The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES,PER,TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare Out intended oroffered for sale.IL however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
' builder will have the bunlen.of proving that he did not build or int- IGAS-EA.SYSTEM-OVER 4 (EA.) 2,00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES 'IND CON PB ' Omer
❑ I,as owner of the property,am exclusively contmcling with
licensed contractors m construct the project(S,C,7044,BusinessLAWN SPRINKLERS- 1 INC 5 VB - 600 ASSESSORS PARC 1:1
and Professions Code:The Contractor's License Law does not apply V.S. .
EL NO.
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such morels with a conlo cRans)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 ,TRACT No. PARCEL No.
❑ I um exempt under Sec. ,B.&P.C,for this
reason WATER HEATER W/VENT 6.00 '
Owner Uuta WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to If—insure, ZONING ENG.SITE N0.
or a certificate of Workers'Comr Compensation Insurance,oa certified
copy thereof(Sec.3800,Lab.CU.
Policy No. Company
O 0 Cerlifisdcopyisherebyfurn ishesl' FIRE$Pfl INK ENERGY T-24py -s
Z Z 0 Certified coBled with the city inspection division.
O APP]leadI � i - - REFER TO ORD. y ❑ N[] Y C] NQ
W CFRTIFICA'I'I:OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
L COMPENSATION INSURANCE - PLG.CONTR. ' LIQ NO. pLG
�-"0 (This section need not be completed if the pound is for one TOTAL Y❑ N Y ❑ N❑
Z hundred dollars IS 100)or IessJ
U O 1 certify that in the performanee of the work for which this per- QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
LL U mil is issued, I shall not Workers'
any person in any w manneror is to
become subject to the Workers'Compensation Laws of California.
O y D'etc Applicant BUILDING /
} to NOTICE 'f0 APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F ? emption,YOU should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C-F.M.) 4.00 ;
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE
1 hereby affirm the
there'is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 go
the 7,Cvrmancc of the work for which this permit is issued(SOs' MICROFILM
3097,r's Na.). HEATING UNIT(TO 100,000 B.T.UJ 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T:U.)9.50 � ELECTRIC
1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct 1 agree to comply with all city.arul county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of
Bu tpurposes.to
his City enter upon the
above-mentioned property for inspectionBOILER-COMP Iowa,100,000 BTU)SEE FEE SCH. MECHANICAL
-
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
i
may in any way accrue,agairJ,51 sand City m consequence of the
ranting of[/hi5y@r // . eMECH,CONT. - LIC.NO, �n
a TOTAL ' TOTAL /% 1 V
$hgna[ure of Apph nt/ ontrac[or U '-v U
OFFICECOPY