18919 - FOSTTHIS.CARD.NEAR FRONT OF BUILDING . ,
' :. PERMIT NUMBER
CITY OF-'CUPERTINO L899 .
' ' INSPECTION DIVISION .
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDR UNIT# - -COT#
•. �T •PERMITEXPIRES IFWORK
OWNER `Q. C.0 coIvTRAcroR'" IS NOT'.STARTED WITHIN ,
INSP9&ION DATt I INSPECTOR INSPECTION RECORD .190 DAYS of PERMIT ISSu-
•FOUNDATI ON ANCE OR 180 DAYS FROM
LIFER -ALL GR .
NOTE:GR, I•AIDING - LAST CALLED INSPECTION. ,
" - - AND DRAINAGE SHALL BE
PREGUNITETO COMPLY WITH,THE APPROVED PLANS AND CITY OF PERMITVAI.IDATION
CUPERTINO STANDARDS."
GARAGE SLABS �,j -'�. "•,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IL 1. f
• - UNDERGROUND /SLAB' - jV(}V1' w iQG7ti. 1-
PLUMBING - - - - aat'.�
ELECTRICAL - _.j`•1r,•
ih• IISSUANCE DATE
� ^npq'{'nn G . .
MECHANICAL ' - - eEuc. .ELEcr. PLG. M�ecR,
1:1 El ❑ �yy
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR.. `»k;vawnnON .
PLUMBING '. � qp $RFT
MF,CHANICALr, - '
ELECTRICAL ((NII. TERM rO
.-. FRAMINGy� T
'
INSULATION'. _ srO,R¢s Tv EroNsrR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' I - , SO FT.FLOOR AREA TOTAL ACREAGE
'ROOF NOTE:NO`FINAL INSP.SHALL BE MADEBEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
OROOFING'UNTIGABOVE - BUILDING USE
`• ROOF SHEATHING .. - - , RESINO -CON Pe Ong
APPLY'N •.
E'HASBEEN-SIGNED.: FINALS,,--- ' ;DATE '+INSP: �� � � � ' � 4-I
ROUGHSAN.p ASSESSORS PARCEL,NO
' .,
PLUMBING ,ELECT.ENERGY
TRACT NO PARCEL NO.
TUBSBSHOWERPAN - PLUMBINGENERGY -
MECHANICAL - MECH.ENERGY
' ELECTRICAL • - BUILDING ENERGY Acc.DATE ACC WEE NO
FRAMING
ELECT.FINAL TEST -
INSULATION ` PLUMBING ZONING ENG.SITE NO,
GAS TEST GAS.
• I s FIRE 5PRINK ENERGY T 24
MECHANICAL - i . '
COVERAO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING , " Y "El "�
EXTERIOR,SHEAR ELECTRICAL RELEASE FLOOD ZONE 'A.L U.c.
INTERIOR SHEAR - FIRE DEPT. .. Y❑ NL YL NL
SHEETROCK GRADE • FEE SUMMARY -
TEMPORARY APPROVALS
EXTERIOR LATH - BUILDING
INTERIOR LATH BUILDING,,
SCRATCH COAT • ELECTRIC. . r' � PLAN CHECK
GAS - ar. FEE
NO TAPE OR PLASTERFUNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE'" '
OCCUPANCY'OF BUILDING'ISNOT.PERMITTED UNTIL BUILDINGFINAL'ISSIGNED BY BUILDING INSPECTOR: MICROFILM .
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
uJ
ONE WORKING DAY BEFORE REQUIRED INSPECTION PtunnaiNc . .
00" o .' PLEASE GIVE JOB ADDRESS WHEN PHONING
Z — SEE PERMIT; FOR'EXPLRATION;;DATE, +;' MECHANICAL ( DO
• IMPORTANTI CONST:TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR'FINAL INSPECTION-. - ;TOTAL . I US.0
a ;OFFICE'COPY'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION - PERMIT NUMBER
BUILDING APPLICATION & PERMIT Q o 1 Q
ID.DEss \
BUILDING'-ELECTRICAL-,PLUMBING-MECHANICAL
OWNEn'S - / - - PLAN CHECK VALIDATION
' rv4ME7.QTY. ,, = ELECTRIC PERMIT - FEE.
CONTRACTORSRECEP •'10.00/1.00
NAME v coV51r( OUTLETS-SWITCHES- -
• - �.� LIC.ND. ' +- LIGHTING FIXTURES " : 10.00/1.00 -.
DONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS _
PRONEPANELS 10.00 - .DATE OF APPLICATION "-
' ARCHITECT • { PLAN CHECK FEE P.C.NO.
OR r PANELS (OVER 200 AMP) 20.00
ENGINEER .Af
SIGNS TRANS. °- .3.00
ARCH,OR G. ` - PERMIT VALIDATION
ADDRESS e�, / SPECIAL CIRCUIT .5.00 - t
MAP �L�'Lc{' a .S EMP. METER`OR POLE INS -20.00
noo3wTS - MOTORS SEE FEE SCH. •a�.ly1
/�.
SERVICE CHANGE JJ" 2000
'. 21
,o o � LICENSED CONTRACTORS DECLARATION !"�9'Mt�'^
F0 w 1 hereby affirm that'[am licensed under•provisions'of Chapter 9 - ,- ___ / 1 ISSUANCE DATE
se 1 u (commencing with Section'7000)of Division 3 m the Bosloess and BLDG.` ELECT. PLG. MECH.
H D z Professions Code,and my license is in full force and effect. V. .� J Iy0` �-r -
o z"w o License Class Li,.Number '�. � ''y1
Date Contractor 'Y
Y t - City Pt�irut111Q1 � BUILDING PERMIT
W Ic w a OWNER-BUILDER DECLARATION - - - - INFORMATION -
wO LL y 1 hereby affirm that Lam exempt from the Contractor's License MISC..- REFER TO ORD
`F
ac o w< Law for the following reason.(Sec.7031.5,Busmessand Professions- VALUATIONPERMIT ISSUANCE '110.00
$/ET.
Code:Any city or county which requires a permit to construct,alter, "
0 improve,demolish,Or repair any structure,prior to its issuance,also ELEC:.,CONTR. - LIC.NO. - ELEC. -
- wo u I cgmres the applicant for such permit to file a signed statement that TOTAL PERMIT TO
Es Ke is licensed pursuant to the provisions of the Contractor's License
i Law(Chapter 9(commenoingwith Section 7000)of Division 3 Little
io Business and Professions Code)or that he is exempt'therefrm,and OTV. PLUMBING PERMIT- FEE C
K'r m the basis for the alleged exemption.Any violation of Section 7031.5 TORIES .TYPE CONSTR.
d3 _ by any more than
fora penult subjects the applicant toacivil penalty ALTER-DRAIN VENT-WATER 5.00 '
of not more then five bandied dollars($500).): '
❑ I,as owner of the property,or my employees with wage"' BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP - „RES.UNITS
their sole compensation,will do the work,and the structure is not
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 1hencon,and who doe,Sneh work FIXTURES-PER TRAP - 5.00 ' SD FT.FLOOR AREA TOTAL ACREAGE
himself or through has own employees provided that such Improve-
.cuts are notintended oroffered f.,sale If,howeer,the building GAS-EA.SYSTEM-1INC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00.
builder will have the burden of proving that he did not build or im- - BUILDING USE -
• prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON PB' Omer ' r
❑ 1,as owner of the property,am exclusively,contracting with - ❑ ❑ ❑ ' ❑ ❑
licervencFcontractors to construct the project(Sec.7044,Business LAWN SPRINKLERS;1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects'withr6 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑, I am exempt under Sec' ,BAP.C.for this
reason WATER HEATER W/VENT 6.00
r
Owner Uate WATER SYSTEM 5.00 _7_
TACC.DATE CG FILE NO.
'WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that'I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified _ ZONING - ENG.SITE NO.
copy[here S 0;Lab.C) �y - - -x
Policy No.� uJbny M o *�l ,
Z ❑ Certifie copy isle by furnished _- - EFIREINK ENERGY T R4z2 Cicaarlified copy is.filed-with die city inspection division. -Applmant MISC.- REFER TO ORD: 'N❑ 'Y ❑. 'i N❑CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 0NE' A.L.U.C.LU > COMPENSATION INSURANCE ' ' PLG.CONTR.. - LIC.NO. - PLG.O' OIThls section need noPbe conrplcled ifthe permit is for one TOTAL .N❑, - V.❑. .,N❑, i t
D Z hundred dollars(5100)or less)' -
;t• U O ,I eertify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE _ FEE SUMMARY
LL F mil is issued,I shall not emdoy,pny peirson in any manner so as to
Q W become subject to lite Workers'Compensation Laws of California.
y Date- Applicant
>_ m BUILDING- _
NOTICE TO APPLICANT:Alf,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F. Z 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 orthis permit shall be deemed revoked. .AIR HANDLING UNIT(TO 10,O170C.F.M.) 4.00
CONSTRUCTION LENDINO'AGENCY "AIR HANDLING UNIT(OVER 10,000C.FM.) 6.00 SEISMIC FEE^;
I hereby affirm that there is a Coast,ruction lending agency for, EXHAUST HOOD(WITH DUCT) 5.00 '
- the performance of the work for which this permit is issued(Sec. ` MICROFILM
30 .C.)._: � HEATING UNIT(TO 100,000 B.T.U.) 8.00 - , ."
Lender's
s Name
Lender's Address HEATING UNIT(OV ER 100,000 B.T.U_.)9.50 ELECTRIC is
-� I cenify'tha,I have read this application and state that the above VENTILATION FAN (SINGLE) . 4.00 - _
information is correct I agree to comply with WI city and county PLUMBING'
ordinances and state laws relating tobuilding construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.)
hereby authorize representatives oL this city to enter upon the. BOILER-00MP'IUver 100,000 BTU)SEE FEE SCH. -
" above-mentioned property fonnspection.purposes.: .. MECHANICAL
• (We)agree to save, Indemnify and keep harmless ihe.City of MISC.- -REFER TO ORD. -
uperlino against liabilities,judgments, costs and•expenses which , PERMIT ISSUANCE '10.00 yQfl "CONST.TAX
ny in any way accrue against said amity In consequence mf the
rantin a arm'. MECH.CONT. - LIC.NO. MECH.
s _ TOTAL: I- 8� ? ' TOTAL
' Sign t of pp want/Con actor a c -
OFFICE COPY