15066 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPE'RTINO • ° 15Qfi6
INSPECTION DIVISION
'JOB INSPECTION RECORD
•r' 'PERMIT-EXPIRATION
JOBADDRESS T62 UNIT# _LOT#
I• PERMIT EXPIRES IF'WORK
OWNER `� CONTRACTOR'. ",r� �.L, IS NOT STARTED WITHIN
INSPECTION DATE I,INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- .
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND.DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIOATTON
CUPERTINO STANDARDS. +
GARAGE SLABS
• POUR NO CONCRETE UNTIL,ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB I'
PLUMBING
ELECTRICAL
' ISSUANCE DATE
MECHANICAL • - BLUq ELECr PLG, M2CHI
El 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED. BUILDING PERMIT,
WOOD FLOOR INFORMATION,;'
PLUMBING
VALUATION S/FT.
� � , .
MECHANICAL - t"• - ' %'"
ELECTRICAL - - PER&BT TO
FRAMING
INSULATION, STORIES TYPE CONSTEE
* 1 OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED , - -
SO,FT,FLOOR AREA TOTAL ACREAGE .
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM .. .THE CONSTRUCTION TAX IS PAID
" BUILDING USE
ROOF SHEATHING RES IND CON PB 611�1.1 '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP?:+ 1:1El0 El EDI '
-.n
ROUGH SAN.a ASSESSORS PARCEL NO I i
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY - TRACT NG. PARCEL NO
MECHANICAL' MECH.ENERGY '
ELECTRICAL - ACC.DATE ACC.FILE NO
BUILDING ENERGY - I
FRAMING _ _$8 ELECT.FINAL TEST,
INSULATION ' - ' PLUMBING ZONING , ENG.SITE NO.
GAS TEST GAS -
MECHANICAL ' FIRE SPRINK. ENERGY T 2A
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ "❑
EXTERIOR'SHEAR, E LECTR ICA L RELEASE FLOOD ZONE A.L U.C.
-INTERIOR SHEAR 'FIRE DEPT. Y ❑ N❑ Y ❑..N❑
SHEETROCK Re
GRADE • FEE SUMMARY
EXTERIOR LATH BUILDING p
INTERIOR-LATH - - TEMPORARY APPROVALS BUILDING
7V,?
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE '
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR. ' MICROFILM
ARRANGEFORINSPECTION BY PHONING 252-4505, ELECTRIC
F• ONE'WORKING DAY BEFORE REQUIRED'INSPECTION: PLUMBING
?o PLEASE GIVE JOB ADDRESS WHEN PHONING.= SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORUNT!, CONST.TAX C.
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
r . _
APPLICANT TO FILL IN INFORMATION WITHIN-RED LINES - USE BALL POINT PEN ONLY
I LDING PROJECT IDENTIFICATION ' ..1' - - PERMIT NUMBER
EDILDIND APPLICATION & PERMIT 1 [O�+
ADDRESS
BUILDING-
��•• - r - - - ;I a) U
ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - - - PLAN CHECK VALIDATION
- "orae CITY. ELECTRIC PERMIT - - FEE
PHONEr 71-/&4/0 • - £ �'�\C,O�.° ,
'- CONTKACTORS I I • -
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
7= .(t,47, uC.NO," LIGHTING FIXTURES- '10.00/100
CONTRACTOR'S .. ' APPLIANCES-RESIDENTIAL; 400 -
ADDRESS G II
��N• PHONE ".�9&5 PANELS - � 10.00 DATE}OF APPLICATION. J
ARCHITECT --' - PLAN CHECK FEE - P.C.NO. -
� OR - PANELS (OVER 200 AMP) 20.00 '
ENGINEER
�7U0/OS" LID No,' SIGNSTRANS. 3.00 i a
ARCH.OR ENG. - r - - PERMIT VALIDATION '
�- ADDRESS 'G' �+LL •-4:,SPECIAL CIRCUIT- +5.00 -
:57, f,"` nP EMP.METER OR POLE'INS. 20.00
APPLICANTS MOTORS t `'• SEE,FEE SCH.
q; ADDRESS
SERVICE CHANGE 20,00
0 o LICENSED CONTRACTORS DECLARATION
Q'u w 1 hereby affirm that 1 am licensed undei provisions of Chapter 9 - ISSUANCE DATE '
(commencing with Section 7000)of Division 3 of the Business and
rn a u BLDG. ELECT. _PLG MECH.
F m i professions Code, my license rs in full force 7VOV
z o m - ' License Class'- Lie.Number_ - El, aEl
o r Date_ Contractor r' IS
< x _ BUILDINGPERMIT
¢ o st OWNER-BUILDER DECLARATION 'INFORMATION
A g R y I hereby affi m that 1 am exempt from the Contractor's Liceasa MISC.- REFER TO ORD
a. o J Law for the foil win.reason.(Sec 7031 5,Bus nessand Professions PERMIT ISSUANCE+.' 17 .
UATION $/FT.
Code:Anycity or county which requires a permit to construct,alter, . 10.00 O improve,demolish,or repair any structure,prior to its Issuance,alsoELEC.CONTR.' LIC.NO. ELECn ¢ requires the applicant for such permit to file a sib ed statement that TOTAL
w m'� he is licensed pursuant to the provisions of the Contr¢,tors License PERMIT TrQ)
rzi Law(Chapter-9(commencingwrth Section 7000)of Divlsion3ofthc
a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
athe basis for the alleged exemption.Any violation of Section 7031.$ "x I STORIES . TYPE CONSTR.
a ; � by any applicant fora permit subjects the applicant Inc civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 '
of not more than five hundred dollars($500).): _ •,
U 1,as owner of the property,or my employees with wages as ggCKF LOW PROTECT. DEVICE 4.00 ,OCC.GROUP. Res.UNITS
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 does not apply to an owner of - .
Property who builds or improves thereon,and who docs such work FIXT,URES-,PER TRAP"`,,, 5.00 SD FT FLOOR AREA TOTAL ACREAGE
himself or.fhrough his own employees,provided[hat such improve-
'
-on nofintended of offered for sale.If,howeveq the budding GAS-EA.SYSTEM-11NC.'4OUTLETS 600
or improvement is sold within one year,of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.1.. 2.00
builder will have the burden of proving that he did nut build Or im- _ BUILDING USE _
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES; :'IND CON- PS - Omer
❑ 1,as owner of the property,am Exclusively contracting with - ❑1 ❑ I•❑ ❑- ❑
licensed contractors toconstruct 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 with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/ .00 TRACT NO. PARCELNO.
the Con tractor's License Law. 10 '[
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER'W/VENT - + 6.00 -, -
reason
Owner Date - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a cortificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING 'ENG.SITE N0.'
copy thereof(Sec 3800,Lah.0 I n„yyn.�Af
Policy No. Company=
O � ❑ Certified copy is hereby furnished. RE SPRINK ENERGY T 29
Z Z $J Certified co y is fde wilh_NQ city inspection division.
� O Af�plicant 'IC( �y - MISC. > REFER TO ORD, v ❑' N❑•' v ❑ N❑
CI'-RTIFICATE OF EXEMPTION FROM WORKERS' PERMIT.ISSUANCE. - 10.00 - FLOOOZONE. A.L.UC..
LU - COMPENSATION INSURANCE. PLG.CONTR. '-. UC.NO. PLG. -
CL O (This section need not he completed if the permit is'for one TOTAL - V❑ ' N V[D NE]
Z - hundred dollars IS 1001 or less.) -
U O• I certify that in the performance of,the work for which this per, CITY. MECHANICAL PERMIT FEE FEE SUMMARY
U F mit is issued,I shall not employ any person in any manner so as to
U W become subject to the Workers'Compensation Laws of California.
Date Applicant BUILDING
} y NOTICE TO APPLICANT: If,'after ranking this Certificate of Ex- ALTER OR ADD TO MECH. 6.00 - O
F2 emption,you,should become subject to the Workers'Conlpensatlon 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)000C.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCYAIR HANDLING UNIT(OVER IO,000QRM.) 6.00 SEISMIC FEE.
1 hereby affirm,ttiat there is a construction lending agency for EXHAUST HOOD(WITH DDCT) 5.00
- the performance of the work for which this permit is issued(Sec. - - MICROFILM'
3097,Civ.CJ. HEATING UNIT(T0.100,000 B.T.U.) 8.00 •'S
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 "
Lender's Address 'ELECTRIC
I certify that l have read this applicationand stale that the above VENTILATION'FAN (SINGLE) 4.00
information is street. 1 agree to comply with all city and county PLUMBING W
infor atio and state laws relating to comply
with construction nd co and BOILER-COMP(3 H.P.or.100,000 B.T.U.) 6.00
hereby authorize representatives ins ec this city to enter upon`[he' BOILER-COMP'IOver 100,00 BTU)SEE FEE SCH. 'MECHANICAL r
above-mentioned property for inspection purposes.-
(We) agree to save, indemnity and keep harmless the City of MISC.- _ REFER TO'ORD. -
upertmo against liabilities,judgments, costs and,expenses which - •CONST.-TAX
may in any way'accrue against said City in consequenceof the PERMIT ISSUANCE '10.00 ..
rantingof this permiC MECH.CONT. LIC.NO. MECH
TOTAL TOTAL / s
Signatureo Applicant/Contractor -
OFFICE COPY