15576 POST THISCARD NEAR FRONT OF BUILDING
,,.PERMIT NUMBER
A INSPECTION DIVISI�I�O
CITY`�OF CUPER 15576"
ON
JOB INSPFCTION'RECOFID
'PERMIT EXPIRATION
JOB ADDRESS
r
'UNIT# _LOT# "j
�_' . PERMIT EXPIRES IF WORK',!
OwNBR` ,�, f - - CONTRACTOR- .� G,a67- IS'NOT,STA RTED,WITHIN 'II SPE 'ION DATE INSPECTOR INSPECTION RECORD -11110 DAYS OF PERMIT ISSU- I
FOUNDATION ANCE OR
DAYS FROM
I NOTE: ' 'rt LASTCALLEDINSPECTION. I
UFER • ALL GRADING�AND DRAINAGE SHALL BE INSTALLED 'r . +
PREGUNI'TE TO COMPLY WITH THE APPROVED PLANS AND CITY'OF - PERMIT`VALIDATION
CUPERTINO STANDARDS. - - '
GARAGE SLABS-
POUR NO CONCRETE'UNTIL ABOVE HAS BEEN SIGNED
LNDERGROUND/SLAB '
PLUMBING
ELECTRICAL
Y' ISSUANCE DATE
MECHANICAL - �. _ - .P °Buy', ELECT. , PLG- MECR,
2 t �ffi ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED:: BUILDING PERMIT
WOOD FLOOR 01 ieOI'"INFORMAT]DIN
'PLUMBING CAIvawanoN u'. 9/FT.
MECHANICAL
ELECTRICAL PERMIT To
FRAMING
$TORIes rvPE CONSTR
' INSULATION �' � °• - �
OCC.CROUP RES.UNITS
PLACE NO SUBFLOOR UNTIUABOVEHAS BEEN SIGNED "
ROOF NOTE:NO FINAL INSP.SHALLBE MADE BEFORE sa Fr F�ooR AREA TOTAL ACAeac
far DIAPHRAGM THE CONSTRUCTION.TAX IS PAID
ROOFSHEATHING BUI LDINC USE -
HES IND CON : PB p ,
APPLY'NO'ROOFING UNTIL�ABOVE II'AS,BEENSIGNEOyx -;��:' aFINA ' 1 "ti„<ti I ,,DAT;E�,, � "INSP 'w ❑ ❑ ❑ ❑ ❑ '• "
- ROUGH - SAN.N nssessoas 1.RwLNo
!PLUMBING .ELECT.ENERGY
I
TUBS&SHOWER'PAN - PLUMBNG,ENERGY TRACT NO� PARCEL No
4 MECHANICAL - MECR.ENERGY " ` 1
ELECTRICAL - - -
BUILDING ENERGY
"� Acc DATe Ace.FILE.No.
FRAMING '
ELECT.FINAL TEST � �-
'.INSULATION
PLUMBING 'i_ "zoNlNc ENcaIrE No:
GAS TEST - GAS _
MECHANICAL _ FIRE SPRINK �ENERGY T24
Y.
N v
COVER NO WORK UNTI � , ❑ .. ❑ N '
L ABOVE HAS BEEN H ❑. . ❑ -
SIGNE EATING
D w
EXTERIOR SHEAR,- - - ELECTRICAL'RELEASE FLOOD ZONE A.L,U.C.
•+ ,,,. INTERIOR SHEAR FIRE DEPT: v ❑ +"'❑' •y ❑ ',NI]
` - 6H EETROCK -
GRADE " FEE SUMMARY
' "
EXTERIOR'°LATH BUILDING' ,.�
` - INTERIOR',LATH TEMPORARY APPROVALSIBUICDiNG
SCRATCH COAT "` ELECTRIC - - PLAN CHEEKY
GAS FEE
- NO TAPE'OR PLASTER UNTIL.ABOVE HAS BEEN SIGNED OCCUPANCY " T - 1•,. seiSMiC FEET,;,
OCCUPANCY O6BUI LDING ISNOT PERMITTED UNTI L BUI LDI NG'FINAL IS SIGNED BY�BUILDING INSPECTOR "
MICROFILM•'. "
ARRANGE FOR INSPECTION BY PHONING 252=,4505, ELECTRIC
oM�
ONE WORKING DAY BEFORE REQUIRED,INSPECTION PLUMeiVG
PLEASE GPHONING..
IVE JOB`ADDRESSMHEN PHG
y•. ' R.
-'SEE PERMIT FOR EXP,IRATION�DATE MECHANICAL� i,' '
IMPQRTANTI
:CONST.TAX
PLEASEREAD•REVERSE SIDE BEFORE TOTAL
CALLING FOR,FINAL INSPECTION:
r;. ,OFFICE COPY
APPLICANT.TO FILL,IN INFORMATIONYWITHIN REDLINES = USE BALL POINT PEN,,ONLY ,
•, ' - -PERMIT NUMBER
BUILDING PROJECT I DENTI FICATION-- +
BUILDING. " . .. APPLICATION'&..PERMIT - 15576
ADDHEss I BUILDING ELECTRICAL—PLUMBING-MECHANICAL „
` OWNER (� - - PLAN CHECK VALIDATION
NAME ' ' ELECTRIC PERMIT - FEE ,
�. coNT A To s OUTLETS-SWITCHES-RECEP"10.00/1.00,'
NAME {{JJ
Ic.rvo Q ' ' LIGHTING FIXTURES . 10.00/1.00 '
r- WRACTORS - APPLIANCES'-RESIDENTIAL 400 ,s. '
ADDHESS
',5_ 2 P UNE- / G� PANELS " 10.00 '. - DATE OF'APPLICATIC; . ,
s R ITECi - - - PLAN CHECK FEE .P.C.+N"'-
0 .�.
R - PANELS (OVER 200 AMIN . 20.00 ,f
ENGINEER ua.-NO, "SIGNS TRANS:, s 3.00 •n' _
ARCH.OR ENG. - . - - PERMIT VALIDATION
ADDRESS, ,;' i SPECIALCIRCUIT . 5.00 ' '
- -
ZIP TEMP.METER OR POLEINS., "20 00
APPucnrvrs - - MOTORS SEE,FEE SCH
ADDRESS
SERVICE CHANGE 2000 '
o o LICENSED'CONTRACTORS DECLARATION
a v w 1 hereby affirm that I,ma licensed lender provisions of Chapter 9 ISSUANCE DATE
(commencing with Secti n 7000)of Division 3 of the Business and'
r�,•Q a :y PLOD. ELECT. P'� -,'ME❑CH.'
� Professions Cod a license is in lull fort u f
F' z �§
9 O'; — License Chess_ ' r(�_^_Lic.Number . - t'
9 m— 2 Data Contractor - - '
a m - ILDING PERMIT
¢ o a o OWNER-BUILDER DECLARATION ' INFORMATION
X ; LL^m I hereby affirm that Lam exempt from the Contractor's Lmcase 'MISC - I ' REFER TO OR p TION,
o ¢ Law for the following reason(Sec 7031.5,Bu.Iness and Professions 01 �'( . . -S/FT.
.H - PERMIT ISSUANCE 10,00 1 Up -
FuI Code:Any cilyor county which regmresa permilto construct,eller! - b
I[ ¢ Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO.
'D ¢' requires the applicant for such perm,t to file a signed s'tatemeni that. - - , . TOTAL s
x m LL . S PERMIT TO -
he is licensed pursuant to the provisions of the Contractor's
Fz 0Law(Chapter 9(commencing with Section 7000)ofDivision 3 oflhe - -
Q Business and Professions Code).or that he is exempt therefrom and OTY. PLUMBING_ PERMIT FEE
{p r m the basis for the alleged exemption.Any violation of Section 703 LS -, STORIES .,TYPE CONSTR.
a3 .- by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN IEA.).
of not more than five hundred dollars($500).): - ALTER- 5.00
s i' ❑ 'L as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE '1 14.00 ' - e
their Pole compensation,will do the work,and Die structure Is not ,OCC.GROUP REb.UNITS '
intended or offered is sale se Law
Business and Professions ' DRAINS-FLOOR,ROOF,AREA,GOND. 5.00Code
property Contractors License Law does not apply to s such w of -
+ eor
r builds or improves employees,
pr and who does such work, FIXTURES-PER TRAP 5.00 s0.FT.PLODR AREA TOTAL ACREAGE
Butshimself m through his own employees provided that such improve-
Bouts
mprove - ...
• or improvnotement tended Or withi redfor sale I completion the building GAS-EA.SYSTEM-11NC.40UTLETS 600
or improvement will have
is sold burden
o`pr 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 it.- _ . BUILDING USE
prove for purposeofsale.). c RES IND CON - PB Orh
❑ I,as own of the property,am exclusively contracting with INDUSTRIAL WASTE INTER;- `30.00 ❑ El 11 _ 1:1
❑ -�
licensed contractors to construct the project(Sec 7044,Business - LAWN SPRINKLERS'='1"INC 6 V.B: ' 6.00 A85ESSOR6 PARCEL NO. "
and Professions Code::The Contract.,',License Law does not apply '
' to an owner of pi'operty'who builds or improves thereon,and who' LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
he Ccontracts for such projects with a conlraetor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 R
the Contractor's License Law. TRACT N0. PARCEL NO.,
o l am exempt under Sec. ,B.&P.C.torthis WATER HEATER W/VENT Q�
reason
Owner—_- Date WATER SYSTEM - - 5.00 . ' ACC.DATE ACC.FILE NO
'.WORKCRS'COMPENSATION DECLARATION WATER TREATING EQUIP: , .5.00 -
hereby affirm that I have a u'rtilieni,ofco Pent to self-insure - - -(.•
or a certificate of Workers'Compensat n Insurance, r a certified, - _ 20NING ENG.SITE NO. .
copy t c. 800,Lab C)
PolicyC Co.Pan�-all
0 ❑ C I Cry is hereby u (shed y FIRE SPRINK ENERGY T-24
.z z. ��C'orf ified y i- filed with the city'inspection division. ,
�� _ MISC.- ' �5'- REFER TO ORD. N v N
O pA�plicant Y ❑. ❑ ❑ . .❑ '
- ~ PERMITISSUANCE 30615 - 2c:I FLOOD ZONE A.L.U.C,
CERTIF TE OF EXEMPTION FROM WORKERS'
'W > ^. COMPENSATION INSURANCE PLG.CONTE. .LIC:NO. PLG.
.CL a (Thls.sectibn need not,be completed If the perit is for one TOTAL', J- d(�, Y❑ N❑ "H❑ �N❑
hundred dollars(Sloo)or less) -
U
2, 1 certify that in the performance of the work for,which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY -
LL,I-' mifis issued,I shall not employ any person in any msnnei so as to
O W become subject to the Workers''Compensation Laws of California. - - - -
d Date Applicant . ALTER OR ADD TO MECH. 5.00 BUILDING-
'i} to NOTICE TO APPLICANT: If,after making"lhis Certificate of Ex-
F 2. emption,.you should become subject to the Workers'.Compensation - APPLIANCE 1 5.00 PLAN CHECK
provisions of the Labor Code, You must forthwith comply with FEE
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(T0.10,000GF.M.) ,:4:00 +
-.CONSTRUCTION LENDING AGENCY°.; AIR HANDLING UNIT(OVER 10SWC.F.M.)'6.00 SEISMIC FEE -
I hereby affirm that there is a micUruction lending agency for _ EXHAUST HOOD(WITH DUCT) :5.00
-
tire performance of the work for which this permit Is issued(Sec. - MICROFILMx r
3097 Civ.CJ.' 'HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's'Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC -
I certify that I have read this appllc.imn and state that the above VENTILATION FAN (SINGLE) 4,00 ;
information is correct. I agree to comply with all city ind'county - PLUMBING /
ordinances and state laws relating to building constrction, and BOILER�COW(3 H.P.or 100,000,B.T.U.)'6.00 -
hem6y authorize representatives of..lhis city to enter upon the °. BOILER-COMP lover 10Q000 BTU)SEE FEE SCH.
MECHANICAL
above-mentioned properly for inspection purposes..'
(We) agree to save indemnify and keep harmless the Cityrof. MISC. REFER,TO ORD
pP` trio again, liabilities,judgments.costs and expenses which PERMIT ISSUANCE... - 1Q 00 CONST.TAX - -
fm 'i any way accrue�'agains[ said City in consequence of the , n
r ntin Ufthis pe mit MECH.CONT LIC.NO. - MECH
p - i' JO1 TorA�. r, •� TOTAL
i Sig t reof Applicant/Contractor --Da e - ! ,
r
''OFFICE COPY:`