15005 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY. OF CUPERTINO 15005
INSPECTION DIVISION
JOB INSPECTION RECORD
JOBADDR ADDRESS p`�.,Z' LK�✓�- �• - - PERMIT EXPIRATION
,.. f [J-T -� UNIT# .PERMIT EXPIRES IF WORK
owNER -2 .� ,g.-. :S' COMiTRACTOR GK p/L:z� L(3 (>- IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- .
FOUNDATION - NOTE: ANCE OR 180.DAYS FROM
UFER ALL,GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF . PERMIT VALIDATION
CUPERTINO STANDARDS.-
' - GARAGE SLABS' -
POUR NO CONCP.ETE UNTIL ABOVE HAS BEEN SIGNED - - - .. is • ' --
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL - - - BLDG ELECT I PLG.. MECH.
❑ •❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING
VALUATION $SFT.
- �• - � - , ,
MECHANICAL - - -
ELECTRICAL PERMIT TO
FRAMING /; ` . '- . ppw• ,
INSULATION .I I STOHIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTI ABOVE HAS BEEN SIGto�nvo`
• RO F ' SOFT FLOORAREA TOTAL ALNfAGE
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE..
DIAPHRAGM I I THE CONSTRUCTION TAX IS PAID
ROOFSHEATHING . "'Hes ' BUILDING USE
' wO CONPR ov— n
APPLY NO ROOFING UNTIL OVE HAS BEEN SIGNED I FINALS DATE INSP. El-'❑ ❑ ❑ ❑
ROI 'JH SAN.N. - - , A SSESSORSPAHCEL NO.
• PLUMBING ELECT.ENERGY'
TUBS&SHOWER PAN - - PLUMBING ENERGY. ,. „� TRACTOO, PARCEL NO
MECHANICAL - j ,y/, MECH.ENERGY ,+f�' vo
ELECTRICAL, BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
INSULATION l PLUMBING - ZONING ENG.SITE NO.
GAS TEST ' .5.�8 GAS �s",�i
MECHANICAL yp FIAESPRINK ENERGY T 2
'S - a0
COVER NO WORK UNTIL VE HAS BEEN SIGNED HEATING 7-S Y ❑ N❑ Y ❑ y❑
EXTERIOR SHEAR I ELECTRICAL RELEASE FLOOD ZONE A.Luc•
INTERIOR.SHEAR (. FIRE DEPT. - Y ❑ "❑ r ❑' N❑
SHEETROCK - ( GRADE - FEE SUMMARY
EXTERIOR LATH I BUILDING
INTERIOR LATH • r 1 TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS '.FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED13Y BUILDING INSPECTOR. MICROFILM
ARRANGE F II INSPECTION BY PHONING 252-4505, ELECTRIC
I- ONE WORKII G DAY BEFORE REQUIRED INSPECTION. PLUMBING G
z PLEASE GIVI�JOB ADDRESS WHEN PHONING:
- S EE ERMIT-FOR EXPIRATION DATE .- . MECHANICAL .
IMPORTANTI CONST.TAX
PLED ' READ REVERSE SIDE BEFORE TOTAL
CA ING FOR FINAL INSPECTION.
l l OFFICE COPY
/
APPLICANT TO FILL IN INFIIRMATION WITHIN REDLINES — USE BALLPOINT PEN ONLY
BUILDING PROJECT I DENTI FIC [ION PERMIT NUMBER
eGI7Lmen. APPLICATION & PERMIT 1500
AOORE55%1
BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S
NAME '� .PLAN CHECK VALIDATION DTV. ELECTRIC PERMIT FEE
/
PRONE
CONTRACTOR'S f
NA �I OUTLETS-SWITCHES-RECEP 10.00/1.00 -
/ G/1 OO,NO Q �,j LIGHTING FIXTURES 10.00/1.00
CONTRACTORS Ij PPLIANCES-RESIDENTIAL •4.00
/Q ,I,. }t d PRONE i PANELS - 10.00 DATE OF APPLICATION
ARCRITECr PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
NGINEER
uc.NO SIGNS TRANS. 3.00
ADDRESS ENG. Aj SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
AODRESPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20,00
'0 o LICENSED CONTRACTORS DECLARATION
¢ z w I hereby ofErnt that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE '
(commencing with Section 7000)of Division 3 of the Business and _
¢ Professions Code an m Ilcenso is in Cull fore an effect BLDG. ELECT. PLO. MECH.
z ❑ ❑
2 i_ License d5sS1�6_Lic.Number`!
o w H j Date / n1 PP Contractor
a x - BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION INFORMATION
w ;u y I hereby affirm that 1 am exempt from the Contractor's License MISC.— - REFER TO ORD
.. o¢ Law for the following reason.(Sec.703 L5,Business and Professions VALUATION $/FT.
— PERMIT ISSUANCE 10.00
Code Any city or county which requiras a permit to construct,alter,
R ¢QO improve, or repair any structure,pricrlo itsissuance,als0 ELEC.CONTR. LIG NO.' ELEC.
aa n w o M requires lite applicant for such permit to file a signed statement that TOTAL - PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the
s 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H Q the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as 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 does not apply to an owner of
• property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 = SQ.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
meats are not intended or offered for sale.If,however,the building / GAS EA.SYSTEM-11NC.4 OUTLETS 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 an- BUILDING USE
prove for purpose of s'ale.). - RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 1:1 El El - El
licensed contractors 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 with a contractor(s)licensed pursuant to
the Contractor's License Law. / SEWER-SANITARY-STORME 10.00 Oma'- TRACT NO. PARCEL NO.
❑ I am exempt under Sec ,B.&P.C.forthis WATER HEA M
_
reason
Owner Date WATER SYSTEM ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQU
1 hereby affirm that I have a certificate of comamt to se1C-insure• _ZONING ENO.SITE NO.
or a certifi vte oI Workers'Compenw Ion Insurance,or o certified
copy thereof fSec.3800,Lab. -�9�-- ULM
Policy No. Company llirif—
O ❑ Certified copy is hereby famished
z Z ❑ Certified my is f�yyy�7 with city�aap action division. FIRE SPRINK ENERGY T-Z4
Applicant �/G� � MISC.- REFER TO ORD, YEj N❑' Y ❑ N[]
y -CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 — FLOOD ZONE A.L.UG.
LU COMPENSATION INSURANCE PLG.CONTR. -----. PLG. Q� ❑ ❑ [:]
❑
CL O (This section need not be completed if the permit is for one TOTAL Y N Y N
Z hundred dollms($100)or less.)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1— mit is issued, I shall not employ any person in any manner so as to
O W become subject m ore Workers'Compensation Laws of California. BUILDING
M Datc Applicant ALTER OR ADD TO MECH. 5.00
} y NOTICE TO APPLICANT'. If,after making this Certificate of Ex-
? 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 10p00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.E.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the 3097.performance
Cb.C. ce of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
a� information is correct. I agree to comply with all city and county PLUMBING Q
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives ofec this purposes.s city to enter upon the
inspection above-mentioned properly forBOILER-COMP IOYE1100.000 BTU)SEE FEE SCH. MECHANICAL
hi
(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
may in any way accrue against said City In consequence of the
ramECH.
i Of this permit. - MECH.CONT. LIC.NO. - M
e / P TOTAL TOTAL
Signature of Applicant/C tractor Date
OFFICE COPY