15312 POST THIS CARD NEAR FRONT OF BUILDING PE RMIT NU MBFR
CITY OF CUPERTINO 15312
INSPECTION DIVISION \
JOB INSPECTION RECORD
p_ l,� = C_- PERMIT EXPIRATION
JOB ADDRESS
L �eYl `` UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER 'e. �L 1p/ 1iL. L1 CONTRACTOR �Re e.c11:7: IS NOT STARTED WITHIN
NSPECTION DATE 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 VALIDATION
GARAGE SLABS fw
CUPERTINO STANDARDS. .PAID r-
/
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ocr 17 1989 f
.UNDERGROUND /SLAB
PLUMBING
Clht Of( ttOol{IR�
ELECTRICAL IssuANCE uarz
MECHANICAL BLDG ELECT. PLG. MECH
El ❑ ❑ .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I - BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING a
INSULATIONuv' ST res TVPECONSTR
UCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE S11111 '100RAREA TOTAL ACREAGE
DIAPHRAGM I I d THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING I I RES IND CON Pa Oo—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Cl ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT,ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY '
ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG,SITE NO.
INSULATION PLUMBING
GAS TEST - - GAS
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING AE] NE]
EXTERIOR SHEAR ELECTRICAL RELEASEI I
FLDDU ZONE A.LULI
INTERIOR SHEAR FIRE DEPT,. -�" --""' Y❑ N❑ ° ❑ -❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT JELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occUPANCv ISEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
(` F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL �3 dD
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTALS va
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
_1
'-%U I LDING PROJECT I DENTIFICATI ON
it liwwwam^JJJI I' .PERMITNUMeER
GIL
-Tr-NRIOPLUMULDING -ELELTCAL- BING-MECHANICAL 1531 -n'
OWNER'$
NAME PLAN CHECK VALIDATION
OTS. ELECTRIC PERMIT FEE
vhsaNE �_
ME
comrRACTofls UTLETS-SWITCHES-RECEP 10.00/1.00
nt3 uc.rvDoL40 LIGHTING FIXTURES 10.00/1.00
f,ON RE Is RS '
A RE APPLIANCES-RESIDENTIAL 4.00
PRONE PANELS 10,00 DATE OF APPLICATION
ARCHITECT • ^_ �s•/\V�
GR PJf\. VV1I PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,C:NO.
ENGINEER
LIC No. SIGNS TRANS, 3.00
ARCH.OR ENG.
ADDRESS . SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
noo essTs - MOTORSl
SEE FEE SCH.
SERVICE CHANGE 20.00 J `�
H O o LICENSBU CONTRACTORS DECLARATION /f VV L
ri I hereby affirm [hot I am licensed under provisions of Chapter
¢ (commencing with Section 7000)of Division 3 of the Business and ,',r
ISSUANCE GATE t
H m i Professions Co license is in full fore 7
19 0 BCOG.. ELECT. PLG. MECH.
Z 0 w C Lictol ss Lic.NumbeOCT 1
_ m H Dole
Contractor ❑ ❑ ❑
¢ ¢ w ¢ OWNER-BUILDER DECLARATION •✓tir .. a' BUILDING PERMIT
aal ; U INFORMATION
r ls0n I hereby affirm that I am exumpl from the Conlrltctor'a'License MISC.- • 'REFER TO ORD
¢ Law for the following reason.(Sec.7031.5,Businessund Professions VALUATION $/FT.
Code:Any city or county which r'home'
p PERMIT ISSUANCE 10.00
3 W y < uinas ermil to conelmct,alleq
Iz ¢ ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
i x m ¢ requires the applicant for such permit to file a signed smtement tial - TOTAL
w m he is licensed pursuant to the provisions of[he Contractor's License PERMIT TO
H Z < La-IChap rer 9(com me acing with Section 7000)of Division3 oRhe � �
4 o Business antl Profeeslous Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
a H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a g .. by any applicant for a perm it subjects'heapplicanl toacivil penally ALTER-DRAIN of not mote t h an five h u nd red dollurs(S500).): (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensaHo n,will do the work,and rhe structure is not OCC.GROUP RES.UNITS
intended Or
offered for Said
(Sec. he Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The CGnframor's License Law does not apply.[o un owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00
himself re through his own employees provided that such improve, S0.FT.FLOOR AREA TOTAL ACREAGE
or nts improvemenotnt is sold within ted une or year o(complever,tion the the o ne- GAS-EA.SVSTEM-1 1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the awner-
builder will have[he burden of proving that he did not build or iia- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 eu1LDING USE
Ellprove for purpose of sale. INDUSTRIAL WASTE INTER, RES . IND CON PS Omar
as owner of tm p property,am exclusively contracting with 30.00 ❑ ❑ 1:1 ❑
. . .
licensedd contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 VB600
and Professions Code:The Con Vudor's License Law does not apply ASSESSORS PARCEL NO.
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 -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec. ,B.&p.C.for this
reason WATER HEATER W/VENT 6.00
Owner - Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKS that I have
a certificate
TION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm ilial I have u ee nsati to of consent hh self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
• copy ttercof_I Sec.3800,Lab.C. _
Policy Nos-LKWCompany - -
qq ��erhf ed copy is hereby(urniehet FIRE SPO INK ENERGY T-Z4
F Z fYCe of/ie� ey�y n f w' h ty��h inspection division. MISC.- REFER TO ORD. V N v N
O APPlicantV k ..L 1 11'�l ❑ ❑ ❑ ❑
LO CE RTI FICATIi 'EXEMPI[ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG.TAL
d D (This section need not he completed if the permit is for one TOY[:] N❑ Y ❑- N❑
0 Z hundred dollars($100)or less)
U O I certify that in the performance of the work for which this per
U. F mit is issued,I shall not employ any person in any manner so as to OTV. MECHANICAL PERMIT FEE FEE SUMMARY
Owbecome subject to the Workers'Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 'BUILDING
} W NOTICE TO APPLICANT: If,after making tills Certificate of Ex-
? sorption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10p00C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec.
3097,Civ.C.), - HEATING UNIT(TO 100,0MICROFILM
00 B.T.U.)
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000B.T,U. 17ELECTRIC
inI certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
formation is correct, I agree to comply with all city and county PLUMBING
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 of this city to enter upon the
above-mentioned property for inspection purposes. BOI LER-COMP(Over 100,000 BTUI SEE FEE SCH. MECHANICAL
(We) agree to ave, indemnify and keep harmless the City of MISC.-
Cupertino against liabilities,judgments, TO ORD.
s, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE
rant this permit ' MECH.CONT. LIC.NO. MECH. '
Vea`rmi TOTAL �� TOTAL 3. 00
Sin sof Appllranl/Contractor - D [e � `...,�"�In`T _�
- OFFICE COPY