15227 POST THIS CARD NEAR FRONT OF BUILDING
RM1NUMBER,.
CITY OF .CUPERTINO 1N5Y27
INSPECTION DIVISION
JOB INSPECTION RECORD
' PERMIT EXPIRATION'
JOB ADDRESS 10235 South Blaney AVenjte. UNIT# _LOT#
- PERMIT EXPIRES IF WORK
OWNER ' DebCOT CONTRACTOR ' IS NOT STARTED WITHIN
INSPECTION 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
CUPERTINO STANDARDS. ,.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,•� �' L'
A UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - - ISSUANCE DATE
MECHANICAL BLDG ELECT. PLG. MECR.
pP►ID ❑ Q ❑ L❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
WOOD FLOOR INFORMATION
�p VALUATION SIFT.
PLUMBING ^,� CuY� pO
MECHANICAL W
ELECTRICAL PERMIT TO
FRAMING
INSULATION _ STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING I I Res .IND CON PB on,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH SANA
PLUMBING ELECT.ENERGY -
' TUBS 80HOWER PAN PLUMBING ENERGY ' TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY '
ACC DATE ACC FILE NO
ELECTRICAL, BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE No:
- GAS TEST . GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N Y N�
EXTERIOR SHEAR . ELECTRICAL RELEASE cL000 ZONE A,c.u.c -
INTERIOR SHEAR FIRE DEPT. v `^`°❑ N❑ Y ❑ No,
I' SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDwG
SCRATCH COAT JELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JUCCUPANCY SEISMIC FEE
OCCUPANCVOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ,MICROFILM
ARRANGE FOR INSPECTION BYTHONING 252-4595, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
—,SEE PERMIT FOR EXPIRATION DATE— MECHANICAL
IMPORTANT!
CONST.rnx
PLEASE READ REVERSE SIDE BEFORE • TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER,
BUILDING PROJECT IDENTIFICATION . APPLICATION & P5RMIT
nLOINc
Apo REss 2
BUILDING–ELECTRICAL–PLUMB( 15227 NG–MECHANICAL '�'
OWNER'S v PLAN CHECK VALIDATION
'AEE QTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S
/ NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
1 ll LIC.No. LIGHTING FIXTURES 10.00/1.00
AoonEssTOR'S 4u1 —I(,j1 PPLIANCES-RESIDENTIAL 4.00
loos s PANELS 10.00 DATE OF APPLICATION'
ARCHITECTPANELS (OVER 200 AMP) 26,66 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.NO ISIGNS TRANS. 3.00
noo Ess ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20,00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE .00
�
02 LICENSED CONTRACTORS DECLARATION as Tc/t &,3
a v 1 hereby affirm that 1 am licensed under provisions of Chapter 9 U4 6-4 ISSUANCE DATE '
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
'A" Professions Code,and my license is in full force and effect. 0 ❑ ❑ ❑
z o m Licens Cl as Lic.Numb
o w H w Datc• –
Contractof _. �xt 00
¢¢w OWNER-BUILDER DECLARATION ►a7 of CiQ�®. BUIL NG PERMIT
MISC.– REFER TO ORD INFORMATION
w;a N I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.-
H u 0 J Law for the following reason.(Sec.7031.5,Businessand Pmfesomms PERMIT ISSUANCE U):@0
,A i Code:Any city or county which requiresa permit to conslnlnL alter,
¢ 2 ¢ improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC.
u 0¢ requires the applicant for such permit 10 file a signed Statement that TOTAL 7 PERMIT TO
w e he is licensed pursuant to the provisions of the Contractor's License ELCZ�t
H 2 a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 0 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢1- p the basis forthealleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
by any applicant for.permit subjects the applicant too civil penalty ALTER-DRAIN -WATER IEA.) 5.00 v
of not more than five hundred dollars(5500).1:
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 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 dolts not apply to an owner of -
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.66 SD.FT.FLOOR AREA TOTAL ACREAGE
meats are not hrough
ownemployees,for Lott.
If,cd ever,hat the
improve. GAS-EA.SYSTEIIINC.40UTLETS 6.00
meats are not intended or offered for sale.if,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Other
prove for purpose of sale.)., INDUSTRIAL WASTE INTER. 30.00 -
❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 Contractors 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 conlructorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft 110.00 TRACT NO. PARCEL NO.
❑ lam exempt under See. ,B.&P.C.forthis 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 hemby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
-� Policy No. Company
❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z-2
❑ Certifil opy I filed w h the cit Inspection division.O`AApplicanf�� MISC.- REFER TO ORD. y❑ N❑ Y ❑ .N❑
CC rn �— PERMIT ISSUANCE 10.00
� CERTIFICATE OF EXEMPTION PRO ORKERS' FLOOD 20rvE A.L.u.c.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CLO (This section need not he completed if the permit is for one TOTAL Y❑ NY❑ N❑
❑
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Cinummsafion laws of California.
0 y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} a NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become subject to[be Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of it,, Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M-) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10400C.F.M.) 6.00 SEISMIC FEE ,
1 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., HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM
3097,Civ.C.). /q
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4,00
information is correct. 1 agree to comply with all city and county PLUMBING
1 ordinances and state laws relating 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 BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City DI' ,MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accruA against Said City at consequence of the PERMIT ISSUANCE 10.00
` Bra Oft 's perm
CJMECH.CONT. LIC.NO. MECH
TOTAL. . a
'
/ hgnafure of A pplicant/Contractor JDate TOTAL
OFFICE COPY