14876 I '
POST.THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO �j
INSPECTION DIVISION �. 1487"
JOB INSPECTION RECORD `
PERMIT EXPIRATION
JOBADDRESS � S� �•�'✓ ✓ 'UNIT# _LOT#
- PERMIT EXPIRES IF WORK
OWNER, des 1-7-h CONTRACTOR �QlL� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ ANCE OR .180 DAYS FROM
NOTE: LASTCALLE6 INSPECTION,
LEER 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 P-X Y e--AW
UNDERGROUND /SLAB0.J0. 2
PLUMBING (' P y
MECHANICAL t�`5
ELECTRICAL cP eta Ne�Y9 �'i X LA10 (0.yYN ISSUANCE DATE
, e�qT ELECT PLG. MECH.
ovev I�I�c�AcN ED
.El
Ip-2`d- � CO(1 '10 LY El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED L•v i Ivg room oft hC ING PERMIT
V INFORMATION
WOOD FLOOR 11-I 8 N VALUATION SIFT,
PLUMBING
MECHANICAL ,,•3 , 6!i- O/(, .�� N1.7�
ELECTRICAL 5_ LR47Fitfvjtof PERMIT TO
FRAMING
INSULATION
STORIES TYPE CONST..
_LI-�j (' � • �-,�
N '•- /LOV.+O Zr.y-. ♦ OCG GROUP 'RES UNITS
Al.Oiti LCrT70n..
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ia. "
'ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD.,FT.FLOOR A«en .TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON Pe MIL-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑ 0 D ❑
ROUGH SAN.H ``�� /ASSSESSORS PARCEL NO
-�- PLUMBING � ELECT.EN RGY • '"'6 P-Irz— "'-
TRACT NO. PARCE LN(�l ,rc•
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL o MECH.ENERGY
ACC. DATE ACC.FILE NO'.
ELECTRICAL BUILDING ENERGY
1 FRAMING ELECT.FINAL TEST zoNwO ENG.SITE No.
` INSULATION PLUMBING .�J
GAS TEST g GAS
MECHANICAL FARE SP.INK ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [] ND Y 0 N[
FLOOD ZONE AL.UC.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIREDEPT. Y❑ N❑ YL N❑
SHEETROCK I• GRADE - FEE SUMMARY
EXTERIOR LATHQ !Q-a.$ $ BUILDING _ T- BUILDING 0 sa
INTERIOR LATH TEMPORARY APPROVALS -
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE IdE
OCCUPANCYOF BUILDING tSNOTPERMITTEDUNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION:I PLUMBING �. II�
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ,
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL o/
CALLING FOR FINAL INSPECTION.
OFFICE COPY
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -'
' ^ BU&LDI NG PROJECT I DENTI FICATION LadPERMIT NUMBER /.
BILGING APPLICATION & PERMIT
ACOREss p 14 O 7 C
. Q aO "o �' � BLP�fF� BUILDING-ELECTRICAL-PLUMBING -MECHANICAL o fVl
OWNER'S t_TDe
N E P Y C W
/� /� QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
�.LPN tE- PHONE p( 1'f'� -03
C NTRACTGR' -
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
U.t�v QOQ. /4�/
LIc.rvG. I uo -LIGHTING FIXTURES 10.00/1.00
ADDRESS rolls)QOO "TKEEM�s O PPLIANCES-RESIDENTIAL 4.00
' S O PHONE A(' Q PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
-uc.No. Pow ISIGNS TRANS. 3:00
nmH Go ENG. NC G2.K SPECIALCIRCUIT 5,00 PERMIT VALIDATION
�( `20o69 6 3W . .
<2upig CIA zIP EMP.METER OR POLE INS. 20.00 (�
APPLICANT-$
ADDRESS MOTORS SEE FEE SCH.
,
SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION _ IPOC
�I
a Z w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
n a (commencing with Section 7000)of Division 3 of the Business and w ELECT. PLC. MECH.
O Professions Co en m 'license is in full forte e frj t�
z 0. - License ass Lic.Numbe -a2lo-
z r )ate'-` Conttuclor
a x BUILDING PERMIT
OWNER-BUILDER DECLARATION
o a v INFORMATION
La g n r 1 hereby affirm ing I,. exempt from the Contractor's License MISC.- REFER TO ORD
u ve Law for the followin reason.(Sec.7031.5,Business anJ Professions VALUATION $/FT.
- g PERMIT ISSUANCE -f9.g9'
Code: e.deAny rayorcor ntywhich structure permi�oconsuanc , ler, 4� ...w_.x
ce Q¢ improve,demolish,or repair any structure,Prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a c¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E
m a- he is licensed pursuant to Iha provisions of the Contractor's License
Fir Law.(Chapter 9(commencing with Section 7000)ofDivision 3ofihe
a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
7 i'o
T . ¢ r r� the basis for the alleged exemption:Any violation of Section 7031.5 STORIES TYPE CONST
A5 by any applicant for a permit subjects the applicant ma Civil penalty ALTER-DRAIN IEA.) 5.00
orn
of not mthan five hundred dollars(S500)J:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not oC GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 /�-3 /
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided however,
such improve- n
hiarts mself C throuot gh
intended orafferedemplo employees,
or mole. ded that
the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 aC /
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 1,as owner
of the.). INOUSTR IAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ d as owner of the properly,he exclusively contracting with
r. licensed contractors t0 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 docs not apply
to owner of property who builds or improves thereon,and who who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts ifor such projects with a conhactor(s)licensed pursuant to
ontv
'
the Ctractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 � TRACT No, PARCEL No.
❑ l 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
1 hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy Ibereof(Sce.3800,Lab.CJ./NA. /�l/BLra4.
Policy No. Company '
0 Certified copy Is here for. d. FIRE SPRINK ENERGY T-24
z 2 Certified s I w' lip i ' section division. MISC.- REFER TO ORD.
A iCan[ - Y N� V No
U05<,
S, = - Cli RTIPCATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE �1BA0 I.X FLOODZONE A,L.U.C.
W COMPENSATION INSURANCIi PLG.CONTR. LIC.NO. PLG. '7 9 SF
CL Z IT his section peed not be completed if the permit is for one _ TOTAL / aC V 1-1 N� V N�
hundred dolhoa($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 F mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
U a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �s4-20
} 0 NOTICE TO APPLICANT: If,after making this Certificate of hx..
F 2 emplum,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 ur this permit shalt be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE �Q 7E
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. MICROFILM
3097,Civ.C.I /1 �) - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name l.-.(1PT- r`rArL-
Lender'sAddress } HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 7�
.I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
'fl information is correct. I agree to comply with all city and county PLUMBING 7a
ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby entioed representative,ins of this city es enter upon the BOILER-COMP IOVBr 100,000 BTU)SEE FEE SCH. MECHANICAL
4�
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City Of MISC.- REFER TO ORD4
upertinG against Iia bilines,judgm s;cost and expenses which CONST.TAX p p e'Z t
May in any way accrue ngains aid i o qucnce of the PERMIT ISSUANCE a4'6:80 of a 0 '�
renlin MECH.CONT. LIC.NO. MECH.
TOTAL 7,� TOTAL 8/a
n
ignalu of Applicant/Contractor U c
OFFICE COPY