15674 POST THIS CARD'NEAR FRONT OF BUILDING Pe'RnnlT NUMBER
CITY OF CUPERTINO '
INSPECTION DIVISION ,
1"5674 ;
,. JOB INSPECTION RECORD "
PERMIT EXPIRATION
JOB ADDRESS O . N"`'•"" '- +" UNIT# _•LOT#
_ PERMIT EXPIRES IF OR K,
OWNER
Vbt4^
W
` CONTRACTOR �'�I - IS NOT STARTED WITHIN
INSPEC ON DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION . - ANCE OR 180 DAYS FROM "
NOTE:
UFER LAST CALLED INSPECTION.
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANSAND CITY OF PERMIT VALIDATION
GARAGESLABS CUPERTINO STANDARDS. -
POUR NO CONCRETE UNTIL ABOVE HAS BEeN SIGNED
UNDERGROUND /SLAB' - - $� c •-_ ('.•',.., - '
PLUMBING mv.0
ELECTRICAL
ISSUa CE•DAT
MECHANICAL : EL P M H, -
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
.WOOD FLOOR - INFORMATION -
PLUMBINGVALUATION $/FT. -
. ' - � - -
MECHANICAL o
n
ELECTRICAL - - PERMIT TO
FRAMING _ _ `L t,.'}'�1'.i...��"••_..
INSULATION a,. - STORIES 1 TYPE CONSTR. I
--- OCC,GHOUP. RES.UNITS
i PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
S0 FT FLOOR AREA TOTPL ACRE PGE. .
ROOF NOTE:NOFINAL INSP.SHALL BE MADE BEFORE - - -
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING . BUILDING use
^� �7 - _ RES IND CON PB 09—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - 'DATE INSP. '❑" ❑ ❑ ❑ ❑
'ROUGH SAN,# ., ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY,
" TUBS&SHOWER PAN PLUMBING ENERGY q TRACT NO." - PARCEL NO
MECHANICAL, - MECH.ENERGY
ELECTRICAL - BUILDING ENERGY - ACC.DATE ACC File rvo.
FRAMING . -- ELECT.FINAL TEST
INSULATION - PLUMBING �i 0. z°NINcENc SITE NO.
•, GAS TEST- GAS
MECHANICAL FINE SPRINF " ENEHcv nI2.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - �7 `" ❑ N',❑ ° ❑ N❑-
EXTERIOR SHEAR_' ELECTRICAL RELEASE T\ I FLOOD ZONE A U.C.
INTERIOR SHEAR FIRE DEPT. `"❑ "❑ ❑ . N❑
SHEETROCK _ _ GRADE - • ' FEE SUMMARY
EXTERIOR LATH - - - BUILDING
INTERIOR LArH' TEMPORARYAPPRO BUILDING a .
SCRATCH COAT ELECTRIC PLAN CHECK ;,...•
• GAS.. I - FEE . . ,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY V "SEISMIC FEE'OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY13UILDING INSPECfO
9. MICROFILM
ARR'ANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED.INSPECTION. v
° PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBINGf�
Z MECHANICAL j.
SEE PERMIT FOR EXPIRATION DATE - D
.:IMPORTANT! _
'CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. b i
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Pal LD1 NGPROJE T I DENTI FICATION - ,PERMITNUMBER '
.APPLICATION & PERMIT
_
DRESS
15674-
.
/OS L E BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK V IOATION
WNER'S
AME QTY. ELECTRIC PERMIT FEE
1( 0L 4/ PHONE a.7 s;L,)
CONTRACTORS (/
rva7E� �,p� ,7 OUTLETS-SWITCHES-RECEP 10.00/1.00 '
I.El dUGXLnC.No, LIGHTING FIXTURES 10.00/1:00 -
f.ONTRALTOR'S
A1111o s�sa/ '1,I PPLIANCES-RESIDENTIAL 4.00
1 t1e_A1✓C_PH0 N E�IT3-37S PANELS 10.00 r DATE OF APPLICATION
OgcHlTecT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.c:No,
ENGINEER. N./ -
OzY� sec.NO. SIGNS TRANS. 3.00
ADDRESS ENG. PERMIT CIRCUIT 5.00 PERMIT VALIDATION -
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH. J�
APPLIEA
q7 �OdGL dL- VE a/�/✓ SERVICE CHANGE .00 Sla��88.
Oci
H o o• LICENSFD CON'T'RACTORS DECLARATION
Q W I hereby affirm that I am lieensed under provisions of Chapter 9 - ISSUANCE GATE
(commencing with Section 7000)of Division 3 of the Business and BLO ELECT. PLG. MECH
r z Professions Cole, J my license iso full for •' def T: h
oz icense Class, Lic.Number
a H J are ��=�� Contractor fs.{rr of Cupei,n
A, x i s S/IV N IU BUILDING PERMIT
X 4 OWNER-BUILDER DECLARATION
W °ca MISC.- REFER TO ORD INFORMATION
3: LL y I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
u o¢, Law for the following reason.(Sec.7031,5,Business and Professions
r- - PERMIT ISSUANCE
Code:Any city.,county which requires permit toconstruct,alter, i&B6 _ Cob
Sms...�x
Q ¢0 improve,demolish.Or repair any structure,prior to as lssuanee,d]SU ELEF CONTR. LIC.NO. ELEC.' r�a
n wO er requires the applicant for such permit to file a signed statement that TOTAL
$w he is licensed pursuant to the provisions of the Contractor's License
Fir Law(Chapter 9 f commencingwith Section 7000)of Division 3 ofthe '
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
ce the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
u; by anyapplicantlor a permit subjects the applicant toacion penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 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 tirestructure 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 does such work 1 F IXTUR ES-PER TRAP. 5.00 50.FT.FLOOfl AREA TOTAL ACREAGE
himself re through his own employees,provide)that such improve-
rents are not intended or offered for,provi,however,ded
that such
he building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
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 Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ d as owner of the property,he exclusively contracting with
licensed contractors to construct the project La due, Business LAWN SPRINKLERS-1 INC 5 V.B." 6.00 ASSESSORS PARCEL NO.
and Professions Cole:The Contractor's License Law Joos not apply
to anowner of property who builds improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with u contrtractor(sl licensed pursuant To
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft110.00 TRACT NO, PARCEL NO:
❑ I am exempt under Sec. ,BARC.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ,
ACC.DATE ACG FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insum, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.�
/- Policy No. Company � .- -
O Certified copy is hereby to
niched: T FIRE SPRINK ENERGYT20
Z Certified co 1s filed ith iVsp lion division. MISC:- - REFER TO ORD. 0 ❑ ❑
pp)icant Y N Y N
CC �+ / 4:7 PERMIT ISSUANCE
Lu - CERTIFICATE OFBATION INS PROMWORKL'RS' - �e0 FLOOD ZONE A.LU.L.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG..
Il O (This section need not be completed if the permit is for one TOTAL O Y❑ IN Y❑ No
D.Z no ndred dollars IS 100)or less,
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. F mil is issued,I shall not employ any person in any mannerso as to
,0 W become subject to the Workers'COmpersation Laws of California.
y Date - Applicant BUILDING -Air'sid 00
>_ N NOTICE TO APPLICANT'. If,after making This Certificate of fix- ALTER OR ADD TO MECH. 5.00
F ? emption,you should become subject 10 file Workers'Compensation ApP-LIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.)�. 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.),6.00 SEISMIC FEE 3I
I hereby affirm that them 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.) - HEATING UNIT(TO 100,000 B,T.U.) 8.00 /
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address - LECTRIC
I certify that I have read this applicmion and stale that the above VENTILATION FAN (SINGLE) 4.00
- information n estate l I agree To comply with alconst and cOua d 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. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- 'REFER TO,ORD.
uper DID against liabilities,judgments, costs sad expenses which PERMIT ISSUANCE - -yQ,pB ONST.TAX
may in any way accrue against said City consequence of the
e ruling his permi ;� MECH.CONT. LIC.N0. MECH.
l (� � TOTAL. 5(� TOTAL
SignaMre of Applicant/Contractor Date
OFFICE COPY