15746 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
1576
INSPECTION DIVISION
JOB INSPECTION RECORD
� r '• O � "�V� PERMIT EXPIRATION 1
JOB ADDRESS J UNIT# "lLOT'#�l
PERMIT EXPIRES IF WORK f
OWNER SO L/.>� CONTRACTOR 'C(�� (� 6- IS NOT STARTED WITHIN.'
INSPECTIO DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
.. FOUNDATION - ANCE OR 180 DAYS FROM .
NOTE:
ALL INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITETO COMPLY WITH THE APPROVED PLANS AND CITY Of PERMIT VAL DATION
'CUPERTINO STANDARDS. ,. {
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL - -
ISSUANCE DATE
MECHANICAL BLDG ELECT. PLCa., MECR. .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' - - \ BUILDING PERMIT
WOOD FLOOR d O.INFORMATION
PLUMBING, - _ vALunnoN SIFT.
IWO
MECHANICAL -
ELECTRICAL _ PpPERMIT TO
FRAMING
INSULATION - STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
�:F\ - e • $O FT FLOOR AREA TOTAL ACREAGE
t ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM _ .THE CONSTRUCTION TAX IS PAID
"^+ BUILDING USE
ROOF SHEATHING Res INC. - coN_ PB CIO-,
' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED -FINALS DATE INSP:. ❑ 0 ❑. ED ~
ASSESSORS PARCEL Na.-
ROUGH SAN.#
PLUMBING.-' ELECT.ENERGY•
TRACT N0. PARCEL NO,
TUBS&SHOWER PAN - PLUMBING ENERGY • -
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC.DATE., ACC.FILE NO.
' FRAMING -. ELECT.FINAL TEST - -
INSULATION - PLUMBING - ZONING END,SITE NO,
GAS TEST GAS � '
MECHANICAL _ FIRE SPRINK ENERGY T 24 '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y 11 '"c � ❑ - N❑,
• FLOOD ZONE 'AL U.C.
EXTERIOR SHEAR '. ELECTRICAL RELEASE
INTERIOR SHEARFIRE DEPT. Y ❑ 'NE] Y L7NE]
SHEETROCK GRADE - - FEE SUMMARY
` EXTERIOR LATH BUILDING -
INTERIOR-LATH
TEMPORARY APPROVALS BUIcowG
SCRATCH COAT ELECTRIC PLAN CHECK-
. GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALIS'SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� . ONE WORKING DAY BEFORE REQUIRED INSPECTION. PILL)MBING
0PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
_1 — SEE PERMIT FOR EXPIRATION DATE MECHANICAL
-
IMPORTANT!
IMPORTANT! coNsnTAx
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
. BUI LDI NG PROJECT 1 DENTI FICATION - .PERMIT NUMBER
Em LOING. - APPLICATION & PERMIT
ADDRESS (0 - 1 J 5 7 4 6
qUI LDING -ELECTRICAL-PLUMBING-.MECHANICAL
OWNER'S
NAME - QTY PLAN CHECK VALIDATION
53_q(0 ELECTRIC PERMIT FEE
S O R PHON -'I
CONTRACTOR'S �(L(-� L
NAME, J �aZ 9�S5 S� OUTLETS-SWITCHES-RECEP 10.00/ 00
• &, ' 1'4 S - uc.No LIGHTING FIXTURES 11.00
corvTRacroR's
aooREss AO, q APPLIANCES-RESIDENTIAL 4,00 ^°
H'
E'T 3-�3a I PANELS - 10.00 ..
DATE OF APPLICATION'
aecwrecr. - PLAN CHECK FEE P.C.NO.
oR PANELS (OVER 200 AMP)^ - 20.00 '
ENGINEER _ t
- uc.No. ISIGNS TRANS. r 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT - 5.00 ..
ZIP TEMP.METER OR POLE INS. 20.00 /f
APPLICANT'S
ADDRESS MOTORS "SEE FEE SCH. I'/_J�JLI-•,
SERVICE CHANGE - 20.00 U ' ,p'�i -
0 02 LICENSED CONTRACTORS DECLARATION - - 7/ �//0 O
a U I hereby affirm that 1 am licensed under provisions of Chapter 9
rt n ISSUANCE DATE(commencing with Section 7000)of Division 3 of the Business and '
F- 2 Professions Code and my license is in full force and effect. BLDG. ELECT. PLG. MECH.
oi o License Class Lic.Number ❑ t ❑
r b H J Date Contractor
IF X a -OWNER-BUILDER DECLARATION BUILDING PERMIT
w_ °' U• MISC.- REFER TO ORD INFORMATION '
3 W y 'I hereby affirm[hal I am exempt from the Contractor's License _
u o j Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
La Code:An'ycity orcounty which requiresa permit to construct,alter, PERMIT-ISSUANCE 10.00 _ '
re ¢ Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
.n w m he is licensed pursuant to the provisions of the Contractor's License I '
H z a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the - PA
f E o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT - ISC
w I- the basis for.the alleged exemption.Any violation of Section 7031.5 T�ppryE$ TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 '�l ;l'7
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
their sole compensation,will do the work,and the structure is not - OCC 56 UP RES.UNITS
intended or offered for Sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 CuPert
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 50.FT.FLOOR AREA NOTAL ACREAGE
himself or through his own employees,provide)that such inmrove-
mentsarenotintended or offered for sale,If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND .CON PB Orbar
❑ 1,as owner of the property,am exclusively contracting•wilh - '❑ ❑ ❑ ❑ ,❑
licensed wntracmrs to construct,the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 -
and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon,and who LAWN SPR IN KLERS-OVER 5(EA.) 1.00 t
contracts for such projects with a contortionist licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B.&P.O for this
reason WATER HEATER 111 - 6.00
Owner Date WATER SYSTEM ACC.DATE' SACC.FILE NO.
WORKERS'COMPENSATION DECLARATIONWATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsem to self-insure, -
or a certificate of Workers'Compensation Insurance,or a certified, ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. ,
Policy No. Company -
O ❑ Certifiedcapy is hereby furnished. FIRE SPRINK ENERGY T$4
Z
, Certified copy is fed with the city, inspection division -
� �APP icant, �,E ii�ry .11
, _MISC.- _ REFER T60RD. Y Q N❑ Y ❑ N❑ '
T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 19:80 PLFLOC
ZONE A.L.U.0 vl
LU COMPENSATION INSURANCE. G.CONTR. LIC.No. PLG.•
CL o (This section need not,be conmleted if file permit is for one TOTAL Y❑ N❑ Y ❑ N❑
0 Z hundned dollars IS 100)or less)
U O 1 certify that in the performance of tire work for which this per-
QTY. MECHANICAL PERMIT: FEE FEE SUMMARY
LL F mit is issued,1 shall enot W employ any person in any manner to
O W become subject to the Workers'Compensation Laws of California.oiu _
Data Applicant � � BUILDING
0
} N NOTICE TO APPLICANTICANT:: If,after making this Certificate of Ex. ALTEROR ADD TO MECH. 5.00 1.
2 emption,you should become subject to the Workers'Compensation _ APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with C„) FEE.such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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. MICROFILM
3097,Civ.C.). ., HEATING UNIT;(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address - HEATING UN IT(OVER 100,000 B.T.U:)9.50 ELECTRIC
1 certify but I have read this application and state Thal the above VENTILATION FAN (SINGLE) -4.00 4
information is correct I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 - PLUMBING
ordinances and slate laws relating to building construction, and -
hereby authorize representatives of this city to enter'upon the - I
above-mentioned property for inspection purposes. BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. 'MECHANICAL "
(We) agree to save, indemnify and keep harmless the City of MISC--- REFER TO ORD. "
Cupertino against liabilities,judgments;costs and expenses which - CONST.TAX.
may in any way accrue against said City in consequence of the PERMIT ISSUANCE -10.00 '
mnling of this return. - MECH.CONT. LIC,NO. MECH. - -
TOTAL
h alure of Applicant/Contractor Date TOTAL
OFFICE COPY