17533 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
-. 'CITY OF CUPERTING A7533
- INSPECTION DIVISION
JOB INSPECTION RECORD
- PERMIT EXPIRATION
JOB ADDRESS, F O 'Ca UNIT#- _LOT# -
PERMIT EXPIRES IF WORK
OWNER' coNTdAcroR ISNOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD .180 DAYS OF PERMIT ISSU-
FOUNDATION .NOTE: ANCEOR,180 DAYS FROM
UFER - - ALL GRADING AND.DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND Cl7YpF ^PERMIT VALIDATION.
CUPERTINO STANDARDS. - -GARAGE SLABS - - 7—
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED —• ' L.,, + t
UNDERGROUND /SLAB PAI
PLUMBING -
ELECTRICAL - f1V 1, 2 989
' f'71 ISSUANCE UAiE
MECHANICAL ; BLDG. ELECT. PLc. MEC
Ci#y.Of eli B", ❑ CT
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILOlNG PERMIT
W OOD.F LOO R I N F W MATI ON
PLUMBING VALUATII OWN $11T,
MECHANICAL -
ELECTRICAL • - PERMIt rO
FRAMING
INSULATION - - .. STORIES TYPECONSTH.
UCc,GRCUP RES UNITS
PLACE NO SU.BFLOOR UNTIL ABOVE HAS BEEN SIGNED m.E. ' '
. .ROOF SO.Fi.FLOOH AHE4 TOTAL ACREAGE
NOTE:NO FI L INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING- BUILDING USE'
... RES, IND CON PB 00",
• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ El ED ElASSH GHS F, R FL NO •
ROUGH SAN.M � .• '
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN - PLUMBING ENERGY - M1 TRACT NO. PARCEL No
` MECHANICAL - MECH.ENERGY --
ELECTRICAL - - BUILDING ENERGY - ACC.DATE ACC FILE NO
FRAMING . ELECT,FINAL TEST - -
INSULATION - PLUMBING zoNlNc ENC.sIrE No..
-
GAS_TEST - GAS -
MEDHANIGAL .• FIRE SPRINK ENPRGY L24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ❑ N❑ Y ❑ N❑ ..
EXTERIOR.SHEAR - 'ELECTRICAL RELEASE FLOOD ZONE ,A.L.U.C.
INTERIOR SHEAR FIRE DEPT. - Y ❑ NE '''.Y ❑ 'N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING,".. .
.INTERIOR LAAHTEMPORARYAPPROVALS'. BUILDING ,•
SCRATCH COAT ELECTRIC '+ PLAN CHECK
• _: GAS ' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTEDUNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM`• '
ARRANGE FOR INSPECTION BY PHONING 252;,4505, ELECTRIC
o.� ONE WORKING DAY-BEFORE REQUIRED INSPECTION. PLUMBING ' �� •.
Z PLEASE GIVE JOB ADDRESS WHEN,PHONING'.', -
SEE PERMIT FOR EXPIRATION'DATE;- MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE�BEFORE TOTAL !r �.�
CALL ING'FOR'FINA'L INSPECTION. ! ,/.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
l..4
- BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
ADORINGp - APPLICATION & PERMIT 1,7533
ADORES BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 1 ]
5
NAMER's
- PLAN CHECK VALIDATION
NAME i—
PHO DTV. - ELECTRIC PERMIT - FEE
S'�
CO RACTORS
NAE r r ,p OUTLETS-'SWITCHES-RECAP 10,00/1.00
lW ua NO Q LIGHTING FIXTURES 10.00/1.00 i
AOOHESS TOfls APPLIANCES-RESIDENTIAL 4.00
Or PHONEd9,$!62 PANELS 10.00 DATE OF APPLICATION f
ARCHITECT • PLAN CHECK FEE, P.C.NO.
OR 5 ; ) t PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNSTRANS. 3.00 - -
ARCH, ENG. PERMIT VALIDATION
ADDRESS - SPECIALCIRCUIT� 5.00 -1
i
'
ZIP TEMP.METER OR POLE INS. 20.00 _
BPPCICANT'S
ADDRESS MOTORS t , SEE FEE SCH. J. .A1-aTOt-1l�'fr✓'aI
SERVICE CHANGE 20.00 511.2189
o o LICENSED CONTRACTORS DECLARATION ' -
a u b I hereby affirm that 1 am licensed under provisions of Chapter 9 -
Zy 'ISSDANCE'DATE '
,Hm a (commencing with Section 7000)of Division 3 of the Business and ELECT, -PLG MECH.
H H z Professions Cod• nH}y license is in full for r -
o o m o License Class_ S�L'2_Llc.Number ��
V,r w Date Contractor._ ❑ ❑ ❑
Q y f J _ - CII CU�1B .BUILDINGPERMIT
IS M wIII: o a OWNER-BUILDER DECLARATION r -
3 MIS'C.—'� REFER TO'ORD ' INFORMATION
Li
% ;w H I hereby affirm that I am exempt from the Contractor's License'
w u O¢ ' Law for the following mason.(Sec.7031.5,Business and Professions VALUATION $/FT.
� - � Code:Any city or county which requires a permit to construct,alter, - PERMIT ISSUANCE 10.00 -
ag a N improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.
al IS requires the applicant for such permit to file a signed statement thates ELEC.
u %m¢ he is licensed pursuant to the provisions of the Contractor's s License TOTAL
' PERMIT TO -
r z a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the 1 —
4 D Business and Professions Code)or that he is exempt therefrom and QTY. •PLUMBING PERMIT FEE
w I- o the basis for the alleged exemption.Any violation of Section 7031.$ . STORIES TYPE CONSTR.
aim by any applicant for a perhnit Subjects the applicant toacivil penalty gLTER-DRAIN&VENT-WATER (EA:) 5.00
of not more than five hundred dollars(S500)J: ,
❑ I,as owner the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OCG 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 docs not apply to an owner of
property who builds or improves,thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOflAfl AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
ments am not intended or offered for sale.If,however,The building GAS-EA.SYSTEM m I INC.4 OUTLETS 6.00 -
or improvement is sold within one year of completion,the Owner-
'^ builder willhavethe burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.), 2.00 . BUILDING USE
prove for purpose ofthcontracting
INDUSTRIAL WASTE INTER. 30.00 . E]RES I❑ ❑N ❑ O❑
ND
❑ 1,as owner of the property;am exclusively niracfing with
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. . 6,00 AssESSORS PARCEL No..
and Professions Code:Tire Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 t. '
contracts lot such projects with a contractors)licensed pursuant to - -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
71I am exempt under Sec.—,B.&P.C.I
reason 'or this WATER HEATER W/VENT 6,60
Y!I
Owner Date WATER SYSTEM 5,00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 +
I'hemby affirm trial\[have a certificate of consent to self-insure,
or a certificate of Wor •rs'Compensa[iph Insurance�gr a certified ]CONING ENG.SITE NO.
.- copy 0,Lab.C / a
colic Co any L _ '• ..
O ❑ rtifl decoy is he by fur hcd. ' { I FIRE SPRINK ENERGY T-24
Z 2 y is Ile with the cilY inspection division. -
FO picant - MISC.- - REFERTOORD. YN •v ❑•' ,IN[:]
� y CETI ICATE OF EXEMPTION FROM WORKERS' PERMIT,ISSUANCE - O �60 FLOOD ZONE 'A.L.U.C.'
DJ COMPENSATION.INSURANCE PLG.CONTE, LIC:NO. PLG. "
C- O (This section need not be completed If the permit is Cor one TOTAL �� v❑ N� V ❑. ,N❑ '
2 hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the we for winch this per- QTY. -MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. -
y Date Applicant ALTER OR ADD.TO MECH. 500 BUILDING
} US NOTICE TO APPLICANT', If,after making this Certificate of Ex- ,
2 emption,you should become subject to the WorkersCompensation APPLIANCE_ 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with V i. FEE such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOC.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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.), 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address "
I certify That I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COMP13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING'
ordinances and state laws relating to making construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree Jor save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upeigino agai t liabilities,judgments, costs and expenses which pERM1T ISSUANCE 10.00 CONST.TAX
m in any waxaccrue against said City in consequence.Of the _
an gof f Ah.Hp mit. - ^� MECH.CONT. -. LIC.NO. MECH.
(]l(
TOT.
OAL TOTAL
S na re opplicmot/contractor Date i
OFFICE COPY