14874 POST F
,CARD NEAR RONT OF BUILDING
PERMIT NUMBER
�. CITY: OF CUPERTINO .; 7
INSPECTION DIVISION 48 `
JOB INSPECTION RECORD
l� PERMIT EXPIRATION
JOB ADDRESS /0 U 6 ��a� ��`- - UNIT# _LOT#
- ' - - PERMIT EXPIRES IF WORK
OWNER, L r: ✓/'7 VIT CONTRACTOR 7/�c.2.y f,�- IS NOT STARTED WITHIN
IN ECTION DATE INSPECTOR INSPECTION RECORD teo Dgvs of PERMIT issu
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: -
LIFER
FER � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. _
GARAGE SLABS. '
r.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED :'�, •� +,,.;
UNDERGROUND /SLAB,
PLUMBING ,
ELECTRICAL ISSUANCE.DA TES
MECHANICAL BLDG ELECT. PLG, MECH-
❑ El " ❑" .Q
• DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
.. WINFORMATION
WOOD FLOOR
VALUATION
PLUMBING
MECHANICAL_ '
ELECTRICAL - �/rENMn'TO
FRAMING -
STORIES
rvvE cOrvsnv
INSULATION
" n
GHOUR RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED Ot
SO.FL.FLOOR AREA TOTAL ACREAGE
- .• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOFSHEATHING RES IND CON Pe 00,11
- APPLY NO•ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. I] L ❑ - 0
ASSESSORS PARCEL NO.
ROUGH SAN,#
PLUMBING - - ELECT.ENERGY '
TRACT NO. PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY
MECHANICAL - -pT{/, MECH.ENERGY '
ELECTRICAL_ BUILDING ENERGY ACC DATE I - ACC.FILE rvo
FRAMING - ELECT.FINAL TEST ZONING ENG.SITE NO.
INSULATION ' PLUMBING '
GAS TEST - GAS
FlRF.SPRINK ENERGY iqa
.. MECHANICAL Y ❑ No v 11 No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD/ONE A.L.0 C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. S' - ° NL v L N❑
SHEETROCK' GRADE FEE SUMMARY
EXTERIOR. LATH" BUILDING'• '
INTERIOR LATH - TEMPORARY APPROVALS BUILDING
SCRATCH,COAT ELECTRIC PLAN CHECK -
, GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEO-1 OCCUPANCY I ySEISMIC-FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. N1XROFILM
0 ARRANGE FOR INSPECTION BY PHONING 252-45051 ELECTRIC
ONE'WORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING. '
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —'
IMPORTANT! covsT.TAX
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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
/. BUILDINGAPPLICATION & PERMIT 14874
/ ADDRESS - -
10061 !� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S /� PLAN CHECK VALIDATION
AME
P L.E GOMP ONE DTV. ELECTRIC PERMIT FEE
NAMERncTon's UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. O64C' LIGHTING FIXTURES 10.00/1.00
CONTRACTORS - PPLIANCES-RESIDENTIAL 4,00
ADD/R'E��SS pp-JDp •�'
,• a�JRONe-�JJ- / - PANELS - 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200'AMP) 20.00 PLAN CHECK FEE P.C.NO.
on
ENGINEER
sec.No. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
IIP TEMP.METER OR POLE INS. 20.00
APPLI MOTORS SEE FEE SCH. O.dLU-Q.%t`)
ADDRESS
SERVICE CHANGE 20.00
Foo LICENSED CONTRACTORS DECLARATION
u I hereby affirm that I am li<enseJ under provisions of Chapter 9' /ISSUANCE DATE
y e,"' (commencing with Seciloo 7000)of Division 3 of the Business anJ, BLDG. ELECT. PLG. MECH.
m i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ rtll
' 0.- License Class Lic.Number L[TI
9zH Dale-4 Contractor � --
a Y BUILDING PERMIT
ac rc w u OWNER-BUILDER DECLARATION INFORMATION
x o A MISE.- REFER TO ORD
w ;LL y 1 hereby aflirm But I am exempt from Ne Contractor's License
uo4 Law for the following reason.(Sec.7031.5,Businessar Professions PERMIT ISSUANCE 10.0QC
0 VALUATION
r - -' Code:Any city or county which requires a permit mconstn¢q alter,Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
requires the applicant for such permit to file a signed statement that TOTAL - PERMIT O
A w m he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
re H,$ the basis for the alleged exemption.Any violation of8ection 7031.5 STORIES TYPE CONSTR.
w 3 - by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dolLnx($5001.):
❑ 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 DOC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Profemions 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,an&who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
. mems are not hrough
ownemployees,for sale.
If,however,[lie
improve- GAS-EA.SYSTEM-1 6.00
mems are not intended or empll for sole If,ed that s the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not Build or im-
provefor purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND cOry Pe Other
13I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL 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 pnoccis with a contmctor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for Nis WATER HEATER W/VENT 6.00
reason
Owner - Dale WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affum that I have a certificam ofconxnt to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Com eIs I on Insurance,or a certified
Copy thereof(Sec.3800,Lab.C. . C ��
Policy No. Company -
0 El Certified copy is hereby fu ommil. FIRE SPRINK ENERGY T 24
Z Z J@ Cenifiej co rg is NI ski 'th Ih city inspection division. MISC.- REFER TO ORD.Applicanl� Y❑ N❑ Y ❑ No
V5 PERMIT ISSUANCE 10.00
- CERTIFICATF 01°1AEMP'I'ION M WORKERS' FLOOD ZONE A.L.0 c.
LMU >_ COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG.
O- O (This section need not be completed if the permit is for one TOTAL Y E] N❑ v❑ NE)
7) Z hundred folk rs IS 100)or less.)
00 1 certify that in the performance of the work for which this per- TV. MECHANICA PERMIT FEE FEE SUMMARY
U. F mit is issued,I shall not employ any person in any manner so as to /+
U became subject to the Workers'Compensation Laws of California. '
0 tN Dale Applicant BUILDING
a - ALTER OR ADD T 5.00
} w NOTICE TO APPLICANT; If,after making this Certificate
mme sa Ex Fri
♦- 2 pr visions
you should become subject to the Workers'Compensation APPLIANCE "k.00 PLAN CHECK
provisions io the Labor Cit sh you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0=C.EM.)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 1'or 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 ELECTRIC '
Lender's Address
I certify that i have read(his application and state that the above VENTILATION FAN ISINGLE) 4.00
low
information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-713,H.P.Or100,000 B.T.U.) •6.00 p
hereby authorize representatives of this city to enter upon the
BO LE
(Over 100,000 STU)SEE FEE SCH. MECHANICAL O
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep hamdcss 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
ranting of this permi MECH.CONT. I LIC.NO.- MECH.
. - TOTAL TOTAL
p. Signature plicanl contactor Date
OFFICE COPY