18537 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
If
CITY OF. CUPERTINO
8537
INSPECTION DIVISION .t
JOB INSPECTION RECORD
/ J RL PERMIT EXPIRATION
JOB ADDRESS_J.—L–a C all J �`--�� UNIT# _LOT# 'PERMIT EXPIRES IF WORK
bWNER ) Or _S CONTRACTOR V J�'r (,, IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION kECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
LASTCALLEDINSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APP�1pV'd P ANS AND CITY OF PERMIT VALIDATION
PR EGUNITE CUPERTINO STANDARDS. E(~i�•lllO
GARAGE SLABS - "'J _ ! •� _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED c
UNDERGROUND /SLAB SEP_
PLUMBING - .. f41u at Q_...` D, � ,�••Ps4f. t .
ELECTRICAL a�L J ISSUANCE DATE
MECHANICAL BLyc. ELECT I PLG. MEC.
12xt ^1,_ ❑ I [� 1 ❑ 1 ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED O ki- ;" Wa
I , BUILDING PERMIT
INFORMATION_
WOOD FLOOR VALUATION $IFT.
PLUMBING
MECHANICAL .
PERMIT T
ELECTRICAL I pI�-E••., '
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCCGROUP RES UNITS
!: PLACE NOSUBFLOORUNTICABOVEHAS BEEN SIGNED 50,FT.PLOGRAI+EA' .OTALACREAGP
INA ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING HES IND ILD
CON USEPBom,.�
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. SP 11.
ASSESSORS PARCEL N0.
ROUGH - SAN.#
PLUMBING ELECT.ENERGY '
TRACT NO: PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
_ ACC DATE ACC.FILE NO
ELECTRICAL - BUILDING ENERGY.'' -
FRAMING - ELECT.FINAL TEST ZONING ENG.SITENO.
INSULATION - PLUMBING '
GAS TEST GAS
FIRE SPRINK ENERGY T.ja
MECHANICAL Y ❑ N❑ 1, Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE a_1 c.
INTERIOR SHEAR FIRE DEPT. - v Q N� r ❑ NE]
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH ` BUILDING - --
INTERIOR LATH - -TEMPORARY APPROVALS BUILgwG
SCRATCH COAT ELECTRIC PLAN CHECK
GAS 'FEE• 'NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UN TIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY'PHONING 252-4505, ELECTRIC ` 6rYO
F' ' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
I. IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL /".CjC
CALLING FOR FINAL INSPECTION'.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LOI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
aDILDING 1013 Qk� ZS APPLICATION PERMIT n 8[ 37
ADDRESS J 1
O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL $:
jar OWNER'S ,{AIII�� S S CM PLAN CHECK VALIDATION
1 NAME /tlV 41 y QTY. ELECTRIC PERMIT FEE
PHO Cr •
CONTRACTOR
NAME /N)(
M E
NAME I U & lL 166 OUTLETS-SWITCHES-RECEP 10.00/1.00 ,l'.b
LIC.NO. 208 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
ADDRESS
DR's p.n. `9 7oo353 APPLIANCES-RESIDENTIAL 4.00 r
��••PIT�
9 PHON ) PANELS 10.00 pv� DATE OF APPLICATION
OR A]02!Z �✓ ,AI (4V4I [SMS PANELS (OVER 200 AMP) 2QDD PLAN CHECK FEE P.C.NO.
OR " O JV Ie• LLS4V4
ENGINEER
uc.No ISIGNS TRANS. 3.00
ARCH.OR pEND G NIT1� 5 SPECIALCIRCUIT 5.00 PERMIT VALIDATION
SS
EMP.METER OR POLE INS. 20.00
ADDREMOTORS , SEE FEE SCH. /
ADDRESS
SERVICE CHANGE 20.00
Foo LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE v`
a c (commencing wIli,Section 7000)of Division 3 of the Business andSEP B ELECT. PLG. MECH.
H w i Professions Code nJ eresn�
y license is in full foe eel _ ❑
Z, z w' o License Class sc.Number El ❑
H y H J Yl
Date Contractor _ fsllu at CIIIIC�'
¢ Y a 1L "1^r BUILDING PERMIT
¢ 0 w OWNIiR-BUILDER DECLARATION INFORMATION
h'xu LL N I hereby affirm thai I am exempt from the Contractor's License MISC.- • ' REFER TO ORD
u O¢ Law for the following reason.(See.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION
� - 0 Code:Any City or county which requiresa permit to construct,alter, -
2 w Q Q improve,demolish,or repair any structure,prior to il5 issuance,also ELEO CONTR. LIC:N0. ELEC, p'
O, requires the applicant for Such permit to file a signed statement that - TOTAL I a 6 I�a PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
i
Law(Chapter 9(commencingwith Section 7000)of Division 3 of the
f 4 o Business and Professions Code)or that Be is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CON TR.
dg � by any applicant'for a permit subjects the applicant to a civil penalty . ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of Ilse property,or my employees with wages as BACK FLOW 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 (See. 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 FIXTURES-PER TRAP 5.00 .SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-. GAS EASYSTEM OVER 4 (EA) 200
builder will have the burden of proving that he did not build or Im - . - . .
- BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ I,as owner ol'tile property,am exclusively contracting wits INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ El El ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-11 INC 5 V.B. 6.00 ASSESSORS PARCELNO.
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 projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.- ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
. ACL.DATE ACC.FILE NO.,
r WORKERS'COMPHNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0,
or o Certificate of Workers'Compensation Insurance,or a ce Nificd
copy thereof(Sec.3800,Lab.C.).-,'II
P.] No. Company
0 A Certified copy is hereby furnished. - FIRE SPRINK ENERGY T 24
Z Z ❑ Certified 'Copy is filed will the y inspection division.
O APplicant�*y�;µM_E w�. MISC.- 'REFER TO ORD. Y bi Y❑ N�
~ lnPERMIT ISSUANCE - 10.00 FLOOOZONE' A.L.U.C.
CC � CERTIFICA'I'E'OP IiXEMP1'ION FROM WORK ERS'
LU 2: COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y C3 N Y❑ N
CL D This section need not be completed if the permit is for one TOTAL
Z) Z hundred de11ars(SI00)Or less)
U O I certify that in the performance of the work for which this per- OTY. 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.
IL - Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificate of fix-
I.. ? emption,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 or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LEND INC,AGENCY AIR HANDLING UNIT(OVER 10=C.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 HEATINGUN IT(OVER 100,000 B.T.U.)9.50 - g'6� Q
Lender's Address ELECTRIC
I certify that 16uve read this application and state that the above VENTILATION FAN ISINGLE)' 4.00
mf is correct. I agree to comply with all City and county - PLUMBING
00h ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-nsentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ,
ay in any way accrue against said Ci in consequence of the
ranting of this pe it. H.
MECH.CONT. LIC.NO. MEC
� TOTAL TOTAL let �
Signature of Ap lean on[ elor ate- B r
OFFICE COPY