15739 ' POST THIS CARD NEAR FRONT OF BUILDING PFRMITNUMBER
C ITY �OF CUPERTINO 15739
INSPECTION DIVISION . .
JOB INSPECTION RECORD
! PERMIT EXPIRATION
JOB ADDRESS'lo`'�0L/B-LS UNIT# �,, _LOT# /� PERMIT EXPIRES IPWORK
OWNER _ L,OI�—f V7�� CONTRACTOR �QZQtiN L/c� lyR IS NOT STARTED WITHIN
INSP ION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: ' LASTCALLED INSPECTION.
UFERALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS ' '� I -
FOURIN6 CONCRETE UNTIL ABOVE HAS BEEN SIGNED — /- C/L,Gr^� fK ' , ,,,� 1_,� -�'~,'•
UNDERGROUND /SLAB
PLUMBING - • L f•• 1UD•
ELECTRICAL ISSUANCE DATE
MECHANICAL - .. BL n G. ELECT. PLG. MECH. i
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PEaM1T
WOOD FLOORiIDN •- INFORMATION
PLUMBING
VALl1A $LFT,
- -
MECHANICAL
ELECTRICAL /Jy, PERMI TO "
FRAMING
INSULATION ' - _ STORIES Tv ECONSTR. 1
9 pOo
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
FT.,PLooRAHEA TOTAL ACR EAGP
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE B RE so
DIAPHRAGM THE CONSTRUCTION TAX IS PAID.
BUILDING USE
ROOFSHEATHING RES ,ND coN PB on...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
ROUGH SAN.a A55ESSORS PARCEL NO
PLUMBING - 'ELECT.ENERGY
'
^ TUBSBSHOWER PAN � PLUMBING ENERGY THACT NO. PARCEL NO.
' MECHANICAL �f MECH.ENERGY
' ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILENO.
FRAMING ELECT.FINAL TEST -
INSULATION - _ - ZONING ENG:SITE NO.
PLUMBING .
GAS TEST GAS FIRE SPRINK ENERGY T;]a
' MECHANICAL .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ "[] ` "�
' EXTERIOR.SHEAR ELECTRICAL RELEASE ' FLOOD ZONE AT.0.0
INTERIOR'SHEAR FIRE DEPT. v❑ "❑ ° L7 N❑
SHEETROCK _ GRADE FEE SUMMARY
EXTERIOR LATH BUILDING .
INTERIOR LATH TEMPORARY APPROVALS' BUILDING r
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 FINAL ISSIGNEO BY BUILDING INSPECTOR.
MICROFILM
ARRANGE•FO,R INSPECTION BY PHONING 252-4505, ELECTRIC
a� ONE WORKING DAY BEFORE REQUIRED,INSPECTION. PLUMBING
z PLEASE GIVE•JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.rnx
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
PERMIT NUMBER
' aUI LDING PROJECT I IDENTIFICATION-
ADDR `Nd. APPLICATION & PERMIT �`JJ
ADORLss P,' yn BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
INERS � 1W
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
_ ko 4*41 y, PHONE
CONIRACTORs UTLETS-SWITCHES-RECEP 10.00/1.00 `
^"/naj 4yAw�� op ( ipsea NO. Il ( LIGHTING FIXTURES 10.00/1.00 -
CONTRACTORs IW 0 M (. , PPLIANCES-RESIDENTIAL 4.00 -
AooR�sjs� y��,�� `, ./fin
1y Pqf I'f4 • PHONE &DI%V PANELS 10.00 DATE OF APPLICATION
onncH,rl:cT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE ' P.C.NO.
ENGINEER
UC.Na. SIGNS TRANS. 3.00
ARCHOR ADDRESS ENL. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 /' •' -- j
APPUGArvrs I O MOTORS SEE FEE SCH. /LE,-r'�A_'____.�•�
AOORE55 y c
"W r �ozr7 SERVICE CHANGE 20.00 / /��
woo LICENSED CONTRACTORS DECLARATION
rt i 1 hereby affirm(hat I am licensed under provisions of Chapter 9 ISSUANCE DATE
¢ w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H o z Professions Codes d my license is in full hit feet.
G Z 2 G License as DD Lic.Numbe --11 ❑ ❑
Date 'I Contractor
¢ Y f t BUILDING PERMIT,
Ic ¢ OWNER-BUILDER DECLARATION
g o d U - - INFORMATION
X N I Law for til affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
3 u Y Fl - VAWATION E/FT.
Fuoj Codvony lily oriountyng which requires
5,Business tocontrct,alons PERMIT ISSUANCE 10.00 , - -
Code Any city or county permit toco construct,alter,
-
rt ¢¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 3
n w m¢ requires the applicant for such permit to file a signed statement that TOTAL T
he is licensed pursuant to the provisions of the Contractor's License PERMIT O
Fii L..(Chapter 9(cummencingwith Section 700()o'Division3ofthe MCGjJ
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ the basis for the alleged exemptionAny violation of Section
F I O STORIES TYPE CONSTR.
r-$ . malty
a ; � by any more
fora hundred
$th applicant lOacivil penalty ALTER-DRAIN VENT-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 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 does not apply to an owner of
Properly who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SO.FT,FLOOR AREA ^TOTAL ACREAGE
himself re not into his own employees.provided that such improve-building
mems are through
ughhis or offered employees,
provided
that such
ebwlding GAS-EA:SVSTEM-11NC.40UTLETS 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 WN PB 'Dmn
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,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 .ASSESSORS PARCEL NO,
and Professions Code:The Contractor's License Law docs not apply
to an owner of properly 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 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 this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC,DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm that l have a cer(ifcate ofconsent to xv1pinsure' ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certil'icd
copy Ihergqgqf,f 00,Lab.C' -
POhcyNo.IL7 Company�' .fl'>Kr•
O Cetlil'iC copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 , Cerci ed cop I fled wl It the city inspection division.
O AFlFl!icam- — �t'sy. '� MISC.- REFER TO ORD. Y❑ N❑ Y❑ N❑
~ (nPERMIT ISSUANCE 10.00 •'
— CERTIFICATE EXEMPTION FROM WORKERS' FLOOD ZONE A.L.0 c.
LU
'COMPFfiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 In, (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
0 Z hundred dollars IS 100)or less.)
U O I certify that in the perfomlance,of the work for which this per- QTY. MECHANICAL PERMIT FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of Cullfomuua
0 i Date Applmdlt ALTER OR ADD TO MECH. 5.00 ILDING
-} ser NOTICE TO APPLICANT: If,after making this Certificate of Ex-
FZ emption,you should become subject to the Workers Compensation APPLIANCE 5.0 HECK
provisions of the Labor Code, you must forthwith comply with E
C„) such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCI(ON LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.),6.00 . SEISMIC FEE :
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the
i
er performance MICROFILM
3097, ante of the work tor which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
I certify that I have read this application and state that the above I
ILATION FAN (SINGLE) 4,tio 4GD Q.QO -
information is rorrectr I agree to comply.with all city anJ county PLUMBING
Or direm.s and state laws relating to building construction, andR-COMP(3H.P.Or100,000B.T.U.) 6.00hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. ER-COMP(Over 100,000 BTU)EEE FEE SCH. MECHANICALJm
, indemnify and keep harmless the City of .-p� REFER TO ORD. 7QDHE
Ilities,judgments, costs and expenses which CONST.TAX
Grue against said City in c nsaluence of the / PERMIT ISSSU��AANCE sn�E/1n�/.Jrzv"-.BR Itso
'�I_P MF�{rJtH. �N � Wry LIC.NIIVVvr MOTALgq O^ TOTAL
Signature Of Applicant/Contractor 7i/E Date WI ryN I/
OFFICE COPY