14555 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
= CITY OF CUPERTINO 14555
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS • /0 3 Y-� �Uf3l31] UNIT# LOT#
_ - PERMIT EXPIRES IF WORK
OWNER erV CONTRACTOR //� ,els �`ZLsZ-7�iL_ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD ' 1BO GAYS OF PERMIT ISSU.
FOUNDATION _ ANCE OR 180 DAYS FROM
NOTE: LASTCALLEO INSPECTION. •'
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
GARAGE SLABS CUPERTINO STANDARDS.
'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I0-U-
UNDERGROUND /SLAB C/L�T• `� `"" ` �y"
PLUMBING
ELECTRICAL -
/0-/2&f-So. t, -4 Q /1LrLG� ssuANce'OATS1%•u5
MECHANICAL - ELECT PLcm MECH.
sty 6CZ=
❑ ❑ .. .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED U BUILDING PERMIT
WOOD FLOOR t✓1�Y IN FORMA N
PLUMBING
VALUATION aET.
MECHANICAL
PERMIT TO
ELECTRICAL. .'
FRAMING
e Le C-7
INSULATION sroRlEs TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so Pr PLooR ARTA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
.ROOF SHEATHING Res NO CON Pe Ow.•
— - - -- 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El I] ❑ - 11
A55ESSORS PARCEL NO
ROUGH SAN.#
PLUMBING . ELECT.ENERGY
TRACT NO PARCEL NO
' TUBS 8 SHOWER PANPLUMBING ENERGY
` MECHANICAL MECH.ENERGY ACC Rare Acc Pae No.
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO.
_INSULATION . PLUMBING
GAS TEST GAS
MECHANICAL PARE SPRINK ENERGY T.N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING •v ❑ N� C]
EXTERIOR SHEAR ELECTRICAL RELEASE ' L.0 C.
YE] NQ v FLOOOZONE A 0 N❑•
INTERIOR SHEAR FIRE DEPT. �.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
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 UNTILBUILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM
ELECTRIC
w ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE '—
IMPORTANT! covsr.TAX
PLEASE READ REVERSE SIDE'BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER _ -
BwILOING APPLICATION & PERMIT 14555
ADDRESS /�J -
- ESS lew Ko BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NW ER'S �t`. PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT FEE
(�6/c/r
oMERAcroRs L-!o UTLETS-SWITCHES-RECEP 10.00/1.00
V T�lG NC LIC.No. S -7 LIGHTING FIXTURES 10.00/1.00 _
CONTRacr 's p APPLIANCES-RESIDENTIAL 4.00
aDOREss -} ,AJ -7yI - .
•� L'� PHONE � PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE . .P.C.NO.,
OR49 PANELS (OVER 200 AMP) 20.00
ENGINEER
d.V/l ABU Sec.No .fjJ.f' SIGNS TRANS. 3.00
ARCH.OR ADDR"ESSSpENG. /q� d� �j,J SPECIALCIRCUIT 5.00 PERMIT VALIDATION
'LT OS mer me,2o..ti(�f9 ,P /y-l� EMP.METER OR POLE INS. 20.00
APPUCANT'S
ADDRESS MOTORS SEE FEE SCH. �^
3 3 3 SERVICE CHANGE 20.00
O 2 LICENSED CONTRACTORS DECLARATION
¢
U U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
w
(commencing with Section 7000)of Division 3 of Ibe Business and - BLDG. ELECT. PLG. MECH.
rN i Professions Code,and my license is in full fort-as d effe - �0 ❑ ❑
Z 0 w o Licensg lass I Lic.Number' p 'A3EA'
9 r Dato�y T! Contractor O`t
a m
2 , 1\m BUILDING PERMIT
¢ a: ¢ OWNER-BUILDER DECLARATION
X a v INFORMATION
wr 1 harsh affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
w y y P VALUATION
FwN J Law for the following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE :18:{1!7
Code:Any city or county which requires permit to construct,alter,
� QQD improve,demolish,or repair any structure,prior to its issuance,also ELEC,CONTR.
IF
requiresLIC.NO. CSV ELEG Q p
n O yuires the applicant for such permit to file a signet statement that
Vy/%r/N C �,tE� ��6�,.•/S TOTAL PERMIT TO
w$w he is licensed pursuant to lire provisions of the Contractor's License r/
> Law(Chapter 9(commencing with Section 7000)of Division 3 ofilm C �C
F i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
w I- S the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e. , by any applicant fora permit subjects the applicant toacivil penaltyALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than flue hundred dollars(E5001.100.):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE - 4.00 DCC.GROUP RES.UNITS
their sole compensation,will Jo 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
property who builds or improves thereon,ant who does such work FIXTURES,PER TRAP 5.00 SO,IT,FLOOR AREA TOTAL ACREAGE
himselfornot hrough
ownemployees,for sale,
If,ed that however,
the
improve- GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
menta are nae intended or offered for sale If,however,the hunting
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 nal buil)or iIn- RES IND CON PS Other
prove 1,aso neer of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ Cl ❑ ❑
❑ L as owner of the property,he exclusively Comma ing with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
and Professions Cade:The Contractor's License Law Joos not apply
to anowner of property who builds improves thereon.and who LAWN SPRINKLERS-OV ER5(EA.) X1.00
contracts for Such contractor(s)projects with a contrtruatorl sl IicenuA pursuant to
the Contractor's License Lew. SEWER-SANITARY-STORM EA,200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under See. ,B.&P.C.for this WATER HEATER WENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO.
WORK E RS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a CertihCate of Consent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified _
copy therepf ec. 800,Lab.C.)."g0�
Policy Nn Company
❑ Certified copy e,herby furnished. FIRE SPRINK ENERGY T 24
zZ K Certified c py i;• led with the city inspection division.
LD Applicant sites'L♦-M %___W - MISC.- REFER TO ORD. Y ❑ N❑ Y❑ N❑
i y CEiRTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPFNSATION INSURANCE PLG.CONTR. LIC.No. PLG.
CL Z (This Section need not be completed if the permit is for one TOTAL - . Y❑ N❑ Y❑ N❑s'I
hundred dollars IS 100)or less I
V O I certify that in the performance of Ou work I'or which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY \
LL F mitis issued,I shall not employ any parson in any manner so as to
U become subject to the Workers'Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,alter making this Certificate of 1?x-
F Z 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=C.F.M.) 4.00 -
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10p00C.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 NameHEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC O
Lender's Address
I CCfIIIy that I Ilavl`read tI apphCatlO and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree lD comp with all city and county PLUMBING
ordinances and stale laws relating t building construction, and BOILER-COMP(3 H.P.of 100,000 B.T.U) 6.00
hereby authorize representatives of his city to enter upon the B61LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property fori ion purposes.
(We) agree to save, i cosily d keep harmless the City of MISC.- REFER TO ORD.
upeif o against Iia ies,jud ata,casts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay in ny way rue aga' it City n uence of the
I
isp tit MECH.CONT. LIC.NO. MECH. '
TOTAL TOTAL
Si .tura of
heant o clot Date -
OFFICE COPY
I -