18256POST THIS CARD NEAR FRONT OF BUILDING', '
CITY OF CUPERTINO ,.
INSPECTION DIVISION
JOB INSPECTION RECORD -
JOB ADDRESS _Q 3 7 �( c'a ��� WIO Q C�UNIT# LOT#
' -
OWNER A D -- CONTRACTOR
PERMTNUMBER
18256 .
PERMIT EXPIRATION
-
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-"
ANCE OR 180 DAYS FROM
LASTCALLED.INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS. •
LIFER
PREGUNITE
PERNT VALIDATION
-
,p+1�
ISSUANCE DATE.
GARAGE SLABS ''
POUR NO CONCRETE UNTIL A86VE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
-
..
ELECTRICAL
MECHANICAL
BLoc. ELECT
PLG. M�ECH?.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- -
-
BUILDING PERMIT
INFORMATION
• WOOD FLOOR -
VALUATION
SIFT.
PLUMBING
MECHANICAL'
ELECTRICAL
- .P*"��
PERMIT TO
FRAMING.
INSULATION
- -
STORIES
TYPE CONSTR.
OCC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX ISRAID-
- •
sD. FT FLOOR AREA
TOTAL ACREAGE
DIAPHRAGM
ROOF SHEATHING
BUILDING USE
RES INDCON PB ow.,
❑ ❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED '
- FINALS DATE INSP. -
ROUGH
SANA -
ASSESSORS PARCEL NO.
'
PLUMBING -
ELECT. ENERGY
TUBS 8 SHOWERTAN
PLUMBING ENERGY
TRACT NO.
PARCEL NO.
MECHANICAL
MECH.ENERGY
ELECTRICAL
BUILDINGENERGY
ACC DATE
ACC FILE NO.
FRAMING
ELECT.FINAL TEST
INSULATION
PLUMBING
ZONING
ENG SITE NO.
GAS TEST -
GAS
.
MECHANICAL
FIRE SPRINK
v ❑ N❑
ENERGY T 24
Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING _ _
EXTERIOR SHEAR -
ELECTRICAL RELEASE
FLOOD zorvE
v ❑_ "❑
A,L.0 c.
- v L� NEI
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK .GRADE
FEE SUMMARY
EXTERIOR LATH -
BUILDING I
BUILDING
INTERIOR. LATH
TEMPORARY APPROVALS
SCRATCH COAT. a'
ELECTRIC: '.
PLAN'CH ECK
FEE
'
GAS -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
JOCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.'
MICROFILM
-
ARRANGE FOR INSPECTION BY PHONING 252-4505,,
ONE -WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. .
—SEE PERMIT FOR .EXPIRATION DATE —.
"
a
ELECTRIC .
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE, SIDE BEFORE
FOR FINAL INSPECTION.
TOTAL
00,CALLING
OFFICE COPY '
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES --USE BALL POINT PEN ONLY
BUYLDIN@ ROJECT IDENTIFICATION
-
APPLICATION & PERMIT
BUILDING -ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
1 O C C
I o 5 o
BUILDING -
ADDRESS
437 Ca J/C 60 a0 GT
OWNER'S - -
•
PLAN CHECK VALIDATION
NAME yTY
08 FJ t A 1J/d T ,PHONE 7 ij plot
ELECTRIC PERMIT FEE i
- -
-
DATE OF APPLICATION n
CONTRACTOR'S
NAME/
QCrk.t ?fib e. I., LC.N0. YO $
UTLETS--SWITCHES -RECEP ,10.00/1.00
LIGHTING FIXTURES ' 10.00/1.00
CONTRACTORS ^'
(� s *' .
4 E 4¢ 6y ygy.11 PHONE 0rte /d -7 OV?
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT .PLAN
OR
EN01NEEP
' L No. (�,.
PANELS (OVER 200 AMP) 20.00
CHECK FEE P C.,NO.
.. -.
^' SIGNS TRANS. - 3:00
ARCH, OR ENG. r ' ✓"' .
ADDRESS, +!
_ hd ZIP eta.`!'
SPECIAL CIRCUIT- 5.00
•PERMIT VALIDATION
..
�•�� �'
EMP. METER OR POLE INS. 20.00 -
ADDRCSS
ADOREss r."
MOTORS ' ` ` SEE FEE SCH.
•'
-- SERVICECHANGE' - - 20.00
y°
/1--
LICENSED CONTRACTORS DECLA RATION
I hereby affirm that I am licensed under provi-sions of Chapter 9
-
ISSUANCE DATE _
(commencing with Section 7000) of Division 3 of the Business and
Code, and my license Is m full force and effect
License Class Lic. Number
-
BL157
❑
ELECT.
El e
•'.PLG. MECH.Professions
,� try
146U!
Date - Contractor
^"�
- OWNER -BUILDER DECLARATION
I hereby
orthelfolloi that 1 am exempt from the Contractor's License
Professions
or county whichequire (Sec. 703 a permit to construct,
Law, f Any alter,
Code: Any mouse county r pair any structur e p rio it to consu ac e,also
improve, demolish, or for such p sticture, e a prior to its issuance, also
requites else applicant for such permit t0 file a signed statement that
he 16 Capslicensed 9 (co lt[ t0 (Ise with provisions of the Contractor's 3cattle License
Division3of the
Law (Chapter9(cosions Cngwith Section is exempt
Business and Professionsxemption [hal he is exemptSion 7therefrom and
[he basis for the alleged exemption. Any violation of Section 7031.5
BUILDING PERMIT
INFORMATION
MISC.- . REFER TO ORD
VALUATION
'
$/FT.
'
PERMIT ISSUANCE 10.00..
ELEC: CONTE. LIC. NO. .,
` - '
SLED.,
TOTAL -
PERMIT TO .
vTY
_ _
QTY. PLUMBING PERMIT I FEE
STORIES
TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).):
,
ALTER-DRAIN&VENT-WATER (EA.) 5.00
- •-
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
ggCK FLOW PROTECT': DEVICE 4.00
OCC. GROUP
REB. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. '5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does'not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve
ments are not intended or offered Icor sale. If, however, the building
,
-
FIXTURES- PER TRAP - 5.00 -
So. FT. FLOOR AREA
TOTAL ACREAGE
GAS -EA. SYSTEM- 11NC. 4 OUTLETS: 6,00
or improvement is sold within one year of completion, the Owner -
builder will have lite burden of proving that he did not build or im-
prove for purpose of sale.)..
❑ as owner of the property, exclusively contracting with
SYSTEM
-
BUILDING USE
RES , IND CON PB Other -
`. ❑ ❑ ❑� ❑, ❑
INDUSTRIAL WASTE INTER. 30.00
he
licensed contractors to construct the project (Sec. 7044, Business
d
License Law does not apply
and Professions Code:. The who improvesensed n, and who
to an owner of property who builds
LAWN SPR INKLERS-1'INC 5 V.B. 6.00
ASSESSORS PARCEL N0.
LAWN SPRINKLERS -OVER 5 (EA.) .1.00
tr
the Contsctor'shcenects Lwith aeanerucmr(s)licenud pursuant to
the Contractor's License Law.
SEWER-SANITARV-STORM_EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ I am exempt under Sec. ,B.&PC. for this
reaxcm
-
WATER HEATERW/VENT 6.00
Owner Date
WATER SYSTEM. - 5.00
ACC. DATE
ACC. FILE NO..
WATER TREATING EQUIP. 5,00
WORKFRS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure,
or a'certificate of Workers' Compensation Insurance, or a certified
_ -
ZONING
ENG. SITE NO.
-
copy thereof(Sec. 3800, 11m
- -
Policy No. Copany
-
-
FIRE SPRINK -
Y❑" 'N❑'
ENERGY LY4
Y❑ N❑
❑ Certified copy is hereby furnished
❑ Certified copy is 'filed with the city inspection division.
Applicant
MISC. REFER TO ORD, -
CERTIFICATE OF IiXFMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A1. U.c: .
PLG. GONTR, ," LIC. NO. '.
!'
PLG.
TOTAL
COMPENSATION INSURANCE
(This section need not be completed If the permit is for one
Y ❑ N❑
'Y Y ❑' N❑
- -
QTY. MECHANICAL PERMIT FEE
.'
-
FEE SUMMARY
hundred dollars IS 100) or less.)
I certify that in the performance of the work for which this per-
mit is issued, 1 shall not employ any person in any manner so as to
BUILDING
-
hewyy s ec the Workers' m e 'Non cos of Ca fornix.
)ate7'd_��Applicant�
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
ALTEROR'ADDTOMECH. 5.00
APPLIANCE ".r.`_ 5.00
PLAN CHECK
FEE
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10,000C.F.M.) : 4.00
AIR HANDLING UNIT (OVER 10,000C.F.M.) 6.00
SEISMIC FEE.
' CONSTRUCTION LENDING AGENCY "
'I hereby affirm thai 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.
3097,Civ,C.). -
HEATING UNIT (TO 100,000 B.T.U.) 8.06 F0 p'
.MICROFILM
-
HEATI NG UN IT (OVER 100,000 B.T.U.) 9.50
ELECTRIC'
Lender's Name
Lender's Address
I certify that I have read this application and slate that the above
information is correct. I agree to comply with all city and county'
ordinances and state laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER- COMP(3 H.P. or 100,000 B.T.U.) 6.00., `
BOILER -COMP (Over 100,000BTU) SEE FEE SCH.
MECHANICAL
,A"
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes,
MISC. - .' REFER TO ORD:
CONST. TAX
-
-
(We) agree to save, indemnify and keep harmless the City of
uperlino against liabilities, judgments, costs and expenses which
mey,in any way accrue against said City in consequence of the
rantilla, of, his permit. / "
i/lul8 �.
M�
PERMIT 10.00 - V
'✓
MECH. CONT. LIC: NO. MECH.
TOTay �Q'
v�-
TOTAL
�_D�'
sign [e of Applicant/Contractor Date
OFFICE COPY