18568 a POST THIS CARD NEAR FRONT OF BUILDING
r. _ PERMIT NUMBER _
CITY OF CUPERTINO �
- INSPECTION DIVISION 1.8568
• JOB INSPECTION RECORD `
JOB ADDRESS /o4�21 CA J 'I PERMIT EXPIRATION
'UNIT#' _LOT#
PERMIT EXPIRES IF WORK
OWNER �'JB L� ComrpACTOR 12.GG•- ,IS NOT ,STARTED WITHIN
INSPECTION If X
DATE INSPECTOR INSPECTION RECORD ` - 180 DAYS OF PERMIT ISSU-
FOUNOATION P _v_ 7-p NOTE:- - ANCE OR 180 DAYSSFROM UFER ALL GRADING AND.DRAINAGE SHALL BE INSTALLED LAST CALL E DI NSPECTIOW,%
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - - -
POUR NO CONCRETE UNTIL ABOVE HAS BE9N SIGNED
UNDERGROUND /SLAB f/rGr
PLUMBING
ELECTRICAL - - �✓" '"';" 4"'�'�t' �'.".
- ISSUANCE DATE
MECHANICAL BLDGi ELECT vLc MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED euaowc PERMIT
WOOD FLOOR PAID INFORMATION
PLUMBING ' } VALUATION S/FT.
MECHANICAL - - SERI
I 1 1VY�poIIo(� ' / /` Ef .�+. `•.
ELECTRICAL - f/p�s1 ^^.l'- vERMIT To
FRAMING - city 1N
Df- JAS .
INSULATION • STORIES ,"TYPE CONSTR.
OCC.GROUr,_1 RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 's0 FT 11TOR AREA TOTAL ACREAGE
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE aVC
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 1),
ROOF SHEATHING - - "" emunrvc USE
•HRES WZ_' CON PB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE . INSP. - 11 ❑ - �El ❑ ❑
ROUGH, . . SAN.# _ ASSESSORS PARCEL NO.
PLUMBING . ELECT, ENERGY,
TUBS&SHOWER PAN. - PLUMBING,ENERGY," TRACT NO. PARCEL NO.
MECHANICAL . . MECH.ENERGY - q
ELECTRICAL '• BUILDING ENERGYV -11.111_h NOI .
FRAMING - ELECT.FINAL'TEST I
INSULATION PLUMBING �,, _ zorvwG ENE SITE NO. ,
GAS TEST - GAS
'' - MECHANICAL ` FIRE.S?RINK ENERGY T.2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] N❑ V[:] +N❑
EXTERIOR SHEAR ELECTRICAL RELEASE - ELooD zoNE A U.C.
INTERIOR SHEARFIRE DEPT. Y-❑ N❑ Y ❑ No
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR-LATH' " BUILDING -
I
INTERIOR
LATH '' TEMPORARY APPROVALS BUILDING
SCRATCH.COAT - - . ELECTRIC PLAN CHECK , `
GAS - FEE '" /�fJ
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE '
OCCUPANCY OF BUILDING IS NOT PER MIT TED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ' MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, 'ELECTRIC
'I- ONE WORKING DAY BEFORE REQUIRED INSPECTION.• J
0� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
fit' Z -.SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READAEVERSE'SIDE BEFORE TOTAL ✓. , G J
CALLING FOR FINAL INSPECTION. . E
OFFICE COPY e
' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'- ' BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION &'PERMIT ����
-
ADDRESS '
3. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL „
ER's
NAME - PLAN CHECK VALIDATION '
NAM
. OTY. ELECTRIC PERMIT FEE -
vHarvE
NAMERAGTDRs OUTLETS-SWITCHES-RECEP .10.00/1.00
LIC.NO, LIGHTING FIXTURES 10.00/1.00CONTRAC ,
AOOREBB TORE LOS GA-rtfk CA-3. APPLIANCES-RESIDENTIAL 4',00
%JHONE , PANELS 10.00 DATE OF APPLICATION,
A CHITECT.
OR PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C.NO.
OR r '
TWO (:.r LIC.NO. ISIGNSTRANS." - - 3.00
ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT - 5.0D PERMIT VALIDATION
ZIP TEMP..METER OR POLE INS. 20.00'
APPucarvrs - Gp,,.gSc3 MOTORS - SEE FEE SCH.
ADDRESS -
(j * SERVICE CHANGE 20.00 y^"/A
° Ice
r
02 LICENSED CONTRACTORS DECLARATION
v v I hereby affirm that I am licensed under provisions of Chapter 9
2 w ISSUANCE DATE
H a (commencing with Section 7000)of Division 3 of the Business andImm
FNi Professions Cod int license is in full fore and ef��fecyyrr BLDG. ELECT. PLG. MECH.
int ° License Class Lin.Number�'�'7�LI$ '
F iSEP
w r J Dale __Contractor _ r
¢_ m a OWNER-BUILDER DECLARATION BUILDING PERMIT
°'C ° - MISC.- OORD - INFORMATION
X 3 H 1 hereby affirm that I am exempt from the Contractor's License,
u o Law for the followin reason. Sec.7031.5,Business and Professions VALUATION /FT.
E - g ( r PERMIT ISSUANCE 10.00 n
Code:Any city or county which requlresu permit to construct,alteq v( V
pimprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. _
O u requires the applicant for such permit to file a signed statement that TOTAL
n s m the is licensed pursuant to the provisions of the Contractors License PERMIT TO _
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe -
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
ar $ the basis forthe alleged exemption.Any violation of SeclioR703L5 - STORIES TYPE CONSTR.
by any applicant fora imchresubjecr,the 00.)applicant toacivilpenalty ALTERLDRAIN&VENT-WATER IEA,) 5.00 '
of not more than five hundred dollars($500)J'.
❑ 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 OCC.GROUP RES UNITS
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 sa.vr.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
merits are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS'6.00 '
or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER ' 30:00 RES IND CON PB other
.
❑ I,as owner of the property,am exclusively contracting with - 11 0 D ❑' ❑
licensed Contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's 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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 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 qce.DgrE ACC.FILE N0.
l� W *Ery7g CO FF SATs't�0{yE ECLARATION WATER TREATING EQUIP. 5.00
I h6reatllmfflfhC l�vV cer7iRc]LS of cmeent to sell-to sure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. C TOTC=.F�J�d O
Policy No. Company _ -
0 ❑ Certified copy is hereby furnished. II FIRE SPRINK ENERGY T"24
- Z Z Certified w Ilel� withA0 city inspection division.
FO Applicant MISC.- REFER TO ORD. O„ vE] N[] v.❑ No
y CEIiTI ✓
EV MPTION FROM WORKERS' PERMIT ISSUANCE ' o10n00 2 _ FLOOD ZONE a.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. •. PLG. 00
1'O (This section need not be completed if the permit is for one TOTAL' � v N� V N�
::) Z hundred do11ars($100)or less.)
U O 1 certify that in the performance of the work for which this.Per' OTY• MECHANICAL PERMIT - FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to ,
U W become subject to the Workers'Compensation Laws of California. u
IS. DateApplicantALTER OR ADD TO MECH. 5.00 BUILDING' �D�•
} Go NOTICE TO APPLICANT: If,after making this Certificu4 of Ex- ..
Z emption,you should become subject to the Workeri Compensation APPLIANCE
F- - provisions of the Labor Code, you must forthwith comply with 5.00 - PLAN CHECK L�'J
'U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000CF.M.) 4.00 FEE Q
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10ACCflM.) 6.00 SEISMIC FEE
1 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,CR.CJ. K1HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name �1J CL HEATI NG UN IT 100,000 B.T.U.)9.50 '
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
is. information correct 1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state lows relating building construction, and
hereby authorize representatives of,t,this city es enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
'
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX
May
in way accrue against said 'ty in consequence Of the
ranting an his it. �. MECH.CONT,o LIC.NO. MECH.
9 / TOTAL TOTAL. Jll�,'p0
S' ature o J`Appll!m[Pdntrahtor Dae
OFFICE COPY