17471 POST THIS CARD NEAR FRONT OFBUI LDING PERMIT NUMBER
CITY OF CUPERTINO 174.71
INSPECTION DIVISION
7 JOB INSPEECCETION RECORD
JOB ADDRESS a q3 C�1-,�'� (� UNIT# _LOT# ERMIT EXPIRATION
l tT .
PERMIT EXPIRES IF WORK
owNER f l US —xvI D CONTRACTOR - IS NOT' STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR'180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
Pq EGUNITE TO COMPLY WITH THE A LANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - � _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING cm d.0 - III w
ELECTRICAL ISSUANCE DATE'
MECHANICAL -' 'Z'2Q, . BLDG, I ELECT xPLO. 1MITC.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR '
INFORMATION
" VALUATION SIFT.
PLUMBING IqZ <' ww
MECHANICAL - - 2 -I`A , 1 Q,U
/ "PERMIT TO
ELECTRICAL `, N - - '�
,/{ I t
FRAMING '+ +; e STORIES TYPE�, cONSTH.
INSULATION - A 11i%r
- 7 OCC.GHOUP RES UNITS
i PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sq2. LOOK aI-A TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -' � '
' ' BUILDING USE
ROOF SHEATHING 8 HES IND CON PR OILY, ,
APPLYNO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ' DATE INSASSESSORS PARCECNO '
P.
ROUGH SAN.# - -
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO •
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICALMECH.ENERGY ACC.DATE ACC FtLE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING zoRwG ENG.SITE NO.
GAS TEST GAS
- MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS(BEENISI,G.NED„ HEATING Y "� ` "�
EXTERIOR SHEAR ELECTRICAL RELEASE _FLOOD2ONE ALL c.
INTERIOR SHEAR FIRE DEPT. Y 0 ' "❑ Y ❑ N[3
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH UILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING F9 'TO
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 IS SIGNED BY,BUILDING INSPECTOR. MICROFILM
ELECTRIC
ARRANGE FOR INSPECTION BY PHONING 252-4505, 3'A
ONE WORKING DAY BEFORE REQUIRED.INSPECTI
LU ARRANGE
ON. PLUMBING flQ
O PLEASE GIVE JOB ADDRESS WHEN PHONING.-
Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL U'�d
IMPORTANT! CONST.TAX
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
BIOI LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
ILOINa
mAPPLICATION & PERMIT I.frs [•,,, T71
4 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 4
Owry ER'3
PLAN CHECK VALIDATION -'
QTY. ELECTRIC PERMIT FEE -/ C
Tw.�u s s PHDNE -2
CONTRACTOR'S ,�j/q
NAME UTLETS-SWITCHES-PIECED 10.00/1.00 ,�V
LIC.No. LIGHTING FIXTURES 10.00/1.00 � y 2W.
CONTRACTOR'S
ADDRESS APPLIANCES-RESIDENTIAL 4.00 ' -
-
PRONEPANELS 10.06(A PANELS r DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C,NO.•
OR PANELS (OVER 200 AMP) 20.00 -
EN I
SIGNS TRANS. 3.00
ADDRESS ENG.
SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zor6141 TEMP.METER OR POLE INS. 20.00 -Jr.
AADDRESS PPLICANS MOTORS
TSEE FEE SCH: ! � '
♦ SERVICE CHANGE FWD 20.00 /. /\ UU44(, �
w o 2 LICENSED CONTRACTORS DECLARATION
a is w I hereby affmn that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y< y (commencing with Section 7000)of Division 3 cut the Business and s - BLDG, ELECT. PLG. MECH.
r y z Professions CodhWnd my license is in full fici aqqd fe t --
Zo z w a Liccns Class_(/
H N or Data eO�Contractor
a M E d "'d 09110ft BUILDING PERMIT
ce 0M OWNER-BUILDER DECLARATION - INFORMATION
E:
;a.a. H 1 hereby affirm that 1 am exempt from the Contractor's License MISE.- REFER TO ORD
M VALUATION $/FT.
r u a g Law for the following reason.(Sea 703 1.5,Business and Professions PERMIT ISSUANCE 10.00 2.OA
wy Code:Any City or county which requiresa permit to construct,alter, oO
0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /- O O
n 0 LL requires the applicant for such permit to file a signed statement that TOTAL �D y�PE�l M�IT7 TO
w m.y he is licensed pursuant to the provisions of the )of
Diemr's License
H ¢ f La.(ChapterPr.commenCde),,Section is exemfttheron3 ofthe
- a Business and Professions Code)or that he is exempt theref 7031.5 DTV. PLUMBING PERMIT FEE
a. t$ the basis for the alleged exemption.Any violation applicant to a cion malty STORIES TYPE DON$TR.
i3 by any applicant fora permit subjects iho0),) [oacivil penalty ALTER-DRAIN -WATER IEA.) 5.66 .l)v
of not mare than five hundred dollars(my em:
I,as owner at the property,or my employees with wages as BACK FLOW PROTECT,DEVICE 4.00 OCC.GROUP RES.UNITS
their sole r offered
for
will(S the work,and the structure is not
a ' intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such Wolk FIXTURES-PER TRAP 5.00 _ d,d A SQ FT.FLOOR A A TOTAL ACREAGE
menta are not hrough
ownemployees,fors,prrvf,ed however,the
improve- / GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 2.0� 6
mens are not intended or offered for sale.If,boweveq the building
ar 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 in, RES IND CON PB Other
for purpose of sale.). I NOUSTRIAL WASTE INTER. 30.00
❑ I,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 does not apply '
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.06
contracts for fsuch cense Law.
projects with emulations)licensed pursuant to
the Contractor's s LiceSEWER-SANITARY-STORM EA.200ft/10.60 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec.�_,B,&P.C.for this WATER HEATER W/VENT 6.00
reasoo
caner i OA Allier, Date 9e. WATER SYSTEM 5.00 j„OpACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, .ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
0 Applicant Y❑ N❑ Y ❑ N❑
jry CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 2•dp FLOOD ZONE A1.U.C.
>_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. - PLG. vX'1n1
1 O (This section peed not be completed if the permit is for one TOTAL 20-VD Y❑ N❑ Y❑ N❑
::) Z hundred dollars(S100)or less.
U O 1 certify that in the performance of the work for which this per- GTV. MECHANICAL PERMIT FEE 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 California.
i Date-Applicant ALTER OR ADD TO MECH. 5,00 d BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of 'x-
F. Z emption,you should become subject to the Workeri 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 1Op00C.F.IV0- 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE,
I hereby affirm that (here 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,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 7,,911
Lender's Name HEATING UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC 6 .ac
Lender's Address
. I.certify that l have read this application and state that the above VENTILATION FAN (SINGLE) - 4.00 '
information is correct. I agree to comply with all city and county PLUMBING -1,
ordinances and state laws relating to building construction, and BOILER-CON?(3 H.P.oil 00,000 B.T.U.) 6.00
0,0
hereby authorize representatives of this city to enter upon the BOILER-COMP(over 100,000 BTU)SEE FEE SCH. ,MECHANICAL V,-d,e
above-mentioned property for inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgments, costs-and expenses whichCONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE - 10,00 2.0
anting fill IF rat c MECH.CONT. LIC.NO. MECH.
� QQ Dl YM O`er,
4 ./5.8(9 TDTA� �- 0 TOTAL y721
S}iggnature of Applicant/Contractor Date
OFFICE COPY