15449 POST TH IS CAR D N EAR F RONT OF,BUILDING
PERMIT NUMBER
CITY OF CUPERTINO. 15449
INSPECTION DIVISION
JOB INSPECTION RECORD
•, PERMIT EXPIRATION
JOB ADDRESS o6 UNIT# _LOT# "
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR. INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMI?VALIDATION
CUPERTINO STANDARDS. I
GARAGE SLABS � �
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED +!
II4 UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE'
MECHANICAL t,Y f,p' eLua ELECT Pa M❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �.:, BUN GING PI IT
�..,i
WOOD FLOOR VALUATION 1$IFT.
PLUMBING
MECHANICAL
ELECTRICALAlp
FRAMING " ! ?�c"•A-t �Y, �G„
- STORIES `TYPE CONSTR.
INSULATION W. Te,L� .
r
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS B EN SIGNED
50.FT FLOOR AREA -TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ,
DIAPHRAGM
THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING . RES IND CON PB DU,"'
APPLY NO ROOFING UNTIL ABOVE HAS B EN SIGNED FINALS DATE INSP. ❑ [] ❑ ❑ 0
ASSESSORS PARCEL NO
ROUGH' SANA " .
PLUMBINGELECT.ENERGY
TRACT NO, PARCEL NO.
TUBS B SHOWER PAN PLUMBING ENERGY -
MECHANICAL - - MECH.ENERGY -
'ELECTRICAL ACC.DATE ACC.FILE NO
BUILDING ENERGY.,
FRAMING ELECT.FINAL TEST. zoNlNc END SITE No�
INSULATION PLUMBING -
GAS TEST. GAS '
- FIRE SPRINK ENERGY T2
MECHANICAL
COVER NO WORK UNTIL ABOVE HAVBEEN IGNED HEATING Y E] N[] Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A,L U.C.
INTERIOR SHEAR FIRE DEPT., v0 No vL !"�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH ' TEMP ARY APPROVALA - 6/ - -
SC RANCH
J/SCRATCH COAT ELECTRIC PLAN CHECK -
.- GAS -
F
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. ,'SEISMIC FEE • 5
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE'- MECHANICAL
IMPORTANT! '.
CONST.TAX
PLEASE READ REVERSE'SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
RPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL.POINT PEN ONLY
BUI LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
71 BUILDINGAPPLICATION III PERMIT 1544[ A /�
AOO206 2L Glee L DrL I �J`}°}
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL I. �>
OWNER'S PLAN CHECK VALIDATION`
NAMELJ ki a NFA Z1, 3� OTY. ELECTRICPERMIT FEE-
NAMER^crow's 1, OUTLETS-SWITCHES-RECEP 10.00/1.00
uc.No. LIGHTING FIXTURES - 10.00/1.00 _
r,ONTRACTOR'S - APPLIANCES-RESIDENTIAL 4.00
ADDRESS
pnD PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
\/ DR 1 NlU �Y1 61� PANELS (OVER 200 AMP) 20.00 C- 3
ENGINEER l p
LIC.NO Cbz Z..4b SIGNS TRANS..' • 3.00
nooeiss END 5.00< C SPECIAL CIRCUIT 5.00 ntl f� U 1 . PERMIT VALIDATION
t Z:LD ) V J p °L EMP.METER OR POLE INS. 20.00 x:11-"• y
ADDRESS J MOTORS SEE FEE SCH. _ ,, r ^,1 `_
SERVICE CHANGE 20.00 �'`' p•(�
DooH. LICENSED CONTRACTORS DECLARATION 3 ��Q Q
<L,u 1 hereby affirm that I am licensed under provisiousof Chapter i) •`/v ISSUANCE DATE
¢ w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
o i Professions Code,and my license is in full force and effect. _
V rI ❑ ❑ El o License Class Lic.Number �aIN
I_w • DateCommctor
a Y f �, - BUILDING PERMIT
IS u OWNER-BUILDER DECLARATION r^ rt,II INFORMATION
K.;u n 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD 41' VALUATION SIFT.
"'u 04 Law for the following reason.(Sec,7031.5,Business and Professions PERMIT ISSUANCE 10.00
� - Code:Any city orcounly which requires a permit to construct,alter,
ISY ELEC.CONTR. LIC.NO.
¢o improve,demolish,or repair any structure,prior 4t its issuance,also ELEC. ,
O LL requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO
a au m he is licensed pursuant to The provisions of the Contractor's License
rzi
Law(Chapter 9(commencing with Section 7000)ofDivision 3olthe �..Jejj�s-[, I
S i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
ISI-$ the basis for the alleged exemption.Any violation o f Section 7031.5 STORIES, TYPE CONSTR.
iby any applicant lot a permit subjects the applicant to acivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,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
Property who builds or improves thereon,and who does sucli work FIXTURES,PER TRAP '5.00 s4 FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00
mems are not intended car offered I'or sale.If,however,the building
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 int- - RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL 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 COAe:'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 SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exemp under Sea ,B.&P.0 for is WATER HEATER W/VENT 6.00
eason
Owner Dat WATER SYSTEM 5.00 _
ACC.GATE ACO.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 N0.
or a certificate of Workers'Compensation Insurance,or a Certified
copy thereof(Sce.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❑
FwPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
CC CERTIFICATF,OF EXEMPTION FROM WORKERS' '
_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG..
C' 0 (This section need not be completed if the permit is Im one TOTAL Y❑' N❑ Y[DN❑
7) Z hundred dollars I S 100)or less.)
U 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
0 U subjectOl
mil is issued,I shall not employ any person in any manner so as 10
become subject to e Workers'Compensation Laws of California.
C.
to Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE 1'0 APPLICANT: If,after making this Certificate of Ex- .
♦- Z enlption,you should become subject to the Workers'Compensation APPLIANCE r 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10M)CF.M.) 6.00 SEISMIC FEE J
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,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00-
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
imonnmimt is correct.I agree to comply with all city and county PLUMBING
ordinances and state lawn relating to huilding,construation, and BOILER-CL7 I3(H.P.Or100,000B.T.U.1 6.00
hereby authorize representatives of this city to enter upon the B01 LER•COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of 'MISC.- REFER TO ORD. _
uperlino against liabilities,judg ent co . and expenses which CONST.TAX
qay in any way a -me agains ty 1 onsequc oft PERMIT ISSUANCE 10.00
an of this per C MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 113 S�
gnaure of A pplicant/Contractor Date
OFFICE COPY