17692 POST THIS CARD NEAR FRONT OF BUILDING PERMITNOMaER
CITY OF.. CUPERTINO 17692- 1
INSPECTION DIVISION
JOB INSPECTION RECORD
PE MIT EXPIRATION
7 i
JOB ADDRESS / G �-� y �� UNIT# LOT# 4�-
''II�� 1 �) \ / �L PERMIT EXPIRES IF WORK
OWNER 1J V ] p ('� CONTRACTOR ��~ IS 1�IdT,`1TARTiD WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: - ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER Z.LC ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED Py,/ld$,gyp CIT'OF PERMIT VALIDATION
GARAGE SLABS CUPERTINO STANDARDS. '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB' MAY s Y\ \L, L /
PLUMBING YIIy Ot DerfinQ 1 Y�•
ELECTRICAL' ISSUANCE UATE�
MECHANICALoc. fyEc?. PLc,. MECR.
❑ I ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT .
WOOD FLOOR
INFORMATION
- - t VALUATIO - hr SIFT.
PLUMBING
MECHANICAL - - 1�-`"`••+'�'
ELECTRICAL - - PERMIT To
FRAMING - - ' '0 -e
STORI S TYPE CONSTR,
INSULATION - '
• - OCC GROUP -RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
k ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE s°.Fr,aomR AREA roraL ACREAGE
DIAPHRAGM' - THE CONSTRUCTION TAX IS PAID.
BUILDING USE
ROOF SHEATHING Res IND CON Pe om.F
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE JNSP.. ❑ ❑ ' ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH - SAN.# ; . 1 ,
PLUMBING ELECT.ENERGY - -
TUBS 8 SHOWERPANPLUMBING ENERGY TRacT No. PARCEL NO.
MECHANICAL MECH.ENERGY ,
ELECTRICAL BUILDING ENERGY ACC.DATE, ACC.FILE NO.
FRAMING ELECT.FINALTEST *
INSULATION PLUMBING ZONING ENG.SITE NO.
-
GAS TEST GAS
MECHANICAL - FIRE SPRINK ENERGY T 24
COVERAO WORK UNTIL AB VE HAS BEEN IGNED HEATING. v "� r N[]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALuc.
INTERIOR SHEAR - FIRE DEPT. Y❑ N❑ I Y ❑ No
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING - q
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH.COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE.OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE . % 63
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM +"^'
ARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC Zi,
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. •PLUMBING'
c- PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z " MECHANICAL,
— SEE PERMIT,FOR EXPIRATION DATE —
IMPORTANT!
CONST.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
BU I LOING PROJECT I DENTIFICATI ON r ,PE9MITNUMBER
B GING 1 C_ APPLICATION.& PERMIT
w RESS ;Z035? C L J-1 y J T , BUILDING- ELECTRICAL-PLUMBING'-MECHANICAL ', 17692
x,
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE ,.
16 Pkv 14e-V- 1HONE 26-3 1G5
NOrvrRAcrOns
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 �'
.
Gr LIC.NO. LIGHTING FIXTURES 10.00/1.00 _X__40;5` •Va�
CONTRACTOR
ADDRESS PPLIANCES-RESIDENTIAL 4.00
ADDRESS '
PHONE PANELS ' _ I 16.00 any
(5F APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 - v
ENGINEER Y
L'LIC.NO. SIGNS�TRANS. 3.00 '
ARCH OR ENG. p tT SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
=8� W „ i xT TEMP.METER OR POLE INS. 20.00 <^-/ f, �y
ADDRESS MOTORS SEE FEE SCH. J / v - r
.10c3IS / CL.A-Y sr A Illo SERVICE CHANGE - 20.00 L1
w a O LICENSED CONTRACTORS D17CLARATION /// 111
a i W I hereby affirm Thal I am licensed under provisions of Chapter 9 - ISSUANCE OAT
(commencing with Section 7000)of Division 3 of the Business and p BLDG. ELF T. PLG.
"�w i Professions Code,and my license is in Tull force and eftect ❑ ,❑
z D W- License Class Lie.Number M
yr w Uele Contractor
¢ a¢ ¢
OWNER-BUILDER DECLARATION cityCU 110 BUILDING PERMIT
- « w u INFORMATION
X 0 N I hereby affirm that I am exempt from the Contractor's License MISC:- REFER TO ORD
,u3 VALUATION ,$/FT.
LL N< Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 zt)ti O�
Code:Any city or county which requires a permit toconstruct,alter, (] ^^T
o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. AD 7J
E c u requires The applicant for such permit to f Ile a signed emtement that - TOTAL l~ PERMIT TO
w m he is licensed pursuant to the provisions of the Contractor's License
rzQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe C\�
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE .JI�G7
re�D the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CON R.
i ;$ by any applicant far a permit subjects the applicant to a civil penalty -
ofnot mom than five hundred dollars(5500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ I,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 such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or not hrough
ownemployees,for sale.
If,ed that however,
improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
cents are not intended or offered far sale.If,mplevcq the building wn
p or improvement is sob 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 Other
pr fr purpose nfsale.). INDUSTRIAL WASTE INTER. 30.00
Qyy�y/I,oas owner of the property,am exclusively contracting with _ ❑ -El C1 ❑ ❑-
liferisedcan tractors 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 contractods)licensed pursuant to SEWER-SANITARY-STORM V-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO.. PARCEL NO.
C] Ianl ptund c. ,B.&P.C.lin thi. WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE; ACC,FILE NO.
WORKERS'( MPENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
1 hereby affirm thn 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. FIRESPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MIS(.- REFER TO ORD.
0 Applicant Y ❑ N❑ Y ❑ N❑
CC y PERMIT ISSUANCE 10.00 FLOOUIONE A.L.U.C.
LUCERTIFICATE OF EXEMPTION INS FROM WORKERS' -
W �_ COMPFiNSATION INSURANCE - PLG.CONTR. LIC,NO. PLG. '
CL o (This Section need not be Completed If tiID permit is for one TOTAL Y❑ IN Y❑ N❑
=) Z hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the work for which this per- OTYMECHANICAL PERMIT FEE FEE SUMMARY
.
LL I- mit is issued.I shall not employ any person in any manner So as to Q
U become subject to the Workers'Compensation Laws of California. I�UGO
>: Date Applicant
} ALTER OR ADD TO MECH. 5.00 BUILDING
N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
�.. ? 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
L..1 such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
' CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 110000C.F.M.) 6.00 SEISMIC FEE ` F
1 hereby affirm that There is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the errforiMICROFILM
3097, ance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 q+�
Lender's No
Lender's Address H EATING UN IT(OV ER 100,000 B.T.U.)9.50 - ELECTRIC n�1 Qd
1 certify that I 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
I ordinances and state laws relating to building construction, and BOILER-COW 6.00
hereby authorize representatives of this city to enter Upon the BOILER-COMP I6VBr 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harnTless UTe City of MISC.- REFER TO ORD.
upertino against habililies,judgments, costs and expenses which CONST:TAX
ay in any way accrue against said City in consequence of tile
PERMIT ISSUANCE 10.00
DID
thisp MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
S' eofA pli nt/Contractor Date
2,4
OFFICE COPY