18266 POST THISCARD-NEAR FRONT OF BUILDING '. . PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
�� ` •. ham ! PERMIT EXPIRATION
JOB ADDRESS' v � UNIT# _LOT# '
• ,r PERMIT EXPIRES'IF 16 WORK, ,
OIVNER CONTRACTOR - IS NOT STARTED WITHIN
- - INSPECTION DATE INSPECTOR INSPECTION RECORD 180 oA.YS OF PERMIT ISSu-
.� FOUNDATION •. ANCE OR '180 DAYS FROM
NOTE: ,LASTPALLED INSPECTION.
LIFER , - - ALL GRADING AND DRAINAGE SHALL BE'INSTALLED.
PREGUNIT,ETO COMPLY WITH.THE APPROVED PLANS AND CITUOf PERMIT VA}yiLDAnoN -a
CUPERTINO STANDARDS. „
GARAGE SLABS A• ,f`'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ��s
' - ' UNDERGROUND /SLAB', p.,". {nll�
' PLUMBING- YW6 ,. 'nF•,'
ELECTRICAL ' ISSUANCE DATE;
MECHANICAL BLDG I ELECT. PLLGG/ MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED :. BUILDING PERMIT
INFORMATION
' WOOD FLOOR VALUATION SBFT. ,
PLUMBING � � � '
MECHANICAL
ELECTRICAL' PERMIT TO
FRAMING .. .. lyrle I . .
INSULATION' STORIES TYPECONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'. ROOF - NOTE'NO FINAL INSP.SHALL BE MADE BEFORE 5° `UI LOOR AREn TWAT ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - RES IND, . CON BE, GO,
APPLY NO ROOFING'UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ 11 ❑- ❑
ASSESSORS PARCEL NO.
ROUGH SAN.#
PLUMBING - ELECT.ENERGY -
THACTNO. PARCEL NO.
• TUBS 8SHOWER PAN: " PLUMBING ENERGY'
_MECHANICAL - MECH.ENERGY
ELECTRICAL : BUILDING ENERGY, Acc.DATE . ACc.EaE�No.
FRAMING'. ELECT.FINAL TEST �I
INSULATION - PLUMBING ZONING ENG.LsrtE No
'GAS TEST GAS
" MECHANICAL - nFLOODZONE
NKL� A.L
ENERGY T.ya
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N ❑ No
.EXTERIOR SHEAR ELECTRICAL BELE U.CINTERIOR SHEAR FIRE DEPT. NE] ❑ N❑
SHEETROCK GRADE - FEE SUMMARY
' EXTERIOR LATH BUILDING - -
INTERIOR ,LATH TEMPO RARY'APPROVALS • BUILDING, ,•
SCRATCH.COAT - ELECTRIC .PLAN CHECK
• .. GAS ..FEE
NO TAPE OR PIASTER UNTIL-ABOVE HAS BEEN SIGNED occuPANcv 1. SEISMIC FEE .
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR:
•'MICROFILM
ARRANGE FOR.INSPECTION BY PHONING 252-4505 _ ELECTRIC
� ONE WORKING DAY BEFORE.REQUIRED INSPECTION. PLUMBING
0�'. -. 'PLEASE GIVE,JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE -
MECHANICAL
1
IMPORTANT!.. :- ' CONST.TAX
-PLEASE READ REVERSE SIDE BEFORE TOTAL
wt
�J
CALLING FOR FINAL INSPECTION. ,
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
" BUILDING PROJECT IDENTIFICATION PERMITNUMBER -.
aDILDI.. APPLICATION & PERMIT x18266
AD ES;i W`-'
!(J BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWN EPLANCHECKVALIDATION
NAM
QTY. ELECTRIC PERMIT FEE
PHONE
NAMr croRs q UTLETS-SWITCHES-RECEP 10.00/1,00
® ".No.)- / LIGHTING FIXTURES 10.0011.00 '
rorvTRAcroR's J APPLIANCES-RESIDENTIAL - 4.00
AO RE55_ q
S PHONE - �/ PANELS 10.00 DATE OF APPLICATION '
ORRCNrtecr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
ARCH.OR ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
SS
APPLICANT'S
VIE TEMP.METER OR POLE INS. 20.00 ADDRESS MOTORS SEE FEE SCH. -jam
SERVICE CHANGE 20.00
0o LICENSED CONTRACTORS DECLARATION 219�✓ U 1 _
< i w 1 hereby affirm that 1 am licensed under provisions of Chapter 9 tJ ISSUANCE DATE'
(Commencing with Secti 7000)of Division 3 of the Business spit BE ELECT. PLG. MECH.
w i Professions CodBan license is in full for-ca d eff• !7 ❑ ❑
o z u, 0 Licens loss fC.�� Lic.Number O E,
DdtcL ��Contrnct
Q y E
le 0 w ¢ OWNF.R-BUILDER DECLARA I BUILDING PERMIT
a D A INFORMATION
°
W 3: y I hereby affirm that I am exempt from the Contractor's License SC.- REFER TO ORD
u 0 ¢ Law for the following reason:(Sec.703 L5,Business and Professions VALUATION $/FT.
Ems'> f Code:Any molish county
pair any structurep riort oconstruct,
uancalter,
PERMIT ISSUANCE 10.00
a: M ¢O improve,demolish,or repair any structure,prior to its issuance,a150 ELEC.CONTR. LIC.N0. ELEC.
u w m u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pennant to the provisions oI'the Contractor's License
HiQ Law(Chapter 9(commencingwith Section 7000)ofDwision 3ofthe (�1F11_
i 0 Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE I I I-I F"�
¢ 1-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d ; � by any applicant for ive hemi dollars the$500).[icantmaeivilpenalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred Dollars(Inv employees
❑ Las owner at 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 docs not apply to on owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TR AP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare net intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one yedr of completion,the owner-
builder will have the burden of proving that be did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). . RES IND CON PB Omer
INDUSTRIAL WASTE INTER. 30.00
❑ d co
as owner the property, exclusively contracting with El El 13
licensed ntractorm to construct the
project7044.Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 gssEsgDRS PARCEL NO.
La
and Professions Code:The Contractor's License Law does not apply
to antr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts ctor'shcenecLwirhd contracmrtsl licensed pursuant to
SEWER-SANITARY-STORM EA.200tt/10.00
the Contractor's License Law. TRACT NO. PARCELING.
❑ Iron exempt under Sec. -,e.&P.C.for this
reason WATER HEATERW/VENT 6.00 2.tX�
Owner - Date WATER SYSTEM 5.00
ACC.DATE ALC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 . _
'I hemby,affitin 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(Sec,3800,Lah.C,). -
Policy No. Company ' ^.
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T]4
Z Z ❑ Certified copy is filed with the city inspection division. MISC.• REFER TO ORD. '
Applicant Y[] N❑ Y n NE
Ky CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 40IC) F
10 LOODZONE A.L.UX.
LU O COMPENSATION INSURANCE PLG.CONTR. LIC.NO. TOTAL 14 -�- Y El o V NF]CL Z (This section need not be completed if the permit is for one
hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is is ed,I hall not emplo ny person in any manner s
Q w btc chic t he Workers' pensali ws of Cnl" i
a Da _ Appheart ALTER OR ADD TO MECH. 5.00 BUILDING
} N NO 'E PLICANT: I , t,making this Ccrt ificate of lix-
F ? con ion.you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
CJ such provisionsor this perinit shut[bi deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10.000 C.F.M.) 6.00 SEISMIC FEE
I 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 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
. information is correct. I agree to comply with all city and county - PLUMBING gL.IJ
ordinances and stare laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-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.
upertin.against liabilities,judgments, Costs and expenses which' PERMIT ISSUANCE 10.00 CONST.TAX
a -in a y way accrue against said City in consequence of the
)tin t permit. MECH.CONT. LIC.NO, MECH.
TOTAL TOTAL 1400
i a re of Applicant/Cont for Vale
OFFICE COPY "