14647 POST THIS CARD NEAR FRONT OF BUILDING PER NUMBER
CITY' OF CUPERTINO 14647
r l :.INSPECTION DIVISION
' JOB INSPECTION RECORD
• - dZC ¢U � PERMIT EXPIRATION
JOBADDRESS CJ✓ST / / UNIT# LOT#
LPERMIT EXPIRES IF WORK
OWNER co/j O CONTRACTOR �CE La(y 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,
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - BLDG. ELECT, PLG. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - euILDING PERMIT
W - INFORMATION
WOOD FLOOR
VALUATION $/FT.
PLUMBING
MECHANICAL
ELECTRICAL r- - _ PERMIT To v
4,4 �-
FRAMING - �
STORIES TYPE CONSTR.
INSULATION - T
.- OCC GROUP ARES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SO FT FLOOR AREA TOTAL ACREAGE
ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE ;
DIAPHRAGM - THE CONSTRUCTION TAX IS PAIDBUILDING USE
ROOF SHEATHING res IND CON PB om.I
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ASSESSORS ElPARCEL El
Cl
I ROUGH SAN.#
PLUMBING
ELECT.ENERGY.
NoPARCEL No
TUBS 8 SHOWER PAN PLUMBING ENERGY
TRACT . -
MECHANICAL MECH.ENERGY -
ACC DATE ACC,FILE NO, I
ELECTRICAL BUILDING ENERGY -
FRAMING ELECT.FINAL TEST zawNc ENG.SITE No.
R INSULATION PLUMBING
GAS TEST GAS '
MECHANICAL FIRESPRINK ENERGY T-24
Y 0 N❑ ° [:]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING , "�
EXTERIOR SHEAR ELECTRICAL RELEASE FL000 ZONE A,L,u c.
INTERIOR SHEAR FIRE DEPT, °❑ N v L N❑
SHEETROCK, GRADE It FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS. BUILDING
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 ISSIGNED BY BUILDING INSPECTOR. "MjICROFiLM
•
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING, /a G`v
! z 0 _ 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
APPLICANT TO FILL IN INFORMATION-WITHIN RED LINES - USE BALL POINT PEN ONLY
' BUILDING PROJECT IDENTIFICATION 1
?VILDING APPLICATION & PERMIT PERMITNUMBER
- �'�
ADORE
LDING —ELECTRICAL—PLUMBING—MECHANICAL ,k
O PLAN CHECK VALIDATION
NA _ TY. ELECTRIC PERMIT FEE
/ PHONE
NA nc R / UTLETS-SWITCHES-RECEP 10.00/1:00
LIC. / -LIGHTING FIXTURES - '10.00/1.00
CONTRACTORS - - PPLIANCES-RESIDENTIAL 4.00 -
AO s
PHON PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) 200D PLAN CHECK FEE .C,NO.
OR . .
ENGINEER
I.C.No. SIGNS TRANS. 3.00 '
ARCH.OR ENG. - SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICADREA N
ADT'S MOTORS SEE FEE SCH.
/\
.. SERVICE CHANGE 20.00 c•`{/�/ 71� i(F
°OHI:00 00 LICENSED CONTRACTORS DECLARATION
a U w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE "
y Q y (commencing wit Sectio 7000)of Division o the Busin ss anJ BLDG. ELECT. PLG. MECH.
F w i Professions( cense is in full to
2 o m License Class 1 Lie.Num
o y F w Datc Contractor _ -
a BUILDING PERMIT
¢ ¢Ws a - OWNER-BUILDER DECLARATION INFORMATION
do ° MISC.— REFER TO ORD.
x LL H I hereby affirm thct,l am exempt lion the Contractor's License VALUATION $/FT.
Fro 04 Law for the following reason.(Sec:703L5,Businessund Professions PERMIT ISSUANCE 10.00 �•
Code:Any city or county which requires a permit to construct,aher,
Qa Q Q Improve,demolish,or repair any Structure,prior to Its ISSUann,,also ELEC.CONTR. LIC.NO. ELEC.
requires the applicant for Such permit to file a signed statement that - TOTAL PERMIT TO
K m he is licensed pursuant to the provisions of the Contractor's License 9
La
z r
Low(Chapter 9(commencing with Section 7000)of Division 3 afthe �LO 6—
g¢ o Business and Professions Code)or that he is exempt therefrom and. OTY. PLUMBING PERMIT FEE
¢ F the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty gCTEfl-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500)J',
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not -
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does out apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such improve-mS 6.00
I� mes are not intended or offered for sale.If,however,the building GAS--EA.SVSTEM-11NC.40UTLE
of improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4( .QO BUILDING USE
builder will have the burden of proving that he did not build or im. RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,mn exclusively contracting with, ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V gSSESSORS PARC EL NO.
and Professions Code:The Contractor's License Law does not apply fA
la an owner of property who builds or improves thereon,and who LAWN SPRINKLERS,-OVER 5(EAT 1.00
contracts forsuch projects with a contructons)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO. PARCELNO.
-0 I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 '
reason °
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. '5.00 '
1 hereby affirm that I have a cerlifcme ofconsenl to self- state. ZONING - ENG.SITE NO.
or erti m f WWar s'Co mpe sa' n In ranee,ora ified
c QKI>'6kR3p ab.C.).
P0e `/./�� pony
O erlifled copy' hereby tarnished. FIRE$PRINK ENERGY T-24
Z O A❑ e,tificd co is f0 w 1 Fh c' lsp tin d� ivision. MISC.- t REFER TO ORD. ❑'7 ❑ ❑' ❑
Y N V N
~ w ' PERMIT ISSUANCE N10.00 PLGGD ZGNE A.L.u.c.
j CERTIFI TE OP EXEMPTION FROM WORKERS'
LJ _ OMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 •(This section need not he completed if the permit is for one TOTAL 01CV❑ IN[] Y❑ N❑
0 Z hundred dollars(S 100)or less.) -
L) O 1 certify that in the performance of the work for which-this per- QTY. 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.
of Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
�- to NOTICE TO APPLICANT: If,after making Ibis Certificate of 13x-
F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.0.0 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 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.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 -
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 /
information is correct.1 agree to comply with all city and county PLUMBING /(p �i
ordinances and state 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 SCM. MECHANICAL -
L✓ above-mentioned property for inspection purposes.
(We) agree to save, indemnity and keep harmless.(he City of misc.- REFER TO ORD.
Cupertino against liabilities,judgments, cost and expenses which CONST.TAX
may i y wa crue ay'ainst Said City consequence of the PERMIT ISSUANCE -10.00
ra0t10 this r si �/ n /i>Y/
MECH,CONT. LIC.NO. , MECH.
I///✓/I//.v/✓ TOTA` TOTAL
Signet of Applicant/Conlmet)r Date - 6
OFFICE COPY