18407 POST THIS CARD NEAR FRONT'OF BUILDING
1 PERMIT NUMBER
~+ CITY OF CUPE•RTINO 18407
INSPECTION DIVISION
JOB INSPECTION.RECORD [/
/PERMIT EXPRATION
JOB ADDRESS �d L� s' �e Aw L� •' 'UNIT# LOT# ;j / / 7 , u /
_ PE RMIY'EXPIRES IF WORK
OWNER, ••� GV\-LVV. CONTRACTOR IST .� LNA C IS NOT STARTED WITHIN
. INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE.OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AN6 DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANSANDCITY OF PERMIT VALIDATION
GARAGE SLABS CUPERTINO STANDARDS. PAID h ZSV
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - OCT
UNDERGROUND /SLAB OT 51T7S� - I
' PLUMBING
ELECTRICAL - City O♦:CDpertLRO IssuarvcE unrE
MECHANICAL BL c ELECT . PLG. ME
CR
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION S/F T.
PLUMBING '- - - I - -
MECHANICAL
PERAIIT i0
ELECTRICAL
FRAMING
STORIES . TYPE CONSTR.
INSULATION - -
IJ A
OCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL A OVE HAS BEEN SIGNED
SO FT FLOOR AREA TOTAL ALFEAGE
ROOF NOT NO FINAL4NSP.SHALL BE MADE BEFORE
DIAPHRAGM THE NSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - RES IND CON PB O"'eq
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED VINALS DATE INSP. 0 ❑ O [71 El
ROUGH SAN.q ASSESSORS PARCEL NO
•
PLUMBINGELECT.ENERGY -
TUBSB SHOWER PAN PLUMBING ENERGY TRACING PARCEL NO
MECHANICAL MECK ENERGY
ACC.DATE ACG FILE NO,
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG.SITE No,
INSULATION - PLUMBING
GAS TEST GAS '
FIRESPRINK ENERGY T-2a
MECHANICAL ' Y ❑ NY ❑ NO
COVER NO,WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A,L U C.
Yo No L N�
INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING 'r;�
INTERIOR LATH - TEMPORARY APPROVALS
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. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY. BEFORE REQUIRED INSPECTION. PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING:
z
— 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 BALLPOINT PEN ONLY
<< .BUrLDING'PROJECT IDENTIFICATION - - PERMIT NUMBER
BU .DING APPLICATION & PERMIT 1 p /� O�
AODREss 186 184
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ?'
OWNER's PLAN CHECK VALIDATION .
NAmE QV- GFI 1i`; QTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S
NAME � OUTLETS-SWITCHES-RECEP 10.00!1,00
1'�Z AM LraI/f O(flfUtSl LIC.No ILIGHTING FIXTURES 10,00/1.00 44 `J�J C D
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRE 5
QD ONE PANELS 10.00 DATE OF APPLICATION •-
ARCHITECT PLAN CHECK FEE
OR 1PANELS (OVER 200 AMPI 20.00
ENGINEER
�Irl'Q,k �l LIC.NC �" �i SIGNS TRANS, 3.00
ARCH OR ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
(�?LH k U GIS f Citi zIP EMP.METER OR POLE INS. 20.00
aPPucarvrs MOTORS SEE FEE SCH.
ADDRESS
SERVICE,CHANGE0.00 ] 1� '
� 00 LICENSED CONTRACTORS DECLARATION "•ULL.
a is u I hereby affirm that 1'am licensed under provisions of Chapter 9 ISSUANCE DATE
w l w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
, 00 i Professions Code- my license is in full force(f<aJd./ ❑ - 1:1
❑
Z. o m - License Class C.r Number f T
o H L w Uam�� Comractor N111r_�.Il}j City y
¢_ m¢¢ OWNER-GUILDER OIiCLARATION City Of COpCI LIO BUILDING PERMIT
odea - MISC.- REFER TO ORD 'INFORMATION
w ;u m I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
LL 0 ¢ Law for the following reason.(Sec.]071.5,Business and Professions PERMIT ISSUANCE 10.00
u w Code:Any city or county which requiresa permit to construct,alter,
Q Q Q 0 Improve,demolish,or repair any structure,prior 10 its issuance,also ELE4 CONTR. LIC.NO. ELEC.
0 K requires the applicant for such permit t0 file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
Hii Law(Chapter 9(commencing with Section 7000)of Division 3 of the W`U �g
- ¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 `
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their facie 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
.
himselfornot hrough
ownemployees,for sale.
If;ed ever,hat the
improve. GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
mems arc not intended or offered for sales If;however,lite building
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4(EA.) 200 BUILDING USE
builder will have tile - . .
e burden of proving!lies!he did not build or im- RES IND CON PB One,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ L as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ O ❑
licensed colons ode: construct the project(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO,
and n owns ons Code:The Contractor's License Law docs not apply
to tr owner of property who builds or improves Thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts such projects with u contrvctor(sl licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10,00
the Contractor's LICCOSC fAw, TRACT NO. PARCEL NO.
' ❑ 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
I hereby affirm that I have a certificate ofcorxent to self-insum, ZONING ENG.SITE N0.
ar a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab C.).
Policy No. Company
O ❑ FIRE SPRINK ENERGY T 24
Z z ❑ Certified copy is fled with the insprltion division. MISC.- REFER TO ORD.
0 Applicant �r2A7?LCA - L14(1/ Y❑ N❑ Y ❑ N❑
Cr y CERTIFICA'I F OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C.
LLI > • COAIPENSAT'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N[]
D 2 ', hundred do11ars($100)or less)
U 0 1 certify that in the performance of the work 1'or which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any mannerso as to
O W become subject m the Workers'Compensation Laws of California.
y Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING $`Zk 0
} ret NOTICE TO APPLICANT: If,offer making this Certificate of Ex-
H Z emplion,you should became subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK.
V ,rvisions of tile
or this Labor Code, you most forthwith comply with FEE
such p permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000OF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3, 7E
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
0m performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). �Qdt EATG UIT(O 100,000 B.T.U.)9.50 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Name Lender's NHI NG ER T9
Lender's Names ELECTRIC �1
I 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
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 SCH. MECHANICAL
above mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino ugainsl liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
gran fthi5 MECN.CONT. LIC.NO. MELH.
�0`� TOTAL TOTAL �Sr
Signature of 'p¢anl/Contractor Date - -
OFFICE COPY