18362 POST'THIS CARD NEAR FRONT, OF BUILDING
' PERMIT_NUMBER.
.
CITY OF CUPERTINOR
'INSPECTION DIVISION 18362
JOB INSPECTION-RECORD
PERMIT EXPIRATION
JOB ADDRESS l 'f ✓J1 GG• UNIT# LOT# ; PERMIT EXPIRES IF WORK
OWNER L!/ CONTRACTOR / IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD - leu DAYS OF PERMIT-ISSU:
FOUNDATION '. - - ANCE OR 180 DAYS FROM
NOTE: .
UFER - ALL GRADING AND DRAINAGE SHALL BE.INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT Vn L'BATlory
CUPERTINO STANDARDS.
GARAGE SLABS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB •�
PLUMBING
ELECTRICAL RIM - ISSUANCE GATE
MECHANICAL - BLOC ELECT I PLG. - MECR
I ❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION'
VALUATI
PLUMBING SIJ 'tom
MECHANICAL
/
ELECTRICAL ' PE MIT TO, f["/_I
FRAMING 1 N-
INSULATION - - sroRlEs, TYPE CONSTR.
OCC.GROUP RES.UNITS
/
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $a FT FLOOR AREA roTAL;ACReACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID .
' BUILDIN,USL
ROOF SHEATHING HEs IND CON PB OR—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.q
PLUMBING ELECT.ENERGY
rRAcr NO PARCEL No
TUBS&SHOWER PAN PLUMBING ENERGY V '
MECHANICAL MECH.ENERGY .
ELECTRICAL ,. i BUILDING ENERGY ACC.DATE ACC.FILE NO,
FRAMING ELECT.FINAL TEST
ZONING ENG,SITE NO.
INSULATION PLUMBING
GASTEST GAS
FIRE$PRINK ENERGY Taa
MECHANICAL
❑ N'❑ � ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED, HEATING
EXT RIOR SHEAR ELECTRICAL RELEASE Is
EL000 zoNE aLuc.
INTER QR SHEAR FIRE DEPT. v❑ N NC]
❑ N❑
SHEETFZOCK GRADE yr L 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,BUI LDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED By BUILDING,INSP,ECTOR. MICROFILM
--------------------------------------------
uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ��y0
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
I lea- 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z, - MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE .- .
IMPORTANT! CONST.rAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR-FINAL INSPECTION.
OFFICE COPY
+APPLICANT TO FILL IN INFORMATION WITHIN REDLINES'- USE BALL POINT PEN ONLY
BU LD1 NG PROJECT I DENTI FICATI ON ,PERMIT NUMBER
But APPLICATION.& PERMIT ^ ^
IV ` BUILDING-ELECTRICAL-PLUMBING -MECHANICAL �}, b (J
O 7.4
NER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
- PHONE p
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 .
L7LICNO LIGHTING FIXTURES 10.00/1.00
CONTRACTORS'
ADDRESS
PPLIANCES'-RESIDENTIAL 4.00 SSD /6 5-7 Sf1A,`,*yZ0FbNE C,&3 20 0 PANELS 10.00 DATE OF APPLICATION
OARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
' uc.Na. SIGNS TRANS. 3.00
ARCH OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00 /1
IIP EMP.METER OR POLE INS. 20.00
APPLICANT s y /8
C �1"711i
ADDRESS Lc
DDRESSMOTORS SEE FEE SCH.-
SERVICE CHANGE 20.00
wo oLICENSFD CONTRACTORS DECLARATION _
a i U IRAQ
I hereby afrnn that I am licensed under provisions of Chapter 9 ISSUANCE DATE
r- w (catnmeucing with Section 7000)of Division 3 of the Business and
y Q H . E❑C
H z CoLlp Holl my license is in full force and effect. I' BLDGELECT. PLG. MH.
❑ El ❑
Z, i gD Professions W License Class O Lin.Number .� ' CLs
Date Contracr KL
51
a y f Contract.,
PERMIT
tc ¢o i OWNIi R-BEiLDER DECLARATION RATION INFORMATION
w ; y I hereby affirm that I am exempt from the Contractor's License MISC.- '--REF TO RD
u o¢ Law for lite reason.(Sea 7031.5,Businessamd Professions VALUATION $/FT.
_ 4 PERMIT ISSUANCE - 10.00 /s O
Code:Any city or county which requires a permit to construct,alter,
improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO.
EOTA �/.
DLL requires the applicant for such permit o file a signed statement that TOTAL J PERMIT TOi
u w $ he is(Chapter
pursuant to the provisions oC the )Contractor'sDivision License
0 Laww(Chand Processions Cngwhh Sect is exempt Division of the
Business and itea alleged
or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢
F.$ the basis for line alleged exemption.Any violation tot toa cion malty - STORIES TYPE CONSTR.
by any applicant for apenre subjects tire applicant toacivil penalty' ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑, I,as owner of the property,cur my employees with wages as BACK FLOW PROTECT,DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will no 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 through his own employees,provided that such improve GAS -11NC.40UTLET$ 6.00
meats are not intended or offered for sale.If,however,the building
0r improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 200 . BUILDING USE
builder will have lite burden of proving that he did not build or im - . - . .
RES IND CON PB Omer
. .
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000
❑ 1,as owner of the properly,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 Code:The Contractor's License Law docs not apply
to an owner oI'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 '
the Comraclnr's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec.-,BAIP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'I ION DECLARATION WATER TREATING EQUIP.• 5,00
I hereby affirm that I have a certificate ofconsenl to selGinsure,
or a certificate of Workers'Compensation Insurance,or a cert ificd ZONING ENG.SITE NO.
copy lhereor(Sec.3800,Lab.C.).
Policy No. Company -
0 ❑ Cenifiad copy is hereby fumished. FIRE SPRINK ENERGY T 24
� ZO Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
A licant V N V N
CC m CERIIPICATE OF EXEMPTION FROM WORKERS' - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O (flus section need not he wmpleLLvl if the permit is fur one TOTAL V,❑ N❑ V❑ N❑
D Z hundred dollars(S100)or less.)'
U O ' 1 certify that in the performance.1 the work farwhich this per, OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued.I shall not employ any person in any manner so as to
O W " become subject to the Workers'Compensation Laws of California.
y Date-Applicant - ALTER OR ADD TO MECH. 5.00 ..BUILDING
} N NOTICE TO APPLICANT: IL 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
U 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 10=C.EM.) 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(See. MICROFILM
3097,Civ.C.)., HEATING UNIT ITO 100,000 B.T:U.) 8.00
Lender's Name-
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC ~.150
I 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
r ordinances and slate Ls relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.1 6.00
hereby authorize representatives of this city to enter upon the -
uhove-nientioned property for inspection purposes. BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City oI' MISC.- REFER TO ORD.
upertino against liabilities,judgment, costs and expenses which CONST.TAX
ay in any way aceme against said City in consequence of the PERMIT ISSUANCE 10.00
ranting of thio penniL MECH.CONT. LID.NO. MECH.
9t- /y `7-z�8-f TOTAL TOTAL fS.SQ
siglilmure of Mplicanl/Contractor Date
OFFICE COPY