17546 r
1 POST THIS CARD NEAR FRONT OF BUILDING pERMRNUMRER
CITY OF CUPERTINO
INSPECTION DIVISION ����
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS wYc1r SD - � .Zdd _UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER 1 L CONTRACTOR Ae -f IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - T NOTE: - ANCE OR 180 DAYS.F•ROM
UFER, — ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
.TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERM1UT VALIDATION
PREGUNITE CUPERTINO STANDARDS. _
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - APR p pU a
UNDERGROUND-
/SLAB lata.
PLUMBING city Of Cup81RQ.' f� ��dyi VCc-f
ELECTRICAL ISSUANCEOATE
MECHANICAL - RLUc• ELE11 I PLG. MecH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $/F I.
- PLUMBING � - - � ,
MECHANICAL
ELECTRICAL PERMIT TO
Y
FRAMING A '
'TORIES IVPE CONS R.
INSULATION - -
- OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' � ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO 4'i ILOOIi RHEA TUTALACREIAGE
'
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHINGa RCS NO a"u`N usepe Om
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSPPx'*t �O El I] 0 11
ROUGH SAN.a
ASSESSORS_ PARCEL NO
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO,
TUBS BSHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY '
ELECTRICAL BUILDING ENERGY ACC.'DATE ACC FILE NO
FRAMING ELECT.FINAL TEST,
ZONING- ENGf SITE NO.
INSULATION PLUMBING - ..
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y "� Y "�
P LOUR ZUNL
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR'SHEARFIRE DEPT. Y "❑ ` ❑ "❑
SHEETROCK GRADE - , 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 NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, . ELECTRICQp
H ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
I ZPTOTAL
ICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. j ,,j
pe
COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU1 I'.ANG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT A
ADDRESS r
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL n5 4
OWNER'S PLAN CHECK VALIDATION
NAME
• 1 ,�; CITY. ELECTRIC PERMIT FEE
CPHONE
CONTRACTORS R'S
NA" 14-
1OUTLETS-SWITCHES-RECEP 10.00/1.00 .rD
L No, -Z%-Lt/(D LIGHTING FIXTURES 10.00/1.00 �jt rb
CNTRAC DNTRAGTORs
APPLIANCES-RESIDENTIAL 4.00
��qp1
WI W PHONE _4• I PANELS 10.00 Ab DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP)sI�Q�Kl-t 20.00or
ENGINEER -
uc.No. •�� SIGNS TRANS. 3.00
_AARCH.OR DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 ('�/'
APPLICANTS MOTORS '. SEE FEE SCH. Ot01
c 'Q
ADDRESS _ f�
5OC:% , ,C01%JV'A `sJ AON S-3 SERVICE CHANGE 20.00 'ep
F o o LICENSED CONTRACTORS DECLARATION 12, � IK- '�`1 2ys d O C--4v:P �
a o Cp 1 hereby nfl'Inn that 1 am licensed antler provisions of Chapter 9 I It- 01. T. ,`a p ISSUANCE DATE
y<t (commencing with Section 7000)of Divisiun 3 of the Business and BLDG. ELECT. PLG. MECH.
H w z Professions Code,and my license is in full force and effect. Zp} '• p aO El �-�• ❑ ❑
o z m W License Class Lic.Number
Mr
4 r w Date Contractor _
st a 2 BUILDING PERMIT
Is: ¢ OWNER-BUILDER DECLARATION w v MISC.- RD INFORMATION
W,;LL F I hereby affirm that 1 am exempt from the Contractor's License
y Z�1) VALUATION SIFT.
a- Law Law for the following reason.(Sec.7031.5,Bwinessand Pmfessimss PERMIT ISSUANCE - 10.00
us Code:Any city or county which rcquiresa permit toconstrucL ulteo
a ¢ o improve,demolish,Or repair any structure,prior to its issuance,also ELEC. . LI
CONTRC.NO. - E LEC. yn1
0 ¢ requires the applicant for such permit to file a signed statement that - TOTAL 0 V PERMIT TO
w Cs m he is licensed pursuant to the provisions of the Coutrmtor's License
Fz >
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthc
¢ Business and Professions Cade)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE L�
It =$ the basis for the alleged exemption.Any violation of Section 7031.5 TrTOPINES TYPE CONS R.
by any applicant for a permit subjects the applicant-Ino civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500)J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not _
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTALACREAGE
• himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA) 200 BUILDING USE
builder will have the burden of proving that h . . .
e did not build or im- RES IND CON PB Omar
prove for purpose of sale.h INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am,exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the"Twee,(Sec.7044.Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's Lyase Law does not apply
to an owner of property who builds or improves Thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00
corI for such projects with a contracliu(x)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STO RM EA.200ft/10.00 TRACT NO. PARCEL NO.
0 lam exempt under Sec.-.B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM' 5.00 ACC.DATE ACC.FILE NO.
WORKERS•COMPRNSATION DECLARATION - WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certifieuln of consent In self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Ins.rm r a certified
copy Thereof t$ec. I/'(x r-ne•-A�cc�-.fx e
Policy N 'mm
O ❑ Certif copy S ler by furBifhed. t7jVr FIRE SPR INK ENERGY T2
Z Z 0 Cert if•d o 7aI vitt IL.city-iwpeninn division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
N
CERI&CZE OF EXEMPTION('ROM WORKERS' .PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
LU >_ COMPFNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CLO (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollms0100)or leas.)
U O 1 certify that in the performance of the work Joe which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any mannerso as to
U become subject to The Workers'Compensation Laws of California.
O y DoT° ApplicantALTER OR ADD TO MECH500 BUILDING
>. to NOTICE 1'0 APPLICANT: II',after making This Certificate of Ex . .
� ? London,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.RM.) 6.00SEISMIC FEE
I hereby affirm that (here is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
re MICROFILM
performance of the work for which this permit is issued(See. HEATING UNIT(TO 100,000 B.T.U.) 8.00
a
Lender's An HEATING UNIT 100,000 B.T.U.)9.50 1 p11
Lender's Address ELECTRIC
I certify that 1.have read tisis application andstore Ilia,the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 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 tlm BOILER-COMP IGVer 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep lannless the City of MISC.- REFER TO ORD.
upeNino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any ay o against said City in consequ n • of the PERMIT ISSUANCE 10.00
mating Of t is e n n89 MECH.CONT. LIC.NO. MECH.
`17 TDTAL TOTAL
Signature o Af diem / o Date (�(J
OFFICE COPY