17593 POST THIS CARD NEAR FRONT OF BUILDING RM;TNUMBER
CITY OF CUPERTINO 17593
INSPECTION DIVISION
JOB INSPECTION RECORD
D l ( S^ S
'OP {t–V� '�Z PERMIT EXPIRATION
JOB ADDR ESS— UN IT Jk LOT AE
E.•� \ �l' , PERMIT EXPIRES IF WORK :
owrvER \RC1 CONTRACTOR IS NOT STARTED WITHIN '
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE:„. ANCE OR 180 DAYS FROMT
UFERALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION. -
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY.OF ,� PERMIT VALIDATION
GARAGE SLABS.
CUPERTINO STANDARDS. o? �))
� . ! /
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED f
UNDERGROUND /SLAB PR 11 ,{
PLUMBING - ,Joe !- ,cTe Mutt-,
ELECTRICAL oily at CoAfto ISSUANCE DATE
MECHANICAL BLOC. ELecr PLu.. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION siPr.'
MECHANICAL '
ELECTRICAL PERn+n rD
FRAMING � 'b -0:.��.
INSULATION . STORI S TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT.FLOOR AREA TOTAL ACREAGE
[PLUMBING
HRAGM THE CONSTRUCTION TAX IS PAID '
SHEATHING BUILDING USE
H[ 'El..
CON PB GO,
LY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS. DATE INSP. a ❑ ❑ . ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.a
- ELECT.ENERGY .
&SHOWER PAN PLUMBING ENERGY ACT NO. PARCEL NO
HANICAL - MECH'.ENERGY
ELECTRICAL -( BUILDING ENERGY . ACC DATE ACC.FILE NO
FRAMING ELECT:FINAL TEST •'
INSULATION ^ ' PLUMBING zoNlNc ENE.SITE No:
GAS TEST - GAS' -
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' - Y ❑ "❑ > ❑-- "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A,L U.C.
INTERIOR SHEAR FIRE DEPT. Y N❑ L-_1
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING' -
INTERIOR LATH - r TEMPORARY-APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS - FEE _
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING.IS.NOTPERMII I LU UNT ILBUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. MICROFILM
ARRANGE-FOR INSPECTION BY PHONING 252-4505, ELECTRIC , !!
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE,JOB ADDRESS WHEN PHONING.
- SEEPERMIT 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
BU I LDING PROJECT IDENTIFICATIONPERMIT NUMBER
ENs - APPLICATION & PERMIT p 17593
0 14 No &.4, UILDING— ELECTRICAL—PLUMBING—MECHANICAL i,
DwNER'B PLAN CHECK VALIDATION
NAME
DTV. ELECTRIC PERMIT ' FEE
ONE
r CONTRACTORS
OUTLETS-SWITCHES-RECEP 10.00/1.00A �y
LIGHTING FIXTURES - 10.00/1,00
nrppaEssro(R/s'�'J/ pPLIANCES-RESIDENTIAL 4.00 -
WV'/L� //�V{ • /�ONEa97�� PANELS 10.00 DATE OF APPLICATION -
ARC
HRECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20,00
ENGINEER
Lc.No, SIGNS TRANS. . 3.00
aooAess ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP,METER OR POLE INS. 20.00 0_0 D l —/I
ooliEss Ts - MOTORS SEEFEESCH.
{'r{ SERVICE CHANGE 20.00
D¢'2 ♦ //��
r00 LICENSED CONTRACTORS DECLARATION �IDe- Kum-1
H.
F i w APR
1 hereby affirm that I um licensed under provisions of Chapter 9 ISSUANCE DATE
Z, (commencing will Section 7000)of Division 3 of the Business and BLDG. ELECT.I PLG. MECH:
m i I'ro fessions Code,and my license is in full force anJ effect. City ofcupeffino ❑ y .❑ ❑
o 0 e 0 License Class Lic.Number - - IVX�I
r m J Dale Contractor
a x s BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
o a u INFORMATION
w3 LL w I hereby affirm that 1 am exempt from the Contractor's License MISC:— REFER TO ORD
FLLNj Law for the fulowingreoson.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
x
Code'.Any city orestudy whichrequireso permit toconstruct,alte', �'
ac Q Q Q improve,demolish,or repair any structure,prior 10 Its Issuance,also /p"G.CO T„R. /��/� LIC.N0, ELEC: O
0 ¢ requires'the applicant for such permit to file a signed statement that �"�r �j�s/L/ O TOTAL�i� PERMIT TO
Ea
he is licensed pursuant to the provisions of the Contractor's License QIP A
H z a
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE {
¢ H $' the basis for the alleged exemption.Any violation of Section 7031.$ - STORI S TYPE CONSTR.
a 3� by any ore applicant for vehun re dollars $5 applicant macivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(my em'.
❑ Las owner at the property,or my employees with rwages
not BACK FLOW PROTECT. DEVICE 4,00 OCC GROUP RES,UNITS
their sole compensation,will(S the work and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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
menus are not intended or offered for sale.If,however,the budding; GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or int- GAS-EA.SV STEM OVER 4 IEA.) 2.00 BUILDING USE
prove for purpose of sale.). RES IND CON PB ,Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS:I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law it...not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft
the Contructor's License Law. /10,00 TRACT NO. PARCEL NO.
O tum exempt unser Sec. ,B.&P.C.fur 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 certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO.
copy(locumf(Sec.-3800,Lab.C.). -
Policy No. Company
Q �0 Certified ' y is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 yp Cerf c y f with the city 'pspec Yoa division.
P O pplcant �—�^� MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
CCy CC AI'EOP I'XF,MPTION PROM WORKIiR S' PERMIT ISSUANCE 10.00 FLOOD ZONE
LU > COMPENSAl'ION INSURANCE PLG.CONTE, LIC.NO. PLC.
CL 0 Z (This section need not be completed if the permit is for one TOTAL Y C] N❑ Y ❑ N❑
U O hundred dollars IS 100)or Inc.)
I certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE. FEE SUMMARY
LL I- mit is issued,I shall not employ any'person in any manner so as to
O U become subject to the Workers'Compensation Laws of California.
- ALTER OR ADD TO MECH. 5.00
Ed
y Dale—Applicant BUILDING
} rn NOTICE TO APPEICANI': If,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 he deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
L'ONSTRUCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C F.M.) 6.00 'SEISMIC FEE
I hereby affirm that there is a construction[mining 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 s
I tell ify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• ordinances n correct I agree to comply with all city and county PLUMBING -
ordinances and state laws relating to building l city and co and BOILER-COMP(3 H.P.Or 100,0008.T.U.) 6.00
hereby aulhorite representatives of this city to enter Inion the BOILER-COMP IGVer 100,000 BTU[SEE FEE$CH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses hich PERMIT ISSUANCE - 10,00 CONST.TAX -
inganyrue against mid City in conse ante f[heran gL MECH.CONT. LIC.NO. MECH.
TOTALTOTALSign d/Comrraemr ale
OFFICE COPY