17266 POST-THIS CARD NEAR FRONT OF BUILDING "' < PePMIT NUMBER
CITY. OF CUPERTINO 17266
INSPECTION 'DIVISION
JOB INSPECTION RECORD
1—'
PERMIT EXPIRATION
JOB ADDRESS�lJ�`�� N" ✓'—�' `� � I T# _LOT#
- PERM IT EX{14FE8-IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER 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 PAID
PLUMBING •- - p
ELECTRICAL K 211M - ISSUANCE OATS
MECHANICAL eLOG. ELECT PLG. MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1N! sulL-DING vERMIT
INFORMATION
WOOD FLOOR VALUATION $1E T.
PLUMBING C -
MECHANICAL V' �1Gi�y ':.�5 v1�"Cyv( ._�
PERMIT TO
ELECTRICAL ,
w
FRAMING - --
STORIES TVVE CONSTR
INSULATION
OCL GROUP; RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $O.FT FLOOR.AREA TOTALpCREAGE
DIAPHRAGM . THE CONSTRUCTION TAX IS PAID -
BUILDING USE
ROOF SHEATHING . � RES IND coN PR on.,•.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCH.NO
ROUGH SANA
PLUMBING ELECT.ENERGY
.
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NOFARCE- 'L,NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGYACC,DATE ACC FILE No
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION - PLUMBING '
GAS TEST GAS
MECHANICAL
FIRE SPRINK ENERGY T 24
' � '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 11 "❑ ° ❑ "❑
EXTERIOR SHEAR - ' ELECTRICAL RELEASE FLOODZONE A.L,u.c.
INTERIOR SHEAR
. FIRE DEPT. - Y❑ N❑ Y ^'❑
SHEETROCK . - GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT JELECTRIC _ PLAN CHECK -
, - GAS FEE
NO TAPE O,R.PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF.BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM .
ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRIC
'ONE WORKING DAY BEFORE REQUIRED'INSPECTION. PLUMBING
. z� PLEASE GIVE JOB ADDRESS WHEN PHONING.
. SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL f
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
- B04ILDING PROJECT IDENTIFICATION - .PERMIT NUMBER
BUILDING - - APPLICATION & PERMIT 1 1� C
ADDREO� 1N� I f CJ
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
II PLAN CHECK VALIDATION
rvAME
I� 1� 0 , PHONEL`��, 11'�V T7 OTY. ELECTRIC PERMIT FEE PAir F1AACJAMK
Illli V
NAME AcroR's UTLETS-SWITCHES-RECEP 10.00/1.00 ' 1705 5
E uc.
NO LIGHTING FIXTURES 10.00/1.00 I
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS - 10.00 DATE OF APPLICATION'
ORRCHITECTGINE PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
END
uc.No. SIGNS TRANS. 3.00
AARCH.UR DDRESS NG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP TEMP.METER OR POLE INS. 20.00 ('��'
ASS MOTORS SEE FEE SCH. �. 4 II,.-7/\O -P
A?PLICDDRE
SERVICE CHANGE 20.00 X Ip I 180,
wo o LICENSED CONTRACTORS DECLARATION
ai W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
¢ (commencing with Section 7000)of Division 3 of the Business and BLDG. I ELECT. PLG.- MECH.
F wi Professions Code,and my license is in full force and effect. ' ❑ ❑
Z o y- License Class Lie.Number-
0 z r w Date Contractor
:: y s< IOBlILDING PERMIT
¢ ¢w a OWNER-BUILDER DECLARATION .77�C77��77
0 A u. NFORMATION
X3: n H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
m VALUATION $/FT:
u 0¢ Law for the following reason.(Sec.7031.5,Business:md Professions PERMIT ISSUANCE . 10.00
L- -0 Code:Anycityorcounty which requires it permit to construct,alter, IsppP}jpR
a ¢ <0 improve,demolish,or mpairany structure,prior to its issuance,also ELEC.CONTR: .LIC.NO. ELEC.
n w m u requires the dp pursuant
for such revisit to file u signed sector's i that TOTAL ie yt.P�-D�Q
he is licensed pursuant to the provisions ofthe Contractor's License1IE" p
F z t
Law(Chapter 9(ccmmencingwith Section 7000)oc Divislon3ofthe -
i o Business unit Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢F$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; � by any applicant forapemredd.11ma $5Subjects 00)applicant toacivil penalty ALTER-DRAIN -WATER. (EA.) 5.00 '
of not more than five hundred Dollars(my em):
❑ Las owner at the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will(S the work,and Ise structure is not
intended or offered
rluart for Luce(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law docs not who to an owner of
property who builds m improves(here al,and who docs such work FIXTURES-PER TRAP 5,00 so.Pr.FLOOR AREA TOTALACREAGE
himself re through his own employees,provided that such improve-
oments rimprovemenmuch
dedwithinoffered
oneyeasale.if,mpletion tire the owner-
GAS-EA.SYSTEM-11NC.40UTLETS 6,00
or improvement is sold within one year eacompletion,the owner- GAS-EA.SYSTEM-OVER 4.(EA.) 2.00 BUILDING USE
bXd
r will have the burden of proving that he did not build or im- RES . IND CON PB Omer
-1, pI as
nee of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
L as owner of the property,am exclusively contracting with
ed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 1 qssESsoas PARCEL NO.
owner of Code:The Contractor's License Law docs not apply
to an owner of property who builds tr improvesescreen,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a mntrucmrfs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. - TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Uate WATER SYSTEM 5.00
ALC.DATE ACC.FILE NO.
WORKERS'COMPIiNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a canificute of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workeri Cnm Pensutinm lnauunce,nr n certified
copy thereof(Sec.3800,Lab.CJ. ,
Policy No. Company
O ❑ Cenitledcopyisherebyfurnished. FIRESPRINK ENERGY T 24
Z Z ❑ Certified copy is riled with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y❑ No V ❑ N❑
~ �2P PERMIT ISSUANCE 10.00
Lu CERTI FICOEXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
W 2! CC04ENSATION INSURANCE Pw.CONTR. LIC.NO. PLG, '
C o ('Phis section need not be completed if the permit Is for one TOTAL Y E) N❑ Y ❑ N❑
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performs ce of 0t work for which this per OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is is d,I shall not employ a y pas n in a y manner ur as to
O w bean ec tem Workers' pedsa sof Cvlifarnia.
Date Applicant - BUILDING
a ALTER OR ADD TO MECH. 5.00
} m NOTIC i O LICAN'G n or
m' m this Certificate of Ex.
Z emotion,you should become sub I to the orkers'Compensation APPLIANCE .5.00 PLAN CHECK
provisions of the Labor Code, you m t ❑hwith comply with FEE
U' such provisions or this permit shall be deemed revoked. , ' AIR HANDLING UNIT(TO 10=C.F.Ii 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ,e7
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,CW.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's No H EATI N G UN IT(OV ER 100,000 B.T.U.)9.50
Leader',Address ELECTRIC
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 BOILER-CfJMP13 H.P.or 100,000 B.T.U.1 6.00 PLUMBING
ordinances and state laws rehiring to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
• aLove 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 which - CONST.TAX
a in any w ace a against mid City in conmqu race o the PERMIT ISSUANCE 10.00
r [Ing of fhi •rmit. MECH:CONT. LIC.NO. MECH. -
I.i \. ')r TOTAL
i atmeof p IicanlContractor Dat Ll' TOTAL/
OFFICE COPY