18439 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY. OF CUPERTINO 18439
INSPECTION DIVISION
JOB INSPECTION RECORD 11
JOB ADDR ESS L/L
7/n/ b 9� - 'PERMIT EXPIRATION
UNIT# _LOT#t
I . . PERMIT EXPIRES IF WORK
OWNER ✓ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE:" ANCE OR.180 DAYS FROM
UFERALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALIEDINSPECTION.
.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF E M VALIDATION
CUPERTINO STANDARDS. f
GARAGE SLABS i•I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J P
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - .ISSUANCE DATE
MECHANICAL - BUTG ELECT. I PLG. MEGH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED A u u _ BUILDING PERMIT
WOOD FLOOR .E INFORMATION
•
PLUMBING VALUATION
� Y-1 /�
MECHANICAL CJ'+U•01v
ELECTRICAL PERMi,T/To
FRAMING
INSULATION - STORIES TYPE CONSTR,
I
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO I T FLOOR AREA TOTAL ACREAGL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING - BUILDING USE
RES IND CON PB O,-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS .DATE INSP. 11 ❑ - Ell ED ❑
ROUGHSAN.N ASSESSORS PARCEL NO
;
PLUMBING - ELECT.ENERGY
TUBS B SHOWER PAN PLUMBING ENERGY TRACT No, PARCEL NO
MECHANICAL - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC,DATE ACT.FILE No
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING - ZONING ENG SITE NO.
GAS TEST GAS -
MECHANICALFIRESPRINK ENERGY I 2
COVER NO WORK UNTILABOVE HAS BEEN SIGNED HEATING . ° ❑ N❑ ° ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOODTONE A.L U,C.
INTERIOR SHEAR FIRE DEPT'. °❑ N Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR-LATH IBUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING,
Y-
SCRATCH COAT ELECTRIC PLAN CHECK' ,
GAS . FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
'miftLu ONE WORKING DAY BEFORE REQUIRED INSPECTION.
00
PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL' 4110,j
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN,ONLY
BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
e�OiLOIHG APPLICATION & PERMIT ; q A 0
NAME n
ADORE
�RESS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,t'/' I '} J
OWNER'$ PLANCHECK VALIDATION
��//
\ �, Itpl,,, vMOHE ZS7- DTV. ELECTRIC PERMIT FEE
- NAME ncrons UTLETS-SWITCHES-RECEP 10.00/1.00 `L1 2-lJ
LIC No. LIGHTING FIXTURES 10.00/1.00 ,
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. ER IT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00
ADDAssrs MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS DECLARATION
a U v I herehy affirm that 1 an licensed under provisions of Chapter9
Z i ISSUANCE DATE
w a w (commencing with Section 7000)of Division 3 of the Business anti BLDG. ELECT. PLG. MECH.
F n z Professions Code,and my license is in full force and effect _ ❑ ❑ ❑
oC)m W License Class Lic.Number V J
,�H Dale Contractor
a x ar BUILDING PERMIT
¢ ¢ w a ✓ OWNIi R-BUILDER DECLARATION
o A " INFORMATION
w g LL N I hereby affirm that 1 am exempt from the Contractor's License MISC.- MUPOR TO ORD
u O a Law for Ole following reason.(Sec.703 L5.Birmit.sond Professions VALUATION S/FT.
H - PERMIT ISSUANCE 10.00
Code:Any city or county which requirese permit w construct,alter, ,,l!YYvv�
¢ ¢¢ o improve,Aemolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. 2
O¢ requires the applicant for such permit to file a signed statement that TOTAL
I,
m y he is licensed pursuant to the provisions of the Contractor i License PERMIT TO
H z a Law(Chapter 9(commencing with Section 7000)of Division 3(it(lie - V
4 O Business and Professions Cade)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE K,
¢ r m lire basis for the alleged exemption.Any violdtion of Section 7031.5 STORIES TYPE CONSTR.
nom - by any applicant lora permit subjects the applicant loo civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).):
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 400
Illcir sole compensation,will do the work,and the structure is not . OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOORROOFAREA,CONIC. 5.00
Code: 'File Contractor's License Law does not apply to an owner of , , -
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 so.FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale:lf,Iwwever,the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of'prryM ing that he did not build or im- BUILDING USE
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB other
C 1,as owner of the property,rill exClusively contracting with
licensed contractors to construct the project(See 7044,Business LAWN SPRINKLERS- 1 INC 5'V.B. 6.00
and Professions Code.'1'he Contractor's License Law does not apply ASSESSORS PARCEL NO,
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) - 1.00
contracts fur such projects with a contractotls)licensed pursuant to
the CmHRwor'S License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT
reason 6.00
Owner Dote WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS OAI PISNSATION IJIiCLARA'TION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate of consent to self-insure.
ora certificate of Workers'Compensation Insurance,or d certified ZONING ENG.SITE NO.
copy thereof(Sea.3800,Lub C.).
Policy No. Company
O ❑ Certified copy is herehy furnished.
Z Z ❑ Certified copy is filed with the city inspection division. FIRE SPRINK ENERGY T 24
F0 . Applicant MISC. - REFER TO ORD. YE] N[3 Y [:] NEI
C17RI IFICA'I E OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 1460 � FLOOD ZONE A.L.u.C.
LL COAIPFNSA7'ION INSURANCE QEXHAUST
k1W1T11UrTl-'
PLG.
0 ('this section Decd not be Completed if the permit is for oneTOTAL Y E] NJ[] Y ❑ N
O hundred dollars IS 1004 or less.)
I certify that in the performance of the work for which this per- ECHAFEE FEE SUMMARY
LL U mit is issued,I strait not employ any person in any manner so as 10
become subject to the Workers'Compensation Laws of Calilornia.
If
LU . Date Applicant ADD 5,00 BUILDING L
- 0 NOTICI7 TO APPLICANT: If,a(tor making this CeUificr,of Ex-
? emption,you should become subject to the Workeri CompensmionE5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. ING UNM.) 4.00 FEE
CONSTRUCTION LENDING AGENCY NG UNIF.M.16.00 SEISMIC FEE
I hereby affirm that there is a construction lendingagencyforHOOD T) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
31397.Civ.C.). HEATING UNIT(TO 100,000 BL,ndc .T.U.) 8.00
3097. 's Nome '
Lender's Address HEATI NG UNIT(OV ER 100,000 S.T.U.)9.50 ELECTRIC '
I certify that I have rea11 agree application and state that the above VENTILATION FAN (SINGLE) 4.00
ichmoces d cornet. I agree to ttnnply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-ODMP(3 H.P.or 100,0006.T.U.) 6.00
hereby imthori,erepresentatives of this city to enter upon the
abovrmentioned property forinspection purposes, BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs unit expenses which CONST.TAX
may in any way accrue against slid City in consequence of the PERMIT ISSUANCE 10.00
rung of this permit.
MECH.CONT. LIG NO. MECH.
y'.- TOTAL
TOTAL ^ �v
Signature of Apr icy t/Contractor Udtc
OFFICE COPY