15345 POST THIS CARD NEAR-FRONT OFBUILDING PERNIITNUMBER
CITY OF CUPERTINO 153.45
INSPECTION DIVISION
JOB INSPECTION RECORD .
Dorothy Ann Way PERMIT EXPIRATION
JOB ADDRESS Y Y UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER Gregory Gr Oup CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSP TOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION79 NCE OR 180 DAYS FROM
NOTE: CALLEDAND DRAINAGE SHALL BE INSTALLED 'L"AST CALLEDINSPECTION.
UFER ALL
PREGUNITE TO COMPLY WITH THE APPROVED PLANS A1•p CITY qF �7 q[� PLRNUT va.Iunn ON
CUPERTINO STANDARDS. '1'1MK 1 V IJC�J
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Cjbl 6f i UQB0jRC_( -I /LI I--
UNDERGROUND /SLAB
PLUMBING
ELECTRICALA
ISSUANCE DATE
MECHANICAL BLDG ELECT I PLG. MCC.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION EIFT,
- - _
MECHANICAL -47c
ELECTRICAL - PERMIT TO
FRAMING ! 1- IJ"+11 ill I v.�=`II
INSULATION STORIES TYPE CONSTR
• DEC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
5. Tl I'40II11 AHI.A TOTAL ACREACE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE T
• , DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
' ROOF SHEATHING REs IND CON PB om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.N
ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
.
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECR ENERGY
ACC DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING 'ELECT.FINAL TEST
IzoNlNc ENG SITE No,
INSULATION PLUMBING .•
GAS TEST GAS -
MECHANICAL FIRE SPRINK ENERGY T.74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ Y ❑ "❑
FLOOU/UNE ALUC.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTQRIOR SHEAR FIRE DEPT. - Y ❑ "❑ ` ❑ "❑
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APP OVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE C
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY. SEISMIC FEE
x�
OCCUPANCY OF BUILDIN G IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED B Y BUILDING INSPECTOR. MICROFILM ,
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU
� 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
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY /
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJZ IDENTIFICATION A PERMIT NUMBER
ADDRESS APPLICATION & PERMIT
AOOFE55 p
Ta r r' RRe BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 15345.
C•
OWNER'S�� & PLAN CHECK VALIDATION
TV. ELECTRIC PERMIT FEE
V �aI V/ VHONE ^e �z
CONTRACTORS I UTLETS-SWITCHES-RECEP 10.00/1.00
NAM[
afe sec.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR' a- �� PPLIANCES-RESIDENTIAL 4.00
ADDRESS
A" T p PHOrvE T- PANELS 10.00 DATE OF APPLICATION
ARCHITECT
�w PANELS (OVER 200 AMP) 20.00 A�.Ns CK FEE .C.N0.
.
EN'ey11 LIC,No, SIGNS TRANS. 3.00
ARCH.OR ENO. 5.00
ERMU VALIDATION
ADDREESSn �� ,,s ( r SPECIAL CIRCUIT. _
24pc+ `++x+`� .I' •eat ZIP1,5131 EMP.METER OR POLE INS. 20.00 1
APPLICANT'$
ADDRESS MOTORS SEE FEE SCH. I Of�stlrQlHf�-1
SERVICE CHANGE 20.00
Foo LICFNSBD CONTRACT ORS DECLARATION [-�I
<.u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
y < m (commencing with Section 70001 of Division 3 of the Busine,s and BLDG. ELECT. PLG. MECH.
F m z Professions Code,and my license is In full force and elfeel. ,v.�/ ❑ ❑ ❑
ois� W Licens•Clo_ Lic.Numhcr JuC
w r Date _is, C.ntrun.r _ _
¢ m s BUILDING PERMIT
¢ ¢ te st OWNER-BUILDHR DECLARATION INFORMATION
X
H I hereby affirm that I um exempt from the Contractor's License MISC.- REFER TO ORD
u o`� LTw for the following reason.(Sec.7031.5,Business and Professions VALUATION
I - Code:Any city or county which requires permit m construct,alter, PERMIT ISSUANCE 10.00 r _
2 6 ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �'.J0
- ¢ requires the applicant for such permit 10 file a signed statement that TOTAL PERMIT TO
w $ac he is licensed pursuant to the Provisions of the Contractor's License n�Ty , 1 1I'A
Fii Law(Chapter!)(commencingwith Section 70001.1'D'wision 3oflhe I IV-V t V`lA I
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
re = $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e ; by any applicant for a Permit subjects the applicant toxelvil Penalty ALTER-DRAIN& VENT-WATER IEA.) 5.00
of not mom than five hundred dollars(S500)J:
❑ 1,as owner of the property,or my employees with wagesas BACK FLOW PROTECT.DEVICE 4.00 Dec.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for Vile (Sec. 7144, B.sinms and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code.The Contractor's License Luw dots not apply to an owner of
-
properly who builds or improves III croon,and who does Such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
_ ments are not intended or offered for sale.If,however.the building 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 IEA.) 2.00 BUILDING USE
Owner-
builder will have the burden of proving that he did not build or ins- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,a owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 AES SSORS PARCEL NO.
and Professions Code:The Contractor's License Law does 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 o.ntracons)licensed pursuant t.
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
/ WORK ERS-COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby infirm that I have a ceulkcute.f consent to self:insure. ZONING ENG.SITE NO.
or a cert"21( of Workers'Compensation Insuruncc.uyi cert ifcd
cote the f 14c.3800,Luh.C.1/r /J �
Policy o. _Com cany Ems/
❑ 'rtified c p}'is her by furnished. FIRE SPRINK ENERGY T-29
z Z ❑ liDi, it with Ihx 'nspecfion division.
MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
APOlican V N V N
c. y CE R'I'I FICATE OIs EXHMI'1'ION FROM WORK HRS' PERMIT ISSUANCE 10.00FLOOD zONE A.L.U.C.
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. DLG.
CL 0 This section used nor be completed if the permit is for one TOTALV❑ N❑ v ❑ N❑
Z) z hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE SUMMARY
L H mit is issued, I shall not employ any person in any manner so as to
Q 0 become subject to the Workers'Compensation Laws of California.
Date Applicant ALTER OR ADD TO MECH. 5.00HBUILDING IO-
} Da NOTICE 1'0 APPLICANT: If,after making this Cerlifcxn of Ex-
F Z emption,you should become subject to the Workeri Cmnpensation APPLIANCE 5.00 PLAN CHECK
provisions .f the Labor Code, you must forthwith comply with
U such provisions or this permil shall hedecorevoked. AIR HANDLING UNIT ITO 10=CF.M.) 4.00 FEE e
CONSTRUCTION LENDING AGENCY AIR HANDLING UNff(OVER 10=C.EM.) 6.00 SEISMIC FEE
1 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,Civ.C.). HEATING UNIT(TO 10O,000 B.T.U.) 8.00
Lender's Nan
Address
HEATING UNIT(OVER 100,000 B.T.U.)Lender's ELECTRIC
I certily that l 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 PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMP 13 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection pro.mu.
agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD.
uperlt against liabilities,judgments, is and expenses whichCONST.TAX
ay in cr se accrue against said City G con yucnc of the PERMIT ISSUANCE 10.00
ranlin MECH.CONT. LIG NO. MECH.
sIx a lb && TOTAL TOTAL �n
Signe re of Applicant/Contractor DalI
OFFICE COPY