18866 POST THIS CARD NEAR FRONT OF-BUILDING PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
• / r�'y1
ERM IT,EXPIRATION
JOB ADDRESS O'
�( — ( V��' � DSU N IT# _LOT#
PERMIT
OWNER W CONTRACTOR IS NOT STAR ED WIT HIIN
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
GARAGE SLABS
CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,-kk o
UNDERGROUND /SLAB
NOV,v. 1 J
PLUMBING �,� .nn•1
'IJU.� ` �`�• yt . t I
ELECTRICAL
ISSUANCE DATE
MECHANICAL U'R BLOB ELECT. PLc. mew.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING"PERMIT
-WOOD FLOOR - INFORMATION
PLUMBING VALUATIONC4 S/FT..
MECHANICAL ?)"" _
ELECTRICAL PERMIT To
FRAMING IL
INSULATION STORIES TYPE Co
NSTR
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
K } �` " ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE SIL FT.FLOOR ARIA TOTnL AaRFAGI
�1tx DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING BUILDING USE
RES IND CON PB Oma
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FJENERG
DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH • ASSESSORS PAHCEL NO.-
sAN.a
PLUMBING ELECT.E
TUBS&SHOWER PAN PLUMBINTRACT NO. PARCEL NO
MECHANICAL MECH.E -
ELECTRICAL BUILDIN - ACC.DATE ACC.FILE No
FRAMING ELECT.F
INSULATION PLUMBING ENc.BITE NO.
GAS TEST GAS
MECHAN - EIRE SPRINK ENERGY T"2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGY ❑ N❑ Y ❑ N❑
EXTERIORMABOVE
ELECTRISE FLOOD ZONE A.L,UC,
INTERIOR FIRE DEY ❑ N❑ Y ❑, N❑
SHEETROCGRADEEXTERIOR FEE SUMMARY
BUILDINGvn
INTERIOR TEMPORARY APPROVALS BUILDING
'• SCRATCH CELECTRIC PLAN CHECK J
GA$ FEE
NO TAPE OD OCCUPANCY SEISMIC FEE Ej
OCCUPANCY OF BUILDING IS NOT PERMITTED UN TIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. .
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� 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
CALLING FOR FINAL INSPECTION. YT. p
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION ,PERMIT NUMBER
AUILDING - - APPLICATION & PERMIT ^ n
/°105)111</ ooREss b b
W• L�S'7N73r5 /�/z BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER
$
NAME PLAN CHECK VALIDATION
ZS3 8-I CITY ELECTRIC PERMIT FEE 2.155
PHONE
CONTRACTOR'S fJf r`\\J1• /F l
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 I11f-)
S e LIQ LIC.No, LIGHTING FIXTURES 10.00/1.00
nooeessroas PPLIANCES-RESIDENTIAL 4.00
5/1 wf /r PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
on PANELS (OVER 200 AMPI 20.00 -
ENGINEER.,,,q
15 LICNO SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 / T
ADDRESS
APPLICANT
MOTORS SEE FEE SCH. J
O Q W• Cj ng rq5 plp. SERVICE CHANGE 20.00
Foo LICENSIiD CONTRAC'Ib RS DECLARATION _ �y
a i u I hereby apron that I am licensed under provisions of Chapter 9 "4J%I V ISSUANCE DATE
As 3 m (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r D z Professions Code,and my license is in full force and effect.
ozwo License Class Lic.Number UV 1 J IyZiJ ❑ ❑ ❑
m F Dale Contractor 14
Q w a OWNFR-BUILDER DECLARATION BUILDING PERMIT
w- o A 0INFORMATION
g LL H I hereby affirm that 1 am exempt from the Contractor's License MISC.- r jtREFE'R'TO(b RD
u O j Law for the following reason.(Sec.703 1.5,Business and Professions VALUATION S/FT.
L- - PERMIT ISSUANCE 10.00
Code:Any city or county which requires a perms to construct,alter,
Sc
a, ,= 40 improve,demolish,or repair structure.prior to its issuance,also ELEC CONTR. LIC.NO.
O LL requires the applicant for such permit to file a signed statement that TOTAL MI
A w m Ire is licensed Pursuant to the provisions of the Contractor's License PERT TO
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the /�
E z O Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE A_
L.CJV L-.
1-m the basis for time alleged exemption.Any violation of Section 7031.5
w ; � by any applicant for a permit subjects the indicant toacoil Penalty STORIES TYPE CONSTR.
of not more than five hundred dollar,($5000.) ALTER-DRAIN& VENT-WATER (EA.) 5.00 •
❑ 1,as owner Elf the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended Or offered for sale(Sc,,. 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
properly who builds Of improves thereon,and who does such work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own enl Pluyees,Provided that such improve-
mentsarenotinteidedorofferedforsale.Il',however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or am- BUILDING USE
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar
❑ 1,as owner of the property.am exclusively contracting with .
El D El 0
and sedPro contractor,odro The
the project(Sec. 7044, Business LAWN SPRINKLERS-1 INC5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cade:The Contractor's improv 'th docs not apply
to tr owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
controls for such projects with a conlrclorl sl licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL No.
❑ 1 am •xemP1 1,2 See -,BAP.C.lin this 6.00
reuseWATER HEATER W/VENT
Owner Later Er_-ry WATER SYSTEM 5.00
WORKIiRS'COMPGNSA'f10N DECLARATION WATER TREATING EQUIP-5 00 ACC.DATE ACG FILE NO.
I hereby affirm that I have a certificate ol'crnrse nt to self-insure,
or a certificate of Workers'Compensation Incur nee,or a eerlined ZONING ENG.SITE N0.
copy thereof(Sec.3800,W b.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished.
Z 2 ❑ Certified copy is filed with the city inspection division. FIRE SPRINK ENERGY T-24
F O Applicant MISC.- REFER TO ORD. Y ❑ NE) Y ❑ NEI
CC T CERTIFICATE OF IiXEMP1'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U,C.
W D COMPENSATICIN INSURANCE PLG.CO TR, LIC.NO, PLG.
CL0 (Phis xclum need no[ be completed if the permit is for one TOTAL Y N Y E] N�
2 h u n red dollars IS 100) -tIcu,.)
U O I certify that in the to employ
of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person'In any manner so as m
U become subject to thnm
e Workers'Copensat ion Laws of Cnliforniu.
OQ. Dat` CANT:nl ALTER OR ADD TO MECH. 5.00 BUILDING nC
W 4�
} w NOl'ICIi TO APPLICANT:ICANT: II,alter making this Certificate of lix-
? emption,YOU should become subject to the WorkersCompensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will(
U such provisions or this permit shag be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONS'('RUCTION LENDING AGI?NCY AIR HANDLING UNIT(OVER 10fMC.FM.) 6.00 SEISMIC FEE , FrV-%
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 pernmit is issued(Sec. MICROFILM
3097, 's Name).
7,, HEATING UNIT(TO 100,000 B.T.U.) 8.00
309Na
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify Thal l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
. information is correct. I agree to comply with all city and county PLUMBING
ordinances and state Idws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby autimrile representatives of this city to enter upon Ole
above nteationed property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree W save, indemnify and keep hanaluss the City of MISC.- REFER TO ORD.
uperlino against Iiabilitics,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ran oft ar1y.CGl.ndtf MECH.CONT. LIC.N0. MECH.
Ga [_/�"/_` /)- tl. ?7 TOTAL TOTAL
S dature of Applicant/Contractor Date 7�•J V
OFFICE COPY