14572 POST THIS CARD NEAR FRONT OF BUILDING \
PERMIT,NUMBER
CITY OF CUPERTINO 14572
_ INSPECTION DIVISION
JOB,INSPEC'LION RECORD
- / - / _ PERMIT EXPIRATION
' JOB ADDRESS 7�Od' rQ��e� L¢c'1 Ln7 UNIT# ' _LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR Sk C.eO,. IS. NOT'STARTED WITHIN
INSPECTI DATE INSPECTOR I PECTIO RECORD 180 DAYS OF PERMIT ISSUE -
FOUNDATIONANCE OR 180 DAYS FROM
- " NOTE: LASTCALLED INSPECTION. .
LIFER _ ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE ` '" - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION. -
CUPERTINO STANDARDS. - -
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - - ��.�;. •�;,�
UNDERGROUND./SLAB
PLUMBING - - Wag
i /Y�
' ELECTRICAL, � � 'Issu NCE uare - e.
MECHANICAL.. - BLOC. %ljv.T) PLC. MECH.
,. DO NOT.POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - _ PERMIT
FORMATION
WOOD.FLOOR - _ vawATION +asTET.
' PLUMBING
MECHANICAL
ELECTRICAL y PERMIT TO .
FRAMING
INSULATfON STORIES TYPE CONSTR,
OCC.GROUP -RES.UNITS. .
'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - 'r
f; ROOF NOTENO FINAL INSP.SHALL BE MADE BEFORE So IT,PLOOR AREA - TOTAL ACREAGE,
THE CONSTRUCTION TAX IS PAID f
DIAPHRAGM - - _ `. '-
BUILDING USE
ROOF SHEATHING - • HEs �, IND -ON Pe om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. . ❑ '❑ -El Ll ASSESSORS
- a55E550R5 PARCEL NO.
' ROUGH SAN.q
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN . PLUMBING ENERGY
MECHANICAL MECH.ENERGY
P�
ACC DATE ACC.RLE NO;
ELECTRICAL - - BUILDING ENERGY
FRAMING ELECT.FINAL TEST'.
INSULATION PLUMBING I/��', ZONING ENG.SITENo,
4
GAS TEST - GAS d, FIRE sPRwrc ENERGY T 2 .
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y El -"� 'T ° ❑ N[]
' SHEAR EXTERIOR ELECTRICAL RELEASE FLOOD
INTERIOR SHEAR FIRE DEPT. - Y ❑ N❑ ° �❑ N❑'
SHEETROCK ' GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
_ - TEMPORARY APPROVALS - BUILDING
INTERIOR LATH ---c.
SCRATCH COAT ELECTRIC PLAN CHECK
FEE 9 '
' GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BU ILDINGISNOTPERMITTED UNTILBUILDING FINAL I SSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
"7 Z
- SEE PERMIT FOR EXPIRATION DATE - ` MECHANICAL .
IMPORTANT!. CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL' J
CALLING FOR FINAL INSPECTION. / -
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER -
BU,LOING APPLICATION & PERMIT G
45 ^
ADDRESSlip 4
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I
gvNER'S PLAN CHECK VALIDATION
NAMSITY. ELECTRIC PERMIT FEE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
tl`70.4 uC.NO. 7 LIGHTING FIXTURES 10.00/1.00
CONTRACTOI s APPLIANCES-.RESIDENTIAL 4.00
ADDRESS !
7 PRONE /) PANELS - 10.00 DATE OF APPLICATION'
ooac"IT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE - .C:NO.
ENGINEER
' LIC.No. SIGNS TRANS. 3.00.
ADDRESS ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT S
ADDRESS MOTORS SEE FEE SCH.
p
SERVICE CHANGE 20.00 - �r
,00 LICENSED CONTRACTORS DECLARATION 0 D - o
< u I berehy affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w (Cmmmencing with Section 7000)of Division 3 of the Business and BLD(;. ECT: - PLG. MECH-
D �m
z Professions Cod (llcenw is in full In,
z i F LiccnLic.Numin
g Dam Contractor
ING'PERMIT
rt w u OWNER-BUILDER DECLARATION FORMATION '
d0a MISC.- REFER TO ORD
w ; LL's I hereby affin{I that I um exempt from the Contractor's License VALUATION E/FT:
FLLos, Law for the following reason. 7031.5,Bronessand Professions PERMIT ISSUANCE 10.00 ,
Code:Any city or county which requiresa permit toconslrucL allef, � 000
a,¢ ¢ 22 improve, or repair any structure,prior to its issuance.also ELEC.CONTR. LIC.NO. ELEC.
n
O u requires the applicant for such permit to Ek a signed statement that TOTAL PER IT TO
whe is licensed 9(ocanrmthe provisions of the Contractor's3 fth, _
Business
(Chapter and
Profession,
ingwilir that he is exempt
Dthereo3 and -
a Business end Professions Cort)or that he is exempt chef 0 and OTV. PLUMBING PERMIT FEE
$ the basis for the alleged exam prion.Any applicant
of Section malty STORI B TYPE CONSTR.
n ; _ by any applicant fora hundred
dollars the 0).): am loacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundmJ Dollars($500).1: - -'
_ ❑ 1,as owner of the P,uNHy,or my employ cs with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7144, Business and Professions DRAINS-FLOOR,ROOF,AREA,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 SG.IT.FLOOR AREA TOTAL ACREAGE
• himself or not
ownemployees,for Sale.
If,ho ever,the
improve--
Rent,
GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
mems are not ugh his or offered tar sa 1c.If,ed that s the building _
or improvement is sold within one year of completion,the owner' GAS-EA.SYSTEM:OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
proveforpurposecfsalef. INDUSTRIAL WASTE INTER. -30,00 RES IND CON PB Deer
O 1,as owner of the pinpery,am exclusively contracting with ,❑ •❑ ❑ ❑ ❑
licensed contractors to construct lire project(Sec. 70,14,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESS RS PARCEL NO.
and Profusion,Cede:1he Contractor's License Law dines mol apply
to an owner of property who builds or improves therein.and who LAWN SPRINKLERS'-OVER 5(EA.) 1.00
contracts for such projects with a conlraclurls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,R.&P.C.for this WATER HEATER W/VENT 6.00 `
reason
Owner Dal, WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
N'ORKRRS'-COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificne of consent to self-mn 111, ZONING ENG.SITE NO.
or a ee','rttiiflyate f rkcot Compe00,L1h.C) (n'fmhon I sura ) c olid
co,
folic u_ Contpuny
O ❑ Cerifiedeo is hereby furne,hed FIRE SPRINK ENERGY T-24
Z ZOcJnnifie� file it a city inspection division. MISC.- - REFER TO ORD. Y ❑ N N V
❑ ❑ ❑
N CERTIFICA I'EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LUA.
W COMPENSATION INSURANCE PLG.CONTR, uC:NO. PLG. Y❑ N❑ Y N❑
CL Z 1 'fhis section need not be completed if the permit is for one TOTAL
hundred dollars(S 100)or less.)
U O 1 certify that in the performance of lire work for which this per- QTY MECHANICAL PERMIT - FEE FEE SUMMARY
LL 1- frit is issued,I shall not employ any Person in any manner so as W
U heroine subjectfo Ihe�Workcrs'Compcnsal len Laws of California.
0 a Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: It.after making this Certificate of fix
? emption,you Should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE ----
U, such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTR DCI'ION LEN DING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE S_J.
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the per97, formance MICROFILM
ince of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00
L0ender's Name ' H EATI NG UNIT 100,000 B.T.U.)9.50
Lender's Addmss ELECTRIC
I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information n curate[. I agree to comply with all city and county PLUMBING
o formatio and state laws relating c m building ,city an ion. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorirc representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
strove-mentioned properly for inspection purposes.
'k (We) age sav indemnify and'keep harmless the City of MISC.- REFER TO ORD.
upert again abilities,judgments,costs and cx rues which CONST.TAX -
n an y accrue ago*,tl
CITnce of thePERMIT ISSUANCE 10.00anon his permit MECH.CONT. LIC.NO. MECH.
TOTAL TOTALApplicanl/Contrds ate K
OFFICE COPY