15683 POST-THIS CARD NEAR FRONT OF'BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15663
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS_7 /— �FL(_E--/l/ZL�iJ� �� UNIT# LOT# PERMIT EXPIRATION
( � PERMIT EXPIRES IF WORK
owrvER C n/ /'�C
GSQ—T411 CONTRACTOR • IS NOT STARTEDWITHIN
.
INSPECTION I DATE SPECTOR ,INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION y NOTE: ANCE OR 180 DAYS FROM
- '
LEER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTI ON'.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PBHK9, VALUATION
CUPERTINO STANDARDS.
GARAGE SLABS I '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL - BLDG. ELECT.I PLG. .MECH..
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .. BUILDING.PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION ,S/FT,.� � - - .
MECHANICAL C,
PEHM1LI TO
' ELECTRICAL
FRAMING - p0 q—c
`—
INSULATION - STORIES TYPE CONSTR.
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO rl.FL.IP AneA IOTALACHLACL
•� ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
. ROOF SHEATHING - RES INODILO CIO
usEPB . O,I
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS YAH
RCUGH SAN.a CEL NO
PLUMBING ELECT.ENERGY -
TRACT NO. PARCEL NO
TUBS BSHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACC,FILE NO
FRAMING ELECT.FINAL TEST. '
ZONING {NG.SITE NO.
INSULATION , PLUMBING -
GAS TEST GAS _
MECHANICAL FIRE SPRINK ENERGY T.24
'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L u.C,
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ ` ❑ 'N❑
SHEETROCK - GRADE '
FEE SUMMARY
EXTERIOR LATH IBUILDING - -
INTERIOR LATH - BUILDING UILDING
PLAN CHECK CKSCRATCH COATELECTRITC
_ GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILD ING INSPECTOR. MICROFILM
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC aceet
. 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.
OFFICE COPY''
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
BU LDING PROJECT IDENTIFICATION ^PERMIT NUMBER
BUILDING
IS APPLICATION & PERMIT 15683-[. Qrj
ADDRE / I J 6 0 J
I BUILDING — ELECTRICAL—PLUMBING—MECHANICAL �'
OwnER'S PLAN CHECK VALIDATION
CITY. ELECTRIC PERMIT FEE
Imo- PHONE
NAMERAcrORs UTLETS-SWITCHES-RECEP 10.00/1.00 ,�. —
Lm.No. - Z LIGHTING FIXTURES 10.00/1.00 6
CONTRACTORS
croR's
ADDPPLIANCES-RESIDENTIAL '4.00
Z
PHONE PANELS 10.00 DATE OF APPLICATION
OR
RCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .C.N
ENGINEER
LIC.No, SIGNS TRANS. 3.00 _
ADDRESS E"O' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS
APPLICANTS MOTORS SEE FEE SCH.
SERVICE CHANGE 2000
o o LICENSED CON'I'RACfORS DECLARATION - •
Is
o U I hereby affirm that 1 um licensed under provisions of Chapter 9 SSUANCE DATE
z w (commencing with Section 7000)of Division 3 of the Business and
G ¢ ELECT PLG. MECH.
F D i Professions Code,and my license is in full force and effect. ❑' ❑ ❑
a, 0 2 — License Class Loc.Number , -
O w F w
Due—Contractor
a Y 5 ' BUILDING PERMIT
¢ a n u OWNER-BUILDER DECLARATION INFORMATION
wN I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
.. 0 sf Law the following reason. 70it.5.Business Rofessions PERMIT ISSUANCE IU.0 _ VALUATION 5/FT.
� —
Code:Any city or county which requires a permit to construct,alter.
¢ R s- 0 improve,demolish,or repair any structure,prior 10 its issuance,also ELEC.CONTR. LIC.NO. ELEC. (�
D ¢ requires the applicant for such permit to plc u signed Statement that TOTAL L PERMIT TO
w 9 he is licensed pursuant to the provisions of the Contractor's License
ri > I:uw(Chaptcr 9fcommcncingwith Section]000)o(Divisiun3ofnhc
¢ Hminess oJ Professions erae1 or that he is exempt therefrom and DTV. PLUMBING PERMIT. FEE t
a.=$ the basis for the alleged exemption.Any applicant
oto aclinn en LS STORIES TYPE CONS-rR,
a ; _ by any applicant fora permit subjects the upplicanuoacivil penalty ALTER-DRAIN 5.06
of not more than five hundred dollars 155001.]: - . -
❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sok compensation,will do the work,and the structure Is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 BO.FT.FLOOR AREA TOTAL ACREAGE
honsadf hrough
mnus are
not
ownemployees,for sale.If,ed that however,
the
improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
meets are not intended or offered for Salo.If,however,the building
or improvement iswithin one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 200
builder will have thee burden of proving that he did not build or ins- - . - . . BUILDING USE
Prove for purpose of the.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PR other
❑ d as owner of the property,am exclusively(Sec,
contracting with ❑
and Pro colons od m eeContra the percent(Sec. ]044,Business LAWN SPRINKLERS- 1 INC 5 V.B. . •6.00 ASSESSORS PARCEL NO.
and Professions Of Codegrope The who
intlooscense s th docs not apply
III contracts
o tr owner of property who builds r improves thereon. smind Io LAWN SPRINKLERS-OVER 6 (EA.) 1.00
the Contractor's ts
comructods)licensed punuumm SEWER-SANITARY-STORM EA.200ft/10.00
the COnIrJLInfS License Law. I TRACT NO. PARCEL NO.
_ ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
\/ reason
�r Owner Dale WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORK ERS'COAIPENSA'I'ION DE:LnRATION WATER TREATING EQUIP. 5.00
I hereby affirn that I have a certificate of consent to self-insure.
or a certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lxb.C.). - -
['nlicy No. Company
O ❑ Certified copy is hereby furnished.
z FIRE SPRINK ENERGY T 2
Z ❑ Con ificd copy is plat with fres airy impcction dlvisiml, MISC.- REFER TO ORD.
O nnNicam �y� NyO rv[:]
F— est PERMIT ISSUANCE '10.00
LU 'CI!RTIPICA COMPENSATION
INS PROMS WORKERS' FLOoo ZONE A.L.u.C.
CL COMPENSATION(NSU RA NCI[ PLG.CONTR. LIC.NO. PLG.CL y-� rv� V � rv❑
Z) _ (This section not he campleteJ it the permit is for one _ TOTAL
hundred Jollurs(5S 10 10 0)or kss.l
U O 1 certify that on the performance of the work for which this per, CITY. MECHANICAL PERMIT FEE FEE SUMMARY
EL Umit is issued,I shall not employ any psoam in any manner so as to
become subject to the Workeri Compensation Laws of California.
a Dales ApplicantBUILDING
} w No nCE TO APPLICANT: If,aner making this Cenirteate of Ex- ALTER OR ADD TO MECH. 5.00
F" ? cmption,you should become subject to the Workers'Compensation APPLIANCE s 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)000C.F.NL) 4.00
CONS'l'RUCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 - SEISMIC FEE
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,Civ.C.). - HEATING UNIT(TO 100,000 B.T.U.), 8.00
Lender's Name H EATI N G UNIT(O V ER 100,000 B.T.U.)9.50 _
Lenders Address ELECTRIC .-
I certify that 1 have read this application andstate that the above VENTILATION FAN (SINGLE) . 4.00 ,
information is correct. I agree to comply with all city and count Y' PLUMBING
ordinances and state laws relating to building construction, and BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize roperty natives of this city m enter upon the BOILER-COMP (Oxer 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purl nscs.
(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
may in any way ac m alnst said Cly in consequence of the PERMIT ISSUANCE 10.00
•ra this pe ti MECH,CONT. - LIC.NO. - MECH.
TOTAL TOTAL
I i o p u inns ur )ate
OFFICE COPY