14877 r
POST THIS CARD NEAR FRONT OF BUILDING
,PERMIT NUMBER '.
CITY OF CUPERTINO r „S
,. INSPECTION DIVISION 4877
JOB INSPECTION RECORD
JOB ADDRESS PERMIT EXPIRATION
�9-�L- G�T UNIT# _LOT# v
e n✓r. �T PERMIT EXPIRES IF WORK
DINNER A},�[ �dLC' ` LTAe r� CONTRACTOR 7_4r IIS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I-- INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERM114T VALIDATION
GARAGE SLABS CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (C5-3 -8S, tlpb nkr> > oq,rrIJa1V Elk.
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL p D ISS rvcE PArE
MECHANICAL eL��o.yyc�p ({LE , Lc MECH.
'1 Y` 0
DO NOT POUR FLOOR UNTIL'ABOVE HAS BEEN SIGNED. •„'' gµ�pDING.FERMIT .
WOOD FLOORIf, !`IIO'K014MAT100
w ,
PLUMBING _ riti / VALUATION grFT.
MECHANICAL _ (p�etm
ELECTRICAL PERMIT TO
FRAMING
INSULATION ✓,� ... ,��,,,,� STORIES rvvE CCC TR.
• y ,n�� v C �r(yC.GROUP S.UNITS
PLACE NO SUBF.000R UNTIL ABOVE HAWBEEN SIGNED± / J ` J1 I/
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.ET.rLOORAREA TOTALACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHINGBUILDING USE -
^ RES IND CON PEI Olner'
APPLYrNO ROOFING,UNTIL AB VE HAS,BEEWSIGNEDc`S FINALS A rDATEas ;rINSP,, ;rL
❑ ❑ ❑ ❑ ❑
ROUGH SAN.# /-/L,>-,S' ASSE--- 11ARCEL
PLUMBING r ELECT.ENERGY
TUBS&SHOWER PAN - PLUMBING ENERGY pTRACT NO. PARCEL NO_„�
MECHANICAL MECH.ENERGY OlI *'�`""
ELECTRICAL pj- - BUILDING ENERGY IAcc DATE Acc.PILE No.
FRAMING ELECT.FINAL TEST
INSULATION 0 PLUMBING I L
ZONING ENG.SITE NO.
GAS TEST 10/18
GAS
MECHANICAL EIRE SPRIrvry ENERGY TaA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED IHEATING ❑ "❑ ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE aaoo zaNE A.L.0 c.
INTERIOR SHEAR FIRE DEPT. v❑ N❑ Y ❑ N❑
SHEETROCK
GRADE
'�x�:,syj�FE_ESUMINAHY' +
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING UJa I
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY _ SEISMIC FEE /
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM,
• ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC (o -
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING (o
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL (,
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE Q
cz
CALLING FOR FINAL INSPECTION. TOTAL /ap
OFFICE COPY
APPLICANT TO-FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
FPLAN
NUMBER
gDILDING PROJECT IDENTIFICATIONLaT3 APPLICATION & PERMIT
50ILDING
AEpO BUILDING-ELECTRICAL-PLUMBING-MECHANIC8
7
]
GINNER
LT DI{�- qo8 DTVELECTRIC PERMIT FEEATION
l(�FLint4 PHONE,(
CONTRACTOR �./{ - OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME T -7
Q,� LC,NUl& 'LIGHTING FIXTURES 10.00/1,00
CONTRACTOR'S�/JOO E yi{ 0 PPLIANCEB-•RESIDENTIAL 4.00 - -
✓ ADDRESS // q /J
10 S; SIL G PHONE pC 'O PANELS 10.00 DATE OF APPLICATION -
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR �11
/I\ ENGINEER Ln" ♦ /I,., -,
ICA Y �X,,� uc.No SIGNS TRANS. 3.00
ARCH,OR ENG. 5.00
PERMIT VALIDATION
y ADDRESS Z�p� S-N S C'2K. SPECIAL CIRCU IT
-\ C 4S? i4 iIv EMP-METER OR POLE INS. 20.00 ,--�
ADDRESS
A00RESS is MOTORS SEE FEE SCH.
Ed
SERVICE CHANGE 20.00 -7 /p7
F
000 LICENSED CONTRACTORS DECLARATION L U
a i w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(cOmmPncing with Section 7000)Df Division 3 Df the Business and BLDG. ELECT. PLG. MECH.
mi Professions Cod amt my license Is In foil for d ff t.
z o m - LiceI Class _ Lic.Numbc-�� .0�
9 m r ° Date Contracmr BUILDING PERMIT
aw u OWNER-BUILDER DECLARATION - INFORMATION
w 3 n y I hereby affirm that 1 am muATION $/FT.
exempt from the Contractor's License MISC.- REFER TO ORD
u04 Law for the following reason.(Sec.103 1.5,Business and Professions PERMIT ISSUANCE y
w w� Code:Any city or county which requires permit to construct,alter,
2
42 improve,demolish,or repair any stmclum,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
D u requires the applicant for such permit to file a signet)statement that TOTAL PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License y�
rii Law(Chapter 9(commencing with Section 7000)ofDivision 3oftlic ��-L.Iw�
4 Business and Professions Code)or)hal he is exempt therefrom and DTV. PLUMBING PERMIT FEE
r$ STORIES TYPE CONSTR.the basis for the alleged exemption.Any violation of Section 7031.5
by any applicant lora permit subjects the applicant loacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 ul`'.f/,6�2.
of no it than five hundred dollars(8500).): -
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is hot Q
intended or offered for.sale(See.7044, Business and Professions DRAINS-FLOOR,ROOF,ARENCOND. 5.00
Code:The Contractor's License Law does not apply'0
an owner of
property who builds ur improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself'or through his own employees,provided that such improve GAS-EA.SYSTEM-1 6.00
ments are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int .- RES IND CON PB .Omer
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 ❑ ❑
❑ 1,as owner of the property,am exclusively contracting with 19
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Code:The Contractor's License Law does not apply ')
pply `i1 0 O/
m an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 (V L L14
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT N0. PARCEL NO.
❑" lam exempt under See ,B.&P.C.for this WATER HEATER W/VENT 6.00 g/,' 7
remon
Owner Date WATER SYSTEM 5.00 PCC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or n certificate of Workers'Compensation Insurance,or it certified
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
Z Z� ❑ Certifiedcopyeby furnished. y FIRE SPRINK ENERGY T-24
Certified 1 0�islaws yin t. Ivusiun' MISC.- REFER TO ORD. y N Y � N❑
O(' A plicunl
tn` � � PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
� - \ CIiR'fI FICATEPHN XA IO INSU R N WORK CRS' p
L - COMPENSATIONINSURANCIi PLG.CONTR. uCNO. PLG. [� Y� N� YO NO
CL o (This section need not be completed if the permit is for one TOTAL
0 Z hundred do1lars($100)or less.) '
U O I certify that in the performance of the work for which"his per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,1 shall not employ any person in any mmnner so as to ..
Ow become subject to the Workers''Compensation Laweof California. BUILDING �O�
Date -Applicant ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificxle of Ex,
Fz emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK '.
provisions of the Labor Code, you nwst forthwith comply with FEE
such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=r-F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CEM.) 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.). fN iL 2QJ`�_ HEATING UNIT(TO 100,000 S.T.U.) 8.00 /
Lender's Name� s� r Y� HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 7(O�
Lender's Address,'+- ."-�CC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4:00 ^/
i informmiom:is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING /W
ordinances and.state laws relating to building construction, and / j
r hereby au0iorue representatives of this city to enter upon the FEE SCH. MECHANICAL 7v J
r above-mentilmed property for inspection Puos
rpes. BOILER-COMP (Over 100,000 BTUI SEE,
(We) agree to save, indemnify and keep harmless the City of MISC. REFER TO ORD. ,ol�
- upeHlpn against liabilities, n15, costs and expenses which PERMIT ISSUANCE to ^ CONST.TAX P
may in any way ac r e a ms" s id C' consequ ce of the
mall r A MECH.CONT. LIC.NO. MECH.
rs,f 7 ��'8 TOTAL T(p 9 TOTAL d0
f�Y' Signa rs of Applicant/Contractor ate
OFFICE COPY