18193 POST THIS CARD NEAR FRONT OF BUILDING •
' PERMIT NUMBER
r CITY OF CUPERTINO 18193
INSPECTION DIVISION ,
JOB INSPECTION RECORD . �r yj-
��/�A✓-� _L�� � 'OPEMI7'EXPIRATION
�—�J !
JOB ADDRESS UNIT# LO #
/'� ^p PERMIT gXPIRES`IF WORK
OWNER 'y .C� r.coNTRAcroR / A::�Z4"1!25 IS NOT, ITAf3TED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYSI.OF PERMIT ISSU-
FOUNDATION NOTE:' ANCE OR 180 DAYS FROM
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
� � � \ !�,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / F -
UNDERGROUND /SLAB. t J E
PLUMBING .. I
ELECTRICAL Is ANCE DATELI
MECHANICAL - -, ,BLDG BCT. PLG. MOCR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR ' INFORMATION
PLUMBING VALUATION(to I SIFT,
MECHANICAL
ELECTRICAL - - PfE"A"T TO \
FRAMING sK 6-�` - l
INSULATION - - STORIES TYPE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF50,FT,FLOOR AREA TOTAL ACR[AGE
,NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - > THE CONSTRUCTION TAX IS PAID
pNG
ROOF SHEATHING - UILDIUSEREs IND CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
SAN:p
ROUGH ASSESSORS PARCEL NO
� ,
PLUMBING ELECT,ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY" 7"Acr No. PARCEL NO
MECH.ENERGY
ELECTRICAL - BUILDING ENERGY -ACC.DATE ACE.FILE NO
FRAMING ELECT.FINAL TEST .
INSULATION PLUMBING ZONING ENG,SITE NO.
GAS TEST GAS
MECHANICAL, FIRESPRINK �ENERGYT24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
EXTERIOR SHEAR - ELECTRICAL RELEASE - FLOOD ZONE aL UC
INTERIOR SHEARFIRE DEPT. v❑' N❑ Y L-1. N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - a,
INTERIOR LATH TEMPORARY APPROVALS .BUILDING
SCRATCH COAT ELECTRIC PLAN ) 30
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMIST ED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICRO
FILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,.• ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLLMawc
Z .WHEN PHONING
PLEASE GIVE JOB ADDRESS .
— 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 BALL POINT PEN ONLY
� BUIDING PROJECT I DENT[FICATI ON PERMIT NUMBER -
WA�DEING APPLICATION & PERMIT 1 Q (�
"/ 5 WATT WC'1GO BUILDING - ELECTRICAL-PLUMBING-MECHANICAL I O J
NAM ♦
PNONE �� b nLA
NC
LIGATION
CITY. ELECTRIC PERMIT FEE a
CONTRACTOR'S /�Na -SWITCHES-RECEP 10.00/1.00 P4aCAIL- LIGHTING
FIXTURES 10.00/1.00 ��
CONTRACTOR'S CA"SULG49500 APPLIANCES 4.00 - t!C
ADDRE s lY
10 (f U^4 ONE `JI PANELS O.00 DATE FAPPLICATION "
ORROHIrEOT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER '
LIC.No. SIGNS TRANS. 3.00
ARCH,
on iss ENG - SPECIAL CIRCUIT. 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 ...gree �.,�yy�r,�,��•I:
APPLICANT MOTORS - SEE FEE SCH. .V1
aooREss �/Top
wri Li C SERVICE CHANGE 20.00
-00
O 0 o LICENSED CONTRACTORS DECLARATION PMD
02 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a m (commencing with Section 7000)of Division 3 of the Business and BLDG. ECT. PLG. MECH.
r w Z Professions Code,and my license is in full force and effect. 81989 ❑ ❑ .❑
zm C License Class Lie.Number -
F ,A H j Date Contractor
5 m ¢ ¢ OWNER-BUILDER DECLARATION - _ BUILDING PERMIT
- o it O INFORMATION
w ; H I hereby affirm that I vn exempt from the Contractors License MISC.- REFER TO ORD VALUATION g/FT.
LL o a Law for the following reason.(Sec.703 L5,Businessland Professions
- g PERMIT ISSUANCE 10.00
Code:Any city or county which requirese permit m constant,,also �O00
rt R ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.
e. DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
R
$ he is licensed 9(copursuant to the provisions of the ) n ivisio's License �� I1 �^
r z a Law(Chapter 9(commenCodewith Section 7s exempt
of the •a
Z 4 o Business and Professions emption that he is exempt ectio'rnm and QTY. PLUMBING PERMIT FEE
w H$ the basis for the alleged exemption.abL Any violation ofo.c[ivl malty STORI TYPE CONSTR.
e , by any applicant lira permit subjects the 0).): am toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundredproperty,
dollar,(my em:
❑ Las owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
(S
their sole compensation,will the work,and the is not
intended or offered for sale (Sec. 7044, Business andnd Professions essions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cole:The hContractor's boil,,or License Law does not apply o an owner of
himself
who builds or Improve,
emplo henna end whoat such improve.
work FIXTURES-PER TRAP 5.00 SG.FT,FLOORAREA TOTAL acREAGf
himself re through his own employees,provided that such improve
or improvement not is sold w offethin one or year e.
If,howcompletion,
thebuildingow eI GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold burden
o one year of tom diction,build
owner-
builder will have the burden of proving that he did not build or im, GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
ES
prove for purpose of the
NO CON PB Other
sale.). INDUSTRIAL WASTE INTER. 30.00
❑ as owner of the property, exclusively contacting with ❑ ❑ . ❑ ❑
licensedd contractors to construct the
project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cole:The Contractor's s License Law does not apply
to tr owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the Cons for such pensee is with a ennlractnrl s)IicenscA punu:mt To the Contractor's Sec. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ hum exempt under Sec.., for this -
reason WATER HEATER W/VENT 6.00 '
j
Owner Date WATER SYSTEM 5.001
ACC.GATE ACC.FILE NO.
WORKHRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate nl'cousenl to set Ginsure,
or a Certificate
g of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
cPolicy olic her
No"f -%0BXT, n '12Ar IVA7ouA1.
Q ❑ Certified copy is hereby furnished. nrox
z Z ❑ Certified copy is fled with the city inspection Division. - FIRESPRINK ENERGY T-24
O Applicant misc.- REFER TO ORD. Y❑ N❑ v ❑ N❑
it CERTIFICATEOFEXP.MPTION FROMWORKERS• PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COATPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG.
1 O (This Section need not be congdeted if the permit is I.,one TOTAL Y❑. 'N❑ Y❑ N❑
Z) Z hundred dollars IS 100)or IessJ
U O 1 certify that in the performance of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued, I shall not employ any person in any manner so as to
O W become subject to the Workers'Conlpensat inn Laws of California.
C. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 0�
} Car NOT'IC17 TO APPLICANT': If,after making this Certificate of Ex- -
? 4 .
emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CUECK
U
pr
pmvisi nslor hers permit sie Lor hallou must orthwith M1e deem ed revoked�omply with AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE 30
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE e50 '
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the we for which this permit is issued(Sec MICROFILM
3097,CiL.C.). 11 p�e HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name xx HEATING UNIT 100,000 B.T.U.19.50 ELECTRIC
Lender's Address
1 cel il'y that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information n correct. 1 agree In comply with all city and county BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
information
and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,0006TU)SEE FEE SCH. MECHANICAL
hereby entio ri property Itativot spot this
purposes
(We) agree to saveA indemnify and keep harmless the City of MISC.- REFER TO ORD.
upernino agains li hies,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any rue against sail 6ity,in consequence of the
rantingSoy h pe L �/���r�y� MECH.CONT. LIC.NO. MECH.
Z-2e- TOTAL TOTAL Q0
Signalurc of Applicant/Contractor Data �I u"
OFFICE COPY