15510 POSTTHISCARD NEAR FRONT,OF BUILDING '
PERM IT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
e, JOB INSPECTION RECORD
t RT� 43)
PERMIT EXPIRATION
JOB ADDRESS_S9-1SL�LL� D UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER '1.�I T I Y ll� CONTRACTOR IS NOT STARTED WITHIC
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU+
FOUNDATION 1 . , - AN(P�D0 DAYS FROM..
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF juNP7
MI, TION
GARAGESLABS
CUPERTINO STANDARDS.
� -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDCit'Lof Coperuno
UNDERGROUN /SLAB - O - '�1 ;� •IYL.r-1Vt-�- U
PLUMBING ;, 1 ✓� j;.�
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT I PLG. YECH
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
-
MECHANICAL
ELECTRICAL PERNII TO
FRAMING '" - (('..-T
INSULATION STORIES - TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL)NSP.SHALL BE MADE BEFORE so IT ELooR ARFA Tornr..ACREACF
v. DIAPHRAGM THE.CONSTRUCTION TAX IS PAID
ROOF SHEATHING _ BUILDING USE
RLS IND CUN PB 0"',•,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑" ❑
ROUGHSAN.N - ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO.
FRAMING ELECT.FINAL TEST
INSULATION. PLUMBING ZONING ENG,SITENO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGYT.2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N ❑ N❑
EXTERIOR SHEAR ELECTRICAL EE FLODOZONE A.Luc.
=LATH
- FIRE DEPT. Y ❑ ' ,E) T ❑ N❑
GRADE
FEE SUMMARY
BUILDING
TEMPORARY APPROVALS eulLDwc
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 ( i
~ ONE WORKING DAY BEFORE REQUIRED INSPECTION.
�� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
— SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. ' t`l
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMITNUMBER
BDtLDING P_ ,3 APPLICATION & PERMIT [[ 1 O
ADDRESS J J I
� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
wME 'S
NAME PLAN CHECK VALIDATION
� QTV. ELECTRIC PERMIT FEE
L� HDNE S" o
NAMpRAcroRs CQ UTLETS-SWITCHES-RECEP 10.00/1,00 AW
u c.No. LIGHTING FIXTURES 10.00(1.00
CONTRACTORS _ APPLIANCES-RESIDENTIAL 4.00 - -
(/ PANELS 10.00 DAT ATION
ARCHITECT PLAN CHE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCHEOR ENG. SPECIALCIRCUIT 5.00IT ALI
ZIP EMP.METER OR POLE INS. 20.00
Scity of Cupertino
ADDREDRESSS
ADMOTORS . - SEE FEE SCH.
•-rte
SERVICE CHANGE 20.00 KQJ MUI40fr- I
o¢ i p p
Hoo LICENSED CONTRACTORS DECLARATION
u I hereby affirm than I not licensed under provisions of Chapter 9
Z i ISSUANCE GATE
(commencing with Suction 70001 of Division 3 oC the Business and
BLDG. ELECT. PLG. MECH.
Professions Cod 1.a license is in full for',,�ggq y
z o m License lu�s �_Lia Nwnhc ( E]
w w Dare
Contractor
w a OWNER-BUILDER DECLARATION
BUILDING PERMIT
a 0 0 - - INFORMATION
is ;a I hereby affirn that I am exempt from the Contractor's License MISC.- REFER TO ORD
F .. o j Law for the following reason(Sea 703 L5,Business and Professions PERMIT ISSUANCE12--1e'ee 12.0 VALUATION $/FT.
Code:Any city or county which reyuiresa permit toconstrud,alter,
improve,dernmislL or repair any structure,prior to its issuance,also ELEC.CONTR. LIC:NO. ELEC.L r oU
ac K LL requires the applicant for such permit to file a signed statement that
w he is licensed pursuant to the provisions of TOTAthe Contractor's License - PERMIT TO
F z a
Law(Chapter 9Commencingn'ith Section 7000)of Division 3 ofthe dF:/t-`(
4 O Business and Professions Code)or fled.he is exempt therefrom and QTV. PLUMBING PERMIT FEE 1_I IS- 1
W H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
dam _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5,00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will do the work,and th . .
e structure is nut OCC.GROUP RES.UNITS
intended or offered for sale (Sce. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law docs nor apply to un owner of
property who builds or 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-
ments are not intended or offered for sale,If,however,the building GAS-EA.SYSTEM-1 1NC.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 ire- BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ 1,as owner of the Property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 13 ❑ El El
contractors tO construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V-B. 6.00
and Professions Codc:The Contractor's License Law does not apply ASSESSORS PABCEL NO.
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA-1 1.00
contracts for such projects with a eontraetorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B.&P.C.fur this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACO.FILE NO.
WORK E RS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm filar I have a certificate of consent to self-insure,.
in a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See 3800,Lab.C.).
Policy No. _ Company
O ❑ Certified copy is hereby furnished.
Z Z ❑ Certified copy is filed with the city inspection division. FIRE SPRINK ENERGYT.24
P O Applicant MISC.- REFER TO ORD. v NEI v ❑ N[:]
ir rA CERTIFICATE OIs EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COhIPF-NSATION INSURANCE PLG.CONTR. LIC.NO. PLC.
d O (This dollars r10 not be Completed if the permit is fire one TOTAL V❑ Np Y❑, NE
0 Z
hundreddollars
that(SI 001 or less.)
U O I certify that in rhe Performance of lire work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL mil is issued,I Shull not employ any person in any manor so as to
became subject to the Workers'Compcnsurion Laws of California.
°' Date-ApPI«am ALTER OR ADD TO MECHBUILDING
>_ N NOTICE TO APPLICANT: If,after m .-taking rills Certificate of Ex- 5.00
F ? emption,you should become subject rn the Worker.Compensation APPLIANCE 5.00 PLAN CHECK
provisions-of the Labor Code, you must forthwith comply with
U such provisions or this permit shell be deemed revoked. AIR HANDLING UNIT(TO iOMC.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000GEM.) 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.
3097,Civ.C.L HEATING UNIT(TO 100,000B.T.U.) 8.00 MICROFILM
Lender's Name f�!�
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC i� slA-/
I certify that l have read els application and stn -,I, lb- us, VENTILATION FAN (SINGLE) 4.00
mdunccs is correct I agree to comply with uli city anfi county PLUMBING
Ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby autlmriee representatives ofthiscity W enter upon the
above-memioneJ property for inspection purposes. BOILER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harm Ws the City of MISC.- REFER TO ORD. '
Cupertino against liabilities,judgments, costs rend expenses which - CONST.TAX
may in any vay accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ran ng oft is erre it '
MECH.CONT. LIC.NO, MECH.
TOTAL TOTAL j�
ria are o plicant/ ontraaor Date I LV rM
OFFICE COPY