15176 POST THIS CARD NEAR FRONT OF BUILDING.
PERMIT NUMBER 1
PTY OF CUPERTINO 151 T6
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS ZOSHO HOIR25 t2 aCl - UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER Payless Store CONTRACTOR IS NOT STARTED WITHIN
. INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTEANCE OR 180 DAYS FROM
:
LIFER � ALL GRADING AND DRAINAGE SHALL BE IN LASTCALLEO INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VnuunTlON
CUPERTINO STANDARDS.
GARAGE SLABS 1
I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB-
PLUMBING SLABPLUMBING
' ELECTRICAL IssuANce DA rE.'
MECHANICAL '" - BLDG L ECT. PLG, MECII-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEU BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING '7�I�-v�•-
INSULATIONsroR IES TYPE CONSTR,
gfin OCC.GROUP RES UNITS
!•"
PLACE NO SU BFLODR UNTIL ABOVE HAS-BE EN SIGNED '
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so,1 T rLOOR ARIA TOTAL'ACHEAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING' BUILDING USE
Res IND LON PB Ogle,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED :ELET.
NALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH OHS Yg HCF.L NO.
PLUMBING NERGYTUBS&SHOWER PAN GENERGY TRAC1 ND, PARCEL NO
MECHANICAL NERGYELECTRICAL G ENERGY ACC.DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
INSULATION - PLUMBING 20NING ENG.SITE NO.
GAS TEST _ /9 p GAS
MECHANICAL FIRE SPRINK ENERGY T74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ N'❑ ` ❑ N❑
EXTERIOR SHEAR ELECTRIC A FLOOD SONE n.L.0 e.
INTERIOR SHEAR FIRE DEPT. Y❑ IN �' ❑ N❑
SHEETROCK GRADE
EXTERIOR LATH FEE SUMMARY.
BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT• T ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL.BUILDING FINALISSIGNED ByBUILDINGINSPECTOR.
' - MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
z
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
IWIPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
IPWEE~ PERMITNUMBERROJECY IDENTIFICATION APPLICATION & PERMIT 1 [1 �IJI�y--OME SI--E� BUILDING-ELECTRICAL-PLUMBING -MECHANICAL PLAN CHECK VALIDATION
. DTV. ELECTRIC PERMIT FEE
PHONE
NAME pp OUTLETS-SWITCHES-RECEP 10.00/1.00
l✓�S 24efLC.NO. 060.3 LIGHTING FIXTURES 10.00/1.00
CONTEss TORS PPLIANCES-RESIDENTIAL 4.00
I'Pe41e7*V1e- F-fsWONE(1_3O K1Vv PANELS 10.00GATE '
ARCHITECT PLAN CHECK
APPLICATION
FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER EN
uc.NO SIGNS TRANS. 3.00
Coo Ess ena SPECIAL CIRCUIT 5.00 .PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00
Avvucarvrs
MOTORS SEE FEE SCH.
A
APPLICANT
/
SERVICE CHANGE 20.00
o¢i GOV
-00 LICENSIiD CONTRACTORS DECLARATION
sic it 1 hereby affirm (hal I am licensed under provisions of Chapter 9
i i ISSUANCE DATE
naw (commencing with Section]000)of Division 3 O(,lhe Business and BLDG. ELECT. PLG. : MECH.
H w z Professions Code,and my license is in full force ulp W'fd� ❑ ❑ ❑
z0 0 w o License Class Lic.Number o O
m I- Date Contactor I
Q y L J
¢ ¢ w a firm
Ii-GUILDER DECLARATION BUILDING PER IT
` 13: MISC.- REFER TO ORD INFORMATION
. 13: H I hereby aff rte chat I am exempt (Tom the Contractors License
F LL p j Law lot the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter, 1 O.00
¢ ea ¢ 0 improve,demolish,or repair any structure,prior(o its issuance,also ELEC.CONTR. LIC.NO. ELEC.
E O ¢ requires the applicant for such permit to file u signed statement that TOTAL
6wm he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H z a
Law(Chapter it(comniencingwith Section 7000)of Division 3 offle D
4 o Business and Professions Code)or that he is exempt therefrom andDTV. ��PLUMBING PERMIT FEE Cs
¢ r the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
a , by any applicant for a permit subjects the applicant lon civil penalty
of not more than l'ivchundred doALTER-DRAIN llars($500).): (EA.) 5.
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 0
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,CON 5.00
Code:'rhe 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 % SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided(hal such tmprove-
`� cents are not intended or offered for sale.If however the building GAS .SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, (he owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or in* BUILDING USE
Prove for purpose nfsale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Omer
❑ I,as owner of the property,din exclusively contracting with .
licensed contractors to construct the project(Sec. 7044,
se Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSOR SPARCELNO.
11 11 El 1:1 El
and Professions Code:The Contractor's LicenLaw does not apply
to an owner of property who builds or improves(hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conoaclods)licensed pursuant to
the Contractors License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
re❑nl am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
Owner Dan' WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORK ERS'COMPENSAIION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate ofeonsent to self-Insure,
ar a certificate of Workers'Coinponnation Insurance,or a cerlil'ied ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.}}((� �s
Policy No. Conlpeny[7@G .L* a4l�ei
Q O Ccrli Oed ' p iso by fur d. FIRE SPRINK ENERGYT24
Z Z ❑ Ccrtil is p the I inspection division.
C) Applicant s MISC.- REFER TO ORD. Y N Y N
� = CERI'IFI 'ATI:OF EX EMI I[ ROM WOfl�jRKIi12S' PERMIT ISSUANCE 1 ❑
FLOODZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR_ LIC.NO. PLG,
D' 0 of section need not be completed if the permit is for one TOTAL V N� V ry�
Z hundred dollars(S 1001 or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL mitis issued,I shall not employ any person in any manner so as to
00 beconm subject to the Workers'Compensation Laws of Caltfornia.
y Datc Applman( ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOl'ICE FO APPLICANT: IL after making(his Certificate of Ex-
F Z emption,you should become subject to to Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with
U such,...visions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUcrION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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.
3097,Civ.C.), HEATING UNIT(TO 100000 BTU1 800 . MICROFILM
, . . . .
Lender's Name '
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify(]let I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information correct.I agree tcomply with all city and rounly PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00
abovehcwhmentioned
representatives of this ri to toter upon (he
ahovrmcmioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU(SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD.
uperfino against liabilities,judgments, costs and expenses which CONST.TAX
Dayin a y way accrue a�I__
id City in conseyuenceofthePERMIT ISSUANCE 10.00
f this in . MECH.CONT. LIC.NO. MECH.p TOTAL TOTAL
e of Applica / ute
OFFICE COPY.
' ice
m CITY OF CUPERTINO
lb. py
GASSERVICE44WICE ,3
To ak-',,
You are[IT6reby a horned-to connect the GAS'service for
Owner or'Tenant
17 Ater .�Cu1' r1•f�;'. ati�iff{E9sutlt3?vi �..-`/.^��fk2 '� .. x
NewService
No. o`f Meters' +� Reconnect _ P
'MoveSe"rv�ice�
No. of Add Meters '� r �g
4 ,f '`^ '` .ttMo e'Meter ` ;'
PLUMBING'INSPECTOR
i ik
� ��.�u~r �
y� r r'R-
1w s kn,_„3 ztis r+ ..fs ��J4;� �'..�it_:;:�.,.� ._.•; �:.�