18412 POST THIS CARD NEAR FRONT OF BUILDING
' PCIT NUMBER
CITY OF CUPERTINO 18412
n INSPECTION DIVISION
�7 / JOB INSPECTION RECORD
�/ %�6 90— �7� O PERMIT EXPIRATION
JOB ADDRES /''! / / NIT# LOT 4t
PERMIT EXPIRES IF WORK
OWNER - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAIJDAIION
GARAGE SLABS
CUPERTINO STANDARDS.
�,r.,,. 1•— � !
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND./SLAB
PLUMBING AUU 9 NS
ELECTRICAL ISSUANCE OATE``
MECHANICAL IAIJ Ul UURUM wc ELECT, PLG. MECH.
El El ME] .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED < BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SJFT,
�U—�2- 9- L v �J�
MECHANICAL
ELECTRICAL PERMIT TO
J
C � .2o67� '9S
FRAMING ' c .L /. r I
INSULATION STORIES .TYPE CONSTR.
tlQ /L9'/n.S O�—O OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.FT.FLOOR AREA romL ACREAGE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID -
ROOFSHEATHINGBUILDING USE
RES IND LON PB 011.1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN'SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.ft ASSESSORS PARCEL NO.
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN - PLUMBING ENERGY TRACT NO. PARCELNO
MECHANICAL - - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST'
INSULATION PLUMBING - ZONING ENa srtE No.
GAS TEST GAS
MECHANICAL- FIRE SPRINK ENERGY T.ja
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑I .N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L UC.
INTERIOR SHEAR FIRE DEPT. �❑ 'N❑ YL N❑
SHEETROCK GRADE
EXTERIOR LATH FEE SUMMARY
BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING r°
SCRATCH COAT ELECTRIC
PLAN CHECK
' GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PER MITTE D UNTI L Bl 11 LDING FINAL IS SIGN ED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOWINSPECTION BY PHONING 252-4505,' ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
/
Z— PLEASE GIVE JOB ADDRESS WHEN PHONING. �tnOJ
— SEE PERMIT FOR EXPIRATION DATE— MECHANICAL
�\ IMPORTANT! CONST. TAX /.
l PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTALcif,/JU
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
1,Y PERMIT NUMBER .
U BUILDING PROJECT I DENTI FICATION wtiA,T APPLICATION & PERMIT 18412
Rilll. ES O ��
ADDRESS
1T {� LDING-ELECTRICAL-PLUMBING-MECHANICAL y.
OWNERS , . � 'C LfJeD �, 1� PLAN CHECK VALIDATION
NAME WW `C&AJT`_uJVA CJHO O OTY. ELECTRIC PERMIT FEE
PHONE
NoM VA (,OLABj OUTLETS-SWITCHES-RECEP 10.00/1.00
In I..) LIC.N) LIGHTING FIXTURES 10.00/1.00
CONTRACTOR 5
ADOR APPLIANCES 4.00 -
D "Ro - PANELS, 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR y r' PANELS (OVER 200 AMP) 20.00
ENGINEER NW 7 RSSCt SIGNS TRANS. 3.00 --
ARCH.OR ENG. 9 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT - 5.00
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'$
ADDRESS MOTORS SEE FEE SCH. L � Cl
" 20.00 SERVICE CHANGE �
o ¢ =
02 LICENSED CONTRACTORS DECLARATION I Y-
a u 1 hereby affrnm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
as Q u (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. 'PLG MECH.
F y i PrOI'essions Co mYglyflgense is in full 1'O /_ f1
zo i L o License ass as�Z�S��Lie..Number -lV - El ElDoc. Comractor
¢y4 v
¢ ¢ w a OWNER-BUILDER[)ECLAT ATION BUILDING PER IT ,
A MISC.- _ _ REFER TO ORD INFORMATION
w g LL I- I hereby affirm that I am exempt from ilia Contractor's License
uo � Law for the following reasnn.ISec.7031.5.liusinessand Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00
;,i 4 Code:Any city or county which requiresapermit to construct,after,
¢ C, ae improve,
demolish,or repair any structure.prior to its issuance,also ELEC.CONTR. LIC NO. ELEC.
a wOIL requires the applicant for such permit to file a signed statement that TOTAL
m w he is licensed pursuant to the provisions of the Contractor's LicensePERMIT TO
F z a
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe `� 1
4 o Business and Professions Code)or that he is exempt therefrom and SING PERMIT FEE
¢ H the basis for the alleged exemption.Any violation of Section 7031,5 DTV. PLUM
c- by any applicant for a permit subjects flit applicant toacivilpenalty STORIES TYPE CONSTR.
of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT_WATER
(EA.) 5.00
❑ 1,as owner of tit property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 -
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 Professions DRAINS-FLOOR,ROOF,AREA,CONE) 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs 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.ll',however,the building GAS-EA.SVSTEM-I INC.40UTLETS 6.00
or improsement Is sold within one year.of completion, the er owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
buildwill have the burden of proving that he did not build or im- BUILDING USE
prove for purpose ofsalcJ' INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Omer
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to Construct elm project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:Tire Contractor's License Law does not apply ASSESSORS PARCEL NO.
to am owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 _
contracts for suet,projects with a contractors)licensed pursuant to
Ow ��
Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. .
❑ l am exempt under Sec...B&P.C,for alis WATER HEATER W/VENT 6.00
reason
Owner Darr WATER SYSTEM - 5.00
ACG DATE ACG FILE N0.
W'ORKERS'CO.MPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 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.I-A.C.).
Policy No. Company
O 11 Certified copy is hereby furnished. FIRE SPRINK ENERGY 1,24
z Z CcGiC' coly 's -led®AI I, ilspection division.
Fp plicam- --�1 - _ MISC.- REFER TO ORD. y NQ Y � N�
D- N CERfIIHCA'IFOF EXEMPTION FROM WOR RS' PERMIT ISSUANCE 1-[x00 FLOODZONE A.L.u.C.
W CO\IPF.NSATION INSURANCE PLG.CONT.. LIC.NO. PLG.
(This section need not be completed if the permit is for one TOTAL L Y[] N❑ Y ❑ ry�
Z hundred dollars($100)or Ims.)
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL T- mit is issued,I shall not employ any person in any manner s( as to
O w become subject 1D tl,t Workers'Compensation Laws of Califorl
a Dal` Applicant ALTER OR ADD TO MECH. 5.00 - BUILDING
} to NOl'ICE TO APPLICANT: IC after making this Certificate of Ex-
H Z emption,you should become subject In tie Workers'Compensation APPLIANCE 5.00 PLAN CHECK /
provisions of the Labor Code, you most 1'nrthwini Comply with
U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10000CF.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER iQOWCEM.) 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.L HEATING UNIT(TO 100,000 B.TU) 800
Lender's Name. . . .
Lender's Address - HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC
I candy (list I have read this application and slate 0111 the above VENTILATION FAN (SINGLE) 4.00
fo
inrmation is correct. I agree to Comply with ulI ci(y anJ county PLUMBING V
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives sit this city to enter upon the
above nlentioned property I'nr 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.
uperiino against liabilities,judgments, costs and expenses which CONST.TAX
[�q,u
ay in any way accrue against said City in consmloonce of the PERMIT ISSUANCE 10.00
anC oft,,, -mit �� � ' MECH.CONT. LIC.NO. MECH.
OTAL TOTAL �J��O
lfure of Applicant/Contractor ate S
OFFICE COPY
L '
POST THIS CARD NEAR FRONT OF BUILDING sN•cGL
rCnM1T NUMBER '
CITY OF CUPERTINO 18412
INSPECTION DIVISION
JOB INSPECTION• RECO
R
.TOR AUURES00 /. ._.` ^' ?.I�_+"Y_L IT lt._. OT tt PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
UPR+LN CONTRACTOR IS NOT STARTED WITHIN
INSPECTION I DATE INSPECTOR INSPEUIONfIECORD - 180 DAYS OF PERMIT ISSU-
VOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFEH ALL OF NNAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIIIAIION
CUPERTINO STANDARDS. 'f
GARAC;Ii SLABS /.
.POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _y, • .
UNDERGROUND /SLAB —U #f_(gyp _1 '
ELEC IRICAL ISSUANCE DATE
MECHANICAL OLD(; ELECT PLO. MECU
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDINGPER IT!•n;.;
_ WOOD FLOOR INFORM TOO
VALUATION $IFT.
PLUMPING " 1P� .jTIJgIsY (';TN TINLTfhTT CF!
MECHANICAL r_Yx1,•rr•..0 c.S:,,.^ hp�,�. FrinL�l fn>< nit.f
ELECTRICAL •>.7/-. />r..J..y .� rOIART To
I'RAMING
STORIES TVPE CONST1
(ICL (;"UUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
---'-• •R00(= NOTE:NO FINAL INSP.SHALL BE MADE BEFORE III I rLo1lRARIA TOTALAURAU(
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
17(01SI ILAIIIING BUILDING USE
111 S IND LON PB Ur.a
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATEINSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.11
ASSE SSUrIS PAUCE L NO.
��
IHITSR ING ELECT.ENERGY U95 $MOWER PANnlncT NO n
--FA IT L Nu
PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL nc.c.DATE ACC.FILE No
BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TESD GAS
MECHANICALVRVALS
ElnE srnlNrc ENEncv T.pa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ "❑ ❑ "❑
EXTERIOR S- ELECTRICAL RFLOOD ZONE A.LUC.
INTERIOR SHEAR FIRE DEPT. ❑ "❑ ° ❑ "❑
SREEiROCK GRADE ' T;;•: � 1'F"S f:.
EXTERIOR LATH BUILDING • i
INTERIOR LATH TEMPOBUILDING
SCRATCH COAT
ELECTRIC PLAN CHECK �
_ GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE. HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
v PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX /
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL`
APPLICANTS POSTING COPY