17313IPOST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17313
—' INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS {•TOrT�t'S! d.D
IT# _LOT#
' — -- - PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM .
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF I ERMTI VALIDATION
GARAGESLABS
CUPERTINO STANDARDS. "
- 1 ..
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB r Wj
' PLUMBING
ELECTRICAL
.ISSUANCE UAifi
MECHANICAL Loc ELECT. I PLC. ,MECH
0 ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
' PLUMBING _
VALUATION SIFT,
MECHANICAL
C
ELECTRICAL r vv�eRMn To
FRAMING
A I
INSULATION - STORIES TYPE comsrR. I
��.
OCC.GROUP NES UNIT$ '
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.vr.FLOOR AREA rorA+.ncaeacE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID /
ROOF SHEATHING RES IND
Lm NUN usEPR O
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE - INSP. ❑ ❑ ❑ ' ❑ ❑
ROUGHSAN.p ASSESSORS PARCEL NO
. PLUMBING ELECT,ENERGY
TUBS B SHOWER PAN PLUMBINGENERGY TRACT NO PARCEL NO
MECHANICAL - MECH.ENERGY `
ELECTRICAL. BUILDING ENERGY Acc.OarE ACL FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING - zowNc ENE,51 TE NO.1
GAS TEST- GAS
MECHANICAL FIRE SPRINrc
ENERGY T7
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING `'f❑ N•❑ V ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD SONE A,L UC.
INTERIOR SHEAR FIRE DEPT. v❑ N❑ .' ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR •LATH BUILDING % '
INTERIOR LATH TEM ORARY APPROVALS BUILDING I
SCRATCH COAT ELECTRIC PLAN CHECK .
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE .I
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL-IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H� - ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBINGz
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
FCALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.BUILDING PROJECT DENTI FICATION -PERMIT NUMBER
aG,LDING APPLICATION & PERMIT ' 731
ADDRES�ZU� . �� C t ILDING -ELECTRICAL-PLUMBING-MECHANICAL :' I
�✓'q OWNER'E /(• A ('y�-�-I ' 1J1 ' PLAN CHECK VALIDATION
nAME O >T /.-.8C� e0 ' QT,. ELECTRIC PERMIT FEE
r uoNE -
NAMERAcroRs tl l "SIO OUTLETS
-SWITCHES-RECEP 10.00/1.00
- P►��Ft c- IC.N0.30_X/ LIGHTING FIXTURES 10.00/1.00
oNTEss TOR'S ^4(r YD'O� PPLIANCES-RESIDENTIAL 4.00 -
T...� S I U cAk a ,A s. 2 w - PANELS 10.00 DATE OF APPLICATION .'
ORRCM,TECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.NO ISIGNS TRANS. 3.00 '
An CHL OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
SS
APPLICANT'S
ZIP EMP.METER OR POLE INS. 20.00 �' �L 1-TE 1 •�1
-
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 cJ
°to
F¢
02
to S,0INq6.3 NSCU CC54ACIVRS DECL�8S1
hereby
,
affirm that I am licensed under provisions of Chapter 9 u
H a w (commencing with Section 7000)of Division 3 of the Business and J ISSUANCE DATE
H m Z Professions Code,' d myy��license is in full force and effect. BLDG. ELECT. PLG. MECH.
o i m License Class -[L hie.Number_ - Cliy C yw sow
L H W Datc �. Contructor �
IF w a OWNER-BUILDER DECLARATION
BUILDING PERMIT
- o A " - INFORMATION
K
;LL w I hereby iffinn that I am exempt from the Contractor's License MISC.- REFER TO ORD
u O J Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
L- - PERMIT ISSUANCE 10.00
vsy Code:Any city or county which requires a permit to construct,alter,
✓v
¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO.
O ¢ requires the applicant for such permit to lite a signed statement that TOLE Tss AL
w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
HiQLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe �s
q O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE v'
at H m the basis I'or the alleged t emptiun.Any violation of Section 7031.5
w- by any applicant for a permit subjects the applicant lou civil penalty STORIES TYPE CONSTR,
of not Lure than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages us BACK F LOW PROTECTDEVICE 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,CON D. 5.00
- Cod,The 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 S.DO SO FT.FLOOR AREA TOTAL ACREAGE
himself re through hid own employees,fors Provided that such improve.
.cuts menot in is Sold or withinron (year .If,
ompleveq the the owner-
GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
M1 builder will have the burden of proving 01st he did not build or im' BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 600 ASSESSOES PARCEL NO.
and Professions Code:The Contractor's License Law does not apply .
to an owner of property who huilds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.tin this
a10n WATER HEATER /VENT 6.00 -
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'CO.MPIiNSAT10N DECLARATION WATER TREATING EQUIP. 5.00
I hereby ul firm that I have a certificate of consent to self-jnsure.
or a Certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Ihereof(Sec.3800,Lab C.).
Policy No. Company
O ❑ Certified yishereby furnished. FIRESPRINK ENERGY T�
Z Z �f Certilled ry is filed with the '�spediau 'inion. 24
� O App�Tan 1e � 2I;n _(yrJdls� MISC.- REFER TO ORD. YE) NE] Y [3 IN
Cr i2 CE RTI I4CAT'601'E X FM('TIO N FROM WO RK Ii RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.TC.
W > C0h11'ENSATION INSURANCE PLG.CONTR. LIC.NO. PLG
EL 0 EL Z h (This section need nal be cool pleled if the permit is for one TOTAL Y[] N Y E] IN
wldmd dollars IS 100)or less J
LL O I certify that h the t employ an 0f the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
0L U mit is issued,1 shall not employ any person
satio in any manner So as to
0 w hcmmc subject to the Workers'Cnmpensati0n Laws or California.
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING I 0
} to NOTICE TO APPLICAN'O If,oft,making this Certificate of lix-
F- ? emption,you should become subject to the Workers'Compensation qpp LIANAN CHECK
CE 5.00 PL
,28
provisions of the Labor Code, you nmst I'orthwi Nl comply with ,^
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.lvt0
) 4.00 FEE A
CONSTRUCTION TENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 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 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
-,~-, 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 -•
information n correct I agree tog to b with all city and county PLUMBING
ordinances and state laws relating In building construction,P,,, u .. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby uutimrirc representatives of this City to en ler upon the
•y above-mentioned property for inspection purpous 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.
upertino against liabilities,judgments, costs and expenses which
may in any way accrue against said City in consequence of PERMIT ISSUANCE 10.00 �•
ranti
ng tmit MECH.CONT. LIC.NO. MECH.
I a CONST.TAX
his perTOTAL TOTAL '''1 5
Signature of Applicant/Contractor Ute I G /
OFFICE COPY J .