17870 POST THIS CARD NEAR FRONTOF BUILDING
PERMIT NUMBER
-CITY -OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
=1PERf'll�XPI FiA�'aN
JIM to L
JOB ADDR ESS UNIT# LOT# 'pERM1T EXPIRES IF WORK
. OwNER . .- CONTRACTOR IS NOT STARTED WITHINT;
, I PECTION DATE `INSPECTOR INS ECTI RECORD 180 DAYS OF PERMITISSU;.:
ANCE"OR 180 DAYS FROM"
FOUNDATION' NOTE: -
UFER '; ,, ' 'ALLARADING AND DRAINAGE.SHALL"BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE - - TO.COMPLY.WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -- �••.J � 1
UNDERGROUND /SLAB .. .
PLUMBING - JUL
ELECTRICAL ' ISSUANCE DATE
MECHANICAL - � - Mp� eLuc . i.Ecr PLr,. ecR.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED � eBUILDING PERMIT
q
WOOD FLOOR �+ I V1�trINFORMATION
VALUATIONSIFT,
PLUMBING-, _ ,,//''
MECHANICAL' L�')'Sj'
ELECTRICAL .. / ✓. - PERMIT ro �
FRAMING - "• - - >
,INSULATION " _ - STORIeS - TYPE coNST.IT
1 y OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
$(),IT FLOOR AREA TOTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '
DIAPHRAGM .THE CONSTRUCTION TAX IS PAID . '
'
ROOF SHEATHING T �,, 3, ,. ; :. es DILDING USE
CON IT �00. "
- '"APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. '� El 1:1 E3
A55ESSORS PARCEL NO. .
ROUGH I SAN.N
PLUMBING.`., ELECT.ENERGY -
TRACTNO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY -
MECHANICAL ' .. MECH.ENERGY
NCC.DATE ACC.FILE NO.
' , ELECTRICAL„ �� � � BUILDING ENERGY
• FRAMING - - ELECT.FINAL TEST
ZONING ENG.SITE NO.
,,
INSULATION - - PLUMBING ,' F"
GAS TEST - GAS ',✓f
MECHANICAL , 'FIRE SPRINK ENERGY 120
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y NO Y " "EI
FLOOD ZONE A,L;U.C..
- EXTERIOR'SH EAR., - ELECTRICAL RELEASE Q� ''c*„
INTERIOR SHEAR FIRE DEPT. - v ."❑ 'Y ❑INNSHEETROCK - - GRADE FEE SUMMARYEXTERIOR LATH BUILDING'- W Q_�p—
INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT - ELECTRIC:NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE LT
OCCUPANCY OF BUILDING ISNOTPERMITTED U 1.NTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM .,
::.ARRANGEFOR INSPECTION BY-PHONING-252-4505, ELECTRIC
[:
WORKING DAY BEFORE'REQUIRED INSP,ECTION'. b�uMalNc"OASE.GIVE JOB ADD RESS.WHEN.PHONING. -• .
=-SEE PERMIT FOR EXPIRATION DATE'= MECHANICAL.
- IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE"?' , , 1
I ' TOTAL
CALLING FOR FINAL INSPECTION,.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE-BALL POINT PEN ONLY ,
BU I LDING PROJECT I DENTIFICATI ON - " .PERMIT NUMBER
i.. BUILDING - APPLICATION & PERMIT • q 8 7(.O
ADDRESS �/ - I
1oSL1Q ��9G XpgC BUILDING - ELECTRICAL-PLUMBING-'MECHANICAL
OWNER'S -
NAME PLAN CHECK VALIDATION
_ O ELECTRIC PERMIT - FEE 7.
PHONE 25T-15-b,
CONTRACTORS - .,:-c i- / OUTLETS-SWITCHES-RECEP 10,00/1,00
NAM p G_
�OOL,S' UC.ND. 190/Z LIGHTING FIXTURES `, 10.00/1.00
- ADDRESS CONTRACTOR 'QQa ,(, FJ� Q APPLIANCES-'RESIDENTIAL 4.00
/& J IN PHONE 2.WH-75M PANELS 10.00 DATE OF APPLICATION
ORcHlTecr _ - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEEP.C.No.
ENGINEER
UC.NO' SIGNSTRANS. 3.00' -
a00RE55 E.G. = SPECIAL CIRCUIT 5.00' - PERMIT VALIDATION'
Zip TEMP. METER OR POLE INS. 20.00 �• �•IYt V
'n
ADDRESS
APPLICANTS - MOTORS' SEE FEE SCH. ��-1• ' '^ �W
SERVICE CHANGE 20.00 ,�7
T 0 LICENSED CONTRACTORS DECLARATION 1 g�. -
F,z W' 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE "
¢e (commencing with Section 7000)of Division 3 of the Business and - BLDG. LECT. PLG. ECH.
• F H i Professions Com ant license is N full force yg f ecJ� _ ❑
' 02 - License Class_$,}_Lic.Number_ 7 +L�_
y r° Date_.j' I-9�" ConlractorIM6/YSMId ,. - 'JUL �F ,
¢'se s d 6 BUILDING PERMIT
IF M ¢ OWNER.BUILDER DECLARATION '
a e U INFORMATION
'w ; n a, I hereby aollowi ha ng re am exempt front the Business
cloroLssions
MISC.- REFER TO ORD
U. VALUATION $/FT.Law forthecounty
ontywt.(Sec.7iresal Businessand Professions pEflM1T ISSUANCE ,1ggp p
S 'A> f Cprove.yacityor coy nlYwhiny structureP prior to its issuance.
2 2 ¢O improve,lie applic,or repair any structure,prior to its issuance,also ELEC.CONTR: LIC.NO. ELEC.
p Q requires lhC apBhCallt for such perllln to NIC a SIgnMI statement that TDTA `�J
he is licensed pursuant to the provisions of the Contractor's License
Q 11 PERMIT TO
FiQ
Law(Chapter 9(commencing with Section 7000)of Division 3 of the 9Y�lIMMIr1C P
i 0 Business and professions Code)or that he is exempt therefrom and DTV. -PLUMBING PERMIT FEE
M t-$ the basis for the alleged exemption.Any violation of Section 7031.5 by STORIES TYPE CONSTR.
.fn.1 ore t1ni for ve llundraddollarS 550 applicant tua civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five The prod dollars(5500 1:
❑ Las owner ev the property,a my mpl then ructurth agesas BACK FLOW PROTECT. DEVICE. 4.00 - OCC.GROUP RES.UNITS
their sole compensltlion,will Jo the wo ,anA the structure is'not _ .
-. .. intended-or offered for sale (Sec, 70 , Business and Professions DRAINS-FLOOR,ROOF,AREA;CONO. 5.00
Code:The Contractor's License Law nes not apply to in owner of.
property who builds or improves th eon,and who docs such work FIXTURES-PER TRAP 5,00 SG.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own emplo es,provided that such inhprove- -
r meats are Bot intended oroffere or salla,If,however,He building 'GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
� .. or inhprovement is sold within c year of completion, the owner- GAS-EA.'SVST EM-OVER 4 (EA.) ' 2.00
5;Wer will have the burden o rovin•that hC did not build or hit- UILDING USE
1 prove for purpose of sale.).. t RES p CON PB Other
.- - ❑ 1,as owner uL the pr arty,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑
licensed contractors to co truct the project(See.7044,Idusiness LAWN SPRINKLERS-1 INC 5 V.B. 6.00 A$$E$SOR$vARCI N0.
to El
anrowLneroor Cmeertl1P hon builds or improves thereon.Law
and who LAWN SPRINKLERS-OVER5 (EA.) 1.00 -
p 0 Y P
Contracts t,such prnj with o contructorl sl Ilcanscd pursuant❑a - -
the Contractnr'sLice eL aw. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ Iame) L der Sec. ',BAVC.kir this WATER HEATER'W/VENT '%6.00
reason
Owncr Date WATER SYSTEM - 5,00 ADD.'DgTE AGD,FILE No.
cKl''Ij�yc�pZ 'Yl aSATION n[CLARA'fION WATER TREATING"EQUIP. . '5.00
ZoLur
HIT. I IaI hav a certificate of consent tD self-insure,
ole of Workers'Com,,cKdi.in...InatrmWv,or a curb 'ed ZONING ENG.SITE NO.
Co (Sec.3800,I:eb.CJM/�//��'V� UN/Od
Policy No, C,'mPan Y.-�et6S—CO.
0 ❑ Cetlifi.1Copy is'hereby furnished. ' - FIRE SPRINK ENERGY T-24
z 2 Ad Certifice opy (led with City inspection division,
O pppl;c MISC. .REFER TO ORD. Y❑ IN Y ❑ N❑
CC PERMIT ISSUANCE r�--11
� - CIiRT'114COMPENiAI I'ION FROM WORKERS' sl I01• FLOOD ZONE A.L.0 C.
W:? COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLGCIL .
Z - iThis section teed not be conmleled if tic permit ii; on,one - _ TOTAL W' v❑ N❑ r[:] NEIhundred dollars IS 100)or less.) -
U O I iertify that in the performance of th•work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any pc on in any manner so as to
O w hecome subject to the Wor= Comp' cation Laws of California.
y Datc Applicant— ALTER OR A_DD TO MECH. 5.00 BUILDING za
} w NOTICE TO APPLICAN'E: Ifof making this Ccrtifteate of Ex-
? emPtion,you should becomev act to the Workers'Compensation APPLIANCE'' 5.00 /"PLAN CH ECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE E�
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. HEATING UNIT(TO 100,000 B.T.U.) "'.B.00 MICROFILM
3097,Civ.C.l.
Lender's Name—�Ll�� HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Na m r��.'/A�' ELECTRICROW
I cerlily'That lhave read this application and state t he the above VENTILATION FAN (SINGLE) •.4,00 W
information is correct. 1 agree to comply with all city and county
ordinances and state laws relining to building construction, and BOILER•OOMPI3 H,P.Or 100,000B.T,U.)„6.00 PLUMBING
hereby authorize representatives of this City to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL -
above-nscntioned property for inspection purposes.
-'----- - •(We) agree to save, indemnify and keep harmless the City of MISC.- -REFER'TO ORD. -
C.y in
against liabilities,judgments, costs and expenses which PERMIT.ISSUANCE '”10.00 CONST.TAX
ay in any way accrue against said City in conseyucnce of the
ranon of On reit MECH.CONT. LIC.NO. MECH.
orgL TOTAL
in, ature of Applican C tractor t - -
OFFICE COPY-