15175 POST THIS:CARD NEAR FRONT OF BUILDING
'PERMIT NUMBER
'CITY .:OF •CUPERTINO 1515.
INSPECTION DIVISION
JOB INSPECTION RECORD
.�� �7 / " •• PERMIT EXPIRATION', .
JOBADDRESS � , r �1R"^-� 70wN�� UNIT# - _LOT,# PERMIT EXPIRES-I F'WORK �
q
OWNER, v '' CONTRACTOR r�-� f�7z.,— IS NOT STARTED WITHIN-
L '
- INSPECTION. DATE I INSPECTOR INSPECTION'RECORD - 180 DAYS OF PERMITISSU
- ,
FOUNDATION " .. • ANCE OR 180 DAYS FROM
' A'' 'NOTE: v "' LASTCALLED INSPECTION:
UFER' ALL GRADING AND DRAINAGE SHALL,BE INSTALLED
PREGUNITE ` TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. ,/}. ,r
GARAGE SLABS - - ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I 'UNDERGROUND /SLAB
t
PLUMBING'
_ELECTRICAL,. ISSUANCE DATF',
I MECHANICAL. BLDG. ELECT,I PLG. MECH,
00.NOT POUR FLOOR UNTIL ABOVE HAS.BEEN SIGNED BUILDING PERMIT
INFORMATION
'WOOD FLOOR ., >vn wanDN ,:'SIFT.
"PLUMBING• I._ - -
MECHANICAL
ELECTRICAL - g q- PERMIT.T0
. . FRAMING 19 V !t•?"�""
INSULATION - _ 7 STORIES TYPE CONSTR
M u VA
OCC GROUP RES'UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50,IT.FLOOR AREA TOTAL ACREAGE
ROOF ' ' NOTE:NOTINAL INSP.SHALL BE MADE BEFORE;,
DIAPHRAGM', -
THE CONSTRUCTION TAX IS PAID
_
.�- -
BUILDING USE
ROOF SHEATHING ' �•- 4, - REs . IND, (.ON PB 'O ,r: I
APPLY NO'ROOFING„UNTIL ABOVE HAS BEEN SIGNED FINALS DAM_l .INSP. O' O ' O ❑
SAN,q ASST SSGHS PARCEL�NO
ROUGH ,
PLUMBING ” - ELECT.ENERGY
PLUMBING ENERGY TRACT NO. PARCEL NO.
_ TUBS&SHOWER PAN -
MECHANICAL MECH.ENERGY ..
ACC.DATE ACC.FILE NO.
ELECTRICAL- BUILDING ENERGY
FRAMING - ELECT.FINAL TEST -
PLUMBING ZONING �!F.N G_SITE NO.
INSULATION • ' - _
GAS TEST - _ GAS.
t
MECHANICAL' FIRE SPRINK EIJERGY T-2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . ,�,y�. El "❑ `' ❑' N
ELECTRICAL RELEASE . .FLOODZONE GMfA.;MULL,
EXTERIOR SHEAR - - - .<>.
INTERIOR,SHEAR' FIRE'FIRE DEPT.' v0.. N❑' I.. rQ N
SHEETROCK' - ` GRADE - .FEE SUMMARY
EXTERIOR.LATH - BUILDING
. . INTERIOR LATH TEMPORARY APPROVALS _ BUILDING
SCRATCH COAT ELECTRICS.. I. - PLAN CHECK `
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv - 'SEiSMIC.FEE
• OCCUPANCY OFBUILDING IS NOT PERMITTED'UNTIL BUILDING FINALISSIGNED'BY BUILDING INSPECTOR.
MICROFILM ,
".ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC '
ONE WORKING DAY BEFORE REQUIRED:INSPECTION: PLUMBING
Z RLEASE GIVE'.JTOB ADDRESS WHEN P{HONING:,
MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE — :.�
LMPORTANT!
CONST.rax
PLEASE READ REVERSE SIDE BEFORE �` T•V
CALLING FOR"FINAL INSPECTION. TOTAL
OFFICE COPY � Ya ';
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE.BALL POINT PEN ONLY -
F - - - PERMIT NUMBER',
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
aDILDING •1..51 75
�j aooness/Sg5 � D , - . . , .
/ (X/ BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 'i'o,
OWN E PLAN CHECK VALIDATION
NAME ` TV. ELECTRIC PERMIT FEE
CONTR
CTO
5
/hA� - PHONE ..
NAME C {�_���� �� ��}} OUTLETS..'SWITCHES-RECEP, 10!00!1.00 ,
I—T17 Nuc.No. - -[•( LIGHTING'FIXTURES .10.00/1100 -
CONTRACT His PPLIANCES-RESIDENTIAL 4.00 -
aDDfl E55 ` �� 7�/7�'17� 7
uk.1Gl t PHONE" / (�(2PAN ELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEEP.C.NO.
OR �, PANELS (OVER 200 AMP) 20.00
ENGINEER - - '
LIC.NO. SIGNS TRANS. 3,00
ARCH.OR
ADDRESS ENG. SPECIAL CIRCUIT 5.66 ^' PERMIT VALIDATION
ZIP TEMP.,METER OR POLE INS. - 20.00 . ^—
APPLICANT'S - MOTORS" SEE FEE SCH:
AOOREss
SERVICE CHANGE 20,00 ' •I// 9KdPF
02
oo LICENSED CONTRACTORS DECLARATION I -
m¢u I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
a% (commencing with Section 7000)of Division 3 of the'Business and BLDG. ELECT. PLG. MECH.
F N z Profussinns Cod and ry license is in,(all for n "1.'7 2 � ❑ ❑ '
0 Z m o
License Clus _ Lic.Number. -
H = H j Date
Contlnctor 4
4 m 3 , - - BUILDING PERMIT
¢ ¢w u OWNER-BUILDER DECLARATION INFORMATION
don REFER TO ORD -
w ; n H I hereby affirm that I am exempt from the Contractor's License MISC.s
_m VALUATION SIFT.
FLLoJLaw for the ity or countewhichrm. . uiresa perminess t tocnd Professions PERMIT ISSUANCE 10.00 ..
Code:Any city or county which requirese permit toconstnlcl,alter, v,
Q.�¢ iinpmve,demolish,or repair any structure,prior to its'issuunec,also ELEC.CONTR. LIC.N0. ELEC.
O¢ requires the applicant for such permit to file a signed statement that - TOTAL
be is licensed pursuant to the provisions of the Contractor's License
u w oro u - 19 PERMIT TO
ng
ion
HzQ Law(Chapter Procosion,Codewith Section I,exemfttherefoofthe
Basin,.and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT
a, H m the basis for the alleged exemption.Any violation of Section malty _ - $'[0{{�0 TYPE CONSTR.
i ; •- by any applicant five Immnilsullims the$501H.licuntroncivil penalty ALTER-DRAIN -WATER'.(EA.) 5,00 pWnF1rR7-11 '
oP not more than five hundred dollars($5001.): � I ,
O I,as owner of the property,or my employees with cadges as - BACK FLOW'IPROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP -,RES.UNITS
intended or offered for sale (Sce. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of -
. property who builds or improves tlrarcon,and who does such work FIXTURES-PER TRAP 5,00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
ments are not intended or offered for sale.Il',however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,Om the owner- GAS EA. -OVER 4(EA) 200
builder will have burden of proving that h - . . .
e did not build or ins. BUILDING USE
prove for purpose of sale.). RES IND CON r.PS On.,INDUSTRIAL WASTE INTER. _ 30.00 0 0 0 0 0
❑ 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. 6.06 - ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,turd who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such project.,with a contractors)Iicelrsid pursuant it) SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO, PARCEL NO.
' ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5A0 ACC.OATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION' WATER TREATING EOUIP, i 5.00
I herchy xlfirm that I !Tuve x'ceRificale of Eonsenf 10 scllwinsure, ZONING ENG.SITE N0.
or a certificate of Workety Compensation Insurance,ora certified
Policy
there p[{s epS .,3 rn Lab.C.?�gyp,inpary -52/v r� -
' 0 ❑ Certified copy is hereby(nrnished. " FIRE SPRINK ENERGY T44
Z_
ffeCerlifipd opg is d with cit jpsp Ym d'visiol.. -
APIlcnv -1 ,LC' MISC.- REFER TO ORD. v IN vC] N[]
CC CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT,ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COAIPIINSAT10N INSURANCF PLG.CONTR. LIC.NO. PLG.
Z (This section need our be completed if tum permit is for one _ TOTAL V E] N0 V NE]
hundred dollars(S 100)or less.)
00
I certify that In the performance of the work for which this per- nTy MECHANICAL PERMIT FEE FEE SUMMARY
LL F ul is issued,I shall not 6aploy any person in any manner so as to _ -
U,- become subject to the Workers'Compensation Lows of Calll'ornin. - : - -
a` - Date - -Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>- 'W NOTICE TO APPLICANT: If,after making this Certificate of Ex- _
F Z emption,you should become subject to the Workers'Compensation APPLIANCE' 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith consply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10)OW CF.M.) 4.00
CONSTR UCI'1ON LENDING,AGIiNCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 . SEISMIC FEE ,
1 hereby affirm that there is a construction lending agency foe EXHAUST HOOD (WITH DUCT) 5.00
the 3097,Civ C.lnce of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) B:BO MICROFILM
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify.Ihat l have read this applicntion:md sbitethia the above VENTILATION FAN (SINGLE) 4.00
. info....ation is correct. I agree to comply with,all city and county PLUMBING -
ordinances and state laws relating to building construction, and BOILER•COMP(3 H.P.or 100,000 B.T.U.)'6'100
henebImraby authorize representatives forms of this city R. elver upon the BOILEA-COMP(Over 100,000 BTU)SEE F EE SCH. MECHANICAL a
y authorize
property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
Cupertino against liabilities,judgments, costs and expenres which PERMIT ISSUANCE, •-18-00 Gf'E - CONST.TAX
may in any way oceangmnst said City in consequence of the _
rant nfth rinit. /� MEC C T. LIC.NO. MECH.
/ ` ��� TOTAL ?d TOTAL
ign App¢ant Conlrac r Uatc f-r
OFFICE COPY