14875 POST THIS CARD NEAR' FRONT OF BUILDING
PF'RMITNUMBER
CITY- OF CUPER.. TINO 4$75
INSPECTION DIVISION
•r JOB INSPECTION RECORD - r'
' p -P PE RMIT'E XPIRATION
JOB ADDRESS '�o �u " E �� �'T UNIT# • LOT#
' PERMIT EXPIRES IF.WORK
bWNER _ �/ p CONTRACTOR' !z-.�.G „�K�/�. IS NOT STARTED WITHIN
INSPECTION DATE JINSPECTOR - INSPECTION RECORD 180 DAYS OF PERMIT ISSU:
FOUNDATION ANCE OR 180 DAVS FROM
NOTE: LAST CALLED INSPECTION.
.. „. .: ..
UFER + ALL GRADING,AND DRAINAGE SHALL BE,INSTALLED
'PREGUNITE ` R,. - .TO.COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VAI IDArION -
CUPERTINO STANDARDS.
GARAGE SLABS,, •
POUR NO CONCRETE"UNTIL ABOVE HAS BEEN SIGNED 1 ""
UNDERGROUND"/SLAB
PLUMBING
ELECTRICALS +ssuANce un�iE{
MECHANICAL ' - - BLDG, ELECT I PLG. MECH.
a ❑.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
/ �� � INFORMATION
.WOOD FLOOR .N�-� VALUATION $/FT.
PLUMBING;- -
MECHANICAL F
PERMIT TO
ELECTRICAL + - •"9 _ %TC . '!/
FRAMING - C 4z
INSULATION STORIES TYPE CONSER I
UCC cNOUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "
ROOF - -
-NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.Er.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM .`- - THE CONSTRUCTION TAX IS PAID -
ROOF SHEATHING ' ' ,` _ + - NBUILDING USE
ES IND 'ONING PB 0111n "
APPLY NO ROOFING UNTIL ABOVEHAS BEEN SIGNED FINALS DATE INSP. ❑ Ell ❑ '❑ ❑
ROUGH, _ SAN,N ASSESSORS PARCEL NO.
PLUMBING - ELECT.ENERGY
- TUBS&SHOWER PAN PLUMBING ENERGY " - TRACT NO PARCEL No
MECHANICAL + - MECH.ENERGY - {
ELECTRICAL "+ ..+ BUILDING ENERGY. 'F., ACC DATE ACC,FILE No,
FRAMING' , I' - ELECT.FINAL TEST
INSULATION- -
PLUMBING ZONING ENG.SITE NO
GAS TEST - + GAS '
MECHANICAL - FIRE BPRINK ENE RGY r.24
COVER ND WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ' ❑ N❑�
EXTERIORS
HEA
R
ELECTRICAL RELEASE ELooO zoNE A:L,u c.
INTERIOR SHEAR FIRE DEPT: v❑ "� ° ❑ "❑
SFEETROCK GRADE _ FEE SUMMARY
EXTERIOR LATH BUILDING -
_ TEMPORARY APPfl OVALS BUILDING (�� ..._.
INTERIOR LATH - '
SCRATCH COAT' - - ELECTRIC - PLAN CHECK,
GAS FEE
NO TAPE OR PLASTER UNTIL.-ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTEO UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. N1ICROF.JLN1
w T . -
ARRANGE FOR�I'NSPECTIONIBY PHONING 252-4505,' ELECTRIC ,
LU
.ONE'WORKING DAY BEFORE REQUI'RED,INSPECTION; PLUMeI'Nc
z PLEASE GIVE JOB ADDRESS,WHEN PHONING. . .
- SEE PERMIT FOR-EXPIRATION DATE = MECHANICAL
IMPORTANT! CONST:TAX
PLEASE'READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. g
TOTAL
OFFICE COPY
APPLICANT TO FILL IN' INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
' BU LDING PROJECT I DENTI FICATI ON - PERMIT NUMBER
ED LDIss ING - - 1'` v l
rt - APPLICATION
ADN
USS
AL LE� -�-.� Cr BUILDING''-ELECTIRICAL-PLUMBING-MECHANIC
y+�( OWNER'S PLAN CHECK VA_LJQATION
NA/M'IE��� /� QTY. ELECTRIC PERMIT FEE
�. /�' x-/`�t��IY� •`�� PHONEgoe- 7 l� .
CONTRACTOR 9
.� NAPE ee�� �j OUTLETS-SWITCHES-RECEP 10.00/1,00 .�
��� lTM1I I/Vf�fH Lic.NO//''��/2.7`���••11 1 LIGHTING FIXTURES
_ 0.00400
rOrvTRArORs TIAL 00ADDRESS APPLIANCES-.RESI DEN
bC ((L_ PHONE4/S-gpOJ7
b
'.
PANELS 10.00 DATE OF APPLICATION
ARCHITECT -OR PANELS (OVER 200 AMP) 20.00 PLA_NCHECK FEE
ENGINEER
LIC.NO SIGNS TRANS. 3.00
ADDRESS LNG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
Z11 TEMP.METER OR POLE INS. 20.00 - -
APPLICANT'S -�7^
ADDRESS MOTORS SEE FEE SCH.
Q-&0 GHU2C.H(c__ SERVICE CHANGE 20.00 '
Foo. LICENSED CONTRACTORS DECLARATION_ ��,�/a ,
< it U I hereby alTirm that I am,licensed under provisions of Chapter 9 - `' ISSUANCE DATE
(commencing with Section 70001 Of Division 3 of the Business and
D e. BLDG. ELECT. PLG. MECH:
0 7 i Professions Code, d my license is in full force a/nd eUgey. ® ❑ ❑
2 i Leena ass Co Number "1 Z7
4 I-"w atCContracwry rl IS4 I '
N
a mi d BUILDING PERMIT
II '
at a OWNER-BUILDER DECLARATION - - -
o INFORMATION
X ; a N I hereby affirm that I sam on,(See,
7 front31,5,Be Contractors License MISC.- REFER TO ORD VALUATION $/FT.
H LL o J
Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE y
Code:Any City or county which requires a permit to construct,alter,
rtw¢20 improve,demolish,or repair,any structure,prior to its issuance,also ELEC,CONTR. I.C.NO. ELEC. (�U
O LL requires the applicant for such permit to file a signed statement that - TOTAL /V �- PERMIT TO
is$ he is licensed pursuant to the provisions of the Contractors License
HiQ
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
E 4 o Business and Professions Code)or that he is exempt therefrom and QTY. _ PLUMBING PERMIT. , FEE
r $ the basis lox the alleged ciemption.'Any violation 61Section-7031.5 STORIES TYPE CONSTR.
is by any applicant for it pertmit subjects the applicant to a civil penalty - ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(8500).1:
❑ I,as owner of the property,or my employees with'wagesas BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale*(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License'Law does not apply to an owner of
^hila property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that SUCH improve-
mentsare notiromdedorofl'Bred For salc:.if,however,'the budding GAS-EA.SYSTEM'-1,1 NC.4 OUTLETS 6.00 -
C or improvement is sold within one year of Completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
// builder will have the burden of proving that he did not build or int. BUILDING USE
d'V prove for purpose of Sale.). I RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 '
licensed contractors to Construct the project lSec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner oI'property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1,00
contracts for such projects with a contractods)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.fonhlr MATER HEATER W/VENT 6.00
reason
Owner - ,Date ' WATER SYSTEM 5.00 / ACC.DATE ACC.FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that I have a certificate of consent to self-a sure, •' a v,
or a certificate of Workers'Compensation Inniruse,or a certified -%j ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). -
i' Poli No. Company -
O Certified copy is herebyfurnished. FIRE SPRINK ENERGY T24
I Z Z ❑ CeRifieyL �cop 01qd yJt(I the t inspection division.
p Applicxnl-I<EIJ_4-A' 911A - MISC.: REFER TO ORD. . Y N� - YQ 'N�
~ PERMIT ISSUANCE 10;00
CIiRTI PIC OMPFNEWION INS FROM WORKERS' - FLOOD ZONE A:L.u.C.•
W COMPIiNSA'I'ION INSURANCE PLG.CONTH. I LIC.N0. .PLG: . -'Y ❑ Y , Q
(This section need not be completed it the Permit is far one - _ TOTAL NN
_
I 0 Z hundred dollars IS 100)or less.) - -
U O. 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I Shall not employ any person in any manner so as in
Q w become subject to the Workers'Compensation Laws of California.
Date Applieml BUILDING. O S`O
a ALTER OR ADD TO MECH. 5.00
} W NOTICE'1'O APPLICAsl If,after making this Certificate of Ex.
' FZ
chip'
imi,you should become'subject to tine Workers''Compensation . APPLIANCE '1' 5.00 PLAN CHECK '
provisions of the Labor Code, you must forthwith comply with .FEE
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCT'ION LENDING AGENCY AIR HANDLING UNIT(OVER MODOC.F.M.) 6.00 SEISMIC FEE
-I hereby affirm.that there is a construction lending agency for EXHAUST HOOD(WITH DUCT). 5.00
of the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.C.L i HEATING UNIT(TO 100,000 B.T.U.), 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.0.50
Lender's Address ELECTRIC
rh'x s I certify that I have read this application andstate that the above VENTILATIOMFAN (SINGLE) 4.00 -
Information Is Correct. I agree to comply with all city and county g01LER-COMP13 H.P.Dr 100,000 B.T.U.1 6.00 PLUMBING .
•d ordinances and state laws relating to budding construction,and
hereby antliorize,representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCIi. MECHANICAL
above nuen Toned property for Inspection purposes. =
(We) agree to save, indemnify and keep harmless /he City OI MISC.- "--' +;-REFER TO ORD. "
upertino against liabilities,judgments, costs and expenses whichp PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue Ig,' t id City in consequence of the
rantingof his per I. MECH.CONT. - LIC.NO. MECH.
TOTAL TOTAL
ignition,of Applican/C nlract r Uatc
OFFICE COPY