18602 POST THIS CARD NEAR FRONT'OF BUILDING
, p ' PER M1VT NUMpER
CITY OF CUPERTINO : 16602
--- " INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS ✓ ` �1—./-- UNIT#'' - _LOT# PERMIT EXPIRES IF WORK
W-7
OWNER 1G�/Z/! �l CONTRACTOR O IS NOT STARTED WITHIN
INSPECTION ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER' - ALL GRADING AND DRAINAGE'SHALL BE INSTALLED'
" PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PER VAI.IDAT
CUPERTINO STANDARDS. '
ION
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDrime�qr
UNDERGROUND /SLAB 144
PLUMBING' a .� /`/IA
ELECTRICAL 1 . SSUANCE rE
MECHANICAL - - pLuc.- ELEcr PILO. MECH
_N LD ❑;. ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'BUILDING PERMIT
' INFORMATION
"a .-WOOD FLOOR ¢ - /VALUATION SIFT.
PLUMBING ' -an
MECHANICAL'-
ELECTRICAL - ('cL1 1 PERMIT To
FRAMING,:. - G'e1 .�'S
INSULATION - STORIES TYPE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL' ABOVE HAS BEEN SIGNED
_ . Sn IT,FLooRAR5A ,o,AL.Am+EAGL
ROOF , - NOTE.NO FINAL INSP�SHALL BE MADE BEFORE.
s - ' - THE CONSTRUCTION TAX IS PAID`
DIAPHRAGM i BUILDING USE
ROOF SHEATHING RES IND' CON PB ,Om.,
PAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS - DATE INSP. ❑ ❑ ❑ ❑ ❑
' ASSESSORS PARCEL NO
ROUGH• SAN.# _ ,
PLUMBING ELECT.ENERGYTRACT No. PARCEL No.
-
PLUMBING ENERGY
TUBS&SHOWER PAN - -
MECHANICAL - " MECH,ENERGY _ -
ELECTRICAL-"' - BUILDINGENERGY ' ACC.DATE ACC.FILE NO.
FRAMING ELECT.,FINAL-TEST,. ' � -
INSULATION- , PLUMBING 'ZONING ENG,SITE No.
•, " - ,
GAS TEST + GAS
MECHANICAL tT FIRE SPRINK 'ENE RGY T Sa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING Y❑ "❑ • Y ❑ NE]
EXTERIOR:SHEAR `- ELECTRICAL RELEA F
00 ZONE n,L.u,C.
INTERIOR SHEAR - FIRE DEPT. - Y❑ .N❑ 'Y ❑ - N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR'.cATH .�r TEMPORARY APPROVALS BUILDING
SCRATCH COAT, ELECTRIC - '�- - PLAN CHECK
GAS r FEE ...',
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN"51UMLUI OCCUPANCY , ` - SEISMIC FEE
OCCUPANCY-OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR' MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, . ELECTRICAl
�. •Q(�
F •ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z -
- SEE PERMIT FOR EXPIRATION DATE -., MECHANICAL
IMPORTANT! " ..CONST.TAX
'_PLEASE'READ REVERSE SIDE BEFORE TOTAL
CALLING FOR-FINAL INSPECTION.
OFFICE COPY•
APPLICANT TCTFILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
PERMIT NUMBER
BUI LDI NG PROJECT I DENTI FICATION
BUILDING, q /1 '/ APPLICATION &'PERMIT 860n
. r aoo s / G' V-Lb ,.," P_we ICAL-PLUMBING-MECHANI
BUILDING - ELECTRCAL (f
OWNER'S - - PLAN CHECK VALIDATION
E CITY. ELECTRIC PERMIT FEE
. 06- d R rL�
corvrn re- 's
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
LIQ.NO, LIGHTING FIXTURES 10.00/1.00 '
ADDRESS TORS APPLIANCES-RESIDENTIAL 4.00 -
"`" PHONE PANELS .10.00
DAEOF APPLICATION'
ARCHITfCi PLAN CHECK FEE P.C.NO.
DR- -PANELS (OVER 200 AMP( 20.00 _
ENGINEER '
uc.No, SIGNS TRANS. 3.00
ARCH FNG.
-
ADDRESS SPECIAL CI RCU IT 5.00 ,
ZIP EMP. METER,OR POLE INS. 20.00 PP�EHVALIDATION
ADDRESNrs - MOTORS 'SEE FEE SCH.
ADDRESS
, SERVICE CHANGE 20.00 �� /p
r
09 LICIiNSIiD CONT'kACT'ORS UECLA RATION` -
a U w 1 hereby affirm teal I am licensed under provisions of Chapter 9 �A� ISS NCE E !•
y (commencing with Section 7000)of Division 3 of the Business and
0 n - - BLDG. ELECT. PLG. MECH.•
F�i Professions Code,and my license is in full force and effect
, 02-o ]),I License Class Lie.Number - a 1989 .❑,.
r - (Jots+ - Cool racmr dy Lt rj tl IA 4,
a m s �.. " - 1 IL I' 1 BUILDING PERMIT
X a ¢ OWNER-BUILDER DECLARATION
-
¢W U - INFORMATION
W;a. N 1 hereby affirm that I am exempt from the Contractor's License MISC.- TO ORD In wanON-
wOa Law for the following reason,(Sec.703 L5,Businessand Professions PERMIT ISSUA • - "1 a0(0 q � S/FT.
f � >• J Code:Any city or county,which requiresa permit to construct,alter,
G -T
a Q improve;demollsr or repair anysUudum,prim 101[s issuance,also ELEC.CONTR. LIG.NQ TE EC ra
u wU LL- requires the applicant Grouch permit to fele a signal statement that TOTAL / /. PEHMIT TO
m,A he is licensed pursuant to the provisions of the Contractor's License
on Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
< Business and Professions Code)or that he is exempt therefrom and. CITY. PLUMBING PERMIT FEE
X t�- U the basis for the alleged exemption.Any violation ofSeclion 7031.5 STORIES . TYPE CONSTR.
a ; m by any applicant
l'or a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of Dot more than five huodred dollars(S500o): - '-
❑ 1,as owner of the'prope,ty,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do(lie work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
ptoperly who builds Or improves thereon,and who dues such work FIXTURES-PER TRAP 5.00 SG.FT,FLOOR AREA 'TOTAL ACREAGE
hintaell'or through,his own employees,provided(hut such improve- .
Gents ail not intended or offered lb,sell.IL however the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA ) 200
builder will have the burden of proving that h - . . .
e did not build or im- BUILDING USE
1RES IND CON PB Oahe!
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ r ❑ ❑ 1:1 1-1❑' I,as owner•ol,theeproperty,am exclusively contracting with
licensed contractuis'to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.O. 6.00 ASSESSORS PARCEL NO.
and Professions Coda:The Conlruoflir s License Law does not apply
to an owner of properly,who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) .1.00 + ,
contracts for such projects with a contractor!.)licensed pursuant to
tilt Comracto't Liccpse law: SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. .
@l( I a1 x under ec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
rcas t
Ownc!' Date WATER SYSTEM 5.00 ACC.DATE- ACC.FILE NO,
WORKERS'COMPEN'SAT'ION DE ,LA RATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure. .
or a certificate of Workers'CompeZONING ENG.SITE NO.nsation Insurance,or a cert ifinl
copy thereof(Sec.3900,Lab.C.). '
Policy No. ' 'Company
0 ❑ Certified copy is hereby'furnished. FIRE SPRINK ENERGY T-24Z_ Z ❑ Certified copy is filed with the city inspection Division. MISC.- REFER TO ORD. ❑ ❑ [:] ❑
Applicant - V N 'Y N
~ rn -PERMIT ISSUANCE 10.00
� - CIS. .ICCOf Of FA'6PI'ION PROMS WORKERS' FLOODZONE 'a.L.U.C.
W � '' '�. COMI!IiNSA'I'ION INSURANCE PLG.CONTR. a LIC.NO. PLC. v '
C' 0., (11'his Section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ No
Z. hundred dollars(S IOU)m less.)
U O _ 1 certify that in the performance of the work for which this per- GTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F' mit is issued,1 shall not employ any person in any ma atter so as o
U - beeline subject to lhe,Workem'Com.com ion Laws of.Californin.
U w Date- Applicant" BUILDING '
>_ NOTICE NOTICE TO APPLICANT: Ip after making till,Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
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 10=C.F.M.) 4.00
CONS'I'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)000CF.M.) 6.00 SEISMIC FEE
'11 hereby affirm'that there is a construction lending agency lot EXHAUST HOOD (WITH DUCT) 5.00 -
the performance of the work.for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 '� - �
Lender's Address ELECTRIC
1 certify that I have read this application and state that Ow above VENTILATION FAN (SINGLE) 4.00 ,
information is correct. I agree to comply with all city anJ county - PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMPI3,H.P.or 100,000B.T.U.1 6.00
hereby aathorite representatives of this city to eel er upon the B01 LEfl-CO MP 10v,r 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We),agree to save; Indemnify and keep hunnless the City nl' MISC.- REFER TO ORD. -
Co
pertino against liabilities,judgments, costs and expenses which .PERMIT ISSUANCE 10.00 CONST.TAX
+
mayin any way accrue against said City in consequence of the
rant ingof this permit - MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of Applicant/Contractor bate s
OFFICE COPY