15569 POST THIS CARD NEAR FRONT OF BUILDING .
'PERMIT NUMBER,
CITY OF -CUPERT;INO . 15569
11 . INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION I
JOB ADDRESS- 0Z G�/7.WOD _LOT# - .�
PERMIT EXPIRESAF WORK•.
'OWNERV ` SE 'CONTRACTOR " Gds' G,�.0 IS NOT,STARTED WITHIN:
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU-`'
FOUNDATION - q ANCE OR 180 DAYS FROM
-- - NOTE: LASTCALLED INSPECTION.
' UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND'CITY OF - PERMIT VALIDATION
BREGUNITE CUPERTINO STANDARDS. '
GARAGE SLABS - •,,,r •'I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN
SIGNED-.UNDERGROUND/SLAB '
' PLUMBING - L.
ELECTRICAL _ - - ISSUANCE DATE
..) MECHANICAL FLOG.
E.LECL. PLG.
El
00 NOTPOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
' WOOD FLOOR INFORMATION
PLUMBING - -. VALUATION 5/FT.
pPAO
MECHANICAL.' - -
ELECTRICAL,- - - {{ p Q . PERMIT TO - 61
FRAMING
•oft 7 �STORIES TYPE CONSTH.
INSULATION - . _CItV 0f �110e
I, I' OCC.GROUP- RES.UNITS
-PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SUI IT,FLooq ARLA TOTAL ACREAfE
.; ROOF. NOTE:NO-FINAL INSP.SHALL BE MADE,BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID ' y
" ROOF SHEATHING BUILDING USE
RPS IND CON PB,S O'l-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED • FINALS DATE INSP. ❑f ❑ ❑. ❑ 1:1-
ASSESSORS PARCE
` ROUGH 1 � SAN.N „ - .I LNO
PLUMBING " ELECT.ENERGY
TUBS 8SHOWER PAN, TRACT NO, PARCEL NO PLUMBING ENERGY -
MECHANICAL - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACC.FILENO
FRAMING ELECT.;FINAL TEST < -�•. '
'INSULATION
PLUMBING ZONING ENG,SITE NO,
"� � _
GAS TEST - GAS -
MECHANICAL 7 FIRE SPRINK ENERGY TIC
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N Y ❑ N❑'
ELECTRICAL RELEASE FLOOD ZONE A.L.Uc.-
EXTERIORSH EAR �- _ - ..
'INTERIOR SHEAR, '• FIRE DEPT. Y.❑ S N❑ Y'❑ . N❑'
SHEETROCK „•c GRADE - FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH T'EMPORARY'APPROVALS- 'BUILDING`
+' SCRATCH COAT ELECTRIC' + PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE-HAS BEEN SIGNED OCCUPANCY - - -' SEISMIC FEE
OCCUPANCYOF BUILDINGISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BU I LD I NO I NSPECTOR. MICROFILM
''ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
U� :M1 O.NE`WORKING DAY BEFORE FIEQUIREDINSPECT10N. PLUMBING Od `
zo PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE'PERMIT FOR EXPIRATION DATE - MECHANICAL
I�. ..
IMPORTANT!' CONST.TAX
4 PLEASE READ REVERSE SIDE BEFORE I/
CALLING, FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES' -USE BALL:POINT PEN ONLY
,
BUILDING PROJECT IDENTI FICATION PERMIT NUMBERAPPLICATION $-PERMIT
BDDRE - 15569
[NAME
DRESS - f//J '
NTckro LXX - BUILDING—ELECTRICAL—PLUMBING'=MECHANICAL ,• � '
' NER' - - PLAN CHECK VALIDATION
CITY. ELECTflIC PERMIT FEEPHTRACTOR'$
NAE 'OUTLETS-SWITCHES-RECEP 10.00/1:00
/ LIC.No LIGHTING FIXTURES 10.00/1.00
r. TRA rolls PPLIANCES-RESIDENTIAL 4.00 r
ADORE55. .�Jy� "�
_ - ( j/ PHO -Ay PANELS 10.00 DATE OF APPLICATION C t
0gcertscT' - PANELS (OVER 200 AMP) -, 20.00 PLAN CHECK FEE C.No.
ENGINEER
LIC.No, ISIGNS TRANS. -3.00 _
ADOREss ENG.• SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 L/--✓-/—" .
APPLI MOTORS SEE FEE SCH.
55
ADDRDDfl ESS
- SERVICE CHANGE 20.00
w o 0, LICENSED CONTRACTORS DECLARA'NON
<u w 1 hereby afflun that I am licensed under provisions of Chapter 9 - ISSUANCE DATE T
w a e (commencing with Section 70001 of Division 3 of the Business and BLDG. ELECT. PLG. .MECH.
F o i Professions Ca? 7 licensx is in full f J fPd.3�. ❑ ❑ ❑
z o w - License Class Lic.Number -
y.F wDate Contractor "V"�
a m E J - BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
S,
a U - INFORMATION
w ; LL I- 1 hereby affirm that 1 am exempt from ilia Contractor's License MISC:— c REF ER�TO ORD
F u o a Law for the following reason.(Sec.703 5,Businessand Prole VALUATION $/FT.PERMIT ISSANCE
. 10.00 -
Code:Any city or county which requiresa permi l to construct,alter, -
rt
La¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.GDNTR. - LIC.NO. ELEC. 'l
_ - 0¢ requires the applicant for such permit to the a signed statement that
. TOTAL
a
ac " be is licensed pursuant to the provisions of the Contractors License PERMIT TO
HZQ
Law(Chapter 9(commencing with Section7000)ofDivision3oflhe
i o Business and Professions.Code)or that he is exempt therel'roln and DTV. - PLUMBING PERMIT FEE
.¢ r m the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.'
La i .-- by any applicant Icor a hermit strocds theapplicanitoa civil penalty ALTER-DRAIN -WATER IEA':) 5.00 '
of not more than five hundred dollars($300)J: M
❑ 1,as owner of Ole Property,or my+comloyccs•wiih wagesus ggCK FLOW PROT ECT..DEVICE - 4,00
their sole compensalion;will do the work,and theslraclum is not OCC.GROUP RES..UNITS
intended or offered for sale (Sec. 7044; liusinces'urd Professions DRAINS-FLOOR,ROOF;AREA,COND. 5.00 -
Cod :The Contractor's License Law does not apply to an owner(it. '- F,;
property who builds or improves thercon, nd who doe,mwil work FIXTURES-'PER'TRAP. •, SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through las own employees provided that ser h tai- we-
m - s
mes are not intended or offered for sale N,howevr,the bwlding GAS-EA.SYSTEM-1'INC.4 OUTLETS 6.00
`,• or amprovement.issold within one year of completion,the owner. GAS-EA.SVST,EM-,OVER 4 (EA.)'
builder will have the burdemof proving that he did not huild or int- .. ..._ . . BUILDING USE
prove for purpose of soled. INDUSTRIAL'WASTE IN TER. ,00 rv,10� tO ❑N ❑ o0r
❑ 1,as owner of the property,ant exclusively contracting with
licensed
ro contractors Cod In construct the project La 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 001 •a ASSESSORS PARCEL NO.
and Professions COJc The Contractor's o License s thereon,
reon,an apply - -to contracts
owner ofpToperlyprojects
who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5'IEA.)� .00 -the
Contractor's
Icor such projects with a contmcmrtsl licensed pursuant m
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ftI10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sea ,Ii.&P.C.fortltis WATER HEATER W/VENT.- .Bko -
reason
Owner .Date - I WATER SYSTEM .5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EOUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,or a certificate of Worker. Compensalir Insurance,oyI certified ZONING ENG.SITE N0.
copy file • OO,L b.C). N/moi M/%� .
Policy Comp ny-- W WSJ -
0 ❑ C e opy i 'here yfurnished - FIRE SPRiNK ENERGY T-Za
Z Z Certil ed opy r 01 with thc-city inscelio 'nwJivision.
O plicant E�CeL �"—L� MISC.- REFER TO ORD. vQ .N� v � N�
� y CER 'ICATI>OFISXEMI'I'IONI:RONIWORKF.RS' PERMIT ISSUANCE FLOOD FLOOD ZONE A.L.U.C.
LU — COMPENSATION INSURANC17 PLG.CONTR. LIC.NO. PLG.
,� Z (This section need not be completed if the permit'is for one TOTAL ,LQ Y ElN❑ v❑ NE
hundred dollars($100)or less.)
U O - 1 certify that in the performance of the work for which this per- OTV. -MECHANICAL PERMIT FEE FEE SUMMARY
U_ mil is issued.I shall not employ any person in Bary manner so as 10
0 w become subject to the Workers'Compensalion Laws of California..
Date At licanl BUILDING
a I p ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT: II',after ct nuking this Certificate of ion
Z emvisionyo should become subject Louse Workers'Ccomply minn APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed invoked. . AIR HANDLING UNIT(TO 10pODGF.M.) 4.00 '
CONSTRUCT ION LENDING AG17NCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE-
,I hereby affirm that there is a construction lending agency lar EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILMS,
3097,Ce C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address - ELECTRIC
• I certify that I have ead.this application and stale that Em above VENTILATION FAN (SINGLE) 4:00 '
ordinances
n correct I agree 1 amply with all my and county BOILER r COMP(3 H.P.or 100',000 B.T.U.) 6.00 PLUMBING
information
and stale laws relating, N building all
city anon, and
hereby authorize representatives al this city to enter upon the BOILER-COMP IOver 100,000 RTlJl SEE-FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep haRR10.s the City of MISC.'- m" ! REFER TO.ORD. -
Cupertino agai st'liabilities;judgmmtls, costs and expenses which PERMIT ISSUANCE ' - 410.00 CONST.TAX
ma in any w y accrue against sold City in consaquance of the '
•r
at t ol'this crntiL MECH.CONT. r L LIC.NO. MECH.
•s - TOTAL - f
TOTAL /y
., Sig t re ol'Applcant/Contractor Dale - I' 86
'OFFICE"COPYr