18301 POST THIS CARD NEAR FRONT OF BUILDING .
AfiRMIT NUMBER
CITY,;OF,.QUPERTINO V . 18301
INSPECTION DIVISION
JOB.INSP.ECTION RECORD
PERMIT EXPIRATION '
JOB ADDRESS;'' ;d63� ( �L��tsA_4� d�C�UN1T# _LOT# �
I PERMIT EXPIRES IF.WORK
OWNER �•'Q• CONTRACTOR IS NOT STARTED.WITHIN
INSPECTION DATE •INSPECTOR - INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION - - ANCE OR 180 DAYS'FROM'
NOTE: +
UFER LAST CALLED INSPECTION.
,. ALL GRADING AND DRAINAGE SHALL,BE INSTALLED
•PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
CUPERTINO STANDARDS..
GARAGE SLABS^ 'IFAM /
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ``
UNDERGROUND /SLAB'. d
PLUMBING
ELECTRICAL , ofISSUANCEDATE
4G "'
MECHANICAL - - ucv ELecT. PLc. MEC>I.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
WOOD FLOOR - ',L _, Y. - - -INFORMATION
PLUMBING VAwnns/PT.
opLO
_MECHANICAL - C/
ELECTRICAL I/.,4n TO "
FRAMING rl('�!•�A• s"'L`X'
INSULATION , t„ STORIES• TYPE CONSTR. - -
UCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED `
ROOF NOTE:.NO• LL
FINALINSP.SHABEMADEBEFORE sn.PT.aooPanEA TOTALAcneAGE
DIAPHRAGM'' •' THE CONSTRUCTION TAXIS':PAID '
BUILDING USE
ROOF SHEATHING - RES ,IND CON- 'PB on,„
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ -❑ ❑ ❑
ROUGH SAN.N - ASSESSORS PANCELNO
PLUMBING .'n - ELECT.ENERGY ..- - -
TRACTNO. PARCEL NO,
- . TUBS 8 SHOWER-PAN PLUMBING ENERGY -
MECHANICAL MEGH.ENERGY' -
ACC.OATE ACC.FILE NO.
. ELECTRICAL :- BUILDING ENERGY - -
FRAMING ELECT.,FINAL TEST
INSULATION PLUMBING - , 20N1NG ENG.SITE No.
GAS TEST - - „ GAS - - ,
MECHANICAL .FIRESPRINK - ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ;.• ❑ ' NE] ❑ NE] . '
EXTERIOR SHEAR
ELECTRICAL RELEASE FLDOo zoNE A.cu.C. .
INTERIOR SHEAR FIREDEPT: - ❑:1N❑ G �❑' N
SHEETROCK' ❑
I GRADE • FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - '
TEMPORARY APPROVALS BUILDING �+j0
SCRATCH COAT
ELECTRIC - - PLAN CHECK,.,
E GAS. <-- FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTI L'8UILDING FINALiIS SIGNED BY BUILDING INSPECTOR. ry�ICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-45065 ELECTRIC
- ONE WORKING DAY BEFORE REQUIRED'INSPECTION. PLUMBING
z° PLEASE.GIVE JOB ADDRESS WHEN PHONING. -
— SEE PERMIT FOR EXPIRATION'DATE -• MECHANICAL
'IMPORTANT! , CONST. TAX f
PLEASE READREVERSE SIDE f3EFORE
CALLING, FOR FINAL INSPECTION. TOTAL'
OFFICE COPY
APPTANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINTREN ONLY
BU LDING PROJECT IDENTIFICATION PERMIT NUMBER
NoLDING APPLICATION & PERMIT /��J/�J
' RDORE55 �I 18301 8 J 01 _
S 12Wjn L BUILDING-ELECT,R_ICAL-PLUMBING-MECHANICAL . IY^ V
OWNER'S - PLAN CHECK VALIDATION
NAME
B(c'o PHONE QTY. ELECTRIC PERMIT FEE '
r A�vo G .
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
NAIVE
- Sec.NO. LIGHTING FIXTURES 10.00/1.00 -
CONTRACTOR
ADDRESS
APPLIANCES-RESIDENTIAL 4.00
CONTRAS
PHONE PANELS 10.00 DATE OF APPLICATION ,
RCH]TECT PANELS (OVER 200 AMP) 20.00
OPLAN CHECK FEE
P.C.NO..
OR,
' ENGINEER
Sec.No. ISIGNS TRANS. 3.00
ADDRESS E"o SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS., 20.00 /1y,
APPLICANT'S - MOTORS SEE FEE SCH.
ADDRESS /
06.3.5 / I' ..4VE,9VSERVICE CHANE 20.00
w o O LICENSED CONTRACTORS,DECLARATIONQN/
a v w I hereby affirm that 1 am licensed under provisions of Chapter 9 11•- .t it 19 ISS4UANCE DATE
y Q (commencing with Section 7000)of Division 3 of the Business and „ DG. ELECT. PLG.. MECH.
O i Professions Code,and my license is in I all force and effect. 'El 1:z o. - License Class ' Lied Number
11
w r w Date Contractor. ot Cup=
.,
¢ y s BUILDING PERMIT
¢ o: a OWNER-BUILDER DECLARATION -
aoaD MISC.- REFER TO ORD INFORMATION
LL n I hereby ufl ire that I am exempt fr..the Contractor's License VALUATION $/FT.
F a 0 a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 �.o
Code;Any city or county which requiresa permit tocmtstruct,alter, �
-
S R¢Q improve,demolish,or repair any slnmtare;prior to its issuance,u]so ELEC.CONTR, LIC.NO. ELEC.'
a
O M requires the applicant for such permit to file a signed statement'that TOTAL PERMIT TO
w$ he is licensed pu¢uant to the provisions of the Contractor's License
i M /
H 2 La.(Chapter 9(commencingwith Section 7000)of Division 3 ofthe f; `/ , p�
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
IS = the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty' ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(8500).1:
fld I,as owner of the pruperty,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
thel sole compensation,will do the work,and the structure isnot
" intended or offered for Seale (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
properly who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
• .cuts are not
own employees,Sale.If,ho ever,the
improve- GAS-EA.SYSTEM-11 NC.4 OUTLETS 6,00
meats are nor ugh his ow offered for sale.It,ed that s the building
or improvement is sold within one year of completion, Lite owner- GAS EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden Of proving that he did not build or im- -
' prove for purpose of sale,).- - .INDUSTRIAL WASTE INTER. 30.00 RES IND-` CON PB Omer
❑ 1,as owner.of,the Lmperty,am exclusively contracting with ❑ ❑ "❑ O. ❑
licensed contractors to construct the Lannert(See 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 of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 _
contracts for such projects with a contractors)licensed pursuant to -
theCouractckLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. .PARCEL NO.
❑icaslam exempt under Sec ,B.&P.C.for this WATER HEATER W/VENT "6.00
Owner_ ate^ _ Dee WATER SYSTEM . 5.00 '
ACC.GATE ACC.FILE N0.
WORK 17RS'COMPItNSATON DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsenl to self-insure, ZONING ENG.SITE NO.
or z certificate of Workers'Compensation Insurance,or a certified
copy thercof(Sec.3800,Lab.C.).
Policy No.' 'Company
0 ❑ Certified copy is hereby tarnished. '
FIRE SPRINK ENERGY T 2
Z Z ❑ Certified copy is filed with the city,inspection Aivision.
' O REFER TOORD.Applicunl MISC.-
V,❑ N❑ yV ❑ N❑
PERMIT ISSUANCE 10.00
fL - CISRTI FI'COWI ENSATMI'1'I NSUR N WORKERS' FLOOD ZONE 'A.L:U.C.
W •COMPENSATION INSURANCIi PLG.CONTR. LIC.NO. vLG.
Q' O (This Section need not be completed if the permit is for one TOTAL Y❑ IN Y❑ N❑
0 Z' hundred dollars IS 100)or less.) -
U O. 1 certify that m the,performance of the work for which this per. OTY MECHANICAL PERMIT ' 'FEE FEE SUMMARY
• LL F mit is issued',I shall not employ any person in any manner so as to
O W become subject m the Workers Conspeniation Lws of California.
' y
Law Applicant ALTER OR ADD TO MECH. 5.00 BUILDING P-
} W NOTICE.TO APPLICANT: If, he,making this Certificate of 7,
F ? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of rhe Labor Code, you must forthwith comply with FEE
U such movisions or this permit shall be deemed revoked, - AIR HANDLING UNIT(TO 10MC.F.NL) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.EMX 6.00 . SEISMIC FEE
I hereby affirm that there is it construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit Is issued(Sec: - MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T:U.) . .8.00
Lender's Name ' HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Addmss - ELECTRIC
. . l certify Dat l havereaI this application andsmte that the above VENTILATION FAN (SINGLE) 4,01)
information is correct 1 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.) 6.00
hereby authorize representatives for
of this city,to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
ohuve-mentioned property IHr inspection purposes'. _
'(We) agree IO save, indemnify and keep harmless the City of MISC.- I REFER TO ORD.
upertine against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 - CONST.TAX
may in any way accrue against said City in consequence of the
ng this erin't' MECH.CONT. . LIC.NO. MECH.
.eEtr �' TOTALMh TOTAL �('�
Signature of Applicant/Contractor ) Date ,� e', I
OFFICE COPY
APPROVED
IN ACCORDANCE WITH THE CITY OF
CUPERTINO CODES/AND ORDINANCES,
DATE
SIGNED
This set of .ans and speciffxati.ns MUST
be kept on the job at all times and t is un•
lawful to make any changes or al ragow
on same without m::;tam p::m:ssiin- from
the bui ding Uep. "I "t 111 110 t nil, } r a 1, r,: ii 'All it
The stamping of :hs p'cn no specifications Lc V Z U
SHALL NOT Le tie tpe mit cr t; be an until
approval of the vii;;atiun of any provisions U JUL 1 zf 1969
d anv City 0 d.nance a Slate Law.
LUG. INSPECTION DEPARTMENT.
CITY OF CUPERTINQ
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