15634 ! POST THIS CARD NEAR F;RONT'OF BUILDING
'•PERMIT NUMBER
CITY OF CUPERTINO' 15634
INSPECTION DIVISION '
JOB INSPECTION RECORD ".
'•, � �/ PERMIT'EXPI RATION
JOB ADDRESS__7F_/ (� 7! /A; /lk,/ 'UNIT# _LOT# '
• PERMIT EXPIRES IF WORK
OWNER �/Cr�/L' CONTRACTOR �Ov �/ IS NOT STARTED WITHIN •,
INS ECTION - DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
_ NOTE: � _ 'LASTCALLED INSPECTION.
LIFER. i ALL'GRADING AND DRAINAGE.SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL` !° I' ISSUAINCE DATE
MECHANICAL BLDG ELECT, PLG. MEC..
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED — - BUILDING PERMIT
WOODF LOOR t ,t Q : INFORMATION
_ VALUATION 5 .S/FT.
_
PLUMBING-
MECHANICAL
LUMBING p ♦f1 -` '
MECHANICAL -
ELECTRICAL - - CERMIT T
FRAMING _ �I �CVQg EL `� .
INSULATION' - - STORIES TYPE CONSTR.
I ,
- OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT.FLOORAREA TOTALACREAGE
• fl00F NOTE:NO�FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
rl BUILDING USE
- , ROOF SHEATHING '° � " - ' � J - .• �!- _• - � .EsIND CON Pe
APPLY,NO ROOFING UNTIL ABOVE HAS 8EEN SIGNED _ FINALS -DATE ' INSP. ❑ ❑ ❑ ❑ E]
' " ROUGH SAN.N - AssESSORSPARCEL NO.
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN'
PLUMBING ENERGY THAC7 NU, PARCELNO
MECHANICAL MECH.ENERGY '
ELECTRICALBUILDING ENERGY ACC.DATE ACC FILE NO..-
FRAMING ELECT.FINALTEST .
+, PLUMBING". - zorvlrvc � ENG
s
l I NO.
INSULATION. �a
GAS TEST ' - - GAS' - '
MECHANICAL .. FIRE'SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '. Y❑ NO ❑ N❑
_ EXTERIOR SHEAR - - ELECTRICAL RELEASE - FLooD zorve n:cu,c.. _
INTERIOR SHEAR FIRE DEPT!, v� N� rL N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH _ BUILDING
TEMPORARY APPROVAL , BUILDING^
INTERIOR LATH a (�, .
SCRATCHCOAT !., ELECTRIC PLAN CHECK
GAS FEE ,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY- SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING,252-4505, ELECTRIC , L
F ONE •.WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Ov
,. O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z'
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
-
IMPORTANT! CONST.TAX -.
;
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES — USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION .PERMIT NUMBER- .y
9UIlDING -J{r APPLICATION & PERMIT _ •'
N AOOR Es' / I'''7S/ rI'V I Y
BUILDING — ELECTRICAL—PLUMBING—MECHANICAL
OWNER 5 1 - PLAN CHECK VALIDATION
"AME �, QTY. a ELECTRIC PERMIT FEE I
VIPHorvE
•• CONTRACTORS .
rvAMEOUTLETS-SWITCHES-RECEP 70.00/1.00 -
o .`l'O��I�41c.No, LIGHTING FIXTURES- .10.0041.00 ' :.
f,ONTRACTOR'sPPLIANCES-RESIDENTIAL 4.00 '
DDR S c AbHONE ry�r'}l[�/
JIJ' �� V V • PANELS - 10.001 DATE OF APPLICATION -
' ARCHITECT - PLAN CHECK FEE "P.0 NO.
OH - PANELS,(OVER 200 AMP) 20.00 -
ENGINEER �'
Ll..R. ISIGNSTRANS.: 3.00
ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS r SPECIALCIRCUIT 7'S 1.
ZIP TEMP. METER OR POLE INS. 20.00 n� f '
Ars
ADDRESS MOTORS - SEE FEE SCH.
ADDRESS
SERVICE CHANGE20.00 /�J\/y1h�..t1/�O t -
/ d
o o LICENSED CONTRACTORS DECLARATION _ �Y �..
a v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
z (commencing with Section 7000)of Division 3 of the Business and
• , B ELECT., PLG. MECH.
r w z Professions C0 vin my license is in full forni4 d •lei,
i,--r ❑
License CI�s{�/2 Lie.Number 7 -
F _
¢ m DING PERMIT'
¢ 0 ¢ ¢ OWNIiR-BUILwf Dan, Con
DIift Df:CLARA ON -
O a o INFORMATION
wg a vHi •1 hereby uollowing I um exempt from thu Contractor's License MISC.— 'b REFER.TO ORD
u O¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE vnl:unnoN $/FT.
r y y Code:Any city or county which requires permit to construct,alter, '
rt> ELEC.CONTR. LIC.NO. /Ix
¢0 improve,demolish,or repair any structure,e a sig o its issuance,alw EOTALEC. C.?
—
n m u requires the applicant for such permit 10 filen signed statement that TOTAL - -PERMIT TO
w m lie is licensed pursuant to the provisions of the Contractors License � ��q I ,
HZ >
Law(Chapter 9(commencingwith Section 7000)ofDivision3ofthe e-t`�/
¢ Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE s
EiD
K r$ the basis for the alleged exemption.Any applicant
of Section malty STORIES TYPE CONSTR.
a 3 .. byany applicant fora permit subjects theapplicant to Civil penalty ALTER-DRAIN -WATER (EA) .500
- ol'not more than five hundred dollars(S500).): ' . . "- i - •,
❑ I,as owner of the property,or my employees with wages as BACKFLOW 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,CON D. 5.00
Code:The Contractor's License Law does not apply to an owner of -
' property who builds or iaipowes thereon;and who does such work FIXTURES-PER TRAP ; • 300 sO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mems 0"'t intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS EASYSTEM.-OVER 4(EA.) 2.00
builder will have the burden of proving that h - .e did not build or im- BUILDING USE
RES, IND CON .PB Other
prove for purpose(it the'.p - INDUSTRIAL WASTE INTER: 30.00 - ❑ ❑ ❑' '❑ ❑
❑ L as owner rs the property,um exclusively.7044,Bu with
licensed contractors to construct the project(Sec.does,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codeproperty Contractor's's License Law does not apply
to an owner such
property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for ctor's cense L with a pmt ractorfal licensed punuunt to SEWER-SANITARY-STORM EA.200ft/10,00 '
the Contractor's under
Luw: - BRACT NO. PARCEL NO.
❑ lam exempt under Sec. - ,B.&P.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner Date (NATER SYSTEM - 5.00 ,CC.DATE: ACC,FILE NO.-
'WORK ERS'COmPENSATION DECLARATION WATER TREATING EQUIP. 3, 5:00 '
I hereby a1Fim that 1 have a certificate of consent to self-insure,Film ENG.SITE NO.
or a-"Hificate of Workers'Compensation Insurance,of:I certified
copy thereof'(Sec.3800,Lab.C.). <
policyNo. - Company—!'T
" O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYT.24
Z Z citified copy is Filed with the city inspection division.
O Aplicam MISC!- REFER TO ORD. - - Y. N❑ V.❑ N❑
y PERMIT ISSUANCE - - qq N
L.— .CIi R'I'1I'ICCOI OF I ATION ION F NSURA M WORKGRS' .�7B:0B�OE FLOODZONE Nit.U.C.
W �' . COMI'IiNSATION INSURANCE � PLG.CONTR. -LIC.NO. PLG4 -
? Z . (this vAcliou'deed not be completed if the permit is for one TOTAL / V❑ tl,N❑ V ❑ NO
hundred dollars($100)or less.) 1
L) O !'certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT' FEE FEE SUMMARY
I,L'F iniL is issued,I shell'nos employ any person in any,...tour so as to i - • +
O w _ become subject m the Workers:Compenmlibn Laws of Culinumia.
CL ALTER OR ADD
Date Applicant BUILDING
- TO MECH. 5.00
}•W NOTICE TO APPIACAN'1': If,after making this Certificate IT Fix-
? Cmption,you should become subject to the Workers Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the LOIRE Cdde,;you must forthwith comply with FEE .
U such provisions or this permit Shull be cleaned revoked. - AIR HANDLING UNITITO 10=C.F.M.) ' 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOC.EM.I 6.00 SEISMIC FEE
I,R,4tby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
:. the perforinimee ofthc work for which this permit is issued(See. - MICROF I L'M
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address -
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 - �_•
'. . information is correct.i agree to comply withaWdly and County - PLUMBING' ( s�
ordinances and state lows relating to building construction, and 901LER-00W(3I4.P.or 100,000B.T.U.) 6.00
hereby, authorUe representatives of this city to enter upon the BOILER-COMP (Over l00,00D BTU(SEE FEE SCH. ,MECHANICAL
above mentioned property for inspection purposes. -
(We; agree to save, indemnify and keep Innmluss the City-of MISC.`;,. I REFER TO ORD:, -
upertoo amst liabilities,judgments, costs and expenses whichCONST.TAX
'my in - n ecrue a&4st said City in consequence of the PERMIT ISSUANCE 10.00 J '
mntin f nil. MECH.CONT. LIC.NO. MECH.
't — � TOTAL , TOTAL
'iNn oP a:m thactor. Date
OFFICE COPY