18044 o
POST THIS CARD NEAR FRONT OF BUILDING PEMITNUMBER
CITY 01 CUPERTINO 1 $044
INSPECTION DIVISION
JOB INSPECTION RECORD
I - PERMIT EXPIRATION
U
JOB ADDRESS '1825. - hr—J UNIT# LOT# "
1l1\'II /1 PERMIT EXPIRES IF WORK
OWNER I 11] � ,L\� CONTRACTOR' ' IS.NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 1BO DAYS OF PERMIT ISSU-
FOUNDATION'"' - ANCE OR 180 DAYS FROM
_ NOTE: LASTCALL INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED .d
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT LOCATION -
CUPERTINO STANDARDS.
GARAGE SLABS .4 e.'').•,�i�M!L{C-I -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB u 1989.'
PLUMBING Au
ELECTRICAL ISSUANCE DATE
MECHANICAL R ELECT PLG. 11 MECH.
y 'y. .❑ , ❑ .. 1`❑'
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT.TO
ELECTRICAL - �,'A,•i
E
FRAMING "
'-
INSULATION - - sroRlEs . rwPE CONSTR
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •/'✓/
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5O"Fr•FLooR°HFA TOTAL ACRFAce
DIAPHRAGM THE CONSTRUCTION TAX IS PAID .
BUILDING USE
ROOF SHEATHING RES IND CON PB Om.F
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 11 0 ❑ ❑ ❑.
ASSESSORS PARCEL NO,
ROUGH SAN.n
PLUMBING ELECT-ENERGY
.
' TUBS 8 SHOWER PAN � PLUMBING ENERGY - TRACT NOPARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ' Acc.Onre Acc.FILE No,
FRAMING ELECT.FINAL TEST
.
-
INSULATION PLUMBING � ZONIN,G ENGSITE NO.
GAS TEST GAS
^�- FIRE SPRINrc ENERGY T.74
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ❑ No I 1 No
FLOODZONE' AL.U.L.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT.. v Q. NQ' Y 0 N❑
SHEETROCK GRADE" FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT_ 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 ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU
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 N•
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT.IDENTIFICATION PERMIT NUMBER /
BUILDING APPLICATION'& PERMIT'
A7L-
M9 ,-CCL C et BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 18044.
OWNEP'a / - PLAN CHECK VALIDATION
"� ! �f o ,,,m ahn OE"�f08� O V• ELECTRIC PERMIT FEE
-
�y��J'La'C�l' /I4. 2V z•' vHorvE
NAMERacroRs I, � TLETS-SWITCHES-RECEP 10.00/1.00
t'fTI�.S rJ1 t& UC.No. W"/ /- LIG`PQtNG FIXTURES 10.00/1.00
CONTPACTORR/'F ay�� /� � T/ �p/y� - APPLIA CES-RESIDENTIAL 4.00
ADGR E�W/'/^'WV�I•'V/ �P A7/^W /6
/ NONE PANELS 10.00 GATE OF APPLICATION
ARCHITECTPLAN CHECK FEE
OR PANELS IDV 200 AMP) 20.00
ENGINEER
A- ARCH.OR ENIC,No. SIGNS TRANS. 3,00
G. PERMIT VALIDATION
W
ADOPEss SPECIAL CIRCUIT5.00
(� ZIP EMP.METER OR POL INS. 20.00
1 T S
AODJESS n� ' MOTORS SEE FEE SCH.
JC I�CDNLN IC/LC(�JU SERVICE CHANGE 20.00
o a o LICENSED CONTRACTORS DECLARATIONow
'
a U I hereby affirm that I am licensed under provisions of Chapter 9 SSUANCE GATE
2 w Iconunencing with Section of Division 3 of the I)usineys/pnd LECT. PLO. MECH.
wi Professions CnJ an mense is in full Ib¢e a da le - - ❑'. ❑ ❑
z O,
t: License Class Llc.Number -
o Date Contractor
¢ z w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
o A " REFER TO ORD INFORMATION
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;u y I hereby aftiml that I um exempt Irnm the Contractor's License MISC.- VALUATION $/FT.
O¢ Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 10.00
f � Code:Any city orcounly which requires a permit to construct,alter,
'
p p' y prior to its issuance,also ELEC.CONTR. LIC.NO.
¢ W¢ O improve,demolish,O!!e repair an structure,p ELEC.
DLL requires the applicant for such permit to file a signet)statement that - TOTAL, PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License '1,f
tzi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the'a Business Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢_$ the basis for the alleged exemption.Any violation of Section 703 t.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacied penalty ALT -DRAIN&VENT-WATER (EA.)of not more than five hundred dollars(S500).1: . -
❑ 1,as owner of the property,or my employees with wages is BACK OW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will Jo the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS- R,ROOF,ARENCOND. 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- R TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- ' GAS.EA.SVST -1 1NC.4 OUTLETS 6.00
mems are not intended or offered for sale,If,however,the building ,
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM OVER 4 (EA.) 2.00 -BUILDING USE
builder will have the'buNen of proving that he did not build or im- - RES IND CON Pe Other
prove for purpose ofsale.). INDUSTRIAL WASTE TER. 'c 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ Cl ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLER$-1 I 5 V.B. fi.DD .ASSESSORS PARCEL NO.
and Professions Code'.The Contractor's License Law does not apply
t0 nu owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV E (EA.) 1.00 ,
contracts for such projects with o contraclons)licensed pursuant to
the Contractor's License Law. - SEWER-SANITARY-STORM EA. 00ft/10.00 TRACT NO. PARCEL NO,
❑ I am exempt under Sec.-,L&P.C.for this WATER HEATER W/VENT - 6.00 -
reason
Owner - Dale WATER SYSTEM 5.00 '
ACC.DATE ACC:FILE NO.
WORK ERS'COMPENSAT1ON DECLARATION WATER TREATING EQUIP. .00 • -
1 hereby affirm that I have a certificate of consent to self-insure, -I ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a eertif fil`
copy the oj -2r.Lab C.). 0..._ fAv/� / .
Policy N onmany JLq[it-i _
O ❑ Certificdcopyisherehyfurnislted. FIRESPRINK ENERGY T-24
Z 26/ Certified cop rs fJsy )rith the city inspection division. MISC- REFER TO ORO ❑ ❑ Y ❑ No
2 IT can
~ wCF,RT'I
J C
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
ft. . OM-OP EXEMPTION PROM WORKERS'
LU _ COMPENSATION INSURANCE the PLG.CONTR, LIC.NO. PLG: Y N❑ Y❑ N❑ '
CL Z hundred
section need not be completed if the permit is for one TOTAL
0 Z hundertify that
ars(n The pe)cord
LL O I certify that h the to employ
of the work for which this per. GTY MECHANICAL PERMIT FEE FEE SUMMARY
0 I- mit is mated,I shall not employ any person in any manner so is to
U ' become subject to the Workers'CompensWion Laws if California. '
i BUILDING
Dam Applicant ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT': If,after making this Certificate of Ex
H 2 emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with FEE
CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCT'ION LENDING AGENCY - AIR HANDLING UNIT(OVER I0OWGflM.) 6.00 SEISMIC FEE '
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. - MICROFILM
3097,Civ C.). I HEATING UNIT(TO 100,000 B.T.U.) 8.00
' Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state(list the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-CCNx•1P(3 H.P.or 100,000 B.T.U.) �Q
hereby authorize representatives of this city to enter upon the BOILER-COMP IOvm 100,000 BTU)SEE FEE SCH, MECHANICAL '�/•�•
above-mentioned property for inspection purposes. -
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,costs and expenses whichPERMIT ISSUANCE �¢g0 'CONST.TAX
aY in n way ace gains t said Cily in conspqu nee of the
ran In his elm I. ^f/YA MECH.CONT. LIC.NO. MECH.
I za"' #Yn It a$ Alas . �� TOTAL TOTAL
Sig ture of Applicant/Contractor - Dae �/
OFFICE COPY