14676-'POST THIS CARD NEAR FRONT OF BUILDING
,CITY -OF CUPERTINO_% .
INSPECTION DIVISION
JOB INSPECTION RECORD,
-• -
JOB ADDRESS 7ap,�_ Z— C'7 'UNIT LOT# -
-
OWNER A vi car&,j- CONTRACTOR
PERMIT NUMBER
14676
PERMIT EXPIRATION
'•- '
PERMIT EXPIRES IF WORK
IS. NOT STARTED WITHIN ,
180 DAYS OF PERMIT ISSU
- ANCE OR 180 DAYS FROM
LAST CALLEDTNSPECTION. -
INSPECTION— DATE I INSP CTOR
INSPECTION RECORD
FOUNDATION - _ ..
NOTE:' -
ALL GRADING AND -DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
UFER- -
PREGUNITE ' - -
•PERMIT VAODATION
'� 1ssuANce.uATe
GARAGESLABS''
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
+.. +
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ELECTRICAL - �
MECHANICAL M
-
BLDG
El
ELECT,
El
PLG. MECH.I
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00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
' -
BUILDING PERMIT
INFORMATION
- WOOD FLOOR ,. -
VALUATION
S/FT.
PLUMBING
MECHANICAL
ELECTRICAL
-
//' PERMIT TO
/ld,y/
FRAMING c
�FIVE
INSULATION
- -
STORIES
TYPE CONSTR.
OCC. GROUP
RES, UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' - ROOF•NOTE:
NO FINAL INSP. SHALL BE MADE BEFORE
.THE CONSTRUCTION TAX IS PAID
-
so. FT FLOOR AREA
TOTAL ACReAGE
DIAPHRAGM- - •
ROOF SHEATHING
BUILDING USE
RES' IND CON PB O,o.•,
D D D D' D
APPLY NO ROOFING'UNYIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
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ROUGH
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SAN.N
ASSESS QRS PARCEL NO
- I
PLUMBING
ELECT. ENERGY - -
TUBS &SHOWER PAN
PLUMBING ENERGY
TRACT NO.
PAR , CEL NO
MECHANICAL
MECH.ENERGY -
ELECTRICAL t - %P5
BUILDING ENERGY
ACC. DATE
ACC. FILE NO
'
FRAMING -
ELECT. FINAL TEST' y-
'INSULATION. ,f�g
PLUMBING - -
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ZONING
ENG. SITE No.
GAS TEST
GAS
•
MECHANICAL
FIRE SPRINK
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ENERGY T 34 -
Y. D "�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
-
EXTERIOR SHEAR -, � � �
ELECTRICAL RELEASE �
FLODD ZONE
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A.L U: C. -
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YD A'D
INTERIOR SHEAR -
FIRE DEPT.
SHEETROCK Q.CC '(•V ��_ 8 .GRADE
-
FEE SUMMARY
EXTERIOR LATH coffer, Lo 10-31—
BUILDING -
BUILDING
r-
" -
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC -
PLAN CHECK
.FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY -
.SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR-
MICROFILM
ARRANGE FOR INSPECTION:BY PHONING 252-4505, ..
H ONE WORKING DAY BEFORE REQUIRED INSPECTION.
C� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
—SEE PERMIT FOR EXPIRATION DATE = . `
ELECTRIC
PLUMBING
MECHANICAL
coNsr. TAX
IMPORTANT! - ,
PLEASE READ, REVERSE SIDE BEFORE °
CALLING FOR FINAL INSPECTION.
TOTAL C�
4'
OFFICE COPY.
-,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
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-BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
14676
BUILDING
ADDRESS
5� LCL CT L
OwyN1§E R'S (ffJ -
///,W (r/�j /i%r CWI76S-Z232_ .
PHONE 4oqG
QTY' ELECTRIC PERMIT FEE
-
PLAN CHECK VALIDATION
NAMEEnGToaa
UTLETS-.SWITCHES- RECEP- 10.00/1.00 -
LIC. No.
LIGHTING FIXTURES 10.00/1.00 6 `
CONTRACTORS
ADDRESS'
PPLIANCES-RESIDENTIAL 4.00
PANELS 10.00
PHONE
DATE OF APPLICATION
onCHITECT
ENGINEER
LIC. No.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
nouFEss ENG.
SPECIALCIRCUIT 5,00
PERMIT VALIDATION
TEMP. METER OR POLE INS, 20.00
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ADORES
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MOTORS SEE FEE SCH. �,,,
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
..
I hereby affirm that 1 am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect
License Class Lie. Number
Date Contractor
n
tds SY
V ISSUANCE DATE -
BLDG.-
1.1 �I
'ELECT.
PLG. MECH.
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- - - -
OWNER -BUILDER DECLARATION
I hereby affirm that I eat exempt from the Contractors License
Law for the following reason. (Sec. 7031.5, Business and Professions
Code: Any city or county which requiresapermit to construct, after,
BUILDING PERMIT
INFORMATION
' MISC:- REFER TO ORD
VALUATION
-
$/FT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO.
ELEC. r�
TOTAL 3xS^
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) Or that he is exempt therefrom and
q
( /
PERMIT TO
` �Ey
A?T4,y
QTY. PLUMBING PERMIT FEE 1
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (8500):): .
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
' BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who docs such work
himself or through his own employees, provided that such improve-
men" are not intended or offered for sale. If, however, the building
FIXTURES - PER TRAP 5.00 Q
SO. FT. FLOOR AREA
TOTAL ACREAGE
GAS - EA.SVSTEM - i 1NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or int -
prove for purpose of sale.).INDUSTRIAL
❑ I, as owner of the properly, am exclusively contract .ng with
. -..
GAS - EASYSTEM OVER 4 IEA) 200
BUILDING USE
RES 'IND CON PB other
❑ ❑ ❑ ❑ ❑
WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply
to in owner of properly who builds or improves thereon, and who
LAWN SPRINKLERS.- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
,
ASSESSORS PARCEL NO.
contracts for such projects with a contractor(s) licensed pursuant to
the Contractors License Law. -
SEWER-SANITAR V -STORM EA. 200ft/10.00
TRACT NO,
PARCEL NO.
O l am exempt under Sec. ,B.&P.C. for this
reason
WATER HEATER W/VENT 6.00
Owner Dat
WATER SYSTEM 5.00
ACC. DATE
ACC, FILE NO.
WORKERS'COMPI? A"TION DECI.A RATION
WATER TREATING EQUIP. .5.00
I hereby affirm that I have a certificate ofconsent LLI self -insure,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copy thereof (Sec. 3800, Lab.C.).
Policy No. Company
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the city inspection division.
Applicant _
FIRE SPRINK
Y ❑ N ❑
ENERGY T-24
Y ❑ IN
MISC. - REFER TO ORD.
CERTIFICATES OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00 �"
A.L.U.C.
PLG. CONTE. - LIC. NO.
PLG.
TOTAL
COSIPIiNSATION INSURANCE
(This section need not be completed if the permit is for one
=FLOOD
Y❑ N❑
Y❑ N❑
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars IS 100) or less.)
I certify that in the performance of the work for which this per
mit is issued, I shall not employ any person in any manner so as to
BUILDING
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex
ALTER OR ADD TO MECH. 5.00 `
,
APPLIANCE 5.00
PLAN CHECK
emption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you most forthwith comply with
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
FEE
AIR HANDLING UNIT (TO 10=C-F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
'SEISMIC FEE
3 3
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 (Sec.
3097,
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
3L
Lender's Name
Lender's Address
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
ordinaries and slate laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
f/L2
d .�-
130ILER-COMP(3H.P.or1OO,000B.T.U.I 6.00
BOILER -COMP (Over 100.000 BTU) SEE FEESCH.
MECHANICAL
✓
hereby 'authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
MISC.- REFER TO ORD.
(We)t' agree to save, indemnify and keep harmless the City of
upertino against liabilities, judgments, costs and expenses which
may in any way accme against said City in consequence of the
CONST. TAX
PERMIT ISSUANCE 10.00 V -
MECH. CONT. LIC. NO. MECH.
TOTAL �S-
TOTAL
I, SPI
'
StarrIT s r
Signature of Applicant ntractor Dae
OFFICE COPY