15482 . POST-THIS CARD NEARFRONT•OF BUILDING
PERMIT NUMBER
CITY OF ,CUPERTINO .. 15482
_ I INSPECTION DIVISION
JOB INSPECTION RECORD
�. D,p / PERMIT EXPIRATION I
JOB ADDRESS �1 ls— Z< �-y � UNIT# _LOT#
�, � " PERMIT EXPIRES IF WORK '
OWNER - /� �p'✓ CONTRACTOR IS NOT STARTED WITHIN i
INSP CTION DATE INSPECTOR INSPECTION RECORD 180DAYSO,FPERMIT ISSLI-
FOUNDATION - ANCE OR 180 DAYS"FROM
NOTE: LASTCALL ED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAuoAT17
CUPERTINO STANDARDS..
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � ---�
UNDERGROUND /SLAB t/r�}rc, L. •; (r s;.
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - BLDG ELECT.I PLG. . MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED' BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION
SIFT.
PLUMBING, -
MECHANICAL '
ELECTRICAL PFRMITTO -
.7
FRAMING
INSULATION . - BID RIES TYPE CONSTR.
- OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1
SO IT'FLOOH AREA TOTAL ACREAGE
ROOF: NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM _ - " - 'THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING HES IND CON PB :Ow"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE P
N . - ❑ [j El El El
ASSESSORS PARCEL NO
ROUGH SAN.# n
PLUMBING ELECT.ENERGY I Dw
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No.
MECHANICAL - MECH.ENERGY 0 V'"
ELECTRICAL. - Acc DATE I ACO FILE NO.
BUILDING ENERGY
1
FRAMING' ELECT,FINAL TEST
'ZONING ENG.SITE NO. '
. INSULATION � - � � PLUMBING' - - -
GAS TEST - GAS !
• MECHANICAL FIRE SPRINK ENERGY T P<
_C
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ IV ° El NE_
L.U,C. '
EXTERIOR SHEAR � ELECTRICAL RELEASE FLOOD ZONE A. '
•i I INTERIOR SHEAR FIRE DEPT. v ❑ NO v L "❑
SHEETROCK ': n GRADE . FEE SUMMARY
EXTERIOR LATH BUILDING.
INTERIOR LATH TEMPORARY APPROVALS rFEE
ING
SCRATCH COAT ELECTRIC CHECK
GAS NO TAPE OR PLASTER UNTILABOVE HAS BEEN SIGNED' OCCUPANCY IC FEEOCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. OFILM
ARRANGE FOR INSPECTION''BY PHONING 252-4505„ TRIC
F ONE WORKING DAY BEFORE. REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE -- MECHANICAL
IMPORTANT! CONST,TAX
PLEASE READ REVERSE SIDE BEFORE
TOTAL
CALLING FOR FINAL INSPECTION..
OFFICE COPY
APPLICANT TO FILL ININFORMATION WITHIN RED LINES = USE BALL POINT PEN"ONLY
.PERMIT NUMBER"
BUILDING PROJECT IDENTIFICATION - 1 � F'
BUILDING APPLICATION & PERMIT 54,82 '.
aooRess ] -'
, 3S• �:/� ,e BUILDING.- ELECTRICAL-PLUMBING-MECHANICAL � �' 1 I
PLAN CHECK VALIDATION
NAME : QTY. ELECTRICPERMIT r 'FEE "
ONE
NAMERACTaR UTLETS-SWITCHES'-RECEP 10.00/1.00 t -
Qr 'u C.N.7 Of LIGHTING FIXTURES
10.00/1.00 a -
•p CONTRACTOR ,
ADDRESS �Q{/9/f/Q�j APPLIANCES-RESIDENTIAL ' - 4.00
155 CIO n)0JJ4fftJ?1 HDNE7, PANELS •+'•; 10.00 •DATE OF APPLICATION •.
ARCHITECT - PLAN CHECK FEE P.C:;NO.
OR PANELSJOVER 200 AMP) 20.00
ENGINEER
LIC,NOSIGNSTRANS.• - 3.00
ARCH.OR ENG. ti - t PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 ';
ZIP
TEMP.METER OR POLE INS:,"• 20,00 ,
• neo sats MOTORS - ,'.,,SEE FEE SCH
SERVICE CHANGE• 2000
02 LICENSED CONTRACTORS DECLARATION
u v . 1 hereby affirm that I am licensed under provisions of Chapter 9 ,} ISSU/ANC€DATE V '
H Q vAi (commencing with,Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
r w„Z Professions Code and y license Is in full fort•' d e 1 t- - - LD � •�
Tom - License Class A z I n Con Numbs
9 y E w
Date-,& - BUILDING PERMIT '
w OW,NQGR6-BUILDER DECLARATION , - " "
MISC. ` ' REFER TO ORD .INFORMATION
K
,I'LL w - I hereby affirm that I am exempt from the Contractors License VALUATION $/FT.
1L o a Law for the followingreason.(Sec.7031.5,Businessand Professions 10.00
r - - PERMIT ISSUANCE -
y <
Code:Any city or county which structure,
trequires ura permit to construct,alter,
2 0 p improve,demolish,or repair any permit
toff prior To its issuance,also ELEC.CONTR. : LIC.NO: ELEC.
i w m LL requires the applicant for such permit to file a signed statement that PERMIT-
" he is licensed pursuant to the provisions of the Contractor's Licenae' , ,t
-F z i Law(Chapter 9 ficommencingwith Section 7000)of Division 3 of the N/
sc Business and Professions Code)or that he is exempt therefrom andQTY. PLUMBING PERMIT FEE
¢ = $ the basis for the alleged exemption.Any violation of Section 7031.5 'STORIES ,TYPE CONSTR.
i 3 by any applicant for a'Permit subjects the applicant m a civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of The property,ormy employees with wages as - BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP .
their sole compensation,will do the work,and the structure is not RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ..
Code:The Contractors License Law does not apply to an owner of - -
property who builds or Improves thereon,and who does such work FIXTURES-PER TRAP, ( 5.00 ASO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
mentsamnotintendedorofferedforsale.0',however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 1-
'� or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4.(EA-.)' 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
- prove for purpose of sale.). INDUSTRIAL WASTE INTER.' 30.00 %PES IND :CON PB Omer '
❑ I,as owner of the.property,am exclusively contracting with - - - 1:1 ' El. . I]^, 1:1 I]
licensed contractors to construct the project(Sec. 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 connsctorls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Data exempt under Sec. -,BAP.C.for thi] WATER HEATER W/VENT - - `6.00
reason
Owner Date WATER SYSTEM ,5.00 ACC.DATE,,, ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, -
or a certificate of Workers'Compeasatiop Insu� or a certZONING if ENG.SITE N0.
.. copy[hereof! ey s3 aJ�C.). ,tG>/JIrGy �D///•y
Policy NoQ,�S.pl� fyfF-Ll Y'G�(f'�j/Pe�•�/ • '
Q ❑ Certified Copy is here y rushed.' FIRE 6PRINK ENERGY T-24
Z Z �(' Certified o y s filed will the city inspection division. ,
0 Applicant �-�^`n!' ��y�.. MISC.- REFER TO ORD. YE]- N(]' v (] NQ `
~ D+ - 'e'//�Jjt_� PERMIT ISSUANCE. 10.00
CERTIFICATE OF EXEMPTION 17ROM 1 RKl'a ERS' FLOOD ZONE A.L.U.C.
LU : COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. - Q N
,
IL 0 (This section need not be completed if the permit is for one - TOTAL N Y
hundred dollars IS 100)or Tess)
L) O 1certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FF�B FEE SUMMARY
I-
LL mit is issued,I shall not employ any person in any manner so as to `0
O W become subject to the Workers'Compensation Laws of California. -
y Date Applicant ALTER OR ADD TO.MECH. , '` ( ''5.00 B ILDING'
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex- -
F ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 QQ PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE •'
fJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO'10=C.F,M.)• 4
CONSTRUCTION LENDING AGENCY. AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 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. - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) -.98 -
Lender'sAddress
HEATING'UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
' Lender's Address -
Icertifythatlhavereadthisapplicationandstatethat the above VENTILATION FAN (SINGLE) 4.00 -
information is correct. I 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,of this city to enter upon the BOILER-COMP(OVer 100,000 BTU)SEE FEE SCH. ' MECHANICAL, ,,�I....,,...�
above-mentioned property for inspection purposes, v�
(We) agree to save„indemnify and keep harmless the City of MISC.- REFER-TO ORD.
upeftino against liabilities,judgments, costs and expenses which CONST.TAX'
ay in any way accrue against said City.in consequence of the PERMIT ISSUANCE w .1P.&0 •
ranting this perm L MECH.CONT: LIC.NO. MECH. r
TOTAL Q0 TOTAL
Sign of Applca / ontractor Date '
OFFICE COPY