17182 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTIND 17182
INSPECTION DIVISION
JOB INSPECTION RECORD
• (J [� , A`y., 1. PERMIT EXPIRATION
JOB ADDRESS 03 I-1.IST'�1 G ` UNIT# _LOT#
XI1{.11c' r^. PERMIT EXPIRES IF WORK
OWNER y�O.T�1 5 L� CONTRACTORIS NOT STARTED WITHIN
INSPECTION 6ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED' LAST CALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF POUGiT VALIDATION
CUPERTINO STANDARDS. y ®�
GARAGE SLABS
'POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
B LUG ELECTPLG MECR
MECHANICAL
i ❑ . ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION $/F T,
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING.
' STORIES TYPE CONSTR
INSULATION
Dcc GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SD FT FLOON AREA TOtal ACREAGE
ROOF NOTE,NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING UES TND CON PH oIP"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
.M$$ESBONS PARC[I.NO
ROUGH SANA
PLUMBING ELECT,ENERGY
. TRAGI NO, PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECR ENERGY
ACC DATE ACC FILE NO
ELECTRICAL Z- BUILDING ENERGY
FRAMING ELECT,FINAL TEST (`,V Bt iy
ZONING ENG,SITE NO.
• INSULATION PLUMBING L
GAS TEST GAS
FIRE SPR INK ENERGYL'}4
MECHANICAL r N❑ N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
PL000 ZONE a cu c.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. �❑ N� vL N❑
SHEETROCK .fq GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
_ INTERIOR LATH - TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
FEE EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUI LDI NG IS NOT PERM ITTED UNTI L BU I LDING F INA L IS SIGN ED BY BUI LDI NG INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z 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 IN INFORMATION01THIN RED LINES - USE BALL POINT PEN ONLY
BU LOI NG PROJECT I DENTI FICATI ON .PERMIT NUMBER
BUILDING APPLICATION & PERMIT 0
W
ADORES 2 Q
QJ' G BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,
ONER'S PLAN CHECK VALIDATION
NAME _ / �Lyy OTY. ELECTRIC PERMIT FEE
�/ PHONS- / !I
cory A rocs OUTLETS-SWITCHES-RECEP .10.00/1.00 '3 0
N
�CG .N LIGHTING FIXTURES 10.00/1.00 'Z (p
C
UR ACTOR PPLIANCES-RESIDENTIAL 4.00 fp�00
/ /,j PHOrvEzku PANELS 10.00 1 DATE OF APPLICATION
A MTECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.•N0.
/,r�(�) , A
OR
ENCI E!)�-_�i`�CJJJt// LIC.No. SIGNS TRANS. 3.00
ARC .OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00
ZIP TEMP.METE OR POLE INS. 20.00 -Q 1-1-$9
APPLICANTS
oo eASTS MOTORS SEE FEE SCH. 1(Z �•-
SERVICE CHANGE 20.00 0-O Pr
'0 O LICENSED CONTRACTORS DECLARATION
a u I hereby ottirnl Ilial I am licensed under provisions of Chapter 9 ISSUANCE DATE
H G h (commencing witb Sccl ion ]000)of Division 3 0l the Business nmol BLDG. ELECT. PLG. MECH.
F w z Professions Code {(Pty la4 se is in full ford � t
a o - License Class_��-,!V Co Number pw ❑ ❑
Date �/ItljL Cont neer_ BUILDING PERMIT
F J
IS ¢w¢ N' P BUILDER DECLA RA'I'10 INFORMATION
on `a MISC-- REFER TO ORD
E
u H I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
ra J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 IrlLm
Code:Any city or county which requires a permit toconstruct,alter,
¢ ¢ ¢ improve,dmany structure.p ]4ELEC.
nolish.or repair ntcrior to its I1apec,also ELEC.CONTE. LIC.N0. �y
G S, requires the applicant for such permit to tilt a signed statement that TOTAL�OO. 7O PERMIT TO
A•w m he is licensed Pursuant to tine provisions of the Contractor's License
Hzi Law(Chapter 9(commencing with Section 70001ofDivision 3 of(he
¢ Business and Pon ssiuns Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
f i D
¢ n_$ the basis for the alleged exemption Any applicant
ofSection malty STORIES TYPE CONSTR.
s ; _ by any applicant fora Penn subjecrs S5000.licam tea civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars f5500),I:
❑ 1,as owner of the property,or my employees with wages us BACK FLOW 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,COND. 5.00
Code'.The Contractor's License Law docs nol apply to an owner of
property who builds or improscs thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
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 burden of proving that he did not build or im-
Prove to,Purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 Es IND CON PB ower
❑ I,as owner of the Property,am exclusively contracting with ❑. ❑ ❑ ❑
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 docs not apply
to an owner of Property who builds or innproves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 '
contracts fir such projects with a conlmctnds)licensed pursuant to
the Contractors License Law, SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam excret under Sec. ,B:&P.C.fitr this WATER HEATER W/VENT 6.00
reasm
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC:FILE N0.
WORKERS'COMPENSV'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I lmve a certificate of consent to self-insure, a u
or a certificate if Workers'Compen'Iran Insurance,or a cert'ie ZONING ENG.SITE NO.
copy theo.- Sec.3500,Lab.0 InA
Policy No.- Company -jAN 81 198L3--
0 Ce ed ttmiy is hereby fu red. FIRE BPRINK ENERGY T 2
Z Z rtificd jIL w�ty,pIc IxN`clion� division. MISC.- R FER TO ORD. ❑ ❑ ❑ ❑
O Appicunl_E�GC-F1Y•4B- /-� Y N V N
cr T CER'IT F I CA IT.01'EXI MPTION'FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
lU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
EL O (This Section need not be completed if the permit is for one TOTAL V❑ ry❑ V❑ N❑
D Z hundred dollars(S 100)or Icss.)
U O 1 certify that in Om performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
, H mit is issued,I shall not employ any person in any trimmer so as to
U become subject to the Workcrs'ComPensutlnn Laws of C,litornia.
w Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ tan NOTICE"TO APPLICANT. It,after making this Certificate of I:x-
H ? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER IOPWC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that (here is aconstruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the Performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.CJ. _
Lender's NamHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC loo-30
Lender's Address
I certify that I have read(his application and state that Oe above VENTILATION FAN (SINGLE) 4.00
. information n correct I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and ostaterrec laws relating to comply
with construction, and county
hereby author' -cmarves of this city to enter upon the BOILER-COMP(Over 100,0000TU)SEE FEESCH. MECHANICAL
-be, ed pro -r 'fn - pecoon purposes.
e) a ee t mnify and keep harmless the City of MISC.- REFER TO ORD.
C ertin ag;' A es,judgments, costs and a pe ggges which 'PERMIT ISSUANCE CONST.TAX
ay i u against said City in cons u ge of it
H.
m .71 / MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
S' n o pplicant/Cmrtructor U e /�13a
OFFICE COPY