17181 ''' POST THIS CARD NEAR FRONT OF BUILDING
' PERMIT NUMBER
CITY OF CUPERTINO 1 x'181
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS /�.IU � ll�n �"TI UNIT# LOT#
`, w PERMIT EXPIRES IF WORK
OWNER \0�4L CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATIONANCE OR 180 DAYS FROM
NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERNIIT VALIDATION
CUPERTINO STANDARDS. -Z ,—eq
GARAGE SLABS AI
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �'Gfl
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL
RBL-1)(1 ELECT PLG. MECH.
EDV ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ` BUILDING PERMIT
WOOD FLOORINFORMATION
VALUATION SIFT,
PLUMBING
MECHANICAL
ELECTRICAL PERn+n To
FRAMING I
STORIES TYPE CON$TH,
INSULATION
UCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT FLOOR AREA TOTAL ACREAGL
• DIAPHRAGM THE CONSTRUCTION� PAID
ROOF SHEATHING �Uy ,989 BUILDING USE 7 Ivgs. INu coN PB oln.�
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS E TE INSP. SP
"- ASSESSORS PARCEL NO
ROUGH SAN,# e o
i PLUMBING ELECT.ENERGY �rTHACT NO 'PARCELNO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL ACC DATE ACC FILE NO
—�?. BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS -
' PINE SPHINK .F.NCRLCv T$9
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' r ElN 11y N�
FLOOD ZONE A.L UC.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DE Y ❑ N� Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH ��L7 TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS,NOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I I rap
LuARRANGE
WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00� 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
APPtgCANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT '/' q OQ��
ADDRESS104/C /y I
/ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S �-1 PLAN CHECK VALIDATION
NAME PHONMS:�> _//I 7
OTY. ELECTRIC PERMIT FEE
1CO.A.GTon s UTLETS-SWITCHES-RECEP 10.00/1.00
N 0
aXl �CG C..O Yr-�'� LIGHTING FIXTURES 10.00/1.00 �(p oD
C-ONTRACTORs PPLIANCES-RESIDENTIAL 4.00 6 m
DOREss
,b. / I
P.O."
HON PANELS 10.00 ' 4 CtDATE OF APPLICATION
ARCHITECT PLAN CHECK FEE
OPANELS (OVER 200 AMP) 20.00
OR �� '
ENGINEE5 .v
��J�F•� uc.No SIGNS TRANS. 3.00
ARCH,On ENG. SPECIAL CIRCUIT 5,00 a PERMIT VALIDATION
ADDRESS _
ZIP EMP.METE OR POLE INS. 20.00 Z
APPLICANTS MOTORS SEE FEE SCH. 4&Co �QE
ADDRESS
SERVICE CrHANGE 20.00
0 0 o LICENSED CONTRACTORS DECLARATION -
u U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w<w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F 0 a, Professions Code,and my license is in full force and effect. ❑ ❑ ❑
z 0 m License Class Lia Number
0 H 0 DatcContract.,
BUILDING PERMIT
Q ¢ w U4 OWNER-BUILDER DECLARATION INFORMATION
doMISC- REFER TO ORD
w ; d H I henry collo that 1 so exempt from the Contractor's License
LLo¢ Law for the following reason.(Sec.7031.5,Businessand l'nrlesxions PERMIT ISSUANCE 10.00 �`,t VALUATION $/FT.
H - 2 Cade:Any city or county which rNuiresa pemtit to consuls(,alter, C�
¢ ¢< improve,demolish,or repair any structure,prior 10 els issuance,also ELEC.CONTR. LIC.NO, ELEC.
- 0 IS .stains the applicant for such permit to file a signed statement that TOTAL (� ERMIT TO
he is licensed pursuant to the Provisions of the Contractor's License
F z i Law(Chapmr9(commcncingwith Section 7000).E Division3of the
¢ Business and Professions Code)or that he isexempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r Qo the hasis far the alleged exemption.Any violation of$ection 7031.$ STORIES TYPE CONSTR.
dam _ by any applicant for a permit subjects the applicant 1.a civil penally gLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
0 I,as owner of the property,or my employees with wages as 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 does not apply to an owner of
• property who builds or improves 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-
mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 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 forpurpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON Pa One,
❑ I,as owner of the property,am"elusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
anti I'm fessions Code:The Contractor's Licensc Law docs not apply
to an owner of properly who builds 0r improves thercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmeler(S)licensed persumu to
th,Contractor's Lice ase Law. SEWER-SAN ITAR V-STORM EA.200f1/10.00 TRACT No, PARCEL NO.
❑ 'I tun exarmt under Sec .B.hP.C,ti,r cols WATER HEATER W/VENT 6.00
Icallin
Owner Date WATER SYSTEM 5.00 ACG DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 5100
1 hereby affirm that I have a certificate of cunsem to sell-insure, ZONING ENG.SITE NO.
,it a certificate of Workers'Compepl.( n Insurance,or a a "red
copy thereof(Sec.3 ,Lab G). !(*N 1
I'obcy No.- _Company_
O ❑ C• led copy IS hereby furnished. FIRE SPRINK ENERGY T 24
Z Z _crime yypy f d ' eilTu.� n division. MISC.- RE I(I� Y C] rv❑ Y❑ NE]
O Applicant-V[_
O y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.D.C.
LU > COhIPF-NSATION INSURANCE PLG.CONTR. LIC.NO. PLIS
Cl- a V❑ N❑ Y ❑ N❑
('fres sellar. aced not be completed if the permit is For one TOTAL
Z) Z
hundmd dollars f less.)
U O I certify thatinn the the pe performance al the work for which lhls par OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- unit rs issued,1 siCiE not employ any Person in any manner sn us to
O
U become suhject to the Workers'Compensation Ldwx ot'California.
w
Dale-Applicant BUILDING
aALTER OR ADD TO MECH. 5.00
} w NO]ICE 'ID AITLICANT: If,after making this Certificate of Ex-
F Z enlptiun,you should become subject to the Workers'Conipenwliun APPLIANCE 5.00 PLAN CHECK
.......inns .f the labor Code, you must forthwith comply will, FEE
U such provision..,this permit shall be deemed revoked.; AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
Ole Performance of me work for which this permit is issued ISce. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,CN.C.).
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address 11"30
1 certify that I have read this applica)ion and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordimneg, and rets ting to building construction, and
hereby m11h re pepHeYertipties of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
arose.-one ned properly rinspection purposes.
ice to sa Ify and keep harmless the City of, MISC.- REFER TO ORD.
ape n. Ili' judgments, ells and expenses which CONST.TAX
au •ainst said City in i
ce f thePERMIT ISSUANCE 10.00
MECH.CONT. LIC.NO. MECH.
DTALTOTALApplicant/Conlmctor
OFFICE COPY