14912 POST THIS CARD NEAR FRONT OF BUILDING
f 'PERMIT NUMBER
� l OF CUPERTINO 14912
4 INSPECTION DIVISION
JOB INSPECTION RECORD
/ / p PERMIT EXPIRATION
JOB ADDR ESS �/O "EI / `�H'�A/V- QL] UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER a CONTRACTOR u Is G, , Cd ve-e A)f7 IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHnvT VALIO.TION .
CUPERTINO STANDARDS..
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED q-- 9-as Com, pjy OK --
UNDERGROUND /SLAB
PLUMBING `
ELECTRICAL ISSUANCE DATE
OLUGELECT PLG. MECH
MECHANICAL '
pp10 ❑ i ❑ LEI ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED1� r3 BUILDING PERMIT
fl INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING G0f tS - o qup� \(1ffi[l,p.�•� ,I
MECHANICAL N tl
TO
ELECTRICAL PERhuT
FRAMING -g �� - I T/a-'
INSULATION
STORIES -TYPE CONSTR.
� -�'��"'
OCC CROUP HES UNITS
BYAZ0 t
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -i,�-
t r.;p� so f rLornl AB en TUTALnweAt
G
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
~ BUILDING USE
ROOF SHEATHING HEs IND CON PB OTn.,
9-9- C
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP ❑ ❑ ❑ ❑ ❑. ASSEssDRBPARGELNO
ROUGH SAN.# '
PLUMBING `Z ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS B SHOWER PAN Zi PLUMBING ENERGY
MECHANICAL /`1-W MECH.ENERGY
ACC DATE ACC.PUE No
ELECTRICAL
3f , BUILDING ENERGY
FRAMING py, h, ELECT.FINAL TEST
iZONING ENG.SITE NO,
INSULATION PLUMBING
GAS TEST GASB
FIRE SPRINK ENERGY T.24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED - HEATING Y ED N❑ Y ❑ A,E-1
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOOZONE AL UC
INTERIOR SHEAR FIRE DEPT. / v❑ N v ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
- INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ,4
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
uJ ARRANGE FOR INSPECTION BY PHONING 252-4505ELECTRIC
H� ,
PLUMBING
ONE WORKING DAY BEFORE REQUIRED INSPECTION. qo UD
�
11 OPLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
Ir — SEE PERMIT FOR EXPIRATION'DATE — `—
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'-•BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
`4 8 ILDINss //-- II APPLICATION & PERMIT 14912
1C/ an h Din Vic- BUILDING- -ELECTRICAL-PLUMBING -MECHANICAL
• 1)� AMER'SCAnS - PLAN CHECK VALID TION
N
NAME $ �-1/ll Il pyV
/}p6N6 e-- [� -0333 J ELECTRIC PERMIT FEE /(,
vI,oNE b
CONTRACTOR'S UTLETS-SWITCHES-RECEP_ID ockti 0
N
I / LIGHTING FIXTURES 10'.00t1:00'- ,�
`I [ r LIC.NO.
ADDRIT E croR's APPLIANCES-RESIDENTIAL 4.00
_
ADDRESS APPLIANCES
PHONE PANELS 10.00 DATE OF APPLICATION _
ARCHITECT MIhK� a✓IS PANELS (OVER 200 AMP) 20.00 PLAN CHECKFEE P.C.NO.
OR
ENGINEER 'brals1Le4( A�/���
/'lAL'�(11C.No. r SIGNS TRANS. 3,00
X ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
60 W•444mAvf X4!2 4 /2m JS'Qj7 EMP.METER OR POLE INS. - 20.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20_.00
0 0 o LICENSED CONTRACTORS DECLARATION
a u u 1 hereby affi nn that I wn licensed under provisions of Chapter 9 _ UANCE DATE
"' (conunencing with Section 7000)of Division 3 of the Business and L ELECT, PLG. MECH.
Di Professions Code m license is in full forty uul,I fc< LV
y� ❑ ❑
Z. oy� License Clnss q� � Lic.Num
9 N s. Date r�,2Contractr ^`
¢ w¢ OWNER-BUILDER DECLARATION y` BUILDING PERMIT
0 A " MISC.- REFER TO ORD INFORMATION
wN 1 hereby allinn [hat I am exempt from the Contractor s License vnL U'nTtiON $/FT.
F LL o 4: Law for the following reason.(See 7031.5,Busines,and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which rnryires a permit to construct,alter, /
K Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIQ NO. ELEC. �.S{ \��rT�
O¢ require,the applicant for Such permit 10 file a signed Aatetllent that TOTAL aJ0`-'/ PERMIT TO
n w m LL he is licensed pursuant to the provisions of the Contractor's License "��1
FZQ Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe ��U/7!d•�/
s i O Business and Professions Code)or that he is exempt therefrom and TV. PLUMBING PERMIT FEE
¢ 0 the basis for the alleged exemption.Any violation of Section703L5 STORIES TYPE CONSTR,
ate _ by any applicant fora permit subjects the applicant toacivilpenalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 �p
of not more limit five hundred dollars($500)J:
❑ 1.;e,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 s0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
t ments are not intended or offered for sale.It,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improverne at is sold within one year of completion,the owner-
, builderwm
ill have the burden of proving that lie dui not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove lot purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB oar
❑ I,us owner of the properly,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 improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
for or such projects with a cun(raclorl s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 tun exempt under Sec. ,It&RC,for nd. WATER HEATER W/VENT 6.00
reason
Owncr Date WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WORT;ERS'COMPENSA'ItON TECLARAT'ION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure, ZONING
or a certificate of Workers'Compensation
.Insuranc� r a uficd ENG.SITE NO.
coPY thepy'�t' c 00.LabC'
Policy Z, mmI}l�(y
O ❑ Cc r11 IY Is un i'h' FIRE SPRINK ENERGY T 24
Z Z ❑ C II icA cop 1 .i1J inspcnion division. MISC.- REFER TO ORD.
Applic' •✓d V ❑ N❑ Y ❑ N❑
CCT C. I FICATE 017 EXEMPTION PROM WORK ERS' PERMIT ISSUANCE a0:00 ��'- FLOOD ZONE A.L.u.c.
LU >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
::) 2 hundreddo1lars(S100)or less;)
U O 1 certify that in the performance of the work or which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I shill not employ any person in any mmtner so a,to
L) become subject to the Workeri Compensation Laws ol'Califomia.
O a DalteApplicant ALTER OR ADD TO MECH. '15,W - BUILDING
} 0 NOl IC17'1'0 APPLICANT: If,after making this Certificate of Ex-
? emption,you Should become subject to the Workers'Colnpensutian APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply will FEE
U inch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGI7NCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a co...traction lending agency lot 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.C.).
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC e7 'ST
Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 !N
ordinances.. sh
is correct, 1 agree In comply with all city and county PLUMBING
If ordinances and slate laws relating to
to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.1 6.00 ..``
rr hereby aulhorite representative, of this city to enter upon the BOILER-COMP Mile,100,000 BTU)SEE FEE SCH. MECHANICAL aCSG
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE TT.W /d-- CONST.TAX
may in cc AfitgfoA�
' t try in consequence of the
ra g of this MECH.CONT. UC.NO. MECH.
TOTAL a--� - TOTAL D 9�
��
Si re pplicanl Date
OFFICE COPY
l_.� OF CUPERTINO
INSPECTION DIVISION • '
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