15191I0
POST THIS CARD NEAR FRONT OF BUILDING
- - CITY OF CUPERTINO " `
INSPECTION 131141S
JOB INSPECTION RECORD
JOB ADDRESS �"� NIT# _LOT#
�
.n / CONTRACTOR \fod
PERMIT NUMBER
15191
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD I
FOUNDATION -
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS. '
UFER
PREGUNITE
P1:HMIU VALIDATION
_
- -
'
ISSUANCE DATE
GARAGE SLABSQ
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
i
ELECTRICAL
MECHANICAL
o,Q6❑
BLDG
ELECT
❑
PLG. MECH
❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED\aOv
`.•1{�0
BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION SIFT.
PLUMBING /L/-
MECHANICAL
ELECTRICAL
PEFIN11T TO
/lam (��
S�rO-'"
FRAMING �/L -
INSULATION ��- T -
-
SIOHIES
'. _
TYPE CONSTR,
v r
-
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
$() IT iLOOH AREA
_� ,4
TOTALACREAGE
DIAPHRAGM
BUILDING use
H1;s IND CON PB 010..,
❑ El ❑ ❑ E
ROOF SHEATHING
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ASSESSORS PARCEL NO
ROUGH
sAN.k
PGY
PLUMBING �( ��- /�
ELECT. EN
TRACT NO.
f
PARCEL NO
TU �& HOWE PA -6` 'z
PLUMBING ENERGY
MECHANICAL --FPj /
MECH.ENERGY
ACC DATE
ACC FILE NO
ELECTRICAL r2
BUILDING ENERGY
FRAMING
ELECT. FINAL TEST
Z?NING
ENC, SITE NO,
INSULATION
PLUMBING
GAS TEST -
GAS
FIRE SPHINK
v N�
ENERGY LaA
v N�,
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
TLOODZONE
—yo _R 12
A.LUC
w ❑ NO
EXTERIOR SHEAR
ELECTRICAL RELEASE
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
/• -._
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE -
GAS
SEISMIC FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
LU
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
--_
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL ,
OFFICE COPY
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDIPj9 �ELECTgICAL-PLUMBING-MECHANICAL
PERMIT NUMBER •
' 15191
BUIL NG
ADDRESS
OWNER S
RIE ' n f 1 ,, r --0,`'
G a h W vHONEp4
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
CONTRACTORS
NAME
OUTLETS -SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
LIC. NO.
CONTRA
ADDRESS DR's
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
PHONE
DATE OF APPLICATION '
ARCHITECTPANELS
OR
ENGINEER i 57� kICENO.
(OVER 200 AMP) 20.00
PLAN CHECK FEE P.0 •NO.
SIGNS TRANS. 3.00
ARCH.
D
OR ENG.
E 1
Ili zIv 1 /
SPECIAL CIRCUIT S.00
PERMIT VALIDATION
Q (�
V
EMP. METER OR POLE INS. 20.00
A PLICA T'S
AO R S 0
Q \
MOTORS SEE FEE SC 1t
I SERVICE CHANGE 20. -89
LICENSED CON "f RA TORS DECLARATION
1
1 herehy affirm that I am licensed underprovisionsof Chapte19
ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business all
Pruf,sMcum Code 6A.,y license is in full force and effect
Licenu Lic. Number
BLDG.
1
ELECT.
PLG. MECH.
(_
Dole. Contractor
/
�O
BUILDING PERMIT
WNE-R-BUILDF-R DECLARATION
s the Contractor's License
1 hereby affirm that I am exempt fro...
Professions
Law Code: Any city permit to consuanc alter.
count whichr. c. requirsa emit to
Code: Any city or county which structure, prior n it Statement also
ins mires e applicant repair h permit to
for such permit to fisc a signed actor's nt thatmye
lie is lrt5 thedp pursuant
La Ili licensed 9(scu nlen the provisions of the Contractor's License
Law (Chapter Ihocosions Codewith Section 7000)afttheon3ol the
Business Professions Codes or that ho is exempl there and
INFORMATION
REFER TO ORD
VALUATION $/FT.
a�-1
PERMIT ISSUANCE '4&BB-
ELEC. CONTR. LIC. NO.
TOTAL
TOTAL Q V
PER MIT TO
T
�� a
U /�
QTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
thebasisthe alleged ermnpubje Any violation o n 70
for
toll cion malty
for permit subjects (lie applicant toneivil penally
by any more
of not more tlmn five hundred dollars ($500).1:
ALTER-DRAIN-WATER(EA.) 5.00
❑ 1, as owner of the properly, or my empbyces will' wages as
their sole compensation, will do the work, and the structure is not
intended or offered for sole (Sec 7044. Business and Professions
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00-3
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. PT. FLOOR AREA
TOTAL ACREAGE
himself or through his own employees, provided that such improve-
mmutsare nolintended or offered for sale lL however, the building
GAS - EA. SYSTEM -1 INC.4 OUTLETS 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 im-
prove-urposc of sale.).
as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
B LEE USE
RES IND CON PB other
El❑ ❑ ❑ El
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS -I INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
licencontractors to construct the project (Sec. 7044, Business
sed
and Professions Cud¢ The Contractor's License Law does not apply
to an owner of property who builds or improves Omreon. and who
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for such pro,iects with a contractor(s) licensed pursuant to
Elie Contractor's License Law.
SEWER -SAN ITAR V -STORM EA. 200ft/10.00
TRACT
PARCEL NO.
WATER HEATER W/VENT 6.00
❑ 1an, ;cmPt under Sec.- ,B.&P.C. Fortus
reason
pNO.
8��0
Owner - Date
WATER SYSTEM 5.00
ACC, GATE
ACC. FILE NO.
WORKERS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00
I heroby of Bum that I have a cetlifcaty of consent to sell -insure.
or a certificate of Workers Comp -ns: tsar Insurance, or a certified
copy thercof(Sec. 3800. La b.C.). N ♦ _ '-f li,
Policy No. Company
ZONING
ENG. SITE NO,
FIRE SPRINK
y❑ N❑
ENERGY T 24
y❑ N❑
❑ Ce sic 'opy Is hereby furnished.
lrtlfl Y Ih.- 1 I Illi' t • ; ) Ct 011 fllVlf'IUn.
Applicant __ _
MISE.- REFER TO ORD.
CF.R'I'I FICATE OF EXEMPTION FROM WORKERS'"
COMPF-NSA'1'ION INSURANCE
'il is for o
(This wctilin need not he completed if the pernm
PERMIT ISSUANCE "10[00
FLOOD ZONE
Y❑ N❑
A.L.UC.
Y❑ N❑
PLG. CONTR. LIC. NO.PLG.
LY�
TOTAL V
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars IS 100) or less.) q
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 yr as to
BUILDING
become subject to the Workers'Compensation Laws of California.'
Date Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICANT'. If, after making this Certificate of Es.
emption, you should become subject to the Workers' Compensation
APPLIANCE 5.00
PLAN CHECK
Provisions of the Labor Code. you must forthwith comply with
such provisions or this permit shall be deemed revoked.
FEE
AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00
AIRHANDLING UNIT(OVER 10=C.EM.)6.00
SEISMIC FEE
CONST RUC'DON L17NDING AGENCY
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
I hereby affinn that Olen is a construction Ivtdingagency for
file performance of the work for which this permit is issued (See.
3097. Civ C.).
Lenders Name
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
�i 67
Q 0
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 coney
ordinances and state laws relating to building construction, and
hereby authurme representatives of this city to enter upon the
abovomcntioned property for inspection purposes.ou
VENTILATION FAN (SINGLE) 4.00
PLUMBING
�
'r _7
BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100.000 BTU) SEE FEE SCH.
MECHANICAL
c3it 67
MISC. - REFER TO ORD.03
CONST. TAX Cz
9
(We) agree. to save, indemnify and keep harmless the City of
Cupertino aganst liabilities, judgments, costs and expenses which
may in any way accrue against said City in consKmence.of the
fans • of this permit. I _ I,� n
r%tl('-111f(()I/x/--
PERMIT ISSUANCE dv
MECH. CONT. LIC. NO. MECH.
TOTAL U67
��/
TOTAL
Sig ture of Applicant/Contractor Datc
OFFICE COPY