14657 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 14657
s INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS / O B Q)CUNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER Q VRA L/ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING p - !
ELECTRICAL Pik ISSUANCE DATE
MECHANICAL FE
n j j �y,qM ELECT vE�u-. M
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED V1 ,,tttioll-DING PERMIT
WOOD FLOOR Cj Of C P INFORMATION
VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL. veRMn ro .I
FRAMING L.--(b - 1 Y
STORIES TYPE CONSTR
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 11 [10011 wRE4 TOTAL wCREw[il
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
IAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RCS INC) CON ve Om,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 0 El
ASSESSORS PARCEL NO
ROUGH SAN.H
PLUMBING ELECT.ENERGY
IRAQ NO PARCEL NO
TUBE&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG SITE No.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPR INK ENERGY i.ld
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ❑ N�
EXTERIOR SHEAR ELECTRICAL RELEASE ELOODrONE A.L UC
INTERIOR SHEAR FIRE DEPT. Y[] NE YL- N❑
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING6
BUILDING
-
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�I ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Nov, 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
APPLIICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -
BUI LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDINGMAPPLICATION & PERMIT 4657
AOEss 6 J
M, x E BUILDING - ELECTRICAL-PLUMBING-MECHANICAL p,
OWNERS PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
A/M
PHONE
It' NAMERACTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00
uc.NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
Ra
ADAPPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION '
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.NO SIGNS TRANS. 3.00
ADDRESS ENO. PERMIT CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00 t ,a
APPLICANT S
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
C, BE o LICENSED CONTRACTORS DECLARATION
<U cc, I hereby affirm that 1 arm licensed under provisions
It [or Per 9 ISSUANCE DATE
H <w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
H w z Professions Code,and my license is in full force and effect. 11 El 1:1z o o - License Class m
Lic.Nuber
Q L F D Contractor p
s r BUILDING PERMIT
BE BE w a OWNER.BUILDER DECLARATION FORMATION
o a c' - MISC.- REFER TO ORD
w ; LL H 1 hereby al't irm that I um exempt Irom the Contractor's License ATION S/FT.
n O a Ldw for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Ly Code:Any city orcounty which requires a permit loconstrmct,alteq C�
SE , ¢ 0 improve,demolish,or repainmy fracture,prior to its issuance,also ELEC.CONTR. LIC.N0, ELEC. In�
esu requires[he applicant for such permit to lilt a signed statement that - TOTAL 1 PERMIT
d w m Ire is licensed pursrmnt to the provisions of the Contractor's License n
t
Law(Chapter 9(commencing with Section 7000)(it Division 3 of tie X
r a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ F es the basis for the alleged exemption.Any violation of Section 7031.5 - ST IES TYPE CONSTR.
by any applicant fora permit subjcdsthc applicant toacivil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).)r
❑ 1,as owner of the property,or my employees with wages as BACK F LOW 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 TOTALACREAGE
1Imsulf or Though his own mnployees,provided that such improve-
emsarenolintended oroffered for sale.)however,the building GAS-EA-SYSTEM-11NC.40UTLETS 6.00
r improvement is Sold within one year n1'completion, the Owner-
builder (EA.) BUILDING
will have fine burden of proving that h . . .
e did not build or int. RES IND CON PB Omer
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 ❑ El ElEl❑ I,as owner of the property,ran exclusively contracting with
licensed contractors to construct the project(See 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 contractods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,B.&P.C.lir this WATER HEATER W/VENT 6.00
reason
Owner LateP61- WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sell'-insure
a certificate of Workers'Compensation Insurance,or a certified) ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.L
Policy No. Company
Q ❑ Cerlined copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z O ❑ Certified copy is tiled with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Applicant Y N Y N
CC CER HFICA]t OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U,C.
LU COMPIi NSA'PION INSURANCE PLG,CONTR. LIC.NO. PLG.
CL O 1'fhis section need not be completed if the permit is for site TOTAL Y❑ N❑ Y ❑ N❑
0 Z hundred dollars IS 100)or less.)
U O 1 certify that in the perfurnwnce of the work for which Ills per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
H u
LL nit is issued,I shall not employ any person is any nm niter m as to
U hecone subject to the Workeri Connpenwlion Laws of California.
w Date. A licam BUILDING .
n PP ALTER OR ADD TO MECH.- 5.00 Q
} Do NOTICE. TO APPLICANT: If,after making this Certificate of tix-
H Z annptlon,you should become subject to Ills Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of fine 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 AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affinn 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.) 8.00
Lender's Name
Address Lender's AddrHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
'.r r nation is correct, 1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
aces and late lows rselating to building conxtrumion, and
Loci
authorlee representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
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 10.00 CONST.TAX
may in any way a cmc against said City in conscqunac of the
ranting of this permit Q ME .CONT. LIG NO. MECH.
2.. } Sr TOTAL TOTAL O
ignature of Applicant/Contractor Date
OFFICE COPY