18822 POST THIS CARD NEAR FRONT OF BUILDING
' I'EHM1UT NUMBER
` ~ CITY OF CUPERTINO 18822
INSPECTION DIVISION
JOB INSPECTION RECO D
^C "c "[ / ' PERMIT EXPIRATION
JOB ADDRESS C/ ( UNIT# _LOT#
/12� PERMIT EXPIRES IF WORK
OWNER CC/J coNlHncroH L{' IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSu-
FOUNDATION • - ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTIO .
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF I'LFi T vALIUA nON
CUPERTINO STANDARDS.
GARAGESLABS g
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED , r." - +
UNDERGROUND /SLAB
- PLUMBING
ELECTRICAL Is nrvc I Air[
MECHANICAL RLUcELECT PLG. MECH
� �' _ ❑ ❑ I ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �y BUILDING PERMIT
J INFORMATION
WOOD FLOOR \ � VALUATION SIFT.
PLUMBING + Q1�021A9
MECHANICAL VIM O�
PERMIT TO
ELECTRICAL 16&d —
FRAMING � +
$TORIFi5 TYPE CONSTR.
INSULATION
qcC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING � F+Es IrvD CON Pe 01.—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY '
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS TEST GAS
FIRE$PRINK ENERGY L?9
MECHANICAL v ❑ . NE v ❑ N[:]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOUO 20NE A UC.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y❑ NE] Y L) No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- 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 INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER
.. BUILDING APPLICATION & PERMIT 188 22
ADORESS V/
_ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL p
OwNEB h PLAN CHECK VALIDATION
NA / /[� ,(,')) QTY. ELECTRIC PERMIT FEE
. Z �(I/(r-�/� PHONE 2,1911
N RACTORS
NA 4r, NG OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S1'1%,
/j(y/ PPLIANCES-RESIDENTIAL 4.00
1' '+17 PANELS 10.00 DATE OF APPLICATION '
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO
O .
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.On ENG. E IT VALIDATION x
ADDRESS SPECIALCIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00 l
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS ,
SERVICE CHANGE 20.00
02 LICENSED CONTRACTORS DECLARATION _
¢ v 'I hereby affirm that I urn licensed under provisions of Chap r 9 ��° U IS AUE
w G i Icolnmemm�g [h tion�`Q01 of Uivisiun 3 n' 131 and
BLDG. ELECT. PLG. MECH
F y i ProfessiunsC e [ y+14§�is in fu 1 a ,. _ ....n
zo i a o Liccns � � 'Coil rer %' I J V IJV J ❑ ❑ FRI
m w Dufe _Col or
¢ y s BUILDING PERMIT
¢ ¢ w < NISR-BUILD'R ECLARATION INFORMATION
-RffFER TO ORD
E
3 1 hereby affirm that I am exem I front the Contractor's License MISC.- I VALUATION S/FT.
Fw Oj Law for the following reasml.(Sec.7031.5,Business Professions PERMIT ISSUANCE 10.00
Pi Code:Any city erectility which requites a permit to construct,ulen
BE ¢¢o improve,demolish,or repair any structure,prior to its issuance,xISO ELEC.CONTR. - LIC.NO. ELEC.
- ¢ requires file applicant for such permit to file a signed statement that TOTAL PERMIT TO
¢ new¢ he is licensed Pursuant to Ihbprovisions of the Contractor's License
F z a Law(Chapter 9(commencing with Section 7000)of Division 3 of lire
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
au by any applicant l'or a permit subjects lire applicant to a civil penalty gLTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred doll...(5500).):
❑ I,as owner of the property or my employees with wills az ggCK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,
will do the work,and the structure is lot
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 docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
ments are not intended or offered lot sale.IL however,it,,building GAS-EA.SYSTEM-111NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA) 200
builder will have the border%of proving that Ile did not build,), - . . .
r i[n- BUILDING USE
prove for purpose ofsale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON PB Omer
❑ I,o owner ul the property,ton exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS-I INC 5 V.B. -6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
I(,an owner Of property who builds or improves thereon,and who ILAWN SPRINKLERS-OVER 5 IEA.) 1.00
contrails 1'0r such projects with a cuntmdurl sl licensed pursuant to
IEC CoSEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lntmdo is License Law.am exempt under Sec. ,B.&P.C.I'or this WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00 ACD.DATE ACC.FILE NO.
WORK17RS'COMPI'NSA'fION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm [hat 1 have.certificate of consent to"Ifeboune. ZONING
i enificale of Workers'Compen,.tion In"ifanr .yy a certified - ENG.SITE NO.
copy thereof(Sec 3600,Lab.C.). - / v/1
Policy No. Company_ -ISL
Q �rliI d, is is achy I r a FIRE SPRINK ENERGY T-24
Z 2 Certi Y - file wit[ h• <it inspcc lion division.
O Applicant _- _ _ MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
try CERTIICA'1'1;Ola BX EN I'I'I ON 1:RITA WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u,G.
LU > COMPI'.NSATION INSURANCE PLG.CONTR. LIC.NO. PLG. V❑ N❑ Y [:] N❑
a_ 0 11 his section need mol be convicted if the permit is for one TOTAL
hundred dollars(S 100)or Icsz.)
U O 1 certify that in the performance of fire work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation laws of California.
0 i Late Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE 'f0 APPLICANT: If,after making[his Certificate of I
Z entption,you should become subject to the Worker'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or[his permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)"CF.M.) 6.00 SEISMIC FEE
1 hereby uffirn% that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
file 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.).
Leader's Nddr ess HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Na ,
I eertity that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. infunnutiun is correct. 1 agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize 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) gree tD save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperti against liabilities,jmdgirents, costs and expenses lith PERMIT ISSUANCE 10.00 CONST.TAX
In. i any way a ainsl said City in conseq nce file
I' all pen L MECH.CONT. LIC.NO. MECH.
U �jl TOTAL TOTAL
i nom of Applic nt/Contractor )mJc
OFFICE COPY