14381 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER `
CITY .OF CUPERTINO
14381
• INSPECTION DIVISION
JOB INSPECTION RECORD
- ' PERMIT EXPIRATION
JOB ADDRESS 1�O S�.r iLL17i AV$ _ UNIT# LOT#
PERMIT EXPIRES IF WORK"
OWNER- CJ � UT� L ' .CONTRACTOR �(�eU.GCC.c�7 IS NOT STARTED WITHIN-,
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
LAST CALLED INSPECTION.
r UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE 7• TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB t
PLUMBING
ELECTRICAL \03 SUANCE pnr
MECHANICAL BLDG ECT, PLC, MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEENSIGNEDBUILUINU
RMATIONT
WOOD FLOOR Az/T vnLunnoN .SIFT. -
PLUMBING
MECHANICAL "' ' '
y •
ELECTRICAL z .'I - _ /PERMIT TO
FRAMING �'�''` r
INSULATION - STORIES TYPE CONSTR -
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
le DIAPHRAGM ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So FT FLooR AREA TDrAL AwEACE
THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES 'IND CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS'. DATE INSP. El Cl El El E
ASSESSORS PARCEL NO
ROUGH SANS
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
.- •' =GRADE
FIRE SPRINK ENERG�L]4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED "� "�'
EXTERIOR SHEAR
• 'FLOOD ZONE aL.u.c.
INTERIOR SHEAR - - - - `"❑ N❑ ° ❑ N❑
SHEETROCKI, FEE SUMMARYEXTER I OR,LATH wTeRloa-LATH , TEMPORARY APPROVALS BUILDINGei
SCRATCH COAT ELECTRIC PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVEHAS BEEN SIGNED occuPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED.BY BUILDING INSPECTOR. MICROFILM -
�, ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Y
F ONE WORKING,DAY BEFORE REQUIRED INSPECTION. PLUMBING
z 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
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION "' .PERMIT NUMBER
RUNjeNG APPLICATION & PERMIT �,�� ��
' ADDRESS
OO65 u ti Su BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S ^ // PLAN CHECK VALIDATION
'. N ME �L/Q'/.c.��f ysLL�Gt �p OTY. LEC FEE
re� PHONE
CONTRACTORS ,/ UTLETS-SWITCHES'-RECEP 104*tnn
Llc.Nory /p 2 LIGHTING FIXTURES 109OIT-M !�
CONTRACTOR'S APPLIANCES RESIDENTIAL 4.00
X54z-33. 5x51 PHONE PANELS 10.00 DATE OF APPLICATION
ORRCHIr6CT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE - P.C.NO.
ENGINEER � .
- Lie No. SIGNS TRANS. 3.00
EOR ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
-ZIP TEMP.METER OR POLE INS. 00
APPLICANT'S - -,
ADDRESS MOTORS e_ ' SE 'SCH
SERVICE�CHANGE
woo LICENSED CONTRACTORS DECLARATION Q
<0 1 hereby affirm that 1 am licensed under provisions of Chapter 9 V '4SSUANCE�DATE
i r (commencing with Section 7000)of Division 3 of the Business and n¢ i ` BLDG. 'ELECT. PL MECH.
MECH.
H H i' Professions Code,aAtli license is in full 1'oI'rA�l'BfbuC3 1
z o y - License Class CC..• Lic.Number El o u H w Daley l[� Commclor�y�. -
¢ sa 2'-r 'T-/ '�"-^max-"� t BUILDING PERMIT
¢ ¢¢ OWNER-BUILDER M ,
LDEDECLARATION
` d v - INFORMATION
is 3 m 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD ,��
Fw0J Law for the following reason,(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.0 VALUATION S/FT.
LA0Code:Any city or county which requires a permit to construct,alter,
¢ a, ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
wC u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m y he is licensed pursuant to thu provisions of the Contractor's License
HZ >.
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe
4 ¢o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE r
M I-o the basis for the alleged exemption.Any violation of Scclion 703 L5 STORIES TYPE CONSTR.
d ; m by any applicant for a permit subjects the applicant to a civil penalty' ALTER-DRAIN IEA.) 5,00
of not more than five hundred dollars($500).): -
-' ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE'. 4.00
their sole compensation,will do the work„and the structure is not OCC.GROUP RES.UNITS
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
properly who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
r� himself or through his own employees,provided that such improve-
mentsamnotinlendedorofferedforsale.If,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 lie did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with ❑ 0 . 1:1 Q ❑
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 Contractors License Law Anes 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 contmchms)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate oyf�JWorkers'
�Compensation Insurance,
"o�rr a�ccertified ZONING ENG.SITE NO.
Palthe
ley N9�-�CLWi+dP-6�s'�V
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z .AI jer iE copy is filed with the city inspection division.
F O Apphcanl---a-1....-+11_-. .-tc3- -- MISC.- REFER TO ORD. y�, N v ❑ N�
= y CERTIFICATELO-FuliXliMl'TION IrROM WORKERS' PERMIT-ISSUANCE ' 10.00LU " FLOOD ZONE A.L.U.C.
CL O COMPENSATION INSURANCE PLG.CONTR. , LIC.NO. TOTAL- Y F] N C] Y F] NE]
:3 Z (This section need not be completed if the permit is for one
U O hundred dollars(41001 or less.) ,
I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
lL F mit is issued, I shall not employ any person in any manner so as to
Ow become subject to the Worker Compensation laws of California BUILDING
y Date - Applicant ALTER OR ADD TO MECH�C 5.00
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F. ?" emption,you should become subject to tile Workers'Compensation APPLIANCE _ 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit Shull be deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which INS permit is issued(Sec. MICROFILM '
3097,Civ C.). HEATING UNIT,.(TO 100,000 B.T.U:) '8.00
-
Lender's Name' HEATING A/
Lender's Address - ELECTRIC ..i
I certify that l have read this apphoalion and state that the above VENTILATION FAN ISINGLE) 4.00
information is correct.I agree to comply with all city and county BOILER H.P.OF100,000 B.T.U.1;'6.00 PLUMBING
ordinances and state laws relating to building construction, and ..
` hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP IOvar 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlimo against liabilities,judgments, costs and expenses which PERMIT ISSUANCE '10.00 CONST.TAX
ay in any way 'ecrue against said City in consequence of the -
rantingo this a iL MECH:CONT. LIC.NO. "' MECH.
TOTAL TOTAL
S na of Applicant/Contractor Date '
OFFICE COPY