17995 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUM6ER
CITY OF CUPERTIN
- P 0
17995
INSPECTION DIVISION
JOB INSPECTION ft•ECOR¢( U
.. d 1 ((�
.PERMIT EXPIRATION
JOB ADDRESS�! T—� r ` ,r� E' `� �d- " UNIT# _LOT# •
�(/ • ('� /• _ PERMIT EXPIRES IF WORK
OWNER 'l d P �l V I CONTRACTOR S (T IS NOT STARTED WITHIN
INSPECTION DATE 1ANSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER, : ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE - - TO COMPLY WITH THE APPROVED PLANS AND CITY OF I PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS / C�
POUR NO,CONCRETE UNTIL ABOVE HAS BEEN SIGNED o �^
UNDERGROUND /SLAB LIN
r' PLUMBING : �I V1 1 JA lvC.L.I
ELECTRICAL .^•fy Of ISSUANCE DATE Irw
MECHANICAL - ECoG ELEc I PLG. VECR
`DO NOT-POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WINFORMATION
WOOD FLOOR
va
PCUMBING wanON
• - slFr.
MECHANICAL -
ELECTRICAL PERMIT TO -
FRAMING +.. eC�,
INSULATION STO"If9 TVPECONSTIR
OCC GROUP RES UNITS
P,DACEsNO SUBFLOOR UNTIL ABOVEAAS BEEN SIGNED
. - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE S.,FT.FLooR nReA roTnL Acnenee
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
BUILDING USE
ROOF SHEATHING RES IND CON- PB 0,1,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DATE INSP. El ❑ ❑ .El 0
ASSESSORS PARCEL NO
ROUGH SAN.N '
PLUMBING ELECT.ENERGY "
TRACE NO. - PARCEL NO
TUBS&SHOWER PAN PLUMBING-ENERGY
MECHANICAL - MECH'.ENERGY' -
ELECTRICALACC DATE ACC.FILE NO.
BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. -
INSULATION PLUMBING
GAS TEST GAS , _
FIRE SPRINK ENERGY T2
MECHANICAL'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y 1:1 N� � o N❑
FLOODZONE A.LUL.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. ❑' N�1 ° L-] N[3
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
. OCCUPANCVOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED.BYBUILOING INSPECTOR. ,MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC GA �
~r� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z° PLEASE GIVE JOB ADDRESSWHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL ,Q 6,•C��
CALLING.FOR FINAL INSPECTION.
OFFICE COPY
AILICANT'T0 'FiLL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
ETUI LDING PROJECT IDENTIFICATION PERMIT;NUMBER
BUIRLORN.
APPLICATION & PERMIT . ,
LRESa M6rCTLBUILDING=ELECTRICAL—PLUMBING—'MECH—'MECHANICAL N12AV/ A 17995
OWNER'S nn - PLAN CHECK VALIDATION
100 OTY. `' ELECTRICPERMIT FEE
CONTRACTOR'S
NAME c t UTLETS-SWITCHES-RECEP 10.00/1.00
A+►1�S �I. .)1514 LIC,N,50Z Is�S15 LIGHTING FIXTURES, 10.00/1.00
Actons
DDRESAPPLIANCES.-RESIDENTIAL ' 4.00
T EKA PHONE SS'(.61 S PANELS 1, '� - `� 10:00 'DATE OF APPLICATION
ARCHITECT - - r 'PLAN CHECK FEE P.C.NO.
OR - PANELS IOVER'200 AMP) 20.00
ENGINEER
LIC.No, ISIGNS TRANS.. - 3.00 .'tY
ARCH.OR ENG. VERMIT VALIDATION
ADDRESS r - SPECIALCIRCUIT 5.00 . ;
'IF EMP:METER CREOLE INS. -' 20.00 Q-00 .• j _.'J
APPLICANT'S I I - •1 6
ADDRESS MOTORS, SEE,FEE SCH. -
- - SERVICE CHANGE JVA1020.00 -+
wG O o LICENSED CONTRACTORS DECLARATION _ �1! 3r� -(�T VL
¢i w 1 hereby affirm that I am licensed under'provisions of Chapter 9 ` P Y1UN + ISSUANCE DATE
(commencing,with Section 7000)of Division 3 of the Business and ,BLDG. ELECT PLG..' CH.
0 Professions Cod�pd my,license is in(ell fo c - � � ,.�-,j ❑
0 O H License Class VV ��•'- Lic.Num pyx1 'I fY-\-
aw r ° Dale b' / --C.mme o
¢ r - BUILDING PERMIT'
a: ¢ TION
rc ¢ OWNER BUILDER DEC -
o INFORMATION
K 3.A r I hereby affirm that I am exempt from the rUnctor's License MISC . , REFER TO ORD
w w Ory ,VALUATION
LLo ¢ Law for following reason.(Sec 70315 Business Professions PERMIT ISSUANCE'` ."10:00 V
r - Code.Any city or county which regmtesa permit to construct,alter, -
¢ H ECEG CONTR. . :LIG NO.
¢ ¢o improve;demolish,or repair any structure,Prior toitsissuance,also - " ELEC. g O
O u requires the applicant for such permit to file a signed statement that TOTAL
•Q PERMIT TO
n w m he Is licensed pursuant to the provisions of the Contractor's License "
Fit
Law(Chapter 9(commencing with Second 7000)ofDivision 3 cattle, •t „� �p
¢ Business and Professions Codefor that he is exempt'therefrom'and CITY. PLUMBING PERMIT FEE C_J
¢ r m the basis for the alleged exemption.Any violation of Section 7031.5 � y - 'I STORI TYPE CONBTR.
ni - by any applicant for a permit subjects the applicant to a civil penalty^le 'gLTER-DRAIN&'VENT-WATER (EA.) 5:00 '
of not more than five hundred dollar,(8500).):,
O 1,as owner of the property,or my employees with wages us BACK FLOWPROTECT. 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; Businessand Professibna .- DRAINS-FLOOR,ROOF,AREA,COND,, 5.00
• Code:The Contractors License Law does not apply to an owner of - - f
property who buRdsor improves'thereon,and who does such work 'FIXTURES{PER TRAP' 5.00 SO FT.FLOOR AREA TOTgL'ACREAGE
himself or through hts(wn employees;Provided.that such improve 1+
ments are not intended or offered for sale.df;howeveq the building GAS-EA:SYSTEM-1 INC.4 OUTLETS 6.00 ,
or improvement is sold within one year of completion,the owner, „GAS-EA.SYSTEM-OVER 4,IEA.) 2:00 - ,BUILDING USE.' ,
builder will have the burden of proving that he did not build or im- - . '
prove for purpose of sale.).,; . - INDUSTRIAL WASTE INTER. 30.00 RES .IND CON PS .'Omer
' ❑- I,as owner of the property,am exclusively contracting with Q I❑ .E 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 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
contiacts'for such projects with a contraetons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/70.00
the Contractor's'License Law. _ - TRACT NO. 'PARCEL NO.
❑ I am exempt under Sec: {B.&RCYor:this WATER HEATER W/VENT. x6.00
reason
Owner Date WATER SYSTEM' - 5.00
ACC.DATEACC.FILE NO.
WORKERS-COMPENSATION DECCARATION, WATER TREATI NG EQUIP. '5.00
hereby affirm that I have a certificate of consent to sellinsure, - - '
0r a certificate of Workers:Compensation Insurance,or a certified ='(' - ZONING ENG.SITE NO.
copy thereof(Sec:3800,Lab.0.).
Policy No. - -`• - Company `` r
0 ❑ Certified copy'is hereby furnished. A FIRESPRINK ENERGY T-24
z'Z, erii opy is�l'Ile�with th Ity msp tion civmm�.
2' APPlica -T•4� , MISC. REFER TO ORD. . Y � ' -N� v : NPT _ PERMIT ISSUANCE 10.00
�'— FICATF.OF
EXEMPTION FROM WORKERS' y FLOOD ZONE A.L U.C.-
„ W'� - _ COMPENSATION INSURANCE PLG.GONTR LIC;NO. PLG. '' Y. N Y N
n' G (This section need not.be completed if the•penni[`is for one
;TOTAL' _
Z hundred dollars(s100)or less.) - .I v 1
•U O 1 certify that inThe performance of the work for which this per- QTY.' �MECHANICAL PERMIT FEE FEE SUMMARY
•'LL'F mit is issued,1 shall not employ any person in any manner so as to P r
U become subject to the Workers'Compensation Laws of California. -
It. Date Applicant - - BUILDING.
NOTICE'TO APPLICANT:T(;.after making this Certificate of Ex. - ALTER OR ADD'TO MECH. 5.00 '
F Z emption,you should become subject to,the Workers'Compensation APPLIANCE - :5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked AIR HANDLING'UNIT(TO 10=dF.M.) 4,00 ,
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER IOXWC:RM.) 6.00 "SEISMIC FEE
` - I'hereby affirm that there is i construction lending agency for 'EXHAUST HOOD(WITH DUCT) .5.00
the performance of,the work for which this.pennit is issued(Sec. - MICROFILM3097,Civ C.)., HEATING UNIT(TO 100,000B.T.U.) 8.00
Lender's Name”
Lenders Address HEATING UNIT(OVER 100,000137.U.)9.50 ELECTRIC _00
`
I certify that[,have read'this application and state that the above VENTILATION FAN (SINGLE) 4.00
in monition, is correct..) agree,to comply.with all city
BOILER-COMPI3HP,or100,0B.T. .1:6.00
and county . 00OPLUMBING
ordinances and slate:laws relating to building construction, and -
hereby authorize representatives of this city,es.to enter upon the
above-mentioned property for inspection purposBOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save,..indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments,costs and expenses which —_ CONST.TAX
may in any way accrue)against said City in consequence'of[he PERMIT ISSUANCE 10.00 -
q ting of this permit.. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL L�1• C
tura of Applicant/Contractor
OFFICE COPY' ,