17979 POST THIS CARD NEAR FRONT OF BUILDING !'
PFFMIT,NUMBEH_
CITY OF. CUPERTINO
INSPECTION DIVISION F.. 799
JOB INSPECTION RECORD i / "
•. ryryryy��' , / ;� ' T i f"PER_MIT/EXPIATION
JOB,ADDRESS O ` •C 1 UNIT# _LOT# -,•,� `� L.w
PERMIT`EXPIRE&IF'WORK
OWNER.. Cl' C HVLI'Q- C V TRACTOR��' - ' IS NOT STARTED-WITHIN
INSPECTION DATE I INSPECItR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- .
FOUNDATION. - - - ANC E.OR 180 DAYS FROM
NOTE: - LAST CALLED INSPECTION.
UFER- ALL GRADING AND DRAINAGE'•SHALL BE INSTALLED
f . '
PREGUNITE CU COMPLY STANDARDS:APPROVED PLANS AND CITY OF PERMITVALIDATION
-
'•� CPERTINO STANDARDS:
- GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ) _ _ �-
UNDERGROUND /SLAB _ i r:' J �LvnJ{ I4Uec.
PLUMBING -
, ELECTRICAL - ISSUANCE DATE
w MECHANICAL �' - BLDG.- ELEc r. PLG. n+ecR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - vq wgnoN - SIFT,
PLUMBING
MECHANICAL �
�
ELECTRICAL v nPERMIT r
FRAMING. /Z2WnQ��.6..
INSULATION \ .•f STORIES TYPE CONSTR.
' • OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF .N O FINAL INSP.SHALL BE MADE BEFORE sU.iT.FLOOR qIrEq -rorAc ACREAGE
DIAPHRAGM T ONSTRUCTION TAX IS PAID
• BUILDING USE
ROOF SHEATHING „ RES IND CON • PB 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED • FINALS 'DATE INSP. ❑ El" E 11
ASSESSORS PARCEL NO
ROUGH SAN.N ,
PLUMBING - ELECT.ENERGY,
ivgCi NOvgNCLI NO, '
TUBS&SHOWER•PAN'- PLUMBING ENERGY
MECHANICAL - MECH.ENERGY -
? ACC.DATE PCC.FRfi NO.
• ELECTRICAL - ' BUILDING ENERGY ,
FRAMING. — ELECT.FINALTEST �ZONINc ING.SITE No,
INSULATION PLUMBING '
GAS TEST. - GAS
MECHANICAL FIRE SPRINK ENERGY T�44
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y OO• No I N❑
EXTERIOR SHEAR ELECTRICAL RELEASE - FLooD:mNE,- _n.L uc.
INTERIOR SHEAR • _ FIRE DEPT. - Y❑. N� YL N0
SHEETROCK � �iCj® nnqq ~J GRADE - FEE SUMMARY .
EXTERIOR LATH- _\ w BUILDING• f
INTERIOR'.LATH TEMPORARY APPROVALS'. BUILDING -;• �II j,D,P
SCRATCH COAT -' • . L ELECTRIC - PLAN CHECK
GAS
FEE.
. .. .. 'y
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE i. 0/
OCCUPANCYOF BUILDING IS NOTP ERMITTED UNTIL BUILDING FINAL IS SIGN ED BY BL.I LDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING'DAY BEFORE,REQUIRED INSPECTION. PLUMRING
,!� Z PLEASE GIVE JOB ADDRESS:WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE' MECHANICAL I.DD,
IMPORTANT! CONST.rax
PLEASE READ REVERSE SIDE BEFORE . TAL 7�
CALLING FOR FINAL INSPECTION.' - TOI� 7
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINESL' USE,BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PFRMIT NUMBER
IID'LDING� .APPLICATION & PERMIT 7979
ADDREss t
BUILDING - ELECTRICAL-PLUMBING-Iv�.;HANIGAL r:
OWNER'S IPLAN CHEJ;,�K V�J�I<�8�
NAME OTV. ELECTRIC PERMIT FEE ^J
ItA PRONE ' [�`
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 Asa.
NAME .
LIC.NO LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 L...1 CLr✓t--
ADOR Ess
PRONE PANELS 10.00 DATE OF APPLICATION
ARcnrtscTPANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
- - uc,NO 'SIGNS TRANS. 3.00
ARCH.OR ENG. 5,00 PERMIT VALIDATION
..DRESS SPECIALCIRCUIT c�
. ZIP TEMP.METER OR POLE INS. 20.00 6
A"L"'AnrS MOTORS SEE FEE SCH. - -
AOOREss / /� �,'�'7�
2 bI ZZ r ID SERVICE CHANGE 20,00 J_ f_"IvViV«.(.
ol.
o LICENSED CONTRACTORS DECLAR TION /V - -'
a o wI hereby'affrn'that I:un licensed under provisions of Chapter 9 •q ' i aISSUANCE DATE
. (commuenoing with Section 7000)of Diviorin 3 of the Business and BLDG, ELECT. PLG. MECH..
ri Professions Code,and my liaenu is in'l all force slid effect. - -- NA ❑
z 0 w- License Class Lic.Number. _
o „ Date Contractor City, of Cupertino
- � �w si OWNER-BUILDER DECLARA'T'ION . BUILDING PERMIT
A o A MISC.- REFER TO ORD INFORMATION
w 3 n y' I hereby afOrn that 1 am'exempt lion the Contractors License VALUATION, $/FT.
b,'LL o.¢ Law for the following Reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 �r•
Cade:Any city or county which m9ulresa Perm `O
it to construct, F � 000
m ,¢ 2 improve,the applicant f0!SUCh pefnlll 10 file J signed statement(flat •demolish,or repair any structure,prior 10 i0 issuance,alsu ELEC.CONTR. LIC.NO.
ELEC.
0 ec requires 7� PERMIT TO
a w sa he is licensed pursuant to the provisions of the Contractor's License
H z: <
Law(Chapter 9(eommeneingwith Section 7000)of Divisian3 of the
Business and Podessiens Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢F o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
in
by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(8500).1:
❑ I,as owner of the Property,or my employees will' wages us BACK FLOW PROTECT.DEVICE, 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Codi•:The Contractor's License Law does not apply to an owner of
' properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employeesprovided that such imPmvo- ,r
men's are not intended or offered for sale.If.however,tilebuddi
ng GAS-EA.SVSTEM-11NC.40UTLET$ 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will hive the burden of proving that he did not build or im- REB IND CDN PB Omer
../ prove 1,as opose of sale.(. INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑" d as owner of the property,am project
Se contracting with
licensed contractor 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 s License Law does not apply '
'
to an owner of property who builds or impmvcs thereon.and who LAWN SPRINKLERS-OVER 6(EA.) 1.00
contracts for such projects with a contructons)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCEL NO.
B lamcxcmptundcr .Sec. ,B.&P.C.forthis WATER HEATER W/VENT 6.00
reason
Owner [),to WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKI'RS'COMPENSA1'ION'DECLARAMON WATER TREATING EQUIP. 5.00
I hereby affirm that have a certificate atconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of workeri Compensation Insurance,or a certified
copy Thereof(Sec.3800,Lab.C.).
Policy No. - Company ,
O ❑ Certified copy is hereby hHunhed. FIRE SPRINK ENERGY T 24
Z_ Z "• ❑ Certified 'copy is filed 'will' the city inspection divisim'. ' MISC.- REFER TO ORD. Y❑ NE:] Y ❑ No
- O .. Applicant - .
cc: PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.C.
,� '� CE�TII'ICATIi OF fi Xlihl l'T'ION FROM WORKERS' -
'LU,>.1 - ;COMPENSA1'ION INSURANCE PLG,CONTR. LIC.NO. PLG.
IL ((this section need not be completed if the permit is for one TOTAL v❑ N❑ v ❑ N❑
Z hundred dollars(SIOO)or less.) '
U O 1 certify That in the perfornwnce of the work for which this Per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any runner so as to -
O w become subject To file Workeri Compensation Laws of Cahill BUILDING
Dam Applicant ALTER OR ADD TO MECH. 5.00 Q'D
} 0 NO PICT,TO APPLICANT: IL
after taking this Certificate of Ex- r
Z ciartion'you should become suhjectno the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, yogi mull fnrlhwilh 111111111b, with FEE
•U such provisions or this permit shall be deemed revoked000. AIR HANDLING UNIT(TO 10, CF.M.) 4.00
CONSTRUCTION LENDING AGENCY. AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE O
I hereby afi but that There is a construction lending agency for EXHAUST HOOD (WITH DUCT). 5.00
the performance of the work I'or which this permit is issued(Sec. MICROFILM
3097:Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
'
Lender's Name HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC �-y1
Laulers Address r ] V
I certify That I have read this application and state That The above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U) 6.00 PLUMBING
ordinances and stale laws relating to building construction, and
hereby amborire mpiesenatives of flin'cisy to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(we)'agrec to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 ^G11J CONST.TAX
may in any way accrue against said City in consequence of the
•rami oPthispeniut. MECH.CONT. L(0.NO. MECH.
TOTAL� DO TOTAL �t,)D
Signature of pplisntlonlractor Dose
OFFICE COPY