08076 POST THIS.CARD NEAR FRONT OF.BUILDING
+I PLRMIT NUMBER
CITY OF CUPERTINO'
18.076
INSPECTION DIVISION.'
,JOB INSPECTION'RECORD -
• '• ^�,/: (,`��1.G/Jl��-/�� p. , PERMIT EXPIRATION.
JOB ADDRESS `'LJ "1' /`1 "' •UNIT•Ik _LO
T# .• pERM1T, E%PIRESIFWORK
-
' OWNER • /�/ V CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD aeo,DAvs of PERMIT ISSu
ANCE OR '180,DAYS FROM
• FOUNDATION 'NOTE: , LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE .
TO COMPLY.WITH THE APPROVED PLANS AND CITY OF .PERMn vnuonnoN
' CUPERTINO STANDARDS. .
' GARAGE SLABS : + ' y,J •.�A'/./3 41"If ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB •
PLUMBING
ELECTRICAL 'SUANCE OATe !"
MECHANICAL' .. ELECT, PLG. A CR,
. .
❑ ❑ . .:❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED r +. f BUILDING PERMIT
INFORMATION
WOOD FLOOR Ii ill . r vnwnrloN - siPr.
PLUMBING
MECHANICAL s'
ELECTRICAL
FRAMING �Y L
STORIES PE CONS
.INSULATIONrR. -
• _ OCC.,GROU(! RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
_ ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE.
soT r,110011 AREA ror nynwLAcS .
,
THE CONSTRUCTION TAX IS PAID,
DIAPHRAGM i, ,,Uu.DINGUSE
ROOF SHEATHING "• — - + . REs , IND CON PB
APPLY NO ROOFING UNTIL VE HAS BEEN SIGNED FINALS. DATE INSP. ❑
ASSESSOR S PARCEL NO
ROUGHSAN.# -
PLUMBING .ELECT.ENERGY - - '
113ACI NO. PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL'' - MECH.ENERGY
ACC.DATE ACC.EaENO.
,' ,ELECTRICAL � � � BUILDING ENERGY ' �• N� � '
FRAMING — ELECT.FINAL TEST ZONINGENc.SITE No.
INSULATION ,' PLUMBING
GAS TEST - '' GAS. • + ,
+ LIRESPRINE ENENGY T.]4
• MECHANICAL r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y �� N�
. �- .
' EXTERIORSHEAR ELECTRICAL RELEASEPJ.oOD ZONE -A,L.UC,•
+
INTERIOR SHEAR - - ., FIRE DEPT. .`" N� Y ❑ No
SHEETROCK . GRADE FEE SUMMARY
EXTERIOR LATH - . BUILDING FEE
INTERIOR LATH - TEMPORARY APPROVALS - ••
SCRATCH COAT . ELECTRIC
.. GAS , -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED' OCCUPANCY - 1 _ 0
OCCUPANCVOF'BUILDING'IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
1! ONE WORKING DAY BEFORE REQUIRED,INSPECTION: PLUMBING
II o 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. �l
OFFICE COPY
/ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Lr -
BUILDING PROJECT I DENTIFICATION ,PERMIT NUMBER
-
aG,�D,NG - APPLICATION & PERMIT - � 8076
AooRpss
O O f Ave- BUILDING-.ELECTRICAL-PLUMBING -MECHANICAL' ,
OWNER'S - PLAN CHECK VALIDATION
NAME L OTY. ELECTRIC PERMIT - FEE
J r1cl 1Y10.1r, PHONE
croR's
NAME - 'OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Fray Sm:44, Term;}� LIC.NO.S7Y 3 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS, - _. PPLIANCES-'RESIDENTIAL 4.00
• ADDRESS S'�A. 'j 'C t.
)qtp JL CJ I�N R' PHONE•J70 ' r V 1 PANELS 10.00 DATE OF APPLICATION .I
ARCHITECT . PLAN CHECK FEE P.C.-NO,
on _ - PANELS (OVER 200 AMP) 20.00
ENGINEER �
LIC.NO' ' _ SIGNS TRANS. 3.00
An IT
ENG. SPECIAL CIRCUIT 5.00 � PERMIT VALIDATION
zip EMP.METER OR POLE INS. 20.00 V
ADDRESWrs - MOTORS SEE FEE SCH.
�S0 !/� /
"7� SERVICE CHANGE 20.00 (�
o o LICENSED CONTRACTORS DECLARATION'
tE v I hereby affirm Thal I am licensed under provisions of Chaplet') - I SUANCE GATE
¢ w' (commencing with Section 7000)of Division 3 of the Business and - BLDG. LECT. PLG. 'MECH.
F w z Poxotemions Code and my license is',Poll ford,End effect. I'I ❑_ ❑ ❑
z o m License Class_ Lic.Nwnlu°1 3 .
o D Datefr Cort me for r�T�� -
a m C^"Ira1 BUILDING PERMIT
¢ ¢a ¢-. OWNGR-BUILDfiR DIiCLA RATION INFORMATION
hw. I hereby affirm Thal I am excnhpt from the Contractors License
IMISC.- E
.. oa Lafor tie following rcuson.(Scc.7031.5;Busiressmgl Professions PERMIT ISSUANCE 10.00 VALUATION g/FT.
� - o Code'.Any city orcounly which requires a permit to construct,alter,
QQ Q p' 1111..0se,demolltih,or repair any sIr1ewre.prior 10 it,Issuance,also ELEC.CONTR. • LIC.NO. ELEC. Q
O 0 req Gies the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u w Cs he is licensed pursuant to the provisions of the Contractor's License .
r z i Law(Chapter 9(commencing with Section 7000)of Division 3 oftle -
¢ Business and Professions Code)or that he is exempt therefrom and CITY. - PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 703 L5 STORIES TYPE CONSTR.
u ; by any applicant for a permit subjects the applicant to civil penally
ALTER-DRAIN& VENT-WATER (EA.) 5.00
r -
four more than five hundred dollars(4500).):
❑ I,as owner of the property,or by employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is riot OCC.GROUP RES.UNITS
•- intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code.The Contractor's License Law docs not apply to an owner of -
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP. 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such int Provo-
. cents are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or...grrovemenl is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES . IND CON PB Omer
�.❑ I,as owner of tha property,am exclusively contracting with ❑ ❑ ❑• ❑ ❑
licensed contractors m construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'lie Contractors License Law does not apply
to an owner ofproperty who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts lir such projects with a contraclods)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA:2001t/10.00 TRACT NO. PARCEL NO.
❑ I am uxemPI under See. B.AP.C.for this WATER HEATER W/VENT 6.00
!1.1111
Owner [)air WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKI-RS'CONTPEN'SA'I ION Di CLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to ulFinsure, ZONING
• or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab CJ �•
Polley No.-
0
n.O ❑ Certified copy is hereby furnished. FIRE SPRINK -ENERGY T-24
Z Z ><Certified copy is fled with the City inspection division. MISC.- REFER TO ORD.
O Applicant - Y❑ N❑ Y ❑ N❑
~ rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.uc. -
�.> CIiRTIFIGOMPENIATIONINSUROh1 WORKERS'
W _ r. CUMI'IiNSATION INSURANCE' PLG.CONTR. LIC.NO. PLG.
CL 0 1'I his sectio1n ed not brn P
e coleled if the perme
it is for m - TOTAL v[-] N❑ v❑ N❑
Z hundred dollars lS 100)nr less.)
U O . I tify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P into iscerissued,I shall not employ any person in any manner sc as 10
U , become subject to the Workers'Compensation Laws of California.
OW - Dam Applicant ALTER OR'ADO TO MECH. 5.00 . BUILDING a3• /JO
>_ y NO1'ICF TO APPLICANT': 11,after..laking this Certificate of'['x- _
Z cloption,you shnWd became subjeel to ole Workers'Cnnlpensalion - APPLIANCE - X5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
'U such provisions or this permit shall be deemed revoked. AIRHANDLINGUNIT(TO 10p00C.F.M.) 4.00
CONs'I'RUCTIOfJ LENDING AGENCY AIR HANDLING UNIT 10=C.F.M.) 6.00 SEISMIC FEE JO
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the lerforance of the work for which this Pcrmit is issued(Sac. HEATING UNIT(TO 100,000 B. T.U.) 8.00 - MICROFILM
m
3097.Civ CA
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify Thal 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is caricam
. I agree to comply with all city and county PLUMBING
ordinances and file laws relating m building cont ruction;and BOILER-OCIMP(3 H.P.or.100,000 B.T.U.) 6.00
hereby .uthoriee representatives of this city to enter upon the BOILER-COMP IOver 100,000 STU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD.
upe.tino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
m ing Of this pernuL MECH.CONT: LIC.NO. MECH. v
TOTAL - 1
cEzn. 6 19-�9 TOTAL
• Signature of Applican�ontractor Date -
OFFICE COPY