18475 I. " POST THIS CARD NEAR FRONT OF BUILDING - PERMITNrvMeER�' /
CITY OF CUPERTI NO. 1 $4(7/5
INSPECTION DIVISION
JOB INSPECTION RECORD
/ IJ��J ` PERMIT EXPIRATION
JOB ADDRESS ` Op� 7 UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER 3vgeSuiblok CONTRACTOR - IS NOT STARTED WITHIN
• INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. PAID
SLABS ASI l
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED g6
UNDERGROUND /SLAB . AVU 61' 1989 ,
PLUMBING
ELECTRICAL ^Y,of 'yft IsSunrvcE DAT
MECHANICAL LIG ELECT.I PLG. MFCR
E] ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION 1
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIi T,
FRAMING - I VM ' IK
INSULATION. STORIES.- TYPE NSTR.,
..moi
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sa.PT ELDUR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
- BUILDING USE
ROOF SHEATHING RESIND CON ,PB Dim.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ED ❑ 0 ''❑ ✓❑
ASSESSORS PARCEL NO ,
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
• MECHANICAL, MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING ELECT,FINAL TEST
ZONING ENG.SITE NO.
INSULATION .. PLUMBING
GAS TEST _ GAS
FIRE SPRINK ENERGY T 24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
A.
EXTERIOR SHEAR � ELECTRICAL RELEAS FLOOD ZONE L.0 C.
INTERIOR SHEAR � - - FIRE DEPT. C NE] YL NEl
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
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC
F
LIQ ONE WORKING DAY BEFORE REQUIRED INSPECTION. n
PLUMBING /1 LI y
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE-- MECHANICAL
IMPORTANT! CONST TAX.
PLEASE READ REVERSE SIDE BEFORE TOTAL ` , c-,
CALLING FOR FINAL INSPECTION.
OFFICE COPY
1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
R' BUILOING APPLICATION & PERMIT 1 0
AOpRE55 I v J
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL .r
OWNER'S ^ PLAN CHECK VALIDATION
NAME /// .
�p A'I' 9!e QTY. ELECTRIC PERMIT FEE /��
Nina r• !HoM vHory 44-4 PtYD
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 ag
S,ELF LIC.No, LIGHTING FIXTURES 10.00/1,00 Auii N 19��
ADDRESS TORS - PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10,00 AYlIMEP'lk11x/ou '-
OR
RCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
uc,NO. ISIGNS TRANS. 3.00
AARCH.OR DDRESS ENG SPECIAL CIRCUIT 5,00 - PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPNr$ MOTORS SEE FEE SCH. 6 tel^
ADDRESS WI//
SERVICE CHANGE 20.00
' 02 LICENSED CONTRACTORS DECLARATION
a i. I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
< (commencing with Section 7000)of Division 3 of the Business and DG.: ELECT. PLG. MECH.
rt
r w i 1' don
bseis Code,and mlicense nse is in full force and effect ❑ ❑
o i m W License Class Le.Number
Date.Contractor
Q y f J
c a OWNER-RUILDER DECLARATION BUILDING PERMIT
a co u o INFORMATION
K
; I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u. ✓, VALUATION $/FT,
LL o v, Law for tte following reason.ISce.7031.5,Businessaild Professions
- PERMIT ISSUANCE 10.00
COprove,y city.,County which structure,
requires une permit o its issuance,
also
SE p improve,demolish,or repair any slNCtum,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
or CLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A. w $ he is licensed pursuant to the provisions of the Contractor's License
zi Law(Chapter 9 fcommencingwith Section 7000)of Division 3 ofthe D ,/,-
i E o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE / V _t'�-
r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE C N$TR.
a ; - by any applicant fora permit subjects the applicant loacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
0 of more than five hundred dollars fS500).):
1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 oce.GROUP RES.uNrts
le
IS
compensation,will no the work,and the simcture is not
intended or offered for sale(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 .D�
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenet intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6,00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did Out build or RES IND CON PB Other
th
im-
prove for purpose osale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(See.7044,Businesss LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License,Law does not apply
to an wrier of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
c rues for such pmjeds with a contracmr(M licensed purxuunt to SEWER-SANITARY-STORM EA:200ft/10.00
e Cont clor's License Law. TRACT NO. PARCEL NO.
❑ I' exempt and rSe .B.&P.C.for this WATER HEATER W/VENT 6.00
re' n
Owne Dat WATER SYSTEM 5.00
ACC.GATE ACC.FILE N0.
WORK17"Ob"'
TION DECLARATION WATER TREATING EQUIP. 5.00 "
I h by affirm that I have a certificate of consent to sell'-insure, ZONING ENG.SITE NO.
Br a cc
ificaIi of Workers'Compensation Insurance,or a certified
copy ttereof(Sec,3800,Lab.C.).
Policy No. 'Company
O C1CCrtificd copy is hereby furnished. FIRE$PRINK ENERGY T 24
Z Z C1 Certified copy is filed with the city inspection division.
H O Applicant - MISC.- REFER TO ORD. YE] No Y ❑ No
� N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ,CO FLooD ZONE A.L.U.C.
k1J > COMPENSATION INSURANCE PLG.CONTR. LIC.NO, I'LG.
CL Z
(Phis sect<in need not he completed if the permit Is Iia one TOTAL X00 V❑ N� V N❑
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
O y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING -
} m NOTICE TO APPLICANT: If,alter making this Certificule of Ex-
L.. Z_ emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10MOC.F.NL) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction Fending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
ndcr's Address ELECTRIC
I certify that I have read this application and slate thnl file above VENTILATION FAN (SINGLE) 4.00 `O
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T,U.) 6.00
hereby authorize representatives fort ins ec this city l0 enter upon the BOI LER-COMP(over 100,000 BTU)SEE FEE SCH. MECHANICAL
herebyabove-mentionedautro property for inspection purposes.
(We) agree to save, Indian un yep ha'nle" the City.1 - MISC.- REFER TO ORD.
Cu erUna against liabilities,judg is osts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
n in any way ace a age. id ily in consequence of the
tm in hispe 1g1 MECH,CONT. LIC.NO. MECH.
R 9y 21 TOTAL TOTAL 0
S in ore o Appl c nt/ nlmclor Date
OFFICE COPY '