15737 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15737
INSPECTION DIVISION
JOB INSPECTION RECORD
O PERMIT EXPIRATION
/y/� I
JOB ADDRESS • k--4 UNIT# _LOT#
• L --T PERMIT.nEXPIRESI F.WOR K�•
OWNER �B CONTRACTOR `, SS DG ' 'IS NPT•-STARTED,W6THIN'.
+ y
INSPECTION DATE INSPECTOR INS ECTION RECOR '-1180sDAYS OFPERMITASSIJ-`'!
FOUNDATIONV��ANCE�OR,.180,qAV$;FROM,
NOTE: I l LAS7;lCALLED'JNSPECTION�.�'d
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED . ' .f.'
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION a
PR EGUNITE CUPERTINO STANDARDS. '•�- ' t r ��
GARAGE SLABS - 2—.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED qoe.
"+
UNDERGROUND /SLAB /
PLUMBING '
ELECTRICAL ISSUANCE DATE
MECHANICAL . eupertino BLDG I ELECT I PLO MEC,
❑ ❑ ❑ A -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BU t DING PERF41T e
_ '=:'I NF ORM
'ATION- i.'Y-
WOOD FLOOR VALUATION $IFT.
PLUMBING
MECHANICAL
ELECTRICAL - PEHMIT TO
FRAMING
INSULATION STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE •so Fr.FLOOR AREA roTAL Acn eAOE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUIBDINO USE -
ROOF SHEATHING RES, IrvD CON PB dna; I
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. °❑ !El ❑' d 1:1R
ROUGH SAN.a
ASSESSOPARCELNO '
s- •I
PLUMBING ELECT.ENERGY
TRACT NO ! PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY '
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
'
GAS TEST GAS
MECHANICAL
FIRE SPRINK ENERGY LZC
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ 'N❑ ' ' ❑ Nq
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD zome ALUC t.
INTERIOR SHEAR FIRE DEPT. . Y[:] N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
.INTERIOR LATH TEMPORARY APPR VBUILDING
SCRATCH COAT ELECTRICI.
PLAN CHECK
- GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ,
OCCUPANCY OF BUILDING ISLNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTORrLu MICROFII:M�,--
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED•I_NSPECTION. unnarvc�.,`?
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
—'SEE PERMIT FOR EXPIRATION DATE — _
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL .
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED_ LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
PERMIT NUMBER
aD,LD,NGAPPLICATION & PERMIT
ADDRESS
;7 0/ BUILDING - ELECTRICAL-PLUMBING-ME
/0 CHANICAL 15737
A/C NP Q
OWNER'S
PLAN CHECK VALIDATION
NAME
SR �/ TV. ELECTRIC PERMIT FEE
U T !��/ PHONE
CONTRACTORS
N//����qqE y��/ UTLETS-SWITCHES-RECEP 10.00/1.00
I'(JA//71T/C^/f--P LIGHTING FIXTURES 10,00/1.00
CONTRACTORS
AOGREss 1 APPLIANCES-RESIDENTIAL 4.00
/�� // PRONE q33-8/9/ PANELS 10.00 DATE OF APPLICATION
ARCHITECT0. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
- LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00 2--f
11 „
ADDRESSTS MOTORS SEE FEE SCH. -14
Sen;ess SERVICE CHANGE 7 20.00
rir 0 o LICENSED CONTRACTORS DECLARATION
<U I hereby affirm that I am licensed under provisions of Chapter 9
I- z w (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
F D i Professions Code,}rytd �license is in full force ppd efje5l..2 ❑ ❑ ❑
z 0=o License Cla5s C Lic.Numbe�j_9.9�3/Y� - / ty of CupertinoCK
O r w Dalc �/ 3- Cnnlructor I rba-JO• y>/P yl
F H i J
r s < BUILDING PERMIT
F a w OWNER-BUILDER DECLARATION INFORMATION
w1 e N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD yALUATION E/FT.
LL o ar Law for the followingreason.(Sec.7031.5,Business and Professions
PERMIT ISSUANCE 10.00
Code:Any City or county which requires a permit to construct,alter,
Q S GFO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
Om requires the applicant for such permit to file signed statement that TOTAL PERMIT TO
u w m he Is licensed pursuant to the provisions of the Contractor's License
Fzi Law(Chapter 9(commencing with Section 7000)Of Divlslon 3 ofthe ML
a'. Business and professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
$ the basis for Ute alleged exemption.An
g p he violation applicant
civil
malty STORIES TYPE CONSTR.
by any applicant fora permit subjects S500).licum toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(my em):
❑ 1,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
- Ihelr sole compensation,will Jo tire work,and the struehne is not OCC.GROUP RES.UNITE
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 10 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 improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4 (EA) 200
builder will have the burden of proving that he did not build or im - . • . .
- BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Othar
❑ 1,as owner of the property,ant exclusively contracting with i] ❑ ❑ 0 (]
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 docs 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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
0 I am exempt under Sec.��,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner , Uate WATER SYSTEM 5.00 ACD.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00
1 hereby affirm that I have a certificate of consent to self-insure, _
or a certificate of Workers'Compensation Insurance,or n certified ZONING ENG.SITE NO.
Copy thereof(Sec.3800,Lab.
licy No. Company '
Q ❑ �trifled 'opY is hereby to nishetl. FIRE SPRINK ENERGYTY4
Z Z 411/Cetlifie y file Ib the ity specrion division.
O Applicant �[� 1 MISC.- REFER TO ORD. y [:] N vF] N7
S m C17R'1'IFICA'FE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
B' INSU
0 (This section nod not be PIOINpleted RA NCEif tire pennit is for one PLG.CONTR. LIC.NO. TOTAL Y❑ N❑ Y ❑ N❑
Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,I shall not employ any person in any ma net so as to
O ED become subject to the Workers' tpen 1io n aws Califs "
CL Date //-3-S-YApplicant BUILDING
} 0 NOTICE TO APPI-ICANT: IL after n (king this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
L.- Z emp!mm,you should become snhjecl 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 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD
3097,CieWITH DUCT) 5.00
the performance of the work for which-this permit is issued(Sec. MICROFILM
.C.l HEATING UNIT(TO 100,000 B.T.U.) -8.00
Lender's Namr HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's AAAress ELECTRIC
I certify that Is rove read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is Correct. I agree to comply with all city unit county PLUMBING
ordinances and state laws relating to building construction, and BOiLER•COMPI3 H.P.or 100,0008.T.U.) 6.00 ,yf
hereby authorise representatives of this city l0 enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL p v
/ above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless lire City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
ns
may in any way accrue agait said City in consequence of the
gr Ming of thi •rout' MECH.CONT. LIC.NO. MECH.
3-S-9TOTAL TOTAL
ignatrreof Applicant/Contractor Date
'OFFICE COPY