18432 POST THIS CARD NEAR FRONT OF BUILDING X
PERMIT NUMBER
CITY OF CUPERTINO 18432
`4 INSPECTION DIVISION,
JOB SPECTION RECORD
. // .0 ��(y - PERMIT EXPIRATION
JOB ADDRE .�f V / � � UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER Q� CONTRACTOR IS NOT STARTED WITHIN
PECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION' - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OFPERMIT VAnuATION
- CUPERTINO STANDARDS.
GARAGE SLABS ✓1 •EJI&( C/ '
' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � //// i`I /
UNDERGROUND /SLAB 17 /
PLUMBING - -
ELECTRICAL ISSUANCE DATE///
MECHANICAL Bloc ELECT PL MECH
El a
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED r BUILDING PERMIT
INFORMATION
WOOD FLOOR / VALUATION SIFT.
' PLUMBING � ' '
ME.QHANICAL
ELECTRICAL ' QI�/ - -
FRAMING
STORIES TYPE CONSTH
INSULATION
OCC GROUP HES UNITS
PLACEAO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE sa.Fr FLooe AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING .RES IND CON PB 0"1"
APPLY NO ROOFING UNTILABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ L L L L
ASSE550R5 PARCEL NO
ROUGH SANK
PLUMBING ELECT.ENERGY
' TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ACC PATE ACG FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST'
ZONING ENG,SITE NO.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T as
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING YE] NL Y L NL
EXTERIOR SHEAR ELECTRICAL RELEASEFLOOD ZONE ALUc
INTERIOR SHEAR FIRE DEPT. Y L NL Y L NL
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING l,. ,�
.INTERIOR LATH
BUILDING
TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF,BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
•f"+'+k
ARRANGE FOR INSPECTION BY PHONING 252-4505ELECTRIC, � .
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING E �,
O -PLEASE GIVE JOB ADDRESS WHEN PHONING.
ZMECHANICAL
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
BU LDI NG PROJECT 1 DENTI FICATI ON PERMIT NUMBER
BUILDINGAPPLICATION & PERMIT t
C9 �Qr W D�� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .. 18432
OWNEa'5 PLAN CHECK VALIDATION
_ "A / 11 QTV. ELECTRIC PERMIT FEE
Ja IN PHONE
ICuo"ERQTORR �^ OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
AOOR�I$5
J f
loge- PHONE PANELS 10.00 DATE OF APPLICATION
ARCHI IEci r - -
PLAN CHECK FEE P.C.NO.
OR
PANELS (OVER 200 AMP) 20.00 -,
ENGINEEnn /7 p
1daA7 hS uC:NV010�� SIGNS TRANS. 3.00
ARCH OR ENG.- PERMIT ION
ao^ofR�EJs�p/ SPECIAL CIRCUIT 5.00 /1 /
zlr f?b/ TEMP.METER OR POLE INS: 20.00 `/.//1/////J
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS /
oft SERVICE CHANGE 20.00
o o LICLNSLD CO,TRACTORS U CLARATION _
< Uu I hereby affirm that I am licensed under provisions of Chapter 9 J ISSUANCE DATE
w C to
(commencing with Section 7000)of Division 3 of the Business and BLDG ELECT. PLG MECH.
H m z Professions Code,and my license is in full force and effect.
' 0. -W Liecusc Class Lic.NumberAbd
Date Contractor '
BUILDING PERMIT
¢ 0 i U
OWNER-BUILDER DECLARATION MISC.- D INFORMATION
K ; A. I- I hereby affum that I am exempt from ate Contracmr's License'
'n,. o J Luw(or the I'ollawin rensnn.(Sec.7031.5,Rosiness and Prol'essians 10.00 VALUATION $/FT.
N} s PERMIT ISSUANCE /8 �9 ,
Code:Any city or county,which requirese permit tocol sura .also
a ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
D¢ requires the applicant for such permit to file a signed statement that TOTAL p T T
L11-
ii-
$ he is licensed pursuant to the provisions of the Contractor's Li"nse ��(p Tin
H,zQ Low(Chapter 9(commencing with Section 7000)of Division 3 ofthe -r-(=7Q7211f-�8�)
i 0
Business and Professions Code)or that he is exempt lhercl'mm.ndQTV. PLUMBING PERMIT FEE
T H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any orethan
fire permit subjects lheapplicam toacivilpenalty ALTER-DRAIN -WATER (EA.) 5.00
of not more 1 hea n five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
UNITS-
their sale compensation,will do the work,and the Structure is not OCC.GROUP RES.UNITS
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 to an owner of
Property who builds or improves thereon,and who does such work I VIXTUR ES-PER TRAP 5.O Pot- SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mmntsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion;the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or m_ BUILDING USE
prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Other
`Jr 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(See.7044,BusinessLAWN 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 contractorfs)licensed pursuant to SEWER- ANITAR V-STORM EA.200ft 10.00
the Contractors License Law. $ / TRACT NO, PARCEL NO.
❑ lam exempt under Sec. ,R.&P.C.Ibr Ibis WATER HEAVER W/VENT 6.00
son
-
Owner A WATER SYSTEM 5.00 ACC.GATE ACC FILE N0.
ORKER"COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have u certificate of consent to sell-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thercof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnishCd. FIRE SPRINK ENERGY T-24
Z Z Cl Certified copy is Bled with the city inspection division. MISC.- REFER TO ORD.
O Applicant ry E] N[3 V ❑ NC]
~ w PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
CC CERTIFICATE OIa EXEMPT ION FROM WORKERS'
LU COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG. / ❑ ❑ ❑ C]1L O !This section need not be.completed if the permit is I'ur one TOTA Y N v ry
=) Z hundred dollars IS 100)or less.)
U O 1 Certify that in the performance of the work(or which this per- QTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL.f mit is issued,I shall not employ any person in any manner so as to
Q L) hccome subject to the Workers'Compensation Laws Of California. O V
Q. Datc Applicant BUILDING
} to N011CF. TO APPLICANT': If,after nuking this Certificate OI'Fx- ALTER OR ADD TO MECH, 5.00
).-. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions at the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUC'T'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued ISec. 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.M.50
Linda's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is Correct. 1 agree to comply with all city and county PLUMBING
mamin.,; and slam laws relating to building construction, and LER•COMP I3 H.P.Or 100,0008.T.U.) 6.00
hereby authorize representatives Of thin city to enter upon the BOILER-COMP
B0 IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against Eabiihies,judgments, Costs and expenus which PERMIT ISSUANCE 10.00 CONST.TAX
May
in y way acme age' said City in conscque cc of the
"anti f 1 a p m' . MECH.CONT. LIC.NO. MECH.
�� TOTAL TOTAL l�
Signam of Appli t mtractor etc
OFFICE COPY