15167 I POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF. CUPERTINO 15167
INSPECTION DIVISION
JOB INSPECTION RECORD
,./ j� .PERMIT EXPIRATION
y JOB ADDRESS aS�3 /V-• /-ORT4zzsVt UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER LLS _ CONTRACTOR 'Z, IS NOT STARTED WITHIN
INSP TION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE UA r[
MECHANICAL BLDG ELECT I PLG. MECH
❑ ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
VALUATION $IFT,
PLUMBING
MECHANICAL
ELECTRICAL PERNUT TO
FRAMING
INSULATION - STORIES TYPE CONSTR
OCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 80 FT `Loon a+EA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB Glen
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 1-1 0 0
ASSESSORS PAHCEL NO
ROUGH SANA .
PLUMBING ELECT.ENERGY
rRnr.T No. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY Acc.DATE ncc.FILE No
FRAMING ELECT,FINAL TEST -
20NINf,. ENG.SITE NO,
INSULATION PLUMBING
GAS TEST - GAS
MECHANICAL
FIRE SPRINK ENERGY T 24- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [:] NO 1 Y 0 All
PLOGO ZONE A.I.U c.'
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT.
N L ry�
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING v "Io ' BUILDING
INTERIOR LATH'S - TEMPORARY APPROVALS •-` " I--
SCRATCHCOAT- ELECTRIC
FEE CHECK r y
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE .;r
OCCUPANCY OF BUILDING IS NOT PERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LJ ONE WORKING.DAY,BEFORE REQUIRED INSPECTION.
0- ' PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING:
Z MECHANICAL
— SEE PERMIT-FOR EXPIRATION DATE —
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL / ^s
- 1
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -
BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER I
uILDINGAPPLICATION & PERMIT 1516'
ADDRESS/ �ey
v
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL D
OWNEH'S PLAN CHECK VALIDATION
NAME /�O� T�ie OTY. ELECTRIC PERMIT FEE
C' /PHo`NE
NOMrPAcrDR's9 UTLETS-SWITCHES-RECEP 10.00/1.00
l�i14 15 /� LIC.NO, �/ LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
offs
ADDRESS L�N£ APPLIANCES-RESIDENTIAL 4.00
/y lA/EMONE - PANELS 10.00 DATE OF APPLICATION,.'
AflcmTlfci �+p.
OP aa�t/ CA- ZoS PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE G.C.NO.
ENGINEER -
- uc.NO SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 6,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 ,r
AMOTORS SEE FEE'SCH.
DDRESS E66
ADDfl
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
Ix ma u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a
H Q"' (commencing with Section 7000)of Division 3 of the Business anJBLDG. ELECT. PLG. MECH.
,: h
r D i Professions Code (I y ,ense is in full force' d, cc
❑ ❑ ❑
z D - License Class Lic.Number
9 w r w Date._1_ g�._Cnntractnr
a m s �d_ T.4 BUILDING PERMIT
K0w OWNIiR BUIL)T:R DE S INFORMATION
K
;N N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
F u. Oa Law for the followingrerson.(See.7031.5,9usinessand Professions PERMIT ISSUANCE 10.00 VALUATION____F_
Code:Any city or county which requires a permit to construct,alter, 3�Od
au,¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. r
- O LL requires the applicant for such permit to fife a signed statement that TOTAL PERMIT T
R
w he is licensed pursuant to the provisions of the Contractor's License /
r z � Law(Chapter 9(commenemg with Section 7000)cf Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
o the basis for the alleged exemption.An
6ed p y violation of Section 7031.$ STORIES TYPE CONSTR.
u ; m by any applicant for a permit subjects the applicant toa civil penalty
of net more than five hundred dollar,(S5001.): ALTER-DRAIN&VENT-WAT ER (EA.) 5.00
❑ I,as owner of the property,or my employees with wugesas BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
Sole compensation,will do the work,and tiro structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply In an owner of
t property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5,00 6O.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered 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 IEA.) 2.00
builder will have the burden of proving that he did not build or im. BUILDING USE
RES IND CON PS Other
prove 1,aso nee of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner rs the property,am exclusively contracting with
licensed contractors to The
the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code.:The Contractors License Law docs not apply
to anowner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for projects with u conlruator(sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00
the Contractor'sis L License Law. TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,R.&P.C.I'or this WATER'HEATER WIVENT 6.00
reason
Owner Dane WATER SYSTEM 5.00
ACC.DATE ACL.FILE NO.
WORKT-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate nfcousent 10 s 11hmsuN, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah.C.).
Policy No. Company
0 ❑ Certified copy is hereby tarnished. FIRESPRINK ENERGY T-24
Z 2tyC Cerbfic c pYd with t1 city inspection division. MISC.- REFER TO ORD.
0 Alphcunt_(f.JLJ<1 � I - Y C) IN Y 0 N�
CC CERI1111171-CAI✓F,OF EXE MPTIO N I'ROM WO R K ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z( This section need not be completed if file penFN[]nit is (or one TOTAL Y N - Y ❑ N
hundred dollars IS 100)or cess)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL Umit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Dam ApplicantBUILDING 3
>_ Val NOTICE TO APPLICAN"r: If,after making this Cerfificale of Ex ALTER OR ADD TO MECH. 5.00
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK q "
provisions of the Labor Code, you must forthwith comply with - FEE aG
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000CF.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 far 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
Leader's Name HEATING UNIT(OVER 100,000B.T.UJ9.50
Lender's Addie ELECTRIC
I certify that l hav read this application and st,le0,a,the ubove VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP l3 H.P.or 100,000B.T.U.1 6.00
hereby authorize representutives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep brimless the City at MISC.- REFER TO ORD.
Cupertino again liabilities,judgments, costs and expenses which CONST.TAX
May In any w y accrue against said City in consequence of the PERMIT ISSUANCE 10.00
m gar s nail. MECH.CONT. LIC.NO. MECH. Ks•,�
e TOTAL TOTAL �/ YJ
ignrture of Ap ical UCcn tractor Date
I OFFICE COPY