18421 POST THIS CARD NEAR FRONT OF BUILDING I
' � - 'PERMIT NUMBER
CITY OF CUPERTINO .
18421
INSPECTION DIVISION
JOB INSPECTION RECORD
,h - PERMIT EXPIRATION
JOB ADDRESS-- d� e�I` UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER mow. �. r t� CONTRACTDR S e'.IAL ISNOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPE TION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION - . -ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALUBE INSTALLED
PREGUNITE - TO COMPLY WITH THE APP" y��p NS AND CITY OF PERMIT VALIDATION
+ PERTINO STANDARDS. A-lA�tY, -
GARAGE SLABS "Y\� Y"' �• ^^
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
. UNDERGROUND /SLAB t
PLUMBING ' _ y, LYt I V.11+ d4�t�j_tl
ELECTRICAL ISSUANCE OATC J �/
MECHANICAL , BLDG,_T ELECT. PLG- MEC.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- INFORMATION
WOOD FLOOR VALUATION SIFT,
PLUMBING. -
MECHANICAL -
ELECTRICAL - ,, PERMIT TO
FRAMING. " <U,U( /l1
STORIES TV CONSTR,
INSULATION -
OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD.Er ELDaB AREA roraL aeR EaeE
DIAPHRAGM - . - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - RES IND CDN PB ow..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS , DATE INSP.
ASSESSORS PARCEL NO,
ROUGH SAN.# '
PLUMBING ELECT.ENERGY -
TUBS&SHOWER PAN PLUMBING ENERGY. TRA[;T No rAR CE L:NO
• MECHANICAL MECH.ENERGY
ELECTRICAL. BUILDING ENERGY 'ACC DaTE ACC.FILE NO,
.-
.. FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE No.
GAS TEST - GAS '
FIRE SPRINK ENERGY T-44 ,
MECHANICAL v 'N� v N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR, ' ELECTRICAL RELEASE FLOOD ZONE A.L,U.0
,INTERIOR SHEAR FIRE DEPT.. � ❑ •N❑ Y L N❑
SHEETROCK . - GRADE , FEESUMMARY
EXTERIOR LATH IBUILDING
INTERIOR_LATH ; TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
• GAS - FEE ••
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
D.i' ARRANGE FOR INSPECTION BY PHONING 252-4505, -ELECTRIC
F_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING
Z'� . PLEASE GIVE JOB ADDRESS WHEN PHONING. .•
-,SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL L7,0
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY f�
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 18421
AD OR s
'man did BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
OW ER'a PLAN CHECK VALIDATION
NA
/G X�1^77- ONE t
OTY. ELECTRIC PERMIT
FEE
NgNrRAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00
l///V LIC.NO, &;L
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
^D
5V_
v'Z)C1 /U/X PTCNI XA6& PANELS 10.00 DATE OF APPLICATION
ORcEIrscT PANELS (OVER 200 AMP) 20.00 . PLAN CHECK FEE P.C.No.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
AEMOTORS SEE FEE SCH. v
AGGRDDRESSSS
SERVICECHANGE 20.00 ,
0 o O LICENSED CONTRACTORS DECLARATION
< u w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N (commencing with Section 7000)of Division 3 of the Business and ^QQQ
¢ 1 BLDG. ELECT. PLG. MECH.
F,
as i ProfessionsC R,rm n3 license is in full fnr nSf
Nept.� Ij r4 El El
❑
Z, z m o License a Lie. umber
m w Dalc - Contracto
a Y f -�+ BUILDING PERMIT
rt Be t O OWNER-BUILDER UHCLARATION MISC.- F R INFORMATION
. 3 LL u I herehy affirm that I nm exempt from the Conlructnr's License VALUATION $/FT.
uIj Law for following renson.ISec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
fw>Y Coder.Any city'.,county whichmquires a permit mcanstrud,alteq
¢ a O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC,
c u requires the applicant for such permit to filen signed statement that TOTAL PERMIT TO
A w m m he is licensed pursuant to the provisions of the Contractor's License
> Law(Chapter 9(contmeneingwith Section 7000)of Division 3 ofthe
io Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEEn
¢ I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
ni - by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 U SQ FT.FLOOR AREA TOTAL ACREAGE
Tents are not hmugh
ownemployees,for sale.
If,ed that however,
such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
mems are not itnendis or offered for sale.If,however,the building
' or improvement is sold within one year of completion,the owner- GAS-EASYSTEM•OVER 4 IEA ) 200 BUILDING USE
builder will have the burden of proving that he did not build or im- . . .
RES IND CON PB Omer
CI 1,
for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 0 ❑ 0 0 0
I,as owner of the property,am exclusively contracting with '
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 does 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 Willi a cottlraclor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT _ 6.00 D
Eason
Owner Date WATER SYSTEM 5.00
ACC.DATE ALC.FILE N0.
WORKERS'COMPENSA'FION DECLARATION WATER TREATING EQUIP. 5.00 Q
I hereby affirm that 1 have a certificate oftonsent to sell'-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensfl Incur cu nr a certified
copy If }. It.CA .�
Policy ry(I pany
0 ❑ 7 10 duo 's hereby fished- FIRE SPRINK ENERGYTYa
Z Z jlG Ccrtil'ie0 o ,is i the city inspection division. MISC- REFER TO ORD.
O Applicant i YE] N� Y ED N
CC w CER IT FICATE 01:EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 .Z.U Pl.00D zorvE A.L.u.c.
LU COMPFNSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL F mit is issued,I shall not employ any person in any manner so as to
O U become subject to the Workers'Compensation Laws of California,
y Dare ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} m NO'T'ICE TO APPLICANT: If,uHer nmking this Certificate of Ex-
? emption,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 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10MC.F.M.) 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(Sec. MICROFILM
3097,Civ.CJ. ,.J HEATING UNIT ITO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T:U.)9.50 ELECTRIC
I certify that I have read this application and ,are that the above VENTILATION FAN (SINGLE) 4.00 )
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construelion, and BOIR-LE713H.P.or10O,000B.T.U.) 6.00
hereby aulori, representatives' of this city to enter upon the BOILER-COMP(Over l00,0008TU1 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.
' upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay any way accrue against said City in consequence of the
r tin of thi ennil' MECH.CONT. LIC.NO. MECH.
y TOTAL TOTAL Z 0D
Signature of Applicant/Contractor Date
OFFICE COPY