18302 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 1 $3g2
INSPECTION DIVISION
JOB INSPECTION RECORD hl&cfe
6
-2'- O PERMIT EXPIRATION
JOB ADDRESS—V=Y _ UNIT# _L T# PERMIT EXPIRES IF WORK
corvrRAcroR IS NOT STARTED WITHIN
OWNER 180 DAYS OF PERMIT ISSU-
INSPE ION DATE INSPECTOR !` ' ' INSPEC N RECORD ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PEDIII vnl IunrloN
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
PREGUNITE CUPE IND STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING '�,�
ISSUANCE DATE
ELECTRICAL - '• BLDa ELEECCIT.. -PPL-G(. MECR.
MECHANICAL PITH � ..EI' � �r[J ❑
i'I'YY BUILDING PERMIT
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ;JV�. :INFORMATION
WOOD FLOOR •7� VALUATION s,ET
PLUMBING
MECHANICAL 166 SY1YY PERMIT To.
ELECTRICAL
FRAMING
INSULATION
• UCC.GH�UP n,; RES UNITS
• PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SR.FT,FLOORAREA TUTALACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPIIRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res. IND cl 0 Pe o3
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ::,FINA '�� " ATH INSP. I nssEssaasPARCELNo
ROUGH SAN.# ji . At
PLUMBING ELECT,ENERGY TRACT NO. PARCEL No
TUBS 8 SHOWER PAN PLUM NG ENERGY / '
MECHANICAL IMECH.ENERGY _` Acc.GATE ACC.FILE No.
ELECTRICAL BUILDING ENERGY
FRAMING , ELECT,FINAL TEST ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST
GAS FIRE SPRINK ENERGT'Na
MECHANICAL r Nv N[
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING aouu znNE A.L.0 c.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. C
is ❑ "O ❑ NC
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - "I0 G BUILDING
TEMPORARY APPROVALS 1 ',
INTERIOR LATH PLAN CHECK
SCRATCH COAT ELECTRIC FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ;
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
• w ARRANGE FOR INSPECTION BY PHONING 252-4505,
- ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE—CQPY_
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.;. -'BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
GUILDING ` APPLICATION & PERMIT 183 02
noon�72,v 3d V7 BUILDING - ELECTRICAL-PLUMBING -MECHANICAL y,
ONNER'5 / - PLAN CHECK VALIDATION
NAMEmac q!
4cS ESC _37? CITY. ELECTRIC PERMIT FEE
ON
GDNTRncT Hs
NA E 'L OUTLETS-SWITCHES-RECEP 10.00/1.00
/0
�7 LIGHTING FIXTURES 10.00/1,00
ADDRESS oH's ZS(3 S��• APPLIANCES-RESIDENTIAL 4.00 '
�_/`fnJ W PHO PANELS 10.00 DATE OF APPLICATION -.
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIG,NO. SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG. ! SPECIAL CIRCUIT 6.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S Ly 1;'CJ J MOTORS SEE FEE SCH.
noOREss
I/� 0t>C/ L
ag. SERVICE CHANGE 20.00 ISS 0o LICENSED CONTRACTORS DECLARATION
11 Li
1 hereby affirm Thal 1 am licensed under provisions of Chapter 9 - ' _N (commencing with Section 7000)of Division 3 of the Business and CE DATE
H H Z Professions Code,a y license is in fell force tl fe BLDG. ELECT. PLG. MECH.
z D m License C ass Lic.NumherQ6e_
p m H o Date_ - ( Contractor
a m2 BUILDING PERMIT
rt ¢ w u OWNER-BUILDFR DECLARATION INFORMATION
seg u y I hereby affirm that I am exempt from the Contractor's License MISC.- ER TO ORD
u O¢ Law for The fallowing reason.(See.7031.5,Business and Professions VALUATION $/FT.
r -WPERMIT ISSUANCE 10.0
i au f Code:Any city Or county which structure permit priot O consuance,also
¢ K R O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC. KW�
D¢ requires the applicant for such permit to file a signed statement that TOTAL 1
n w m u he is licensed pursuant to the provisions of the Contractor's License 1 \0 P EMIT TO
H z Q Law(Chapter 9(commencing wi l h Sect inn 7000)o f Division 3 of l he
f s 40 Business and Professions Code)or that he is exempt Iherclinm and OTY. PLUMBING PERMIT "FEE
X
m the basis for the alleged exemption,Any violation OfSection 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant ton civil penalty
of not more than five hundred dollars($5000T ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 ocC.G OUP RES.UNITS
(heir sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 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 FIXTURES-PER TRAP 5,00 SG.PT. LODH HEA TOTAL ACREAGE
_•. himselfor ret. ammugh hisoroemr"Ifor sale i f,ed however,
the
inlpnrve GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
menet are ll intundis w employees,
for sale IL however,Ihu building
or Improvement is sold within one year of completion, the owner,
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 RES ND CON PB Orhe,
❑ 1,as owner of the property,an exclusively conimning with . D ❑ ❑ ❑
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 properly who builds Or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with it conlmetor(s)licensed pursuant in -
theCmdurhr'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Imre exempt under Sec. ,N.&P.C.lar tllis
reason WATER HEATER W/VENT . 6.00
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent W self;insum,
or a certificate of Workers'Compensation Insurance,Or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy 1, Company�� /. r�k ,
0 ❑ Certified copy is hereby furni,Illcd, _ ' FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspcclion division.
F O Applicant MISC.- REFER TO ORD. Y [] N Q Y 0 N[]
CC CER'I'D'ICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG,
iL 0 (This secliein need not be completed if the permit is for one TOTAL R. Y❑ NC] Y❑ NO
U O hundred dollars(S 100)or less.)
I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL - mit is issued, I shall not employ any person in any manner sn us UI
O Wbecome subject to the Workers'Compensation Laws of California,
Ia. Date Applicant BUILDING
} to NOTICE "I'O APPLICANT: If,after making this Certificate of Ex-
ALTER OR ADD TO MECH. 5.00
♦- ? eruption,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 he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 5
11moby .Winn that there is a construutiun lending agency Io, EXHAUST HOOD(WITH DUCT) 6.00
the performance o1the work for which this permit is issued(Sec. MICROFILM
3097,Ccv.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l have mail this applicaGlID and state that the above VENTILATION FAN (SINGLE) 4.00
I�
information n correct.l I agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING'
ordinances and rrrec laws relating ur building all
city construction, and
hereby enti o ed representatives rel this city es Bruer upnn'the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for insp of this
purposes:
(We) agree to save, indemnify and keep harmless the City of MISC.- -REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ue
may in any way accragainst said City in consequence of the
mating of this permit, MECH.CONT, LIC.NO, MECH.
II Q 50
Signature of Applicant/Contractor TOTAL Date - TOTAL-
OFFICE COPY