15590 POST THIS CARD NEAR FRONT OF BUILDING "
yam✓ , ��^ ..• PERMIT NUMBER
CITY 'OF CUPERTINO
'INSPECTION DIVISION
JOB INSPECTION RECORD
11688 Y1NT n I�'vw' PERMIT EXPIRATION
1
' JOBADDRES ,. - IT# _LOT#
" � , . PERMIT EXPIRES IF WORK
d
OWNER •G� . p-yc.o UIA CONTRACTOR IS NOT STARTED WITHIN
INSPECTION TE 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
'? TO COMPLY WITH THE'APPROVED PLANS AND CITY OF PERMIT VALIDATION .
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS - - -POUR NO NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - _ r�. .. •� - ""
UNDERGROUND /SLAB
PLUMBING - ' /j; .j �•.
ELECTRICAL
ISSUANCE DATE
MECHANICAL ,_ BLDG ELECT.I PLG. MECR I
PAI ❑ . ❑ � ' ❑ '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - _ BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION STET,
Y, PLUMBING I`-�T4
MECHANICAL - - I'flRo
Ci ty ofBPERMIT TO
' ELECTRICAL
FRAMING -�+•-"
INSULATION - STORY. TYPE CONSTR,
DCC-GROUP RE,S UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' - ROOF NOTE,NO FINAL INSP,SHALL BE MADE BEFORE so Fr,FLOOR AREA TOTAL ACREAGE ;
DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING ,O IND ON O OIO,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO
- ROUGH SAN.# -
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN i PLUMBING ENERGY TRACT NO, PARCEL NO,
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE No
FRAMING ELECT.FINAL TEST
ZONING ENE,SITE NO,
INSULATION � PLUMBING -
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY Tae
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y,0 N N�
FLOOU ZONE A U,C
' EXTERIOR SHEAR ELECTRICAL RELEASE .
'INTERIOR SHEAR FIRE DEPT. �❑ N❑ YL N❑
SHEETROCK - - GRADE - FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH -- TEMPORARY APPROVALS BUILDING
SCRATCH COAT JELECTRIC - W PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCU PANCV SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BVBUILDING INSPECTOR, MICROFILM
1!7
ARRANGE FOR'INSPECTION BY PHONING 252.4505, ELECTRIC r
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
zo PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE -. MECHANICAL
' IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE.' TOTAL
CALLING FOR FINAL INSPECTION. �(
.OFFICE COPY, �,"
A:PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
r; ,-
BUILDING PROJECT IDENTI FICATION ,PERMIT NUMBER •
aD;LDING -
APPLICATION & PERMIT r 15590
ADDRESS
�AL4 sY/'n ILDING - ELECTRICAL-PLUMBING-MECHANICAL
Ow EH'6 PLAN CHECK VALIDATION
NAME
H
_ Gro _ /� DTV. ELECTRIC PERMIT FEE
Gra r PNGN
CON as UTLETS-SWITCHES-RECEP 10.00/1.00
R 4 /t LIC.ND LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS ✓A l/ PPLIANCES-RESIDENTIAL 4.00 -
Q PHONE �' ,�� PANELS 10,00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR . PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC,NO. SIGNS TRANS. 3.00
ARC"08RESS ENG. _ SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP ' EMP.METER O tPOLEINS. 20.00 74fi� r -��-
APPLICANT'S
aoOREss D�7 MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 /
vR z - - �/
F o o - CICIiNSED CON'IBACTORS DF.CLA RA ION (( (, -
c u u I hereby affirm that I am licensed under provisions of Chapter 9 r
Gi ISSUANCEDATE
% (com.'smul g with Section 70001 of Division 3 Of the Business and BLDG. ELECT. PLG. MECH.
F m i professions CoJ' nd license is in full tome' t ❑ ❑ ❑
o i w O License Cls c NumbL` �f
m r Dmc_�omractor
Q y E J
2 w a - OWNER-BUILDER DIiCLARKI'ION BUILDING PERMIT
w0
°' DD INFORMATION
i% u r I hereby affirm that 1 an exempt from the Contractor's License MISC.- REFER TO OR
ruoJ Law for the ityfollowing reason.(Sec. uires a,ermit tocodProfessions PERMIT ISSUANCE p VALUATION g/FT.
Code: e,demolish,
countywhich requiresapermito its Pstn(et,alter, O
Kar < p improve,demolish,or repair any strucl ora,prior W its issumme,also ELE4 CONTR. LIC.NO. ELE qq' _
W E: o LL requires the applicant for such permit Iii file a signed statement that TOTALy5.
n w m he is licensed Pursuant to the provisions of the Contractor's License 'no PERMITTO
rii
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe yy
4 o Business and Professions Code)or that he is exempt.therefrom and QTY. PLUMBING PERMIT FEE �� t t�!'
2 F the basis for the alleged exemption.Any violation of Seclion 7031.5 STORIES , TYPE CONSTR.
` a ; _ by any applicant fora permit suhjecls the applicant toacivil penuhy gLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500)J:
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 DCC.GROUP RES.UNITS
their sole compensation,will do the work,and the strtmture is Hill
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
properly who builds or int proves thereon,and who does such well FIXTURES-PER TRAP 5.00 so,FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve
ments are not intended or offered for sale.It,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6,00
or improvement is sold within one year of completion.tire owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that lie did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON Pa other
❑ 1,as owner of the property,air exclusively contracting with
licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 VB600 ASSESSORS PARCEL NO.
and professions Code:The Contractor,License Law does not apply V.B. .
- to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contractoNs)licensed pursuant to
the Cnntamors License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PAROEL NO.
❑ I am exempt under Sec..,B&RC for this WATER HEATER WIVENT 6.00
on
Owner Date WATER SYSTEM 5,00 ACC.DATE ACC.FILE NO.
WORK C RS'COM PFNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate ofconsent to self-insure,
or a certificate of Worker,Compensation Insurance,or a certified ZONING ENG.SITE NO:
copy thereof(Sec.3800,Lah.C.).
Policy No. Company
0 �❑l Certified copy is he yfumishod., FIRE SPRINK ENERGY TQ4
Z Z R Cer0If p IIIc with t c 1. ection division.
� O pplirmt r MISC. REFER TO ORD. Y [:] IN[J Y ] IN
N CERTIFICATE OF EXEMPT]ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU 2: COMPFNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not be completed if the peat it is for one - TOTAL Y[-] N� Y [:] N�
0 Z hundred do))...(SIOO)orless.b
U O 1 certify that in the performance of the work I'or which this Per QTY. MECHANICAL PERpAIT FEE FEE SUMMARY
LL 1- mit is issued, 1 shall noDemploy any person in any manner so as In
O become subject to Bat Workers'Compensation laws of California.
a Dmc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
'} W NOlIC17 1'0 APPLICANT: If,after making this Certificate of fix
emPtion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall he doomed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.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(Sea MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender,Address - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC m
I codify that l have read this application.1111 sate that the above VENTILATION FAN (SINGLE) 4.00
' information is correct I agree to comply with all city and county gO1LER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and sate laws relating to building const ruction, and
hereby entho ed representatives of this oily to enter upon the BOI LER-COMP h0ver 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby
property for inspection purpows.
(We.) agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORD.
upertino against 'abilities,judgments, costs mud expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may G any w accrue agars Said City in consequence of the
anti •of hi PGm (r MECH.CONT. LIC.NO. ME H.
TOTAL TOTAL �''
Sig a are Of Applicant/Contractor Ua[
OFFICE COPY