18094Is
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POST THIS CARD NEAR FRONT OF BUILDING
-
CITY OF "CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
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JOB ADDRESS_Iq_Ir����VA_I� `4=j/ I!1_iIvUN I # _LOT#.
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OWNER Ul.. V (. ` L� IS ONTRACTOR sp
I'[RMLT NUMBER
1$094
PE
TE+{ -4 TION
EXPIR�rI$ F;WORK
IS INDSTAR ED V�ITHIN
PERMIkS
188 DOF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION,
INSPECTION DATE INSPEC OR
INSPECTION RECORD
FOUNDATION '
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
UFER
PRRGUNITE
PERMIT VAUDAT1ON
t
',, -I •a 1� V1 � a. r -
'ISSUANCE DATE
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
V�'S%WS 1-3-goGlC� .
UNDERGROUND/SLAB
PLUMBING
-
ELECTRICAL
MECHANICAL
pLDr,
ELCCT.
PLC. MLCI
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
BUILDING PERMIT
•INFORMATION
WOOD FLOOR
VALUATION SIFT.
•_ / I' ryir
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PLUMBING
MECHANICAL-
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ELECTRICAL
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FRAMING
INSULATION O
STORIES
TYPE. CONSTR
OCC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF -
NOTE: NO FINAL INSP. SHALL BE MADEBEFORE
THE CONSTRUCTION TAX IS PAID -
Stl. E O R' HEA
111Y'i"
f
TO TA I: CR EA(iP
(tre
DIAPHRAGM
-
ROOF SHEATHING !
BUILDING USE
HES IND CON.. PB oe„•.
0 L L L ❑
- APPLY NO ROOFING UNTIL ABOVE HAS'BEEff SIGNED
- FINALS DATE INSP.
ASSESSORS PARCEL NO.
ROUGH
SAN.# W (a U E
PLUMBINGELECT.
ENERGY
_
TUBS B SHOWER PAN `D2 -h
PLUMBING ENERGY
rRncr NO.
PARCEL No
MECHANICAL 'Z
ELECTRICAL- 24to8
MECH.
BUILDI Y
Acc. unrE
ACC, FILE No
FRAMING u(l 4
INSULATION
ELECT.
PLUMB
ZONING
ENG. SITE NO,
GAS TEST Q
GAS
MECH ANI L
EIRE SPR INK
v NL
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ENER`v r14
v 1 N D
COVER NO WORK UNTIL ABOVE HAS BEEN S GNE
HEATING
FLOODIGNE
Y NL
ALUc.
v L N❑
EXTERIOR SHEAR
ELECTRICAL RELEASE
INTERIOR SHEAR
FIRE DEPT.
SHEETROCKI)
GRADE
FEE SUMMARY
EXTERIOR LATH -
BUILDING
-
BUILDING
INTERIOR LATH '
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAFEE CHECK
..„._,,,•
GAS -
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY LSEISMIC
OCCUPANCY OF BUILDING IS NOTPERMITTEO UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
'^•-
ARRANGE.,FOR INSPECTION BY PHONING -252-4505, ,
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
o� PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
- SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
-
Z
CONST. TAX
�'p7
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINALINSPECTION.
TOTAL
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OFFICE COPY
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICA IQN
- APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
,PERMIT NUMBER
O
ADOREa �
BUILDINGP114� -
13
D ER'S ,t
"NAME
._.
OTY. ELECTRIC PERMIT FEE
P CON
KfDIDATI
,
CCO•NNTTRACTOR'S
NAME
UTLETS- SWITCHES -RECEP 10.00/1.00
2/
- LIC. No. ✓fp
s
II
LIGHTING FIXTURES 10,00/1.00
CONTRACTOR'S
ADDRESS ��'L- 5£_ y96-3669
S APPLIANCES -RESIDENTIAL 4.00
(
C
DATE OF APPLICATION
PANELS 10.00
ARCHITECT
OR
ENGINEER
c. rvo,Z�6 '0
PANELS (OVER 200 AMPI 20.00
PLAN CHECK FEE P.C. NO.
.._
SIGNS TRANS. 3.00
AR, ENG. ��tl,,,///
ADDRESS
ss a�.� �iA-c.crry
21P
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
b
(/
TEMP. METER OR POLE INS. 20.00(1001,,
AAooREPPLICANT'"
ss
MOTORS SEE FEE SCH:
Si £, -
/t `
J • /L'L�rl� t-\
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
,1.
I hereby affunt that 1 am licensed under provisions of Chapter 9
Icommencing with Section 70001 of Division 3 of the Business and
Professions Code,.Vd my license is in full forc�aryl f eel.
License, Class_Aj Lic. Number_Or?
DIIte Contract.,
OWNER-BUII.DI:R DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License
Law for the following onxr.(Sec. 703 1.5, Ifusinessand Professions
Code: Any city or county which rcquiresa permit to construct, biter,
ISSUANCE DATE
BLDG.
E ECT.
LO. EC .
-
B LDING ERMIT
INFORMATION
MISC. REFER TO ORD
-' -
PERMIT ISSUANCE 10.00 (=Z6
VALUATION --yy $/FT.
�]/411
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL $ • �'
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
I_I I�1
PERMIT TO
QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption. Any violation of Section 7031.5
byanyappllcantforapermit subjects the applicant to a civil penalty
of not more than five handfed dollars ($500f):
STORIES
TYPE CONSTR. -
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
ROOF, AREA, CON D. 5.00
intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,
Code: The Contractor's Licanse Law don not apply to an owner of
'
FIXTURES - PER TRAP 5.00
GAS-EA.SYSTEM-I1NC.4OUTLETS 6.00
property who builds or improves thereon, and who docs such work
himself or through his own employees, provided that such improve--
mentsare notimor
endedofferedfarsale. ILhowevecthe building
SO. FT. FLOO EA
IDS
TOTALPP PAGE
r 00
or improvement is sold within one year of completion, the owner-AALI
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).
❑ I, as owner of the property, am exclusively contracling with
GAS-'EA..SYSTEM -OVER 4 (EA.) .2.00
BUILDING USE
RES IND CON PB Othe,
❑ ' ❑ El El ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.1 1.00
licensed contractors m Cot the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
ASSESSORS PARCEL NO.
contracts for such projects with a contracbms) licensed pursuant to
line Contract.,', License Law.
SEWER -SAN V -STORM EA. 200ft/10,00
TRACT NO.
PARCEL NO.
0 taco exempt lender Sec. ,E.&P.C. Oa Ibis
reason
WATER HEATER W/VENT 6.00
Owner Date
WATERSYSTEM5.00
ACC. DATE
ACC, FILE NO,
WATER TREATING EQUIP. 5.00
WORKBRS'COMPENSATION DECLARATION
I hereby affirm shut I have a certificate of consent to yell -insure.
or a ceniflcate 01' Workers' Compenaa�li n I�nsu,rance, or u cerliffed
copy thereof (Sec , Lab,C
I'nlicy �mpany
❑ CertiSed Copy i. hertby furnished
xL. CertTified col�t' is filed with tspectinn Division.
Applicant /" Q, _y
6Z�
ZONING
ENG. SITE NO.
.
FIRESPRINK
V ❑ N ❑
FLOOD ZONE
Y ❑ N❑
ENERGY T-24
Y ❑ N ❑
A.L.U.C.
Y ❑ N❑
MISC. - REFER TO ORD.
"•f
CL'R1'IPICA'1E OF EXEMPT ION FROM WORKERS'
COAIPENSA'ITON INSURANCE
(This section need not be Completed if the pennit'i_s for one
PERMIT ISSUANCE 10.00 (Z•OD
PLG, CONTR. LIC. NO.
PLG.
TOTAL iZ
hundred dollars IS 100) or less.)
I certify that In the performmnce of the work for which this per-
hill is issued, I ,shall not employ any person in any Conner so as to
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
�^
'�11
become subject to the Workers' Compensalion Laws of California.
Date Applicant
NO'T'ICE TO APPLICANT: II', after making this Certificate of E
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00.
AIR HANDLING UNIT (TO lo=C-F.M:) 4,00
PLAN CHECK
FEE'
_
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you most forthwith comply with
such provisions or this permit shall be deemed revoked
AIRHANDLING UNIT(OVER 10PMC.F.M.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance d' tl work lot w ich ilii p,. rmit s Issued ISea
3097,Civ.C.). % 'ate
MICROFILM
'+--
HEATING UNIT (TO 100,000 B.T.U.6 8.00
Lender's Nam
Lender's Adji,ress' �•
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
$y'•L7
Icertif •�fl-MJvetupplicalion and state that tile, above
VENTILATION FAN(SINGLE) 4.00
information is correct. I agree ,, comply with all city and county
ordinances and state laws relating to building construction, and.
PLUMBING
_L
-
BOILER-COMPOH.P.or100,0008.T.U.' 6.00
BOILER -COMP (Over 1DG,OGO BTUI SEE FEE SCI.
MECHANICAL
7 �L�
hereby authoritt representatives of this city to enter upon tin°
above-mentioned property for inspection purposes.
(We,) agree to save, indemnify and keep harmless the City of
- MISC. - REFER TO ORD. 2.Z7
Cupertino against liabilities, judgments, costs ;cod expen which
may in any way accrue against said ,Ci in Came on • of tl e
moil ren
CONST. TAX
PERMIT ISSUANCE 10.00
MECH. CONT. LIC. NO. MECH.
TOTAL 7/1,�7
1
TOTAL
���,6
Signature of ppllcaul/Cunemctor Date
OFFICE COPY .