18415 POST THIS CARD NEAR FRONT OF BUILDING ,.. PERMIT NDmy ,
G CITY OF CUPERTINO 18415
INSPECTION DIVISION
JOB, INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS'_/V � �V�-�O�UNIT# _LOT#
PERMIT EXPIRES IF WORK
0ER J CONTRACTOR .� IS NOT STARTED.WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTI ON.
.UFER - ALL GRADING AND DRAINAGE SHALL'BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALMAOON
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB,
PLUMBING . 41. I VI t�C.'-•
ELECTRICAL . ISSUANCE DATE~ ..
MECHANICAL =G, eEEcr PLP. nnECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUAnoN SIFT,
PLUMBING
MECHANICAL `•
ELECTRICAL _ ,ERNI LTD
FRAMING - . '_e kV .eOAde .
INSULATION - STOia ES TvrE CONSTR.
DCC.GROUP RES UNITS
EPWr9CE[N.D]SU,BFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE "' Er w.00R AI+EA TOTALAca eneE
NqA _
`DIAPHRAGM ' - THE CONSTRUCTION TAX IS PAID
•
ROOF•SHEATHING RES IND LD`OON use F9• Om",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE - INSP. 0 ❑ 1:1 0 ❑
ASSESSORS PARCEL NO
ROUGH - - SAN.N "
PLUMBING - ELECT.ENERGY
.TRACT NOf PARCEL NO
! TUBS 8'SHOWER PAN PLUMBING ENERGY -
1 MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.PILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG SITE NO.
( INSULATION � � � GJ PLUMBING
GAS TEST - - GAS
MECHANICAL EIRE SPRINK ENERGY r.Za '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v NE] ° [j "E]
EXTERIOR SHEAR ELECTRICAL RELEASE - 7 FLOOD ZONE A.E u.G.
INTERIOR'SHEAR FIRE DEPT. - - Y N� ° L N❑
_ SHEETROCK ,� - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING �� V D
INTERIOR LATH - TEMPORARY A PROVA S BUILDING
SCRATCH'COAT ELECTRIC PLAN CHECK X{ N
GAS FEE J1�C.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR:. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 1��sP
Iw-�; ONE.WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING, -pD
j` PLEASE GIVE JOB ADDRESS WHEN PHONING.
"
- SEE PERMIT FOR EXPIRATION DATE'- MECHANICAL
IMPORTANT! CONST.TAX -----
I'"' PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. .
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
a ILOING APPLICATION & PERMIT I O
AODREss // J
X63 �to-, {-X(A Cl Q BUILDING-ELECTRICAL-PLUMBING-MECHANICAL o
OWNER'S o PLAN CHECK VALIDATION
NAM OTY. ELECTRIC PERMIT FEE
CONTERACTORS UTLETS-SWITCHES-RECEP. 10.00/1.00 ,60 - .
NAMLIC.NO. LIGHTING FIXTURES 10.00/1.00 E
coNTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
AAT
Do Ess ENO' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. '20.00 �- �7
APPLICANTS MOTORS SEE FEE SCH. a l--�I/
ADORESs(� /-
s SERVICE CHANGE 20.00 T f.
•`
a 0 LICENSED CONTRACTORS DECLARATION A_ ` 0 Viii
a u I hereby affirm that 1 an licensed under provisions of Chapter 9 ISSUANCE DATE.
h rt N (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
H z HIA
Professions Code,and dry license is in full force and effect . U 11ED(
z0 w - License Class Lia Number - .UC
mw Date Contractor
a >< s cm cuplum BUILDING PERMIT
ce ¢ ¢ OWNER.RUILDER DECLARATION
o a,u INFORMATION
wg ,� r 1 hereby affirm that I Sin exempt from the Contractor's License MISC.- REFER TO ORD
u D a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
_ PERMIT ISSUANCE 10.00 ,Z, D D DO
,ACode:Any city or county which requiresa permit(.construct,after.re i a 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. (��
O u requires the applicant for such permit to file a signed statement that TOTAL 'g, � V PERMIT TO
A. w m he Is licensed pursuant to the provisions of the Contractor's License -
H z a I-aw(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe
4 st Business and Professions Code)or(hut he is exempt therefrom and DTV. PLUMBING PERMIT FEE .WC
¢ I-m the basis for the alleged exemption.Any violation of Section 703 LS TYPE CONSTR.
S OHIES
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5,00
of not more than five hundred dollars(5500).) , d
❑ I,as owner of tire property,or my employees'with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP 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,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves R,,Pon,and who does such work FIXTURES-PER TRAP 5,00 _o o SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such idrprove-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the ownIT-
builder USE
will have the burden of proving that h .e did not build or im- RES IND CON PB Omer
ing
prove for purpose of Sale.). INDUSTRIAL WASTE INTER. 30,00 C3 1:1 ❑ C3 1:1.. fn,as owner of the property,um exclusively conlructwith
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 Contractors License Law does not apply
to an owner of property who builds or improves thereon.and who ILAWN SPRINKLERS-OVER 5 (EA-) 1.00 -
contractslirsuehprojectswithucont t Fit licensed punusnt to ' SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors Liaenec Law. TRACT NO. - PARCEL NO.
❑ lre mpt undcrS ,B.&BC. br this WATER HEATER'W/VENT 6.00
reason
• Owner Date WATER-SYSTEM 5.00 ,Q V ACC.DATE ACC,FILE NO.
ORKF.RS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate ofconsenl to selGinsure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
O ❑ Certified copy is hereby fumiahed. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is fled with the city inspection division. REFER TO ORD.
'Q Applicant MISC.- RY ❑ N❑ Y ❑ N❑
w CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 / I OD FLOOD ZONE A.L.U.C.
LUQ COM1IPFNSATION INSURANCE PLG.CONTR, - LIC.NO. PLG. , l Y❑ NY ❑ NE]
Z 1'1'his section need not be completed if the permit is for one TOTAL ,/��
hundred dollars(S100)or less.)
U O I certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any drainer so as to
beconm subject to the Workers'Compensation Laws of Caloornia.
O y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ m NOTICE TO APPLICANT: If,after making this Certificate of fix-
F2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PEEN CHECK ^l
provisions of the Labor Cade, you must forthwith comply with
U such provisions or this permit shell be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 N
CONSTRUCTION LENDING AGENCY a AIR HANDLING UNIT(OVER 10MOC.FM.) 6.00 SEISMIC FEE 7a
1 hereby affirm that Imre is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 `-
the performance of tiro work for which this permit is issued(See. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 .
Lender's Address ELECTRIC
I C
I certify that I have read this application and ,are Thal 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 construclion, and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over IOO,000BTU)SEE FEESCH. MECHANICAL -1-Dabove-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
ora IIn any way ac ue mgai t said City in consequence of the Q�
apt g pe I. MECH.CONT. LIC.NO. MECH.
/ �� TorAL/� TOTAL 273
Slg era of Applicant Contractor Dale
OFFICE COPY