18635 POST THIS CARD NEAR FRONT OF BUILDING
' FERMI r NLIMxkH
CITY OF CUPERTINO 1 $635
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION -
JOB,ADDRE S. O� ` �'(� UNIT# _LOT# pERMIT.E%PIKES IF WORK
OWNER CONTRACTOR' IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ 1 ANCE OR 180 DAYS FROM
NOTE:
' UFER � � '� ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTI
PREGUN ITE _ TO COMPLY WITH THE APPROVED PLANS AND CITY OF qfANIIT VALIDA ION
CUPERTINO STANDARDS.
GARAGE SLABS. Cr
POUR NOCONCRETEUNTIL ABOVE HAS BEEN SIGNED ��® p'' ':
UNDERGROUND /SLAB
PLUMBING lT
qq _ 1t
_ ELECTRICAL - ��O ' 0t�J L.U�1 J ISS ANCE UATE`
MECHANICAL .�[ xLuc.. cr. MFCH
PLG.
El 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION S/FT.-
PLUMBING • -
MECHANICAL
ELECTRICAL E Mn )
FRAMING - l �
INSULATION - STORIES TYPE CONSTR.
• OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED-
5 9.11 FI.00RAREA TOTAL ACREAGE
.
ROOF , . NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - • RLS' IND CON PR un...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS . DATE INSP. ❑'. 0 ❑ ❑ 1:1
ASSESSOHSPAHCFL NO
" ' ROUGH � - - SAN.p
PLUMBING ELECT.ENERGY
.
TUB&&SHOWER PAN PLUMBING ENERGY rRACI NOPARCEL NO,
MECHANICAL MECH.ENERGY '
ACC,DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY -
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING zoNlrvc ENG.SITE No.
GAS TEST ! GAS
FIRE SPRINKENERGY T24
MECHANICAL . '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N� Y :, N❑
FLOODTONE AL
,U L.
EXTERIOR SHEAR - ELECTRICAL RELEASE
J
INTERIOR SHEAR FIRE DEPT. Y❑ NO N❑
L�.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING _
INTERIOR LATH TEMPORARY APPROVALS 'BUILDING
SCRATCH COAT .
ELECTRIC
- PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FIN ALISSI GNED BY BUILDING INSPECTOR. MICROFILM
A'R'RANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC -•O
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING - OD
z 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
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
`BLU LOI NG PROJECT I DENTI FICATION tit • PERMIT NUMBER
BULDIN APPLICATION & PERMIT 0. � 18635
O y •�,G Jd� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'EG T,GINAN _ TV
J PLAN CHECK VALIDATION
i ,. "AME DTV. ELECTRIC PERMIT FEE .
I PHONE
NOA.E Rs OUTLETS-SWITCHES-RECEP 16A01I. 50
LID No. LIGHTING FIXTURES Il ro 10. 0/1. 0 - (90
DGR's
ADRESS APP L IANC ES-RESIDENTIAL 4,00
CONTRA
,PH9NC 1 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE PC.,NO.
oR 5 .: PANELS (OVER 200 AMP) 20.00
ENGINEER 1 -
uc. 0 cSIGNS TRANS..
`' 3.00 '
ARC OR ENG.
ADD"RESS t ly1 j� SPECIAL CIRCUIT S.00 ERMIT VALIDATION
21 EMP.METER OR POLE INS. 20.00 '
ASMOTORS SEE FEE SCH.
lh
ADDRESS
SERVICE CHANGE 20.00
O O LICENSED CONTRACTORS DECLARATION' -
< Uw I hereby atICan that I um licensed under provisions of Chapter 9 �nP1 Su '
H Q w (commencing with Section 7000)of Division 3 of the Business au1 - LECT. PLG. MECH.
H m z Professions Code,and my license is in full force and effect. BLDG.-_�t (\,) \J
0 om - License Class Lie Number
r- N 1-w Date Comraclor 1 O
Q Y < DECLARATION Fb(;51r^ ln BUILDING PERMIT
¢ rt w Q OWNER-Iil11LUER -
°' °' u MISC.- 1 REFER TO ORD INFORMATION
w ; y 1 hereby affirm irg I hm exempt from theContractor's
and roLssions
H .. 6oj Law for[he following reason.(Sec.]031.5,Busincssand Professions PERMIT ISSUANCE VALUATION S/FT.
Ew� 3 Code:Any city orcounty which requires a permit to construe(,alter,
Q O improve,demolish,or repair any Structure,prior In its issuance,also ELEC.CONTR. LIC.N0. ELEC. /Ll
o ¢ requires the applicant for Such permit to file a signed statement that TOTAL> t V
u w m he is(Chapter
pursuant to the provisions of the Contractor's License ^� , PERMIT TO
H z i Law(Chapinr9(commencing with Section 7000)of Division3 of the /V✓ 12Z (CiZ
4 o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
t- m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; � by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 6.00
of not more than five hundred dollars(8500)):,
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure Is not occ.eaOUP RES.UNITS
intended or offered for,.IS (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 -
Code:The Contractor's License Law does not apply to an owner of
• pn)perly who builds or improves thereon,and who floes such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4 IEA.) 2.00
builder will have t - .he burden of proving that he did not build or ire- BUILDING USE
prove for purpose ofsale)' INDUSTRIAL WASTE INTER. 30.00 - RES IND CDN PB Omer
Cl 1,as owner of the property,am exclusively contracting with ❑ 1:1 11 ED ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 00 ASSESSORS PARC EL NO.
and Professions Code:The Contractor's License Law does not apply V.B.. .
to an owner of property who builds or improves thereon.and who a..i LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for Such projems with a contractors)licensed purnanl to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec._,It&P.C.lot this WATER HEATER W/VENT � 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORK 1:RS'COM PEN'SATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.'
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby fumishcd' FIRE SPRINK ENERGY T-Z4
Z Z ❑ Certified copy is filed with the city inspection on.
O Applicant MISC.- REFER TO ORD. v ❑ N❑ v❑ N[]
CCN CERTIFICATE OIr EXEMPTION PROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
W � COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG, y�
Q. O ('This section need not be completed if lite permit is for ane TOTAL 1Il Y❑ .N❑ V ❑ N❑
Z) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT If,after naking this Certificate of fix
F Z_ enhption,you should become subject lo lite Worked Compensation APPLIANCE 5.00 PLAN CHECK
provisions of lite Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,(IOOCF.M.) 4.00 '
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency]or EXHAUST HOOD(WITH DUCT) 5.00
lite performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name.
Leader's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
• 1 certify that 1 have read this application and state 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 construction, and BOILER-COMP(O H.P.or 100,000 B.T.U.) 6.00 .QJ
hereby actioned representatives I,or inspection
tris city to altar upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
herebymentioned properly forinsp of tb i purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
my in y way occ gainst id ity i consequent of the PERMIT ISSUANCE 10.00
ran g [his por MECH.CONT. LIC.NO. MECH.
TOTAL
Sign are fApp sant/ onl '10 U L I TOTAL
p �� OFFICE COPY