15467 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER 4
CITY, OF CUPERTINO, 15467
INSPECTION DIVISION
JOB INSPECTION RECORD
e PERMIT EXPIRATION
JOB ADDRESS Z07!? ZI
UNIT# •_LOT#
PERMIT EXPIRES IF WORK
OWNER E aG CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DA INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED t
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE.
MECHANICAL - BLDG ELECT. PLG. MECII
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
'INFORMATION
WOOD FLOOR ' VALUATION s/FT.
PLUMBING
MECHANICAL
ELECTRICAL q PERMIT TO
FRAMING
T � ' \
INSULATION STORIES TVPE CONSTR.
-
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
• ROOF: NOTE:NO FINAL INSP.SHALL BE MADE BEFORE, SO,FT.FLOOR AREA� TOTAL ACREAGE
,
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES INA CON PB omr, ,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 11 ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
.
TUBS&SHOWER PAN - - PLUMBING ENERGY � � TRACT NOPARCEL NO,
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE . ACC.FILE NO. i
FRAMING - ELECT.FINAL TEST
ZONING ENO.SITE NO.
INSULATION � PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T-24 ;
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N0 ° ❑ No
.
EXTERIOR SHEAR ELECTRICAL RELEASE �'. _ FLOOD ZONE AL U.C.
INTERIOR SHEAR FIRE DEPT. ED ND YL No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH. TEMPORARY APPROVALS BUILDING
SCRATCH COAT i ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, -ELECTRIC ,E
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATMECHANICAL
DATE
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 '
BU I LDING PROJECT I DENTIFICATI ON - PERMIT NUMBER
BGILDIN6 APPLICATION & PERMIT
A REaa 15467
U-J y l � -�-,-ti �-.+� b V BUILDING—ELECTRICAL=PLUMBING—MECHANICAL �'
OWNER'S`. PLAN CHECK VALIDATION
NA E GLS _• � OTY. ELECTRIC PERMIT FEE
3
PHONE C I
CONTRACTORS - UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00 0—
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
on PANELS
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.QN .•
ENGINEER
uc.ND. ISIGNS TRANS. - 3.00 '
ADDDRESS Enc. SPECIALCIRCUIT 5.00 PERMIT VALIDATION.
ZIP TEMP.METER OR POLE,INS. 20.00
APPLICANTS - MOTORS SEE FEE SCR. /JCS\L�A7lJ-Lc--/`J
ADDRESS _
' SERVICE CHANGE 20.00
wo o LICENSED CONT RACI'ORS DECLARATION
¢ u I hereby affirm that I am licensed under provisions of Chapter 9 u-1 . ISSUANCE DATE
rz w (commencing with Section 7000)of Division 3 of the Business and
n¢ a ' M
H m m Professions Code,and my license is in full force and effect BLDG. ELECT. PLC. ECH.
❑ ❑ ❑
o i a �[ License Class Lia Number
DCampion,
r
w H j/- ate nt
Coractor
s< s ';t�
¢ ¢ w OWNER-d UILUEIt DECLARATION -
BUILDING PERMIT
I hereby affirm thatI am acmr's exempt from the ComrLicense MISC.— ,'REFER TO ORD INFORMATION
u 0 ¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.0 Q $/FT.
� - Code:Anycity or county which requires a permit toconstruct,alter, 0 VALUATION
SC reamer,¢ O improve,demolish,or repair any Structure,prior its issuanC4 uISO ELEC.CONTR. LIC.NO. ELEC
¢ requires the applicant for such permit to file a signed statement That TOTA.L
u w m he is licensed pursuant to the provisions of the Contractor's License c PERMIT TO
H.iQ Law(Chapter9(commencingwith Section 7000)of Division3 of the -
E o Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE /
w I-�a the hasis for the alleged exemption,Any violation ol'Section 7031.5 STORIES TYPE CONSTR.
a ;� by any applicant for a pemnit subjects the applicant toa civil penalty
of not more than five hundred dollar.(S500).t ALTER-DRAIN& VENT-WATER (EA.) 5.00
0 1,as owner of the property,or my employees will wages as ggCK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work.and the structure is not OCC.GROUP RES.UNITS
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
property who builds or improves tnercon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such imf?ove
.Cuts are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 200
builder will have the burden of proving that he did not build or im- . 'BUILDING USE
prove for purpose of sale.). I INDUSTRIAL WASTE INTER , 3000 RES IND CON PB Other
. .
❑ I,as owner of the property,am exclusively contracting with Q
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'fhe Contractor's License Law does not apply
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
conte its for such projects with a contractor(.)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the lector's license Law. TRACTNO. - PARCELNO.
❑ am exempt order Sec .d.&I'.C.far this WATER HEATER W/VENT '6.00
reason
Owner Daze - � WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPF.NSATION DECLARATION WATERTREATING EQUIP. - 5.00
I hereby uffimt that I have a certificate ofconsent to self-insure
Do'
a certificate of Workers'Compensation Insurance,or a certified - ZONING ENG.SITE NO.
\X' copy thereof(Sec.3800,LA .).
/ Policy No. Company
0 ❑ Certified copy is hereby furnished FIRE SP RINK ENERGY T-Z4
Z Z ❑ Certified copy is tiled with fire city inspection division. MISC- REFER TO ORD.O Applicant Y Q'. N❑ Y ❑ N❑
~ �+ PERMIT ISSUANCE 10,00
2 — CERI'IFICf E EXEMPTION FROM WORK IiRS' FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCfi pLG.CONTR. LIC.NO. PLG.
CL 0 ('Phis section need not be completed if the Permit is for one TOTAL Y NEI Y❑ N
Z hundred dollars IS 100)or less.)
U O I,certify that in the performance of the work for which tl is per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall not employ any person in any manner so as 10
O L)become subject to the Workers'Co.w.unflon Laws of California.
IJatc Applicant BUILDING
} tail NOTICE '1`0 APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
2 anption,you should become subject m file 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 be deemed revoked AIR HANDLING UNIT(TO 10,OODC.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I herehy al'fion that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the 3097 performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 ��
Lender's AAdress ELECTRIC
I certify that l have readibis applimiion and state that the above VENTILATION FAN ISINGLE)" 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00
ordinances and state laws relating to building construction, and
hereby autlmrMe representatives of this city to enter upon the
ubove-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCR, MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.CifA -
rtino against liabilities,judgments, costs and cap el»es which PERMIT ISSUANCE' 10.00 CONST.TAX
y 'n any way accrue again. vid C y in consequence of the
r t gof this MECH.CONT, LIC,NO, MECH.
TOT"` TOTAL
Ig re o' pplicant/Contractor - Date
OFFICE COPY