15700 POST THIS CARD NEAR FRONT OF BUILDING
- _ PFR MIT NUMpER
CITY OF CUPERTINO 15700
INSPECTION DIVISION
JOB INSPECTION RECORD
P E RMIT EXPIRATION
JOB ADDRESS
LYS" - S• S ��ZC-�^�G rte+' UNIT# _LOT#
PERMIT. EXPIRES IF WORK
OWNER �� UQ v4, ' ut--a- �f`1A--, aemblACTOH - IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 186 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM'
NOTE: LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAL IDAtION
CUPERTINO STANDARDS.
GARAGESLABS ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB , +;
PLUMBING
ELECTRICAL 'ISSUANCE DATE `
MECHANICAL BLDG. .ELECr. F.G. MIiCH
Elz. ❑ . '❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR P VALUATION- $IFr.
PLUMBING tf
MECHANICAL • 19ab '
ELECTRICAL TIG PERMIT TO t
FRAMING Qt d�/ tlGTc/
STORIES
INSULATION TYPE CONSTR.
• OCC GROUP RES UNITS
"PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• \ , .10 FT FLOGIAHLA IOTALACf1EAGL
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' '
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - RES IND CON PB Om..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 11- ❑ ❑ E
ASSESSORS PARCEL NO
ROUGH SAN.R
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN - PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECR ENERGY
t
ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING ELECT,FINAL TEST '
INSULATION - PLUMBING - ZONING ENcsI rE NO.
GAS TEST - GAS
FIRE SPRINK ENERGY T 24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ " I ` ❑ N�
L
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A U,C.
INTERIOR SHEAR ' FIRE DEPT. •Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY '
EXTERIOR LATH - BUILDING
INTERIOR LATH I 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 FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505• ELECTRIC
IMI— ONEWORKING DAY BEFORE REQUIRED INSPECTI PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE.PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT-!
CONST.rax.
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPL'ICANT.TO FILLIN INFORMATION WITHIN RED LINES._ USE BALL POINT PEN ONLY'
BUILDING PROJECT IDENTIFICATION " .PERMITNUMBER
- APPLICATION & PERMIT'. �r700
".••>IONTRACT-m
ADDRESS , I
S"O . I1 - BUILDING-ELECTRICAL=PLUMBING_MECHANICAL .,..
wrvER'SPLANCHECK VALIDATION
AME CITY. ELECTRIC PERMIT FEE
CP -IQ,AMEs UTLETS-SWITCHES;RECEP 10.00/1.00a
' Lc.NO. LIGHTING,FIXTURES 10.00/1.00 '
9NTRACTOR'sAPPLIANCES-RESIDENTIAL= _ 4.00
ooRESs „
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER1200 AMP) 20.00 PLAN CHECK FEE c
OR .C,NO.
ENGINEER
' uc.Na. - SIGNS TRANS. '3.00
aRCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT' ..5.00
nP EMP.METER OR POLE INS. 20.00 - - -
nooe CANT Is MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 ^7�jC�,�•y""_"
o o ' LICENSED CONTRACTORS DECLARATIONCs
ce
U w 1 hereby affirm that I am licensed under provisions of Chapter 9 - '- ISSUANCE DATE
(commencing with Section 7000)of Division S of the Business and
G. ¢ y- ELECT. 'PLG. MECH.
H w- Professions Code,and my license is in full faros and effect., ILJCJn�
zoo- License Class Lic.Number - -
o an r Date Contractor
ace 0 c a OWNER-BUILDER DECLARA'f10N PYPFORMATIONIT
F
g I hereby affirm that I am exempt from the Contractors License ,MISC.- REFER TO ORD vALUAg
u o.a. Law for the following reason.(Sec.7031.5,Business Professions' PERMIT ISSUANCE - 10.00 Ct11181� $/FT.
r - Code:Any city orcounty which requires a permit to construct,alter,
¢ w s- improve,demolish,or repair an Structure,prior to its issuance,also ELEC.CONTR.' LIC.NO.
K 6 O Pr P' Y ELEC.
n -
O u requiresm yuires ilia applicant for such permit to file a signed statement that , - TOTAL -
F
m< he is licensed pursuant the provisions of the Contractor's PERMIT T
s License Q � '
'F z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES, TYPE CONSTR.
- a ; - by any applicant for a permit subjects the applicant too civilpenalty ALTER-DRAIN -WATER IEA.) 5.00 -
- of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as - BACK FLOW PROTECT..DEVICE 4.00 OCC.GROUP. RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044„Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
1" Code:The Contractor's License Law does not apply to an owner of
property.who builds or improves thereon,and who does such work FIXTURES-PER TRAP_ _ 5.06 SG.FT.FLOOR AREA TOTAL ACREAGE
himself or'through his own employees,provided that such improve- -
mentsarenotintendedorofferedforSale.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(EA.) .62.00
builder will have the burden of
proving.that he did not build or Ins= - . BUILDING,USE
p v for purpose of sale.). _INDUSTRIAL WASTE INTER., 30.00 RES', IND CON PB Other
I,as owner of the property,am exclusively contracting with - ❑: ❑ ❑ ❑ ,E] y'
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B.I 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License-Law does not apply - o
to an owner of property who'builds or improves'thcomr,and who LAWN SPRINKLERS-OVER 5 (EA.) :1.00 -
contracts for such projects with a commctons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/,10.00
the Contractor's License Law. TRACT NO. PARCEL NO.,
❑ lam exempt under Sea ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner bate % WATER SYSTEM - 5.00 ACC.DATE ACO.FILE NO.
WORKI'.RS'COMPENS ION DECLARATION WATER TREATINGEQUIP. 5.00 -
d hereby affirm that I have a certificate of Consent to self-insure,
of a certificate of Workers'Compensation Insurance,or o certified ZONING .ENG.SITE NO.
- .. copy lhcrcof(Scc.3800,LAC.). , - -
Policy No. - Company
U ❑. Certified copy ishereby furnished. FIRESPRINK " ENERGYL24
Z 2 ❑ Certified copy is Tiled with the city Inspection division:
O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
- GC y - PERMIT ISSUANCE 10.00
L'- CGRTI FICCOMPE EXEMPTION FROM WORKERS' FLOOD ZONE A.LU.C.
W > ,COMPENSATION INSURANCE PLG.CONTR, LIC.N0. PLG. �_ '
"CL 0 I(ITS section need'not be completed ifthe periut is for one _ TOTAL Y❑ „t N❑ '.Y ❑ N❑
hundred dollar's IS 100)or IcsSJ
I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
�n
LL.P unit is issued,I shall not employ any person In any mmerso as to - -
U w become subject to,the Workers'Conmensafion Laws of California
IS. Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
-} W NOTICE TO APPLICANT: If,attar making this Certifiwtc o1'Ex-
? eruption,you should become subject to the Workers'Cmnpemorion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE -
a ,U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000 C.RM.)t 6.00 SEISMIC FEE' .S_a
I hereby affirm that there Alu'coustmction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the 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 HEATI NG UN IT B.T.U.)9.50
-• Lender's Addrexs - ELECTRIC
I.certlfy,that l have road this application and state that the above VENTILATION FAN (SINGLE) 4.00 ' -
information is correct. 1 agree to comply with all city and county PLUMBING -
ordinaaces'and State laws relating to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00
` hereby authorize representatives of this city to enter upon the BOILER-COMP Ovate 100,000 RTU)SEE FEE SCH. MECHANICAL -
above mentioned property for inspection purposes.
.,(We) agree to save, Indemnify and keep harmless the City of MISC.- 'REFER TO ORD.
meattino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX.
tiny
ay,in any way accrue against said City inconsequence of.the
r Ing of this permit. -7if
' MECH.CONT. LIC.NO, - MECH. -
. TOTAL TOTAL'
Signature of Applicant/Contra f Date " -
OFFICE COPY' . - '