15537 POST THIS CARD NEAR FRONT OF BUILDING
. _ -_ PERMIT NUMBER
CITY OF CUPERTINO 15537
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS •11370 S . Stelling UNIT# • 'LOT# '
y PERMIT EXPIRES IF WORK
OWNER . Armenian A ostolic' Chur ObTRACTOR IS NOT STARTED WITHIN.
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
LASTCALLEDINSPECTION.4.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF Ermalt vni.mnTION
CUPERTINO STANDARDS. . ..
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � ' •M
UNDERGROUND /SLAB ,
PLUMBING
ELECTRICAL • P ISSUANCE UAIE
MECHANICAL `\ lvl�U
ELECT I PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDINFORMATION
"FesBUILDING PERMIT
WOOD FLOOR vALUATTON $JET.
PLUMBING
MECHANICAL '
ELECTRICAL ..> PEvnui ra
• FRAMING jjnjl
INSULATION STORIES TYPE CONSTR.
- OCC GROUP RES.UNITS
.-� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so Er PLoov ARCA TOTAL nc HFAee
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - - HITS IND CON Po 00—
APPLY NO ROOFING UNTIL ABOVE HAS'BEEN SIGNED FINALS DATE INSP. 0 ❑ 0 ❑ E]ROUGH SAN.N - - - - ASSESSnHS PARCEL NO
PLUMBING ELECT.ENERGY
THACI NO, PARCEL NO
8 SHOWER PAN•' PLUMBING ENERGY '
MECHANICAL MECH.ENERGY
-ELECTRICAL - BUILDING ENERGY ACC DATE ACC:FILE No
FRAMING ELECT,FINAL TEST .
ZONING ENG.SITENO.
, . INSULATION - PLUMBING
GAS TEST - GAS
MECHANICAL - FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING I ElN(—]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD 20NE ALUC.
N❑ -
INTERIOR SHEAR FIRE DEPT. Y [D NC] YLL:
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH - - TEMPORARY APPROVALS "•
SCRATCH COAT 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 FINAL 19SIGNED BY BUILDING INSPECTOR. MICROFILM
LUARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING. ,
SEE PERMIT-FOR EXPIRATION DATE —
IMPORTANT! MECHANICAL
CONST.TAX-
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
}
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
•
1111.11 LDI NO PROJECT I DENTI FICATION PERMIT NUMBER
aDI nING APPLICATION,& PERMIT 55.37
ICDNTRACTN
551BUILDING -ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION
AMEcNdJDTY ELECTRIC PERMIT FEE
vlsarvE
s UTLETS-SWITCHES-RECEP' 10.00/1.00
LIE,NO. LIGHTING FIXTURES!, 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL - 4.00
AGOG Ess
PHONE PANELS (h 10.00 DATE OF APPLICATION!'
AOPCHITECi PANELS (OVER 200 AMP). 20.00 PLAN CHECK FEE _ P.C.NO.
ENGINEER
uc.NO. SIGNS TRANS. 3.00 '
ADDRRESS ENc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SEH.
DD
AP
SERVICE CHANGE -20.00
H O ) LICENSED CONTRACTORS DECLARA'T'ION
a E,v I hereby affirm that I am licensed under provisions of Chapter 9 G 6uANCE GATE
I" (commencing with Section 7000)of Division 3.lithe Business and<e MECH.
H 7 i Professions Code,and my license is in full force and effect. B,6 ECL PL
z o y License Class Lie.Number _
H w Date Contractor lig ❑G
`a x f � 'DING PERMIT
¢ ¢O M D OWNIi R-BUILDER DECLARATION RATION INFORMATION
F:
; I hereby nl'1'irm that I oro exempt from the Contractor's License MISC.- REFER TO ORD
u O ¢ Law for the following reason.(SCL 7031.5,BuSlnessand Professions VALUATION $/FT.
H _ kr PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
In ¢ a 2 improve,demolish,or reprif any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /v ✓ V
La
w m LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
hpro
e is licensed pursuant to the visions of the Contractor's License
r z i
Law(Chapter 9(conunenuing with Section 7000)of Division 3 ofthc
4 o Business and Professions Code)or that he is exempt therefrom andLUMBING PERMIT FEE
¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 QTY. PSTORIES TYPE CONSTR.
aby any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(4500).):
❑ I,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,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to as owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorcl'oned 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 owner- GAS EASYSTEM OVER 4 (EA1 200
builder will have the burden of proving that he did not build or all. . -
. . . BUILDING USE
pr for purpose of sale.). RES 'IND CON PB Other
1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 El El 1:111
lie sed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds Or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with u contmmorls)licensed pursuant to SEW ER•SANITARYSTORM EA.200ft 10.00
the Contractor's License Law. I TRACT N0. - PARCELING.
❑ l am exempt under See.-,BAP.C.for his WATER HEATER W/VENT 6.00
reason
-•Owne a WATER SYSTEM - 5.00 ALC.DATE ACC.FILE NO,
W CO 9TNSA I : LA [ON - WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsenl to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereol'(Sec.3800,Lah.0.).
x Policy No. Company
O ` ❑ Certified copy is hereby furnished. ' FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city inspection division.
O Applicant MISC.- REFER TO ORD. . Y � N0 Y ❑ NQ
P: ,
PERMIT ISSUANCE 10,00
ul n- CfiRT'I FIC ATB OP EXEMPTION PROM WORKERS' FLOOD ZONE A,LU.C. - -
W �. COd not be IONcoo lNSU RANCI', PLG.CONTR. LIC.NO. PLG. Y� IN Y� EI
CL O hundred
section nee.) not 60 completed if the permit is for one TOTAL N
� Z bundmd dollars(5100)or less.)
U O I certify that in the performance of Ore work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any mmnnerso as to
O L) become subject to the Workers'Compensation Laws of California.
ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
I•" E ¢,option,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must torthwith comply will FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000OF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,ODOC.BM.) 6.00 SEISMIC FEE
T hereby affirm that there is a construction 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 HEATING UNIT 100,000B.T.U.)9.50
Lender's Addresa ELECTRIC e
I certify that I have read this application and state that the above4BOILER-COMP(3H.P.orlOO,0008.T.U.)
ENTILATION 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 6.00
hereby authorize representatives of this city to enter upon theOILER-COMP !Over t00,0008TU15EE FEE SCR. MECHANICAL
above-mentioned property for inspection purposes.(We) agree to save, indennify hod keep harmless the City ofISC.- REFER TO ORD.
Cupertino against bilines j dgments, costs and -1culves which PERMIT ISSUANCE 10.00 CONST.TAX
may in cc st said City in consoque ce the
an
of fl m' . ( MECH.CONT. LIC.NO. MECH.
�O B$ rorAL TOTAL 1
Ignatu o APjQkant ontractor Date'
OFFICE COPY