15350 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15350
INSPECTION DIVISION "
JOB INSPECTION RECORD (\
/PERMIT EXPIRATION
JOB ADDRESS0 J.?`�-'�� '3"L �✓ - UN IT _ _LOT#
�- PERMIT EXPIRES-IF WORK
OWNER Up SL TA--Vc: L1' IS ZI IS NOT.STARTED WITHIN
INSPE TION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- .
FOUNDATIONNOTE: ANCE OR 180 DAYS FROM
LLED INSPECTION.
UFER �Y� ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTC-
A
PREGUNITE Iij TO COMPLY.WITH THE APPROVED PLANS AND CITY OF PLRM IT VALIIIATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ( - ('Obi 1/�.aU� yI 0K C
UNDERGROUND /SLAB.
PLUMBING
ELECTRICAL r ISSUANCE DATE
MECHANICAL BLDG ELECT I PLG. MECH
'❑ ❑ ^❑ ❑ .:
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
_ INFORMATION
WOOD FLOOR - V SIFT.
PLUMBING qq
MECHANICAL tF/i( d. -
ELECTRICAL PERMIT To
FRAMING _ 4. j✓r(/0
INSULATION _ STORIES TYPE CONSTR.
' .00C,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT,FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID'
BUILDING USE
ROOF SHEATHING HCS IND. CON PB 0,1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ F-1 1 '0 13
ROUGH SAN.q SSESSORS PARCEL NO
PLUMBING ELECT.ENERGY -
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO,
MECHANICAL MECH.ENERGY '
ELECTRICAL . ./G/- BUILDING.ENERGY ncc,OnTE act FILE No
FRAMING ELECT.FINAL TEST
ZONING ENG,SITE NO.
INSULATION �)c PLUMBING
GAS TEST GAS
. . FIRE SPRINK ENERGY T 24
MECHANICAL - 'Y N❑ v Q N[]COVER NO WORK UNTIL ABOVE HAS'BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL 0EI!EjjE FLOOD/ONE A.L.0 C.
❑.
INTERIOR SHEAR FIRE DEPT. E] NO I Y ❑ N
SHEETROCK - 7- GRAD FEE SUMMARY.
EXTERIOR LATH . BUIL -
INTERIOR LATH TEMPORARY APPROVALS- BUILDING
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 ISSIGNED BY BUILDING INSPECTOR: MICROFILM '
LU ARRANGE FOR INSPECTION.BY PHONING 252-4505, ELECTRIC 30
I-� ONE WORKING DAY BEFORE REQUIRED-INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING:
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION.DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. cT
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED"LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTI FICATION .PERMIT NUMBER
BUILDING APPLICATION & PERMIT - 153,50
[
ADDiv REa�. ST'E'NAl .SL Lan)L�.
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - _ PLAN CHECK VALIDATION
S"NAME `T r' T}�-� �n��lJB� 47 QTY. ELECTRIC PERMIT FEE
csepiv �SRVE I�,'s PHONE f—sL'i'6I /
NANTRAcrORsNAME 10 OUTLETS-SWITCHES-RECEP 10.00/1.00 p '—
CONT
LIC,No q LIGHTING FIXTURES 10,00/1.00 -
CONTRACTOR5 - PPLIANCES-RESIDENTIAL - 4.00 -
ADDRESS '
PHONE PANELS - 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER ZOO AMP) 20.00.. PLAN CHECK FEE P.C.NO.
OR
ENGINEER,, -'/ - uc.No. SIGNS TRANS. 3.00
ADDRESS ENc. ' - SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
EMP.METER OR POLE INS. 20.00 ,r
APPLICANT'S 5+7-�zW*L �NE MOTORS SEE FEE SCH. (�lr "
AgDORE55 .
CLC/ LTJ SIO' �4")V /IP SERVICE CHANGE 20.00
M O LICENSED CONTRACTORS DECLARATION - _ `
a o I herehy affirm that I am licensed under provisions of Chapter 9 - - P 1Y� ISSUANCE DATE
w<y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H z Professions Code,and my license is in full force and effect:
z z F w License Class Lic.Number @nA 9 n V ' El
° Date Contractor IIAK
¢ m BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION
K w v - �,; 11 c �,, t, INFORMATION
w ° v y I Inner, from that I am exem t from the Contractor's License MISC.- REFER TO ORD
LLu y' p �( VALUATION $/FT.
0¢, Law for the following reason(Sec,703 L5,Rosiness end Professions PERMIT ISSUANCE 10.00 Q"-_
m Code:Any City or county which requires permit to construct,alter, tel' 7
IY Q° improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC. !!II p✓ / /
ac E: O¢ requires the applicant for such permit to file a signer)statement that TOTALV PERMIT TO -
w m he E lieenswl pursuant to the provisions of the Contractor's License
H z Q Law,(Chapter 9(commencingwiOt Section 7000)of Division 3 ofihe �-�d�7Gd A✓
4 ° Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT T FEE
¢ H m the Iasis far the alleged exemption.Any violation of Section 7031:5. STORIES TYPE CONSTR.
dg _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
• of not more than five hundred dollars(S500)J'.
❑ 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 Contractors License Law does not apply to an owner of _
property who birds Or Improves[hereon,and who does inch work FIXTURES-PER TRAP S.OQ SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments
mprovements are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is soldwithin,one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 200
builder will have the burden of proving that he did not build or im- - . - . , BUILDING USE
prove for purpose of sale.).- INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB .Onun
i., ❑ 1,as owner of the property,am exclusively contracting with ❑. ❑ '❑ ❑ ❑
licensed contractor's 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 milds lir improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 _
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the on tractors License Law. TRACT NO. PARCEL NO.
I:un INC ,B.&P.C.dor his' WATER HEATER W/VENT 6.00
Own - Da - WATER SYSTEM 5.00 ACC.DATE ACC.PILE NO.
%woERs•coMPENSATI iCLART oryTREATING EQUIP. 5.00I n that I 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.CJ. ,
Policy No. Company -
O . ❑ Certified copy isheriby furnielod. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is Bled with the city inspection division. MISC- REFER TO ORD.
O Applicant Y❑ N❑ Y ❑ N❑
CC y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00IC) FLOOD ZONE A.L.U.C.
LU - COMPENSATION INSURANCE PLO._CONTR. LIC.NO. PLG.
Z (This section need not be completed if lira permit is 10,one TOTAL '7-1Q Y E] N❑ Y ❑ N❑
hundred dollars($100)lir less I -
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. F mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �aa
>Lm NOTICE TO APPLICANT'. If,after making this Certificate,of F.x-'
F" 2 emption,you should become subject m lire Workers'Compensation gpPLIANCE 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 10,000C.F.M.) 4.00
CONSTRUCTIONLENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.),6.00 SEISMIC FEE
I 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.CJ. J HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that,)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(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
-
(We) agree to sa , Indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperti 'list lin tithes,judgments, costs and expenses which CONST.TAX
may.in as minst said City in consequence of the PERMIT ISSUANCE " 10.00
ranting of this permit ` MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL �y
Signal. of Applicant/C traclo _ Date
OFFICE COPY.