17151 Fr
POST THIS CARD NEAR FRONTOF BUILDING, ".
„ •Ch• • + PERMIT NUMBER
CITY OF CUPERTINO 17151 ,
1
INSPECTION D VISION . .
JOB INSPECTION RECORD ,
• r
RESS • �DPERMIT EXPIRATION -
ql
JOWADD _ e -_UNIT# _LOT# $ pE RM IT;EX PI R ES I_F WOR II
OWNER O co,
CONTRACT ACTOR le. i,,i,' IS NOT STARTED WITHIN'. ,.
INSPECTION DATE' INSPECTOR '. INSPECTION RECORD 'lUU DAYS OF PERMIT`ISSu.
i
. FOUNDATION ANCE OR 180,DAYS FROM
NOTE:. ' + LASTCALLEDINSPECTION���
LEER ,`. '_ _ - ALL GRADING•AND;DRAINAGE'SHALL BE INSTALLED,
P,R EGUNITE '..e TO COMPLY WITH THE APPROVED PLANS AND CITY OF vEr+mrt VAI.IDATtONL.
CUPERTINO STANDARDS..
GARAGE SLABS -
POUR NO CONCRETE UNTIC.ABOVE HAS BEEN SIGNED -
,; . ;UNDERGROUND PSL"AB - + +. -;rJANg 6 1969,'; • ' n
PLUMBING "^ - - - J �Cr! Yi-+�T.
ELECTRICAL'
Clt OI',CG BTtIDO '`
- .._ ISSUANCE O�!E
MECHANICAL "' - •e - BLDG. I ELECT I- PLG. MECH.
' DO NOT'POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED "r,'- BUILDING PERMIT, ,1
WOOD FLOOR �.
' INFORMATION.
'
PLUMBING 4 ' 1 p r Lr VALUATION •.SIFT.- :.
r - 1. - - r „, - -•�
- MECHANICAL
ELECTRICAL ±�^ - PERMIT TO -
FRAMING
• . INSULATION' +- s RIES ,' TIPL CUNSTR F
- OCC GROUP RES:UNITS
PLACE NO SUBF.LOOR UNTIL ABOVE HAS BEEWSIGNED
S),FT,FLOOR ATEA TOTAL,FC+EAGE
- ' • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE _
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
BUILDING USE
ROOF SHEATHING REs IND CON. PB o, ��,
�APPL.Y,,NO ROOFING UNTIL ABOVEMAS BEEN SIGNED FINALS� +-�. DATIE.r<, ' :,,INSP. �� � �' 0, ' E] ���E:l-
ROUGH' SAN.# - ASSESSORSP.ARCEILNO.-
PLUMBING - ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWERTAN PLUMBING ENERGY-
-. MECHANICAL - MECH'.ENERGY
ALL.DATE ACF FILE N0.'
ELECTRICAL
BUILDING ENERGY - r
FRAMING _ . 'ELECT�FINAL TEST'
ZONING- ENG,SITE NO.
.. INSULATION � � PLUMBING � -
GAS TEST GAS,
_ - MECHANICAL EIRESPR INK ENERGv.T 24
COVER NO WORK UNTIL ABOVE HAS BEEWSIGNED HEATING ' ' 1:1 ',N1 .y El 'No
L,u.c,
'
. EXTERIOR SHEAR - ELECTRICAL RELEASE �PLOODZUNE A, -r INTERIOR SHEAR v� . NQ' •�v L.'`N
FIRE.DEPT.
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 BUILDINGIS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR: MICROFILM -
ARRANGE FOR .INSPECTION.BY PHONING 252-4505, ELECTRIC.
LU
� .'ONE WORKING DAY BEFORE REQUIRED INSPECTION., v�unneinc
z . PLEASE GIVE JOB ADDRESS WHEN-PHONING..
- SEE PERMIT FOR EXPIRATIONDATE — MECHANICAL
•
IMPORTANT, covsT..Tnx
PLEASE READ REVERSE SIDE BEFORE
TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY'.
APP,L'•ICANT,TO FILL IN,INFORMATION WITHIN RED LINES - USE BALL POINT PEN,ONLY '
- a
• BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
Bl1nmNG APPLICATION & PERMIT. 1 C
•' ADDRESS 1 1 7 5
'�
1
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL " ,^'^^
OWNER'S "� PLAN CHECK VALIDATION ,
NAME •./'r�1 OTV. :ELECTRIC PERMIT, 'FEE
, ..,.. f
NAMe i10TORs v. „r , f4 .{ OUTLETS-SWITCHES-RECEP, 10.00/1.00 rid
• UC:NO.",-.y(nga� I LIGHTING FIXTURES . 10.00/1.00 )�
DONTRACTORS - - PPLIANCES-RESIDENTIAL 4.00
ADDRESS'
. i,.� .t• •�'HONE ' 'O. I$' PANELS - 10.00 ,Co DATE OF APPLICATION .
ARCHITECT - ' PANELS (OVER 200 AMPI' r 20.00 PLAN CHECK FEE. P,C.,V
ENGINEER ...( , '
LICINo? "� SIGNS TRANS. 3.00 /49
ARCOADDRESS OR ENG - - SPECIAL CIRCUIT S.00 7 �� PERMIT VALIDATION
1
ZIP EMP.METER OR POLE INS. 20.00 0
u ADDRESNr's MOTORS 1/ - -� SEE FEE SCH. 1^ L
ADDRESS �' \\ +
r . .. a A O sec -4f�t� 'aCI: 20.00 o
40k
11I, �� �1
woo LINSBD CONTRACTORS DECLARATION � '�J � `
Q. U I herCby al firm that I hm licensatl wWar provisions of Chapter 9 - ISSUANCE GATE
na (commencing with Section 7000)of Division 3 of the Business and
a m s BLDG. ELECT. PLO.' MECH:
H o z Professions sL_4 and my license is in full I'urcq,.t f ct.
i = License Class�LQJ._Lic.Nunmhur. �i^_1.51 _7
Oz5ooH
Uulc Conlructor_ hS� yy,, ,T��'.�ty-•';
5 s so• _OWNER-BUILDER'DECLARATION 'v"'1�'1+"I+DI LIRO BUILDING PERMIT
. 0. " - REFER T RD INFORMATION
H I hereby affirm that I am o m't 's -License MISC. E 00
X 3 LL y exempt from the Cardec or Lee
w �+ VALUATION
FT
uOa Law forthefollowingntyw.ISec. uiresa,Basin scout Prol'scions
PERMIT ISSUANCE 10:00
y Cope A,demolish,
sh county whiny structure permit ijot o nmsuanc ,also '
2 a improve,demolish,or repair any structure,prior To its issuance,also ELEC.CONTR. LIC.NO. - ELEC. �( �'%�
a w m¢ - requires life aliplicant,lot such permit to lilt a signed statement that �'/jG a &•l TOTAL 7 0 PERMIT TO
he is licensed pursuant io Ola provisions of the Contractor's License ^
i
LOW
(Chapter 9(commencing with Section 7000)O(Division 3 ofthe /"JL_
ic< Business and I'rol'essinns Code)or That In is exempt therefrom and QTY. PLUMBING PERMIT - FEE �M ,
.¢ H in the basis for the alleged exemption.Any violation of Section 7031.5 1 - STOTIIES TYFIE CONSTh.
a3_ bYlany applicam fora permit subjects the npplicam tiro civil penalty ALTER-DRAIN -WATER (EA.) 5.00
-
of nrl noun,film,five hand red d offers IS 500).):
D- 1,as owner of the property,or my employees with..,as as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES,UNITS
their sole compensation,will Jo tlm work,and the Structure Is not
intended or offered lot sole(Sec. 7044: Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO.' 5.00 '
Code The Contractor's License Law docs not apply to an owner of
• `' property who lntllds or l miroves thereon,and who Anes such Work FIXTURES-PER TRAP 5.00
SO. FLOOR AREA TOTAL ACREAGE
himself or Through his own employees,provided that such Improve. .- "
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or impruvemen(is'ould whhin'one year of eonmpletion, the owner- - GAS-EA.SYSTEM-OVER 4(EA.) • 2.00
builder will-have the burden of'proving that he did nor build or im. BUILDING USE
prove for purpose of sale.). - INDUSTRIAL WASTE_ INTER. 30.00 RES IND CON PB omar
.. ❑ I,as owner of the property,am exclusively cmvra,eting with - ❑ ❑, ❑ ❑ ❑
• licensed contractors m construct the project 1Sec.•7044,Business LAWN SPRINKLERS- 1 INC 5.V.B. ' 6.00 ASSESSORS PARCEL NO.
and Professions Code:The ContoOm's License Law does not apply
to an owrI6FbI property who holds oq ailimous tholvon,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 Contractor's License Luw. -TRACT NO. PARCEL NO.
❑ 1 o exempt under Sec. ;'li.&P.C:tin this WATER HEATER W/VENT 6.00
reason
Owner WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK ERS'COMPENSAT ION DECLARATION' WATER TREATING EQUIP. 5.00 - -
�`T ♦
I hereby affirm thal
or I have o penskart In mance,nsent o rel&insure. ' ZONING ENG,SITE NO,
or a certificate of Workers'Compensation Insurance,or a certified
' copy thereof(Stec.3800,.Luh.CJ.
POIICy Nn. p
_ C ant
O ❑ Ctr" opy erch Is ted. • - FIRE SPEAK •ENERGY T 24
Z:Z• �( Ce IfieA <o witlydht ci inspection JiEll visiml. MISC.- - REFER TO ORO. x
~ w - .r PERMIT ISSUANCE 10.00
'LU •CIiRT ICCOM JISATIPI'ION PROM WORKI9RS' FLOOD ZONE A.L.u.C. '
W r CON :N'SATICIN INSURANCE PLG.CONTR. LIC.NO:CL 0PLG.' -
:r -(This section neer[ not he completed if the permit-is for one TOTAL Y❑ NE] Y❑ N❑
hundred dollars($100)or less:)' V'
• UO I certify that in the performance of the work for which This per- DTV. MECHANICAL PERMIT FEE.' FEE SUMMARY '
LL.
is issued, I shall not employ:my person in any manner so as to -
U W become subject to the Workers'Compensation Laws of California. - -
a [)ate ' Applicant- ' BUILDING -
} to• L NOTICE TO APPLICAN9''. If,utmcmaking this Ce'lifenitt of fix- ALTER OR ADD TO MECH. 5.00
emption;.you should becnmeSubject to the Workeri Compensation APPLIANCE 5.00 11 PLAN CHECK
provisions of tire'Labor Code, you must forthwith comply with FEE
U such provisions or this permit Shull be decloed revoked. AIR HANDLING UNIT(TO 10,000OF.M.)' 4.00
.. CONSTRUCTION I.FNDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
'••I hereby nffir'm limit there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
time performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.) HEATING UNIT(TO 100,000 B.T.U.) 5.00
Lender's Name - HEATING UNIT 100,000 B.T:U.)9.50 -
LcnJeisAJJress 'ELECTRIC'
I cepdy that I have lead This eppliclown unit state float the above VENTILATION FAN (SINGLE) 4.00 . .
mtonn tion Is ccrr ct I agree to comply with all city and county PLUMBING
ordinances and State law rolaWmg t .buildi mg cmosrrtoctic4, and BOILER-.COMP(3 H.P.Or 100,000 B.T.U.) 6.00 "
Above-hicireby eutiold rupture,forint f This 'city to enter upon Thr BOILER-COMP IOver 100,000 BTUI SEE FEE SCH. MECHANICAL
above-menWm,d property for inspection of ion p-city 1s. ,
(We) a e to save, indemnify and keep harmless'The City of _FA - - REFER TO ORD.
Cropergr(o•a ct liabili ' dgments, costs and expenses which CONST.'TAX
• mxppAn it uy ac' a airst Said City in consequence of the PERMIT ISSUANCE 10.00
rafitingo d( MECH.CONT. LIC NO. MECH. ` .'• ',�
TOTAL - I TOTAL
D `
in
Contractor Dn Y v
cOFFICE COPY,,