15580f
m
POST THIS CAR D•NEAR FRONT OF BUILDING
.�
.PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION"
JOB INSPECTION RECORD
PERMIT EXPIRATION "
�+
JOB ADDRESS �a371UTzw�s/VS '(Rr'\�LV�UNIT# •� _LOT#
- -
Lc-c-�EtS
PERMITEXPIRESIF WORK
OWNER cni C. T' CONTRACTOR
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
• LASTCALLED INSPECTION.
INSPECTION DATE I INSPECTOR
INSPECTION RECORD
FOUNDATION'S �
NOTE: -
ALL GRADING AND DRAINAGE "SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
LIFER-
PR EGUNITE
-PERMIT VALIDATION,
CUPERTINO STANDARDS.
�0
Q(Q� -
9Vs1S1OANCEDATE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
• UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
il Aw.I.
c
ELECT.PI•c,
1'�1®
MECH
❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
au1LDING PERMIT
INFORMATION `s
' W
WOOD FLOOR
VALUATION
_
""„
SIFT.
PLUMBING
•
MECHANICAL
-
ELECTRICAL
PERMIT TO '
FRAMING
INSULATION -
STORIES
TYPE CONSTR.
-
OCC GHOUP
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS. BEEN SIGNED
-
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
-
IN IT FLOOR ARIA
TOTAL ACREARE
DIAPHRAGM
ROOF SHEATHING
BUILDING USE
RES IND CON PB Om...
E] ❑ ❑ 0 ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED,
FINALS DATE, INSP.
ROUGH
SAN.#
n SSESSORS PARCEL NO
PLUMBING:.
ELECT. ENERGY
TUBS &SHOWER PAN � �
.PLUMBING ENERGY
TRACT NO.
PARCEL NO,
MECHANICAL -
MECH. ENERGY
ELECTRICAL
BUILDING ENERGY
. ACC.DATE
+
ACC. FILE NO,
FRAMING
ELECT. FINAL TEST
INSULATION -
PLUMBING
ZONING
ENG, SITE NO,
GAS TEST
GAS
•
MECHANICAL -
FIRE SPRINK
Y [:j IN
ENERGY r24 -
N
Y O
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
77 FLOOD IONE
Y ❑ NE)
A.LUC.
Yo NO
'INTERIOR SHEAR
FIRE DEPT.
FEESUMMARY
SHEETROCK, -
GRADE
EXTERIOR LATH
BUILDING
BUILDING
INTERIOR LATH - -
TEMPORARY APPROVALS f
SCRATCH COAT
ELECTRIC
PLAN CHECK
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY r I
SEISMIC FEE
G O
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
,MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
07�
o.,ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SE&PERMIT FOR EXPIRATION DATE _
MECHANICAL
CONST. TAX
IMPORTANT!
TOTAL
Q3
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION::
OFFICE COPY
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -.'USE BALL POINT PEN ONLY - - -
BUILDING PROJECT I DENTIFICATI ON
-
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
-PERMIT NUMBER
1 [
50
15
BUILDING
. ADORE:� //
NWWMER E , I
��f�, /iVC ,
PNONE
OTY. ELECTRIC PERMIT FEE
PLAN CHECK V IOATION
�(yJ
"
DATE OF APPLICATI ON 11
CONTRACTORS
NAME/ �•-•r ��yt ^�( A
/C-•�' - /1 �- sec. No�//.�p
3OIGUTLETSG-SWITCHES-RECEP 10.00/1.00 It
LHTINFIXTURES 10.00/1.00
CONTRACTOR
ADDRESS
_+ajeir4W40b4PNONE g
APPLIANCES-RESIDENTIAL 4,00
PANELS 10.09
ARRCHITECT
O
ENGINEER
UC. NO
PANELS (OVER 200 AMP) 20,00
PLAN CHECK FEE P.C.-NO.
SIGNS TRANS. 3.00
ARCEL OR
ADDRESS ENG.
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
EMP METER OR POLE INS. 20.00
' - ZIP
aPPucarvrs
ADDRESS
MOTO S SEE FEE SCH. ,
SERVICE CHANGE 20.00
'
I�
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions
Professions Code, an my lice 5g�e m full for an
et2`L.`Nunlber
Contractor.
i ISSATE
BLDG E PLG. MECH.
❑
•
OWNFRBUILD1iRm
I hereby affirm that I am exemptfrom ATION
from the Contractor's License
Law for the following reason, (See 7031.5, Businessaud Professions
Code: Any city or county which reyuiresa permit if construct, alter'
"
G PERMIT
��. NFORMATION
MISC. - REFER TO ORD
PERMIT ISSUANCE d- ��
VALUATION,
3 &.0 1
$/FT.
ELEC. CONTR. LIC. NO. ELEC. A�/� 7Q
TOTAL ` V ./
improve, demolish, or repair any structure, prior 10 its iSauanca, also
requires (be applicant for such permit to file a signed statement that
lie la licensed pursuant to the provisions of the Contractor's License
pZ,S
PER MIT TO
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom andLUMBING
DTV. P PERMIT FEE
Ilia basis for the alleged exemption. Any violation of Section 7031.5
$
by any applicant for a permit subjects the applicant toa civil penalty
of not more than five hundred dollars ($500).):
STORIES
TYPE CONSTR.
ALTER -DRAIN -WATER (EA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure Is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business end ProfessionsDRAINS-
Code: The Contractors License Law does not apply to an owner of
FIXTURES - PER TRAP 5.90
GAS-EA.SYSTEM-11NC.40UTLETS 6.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
property who builds or improves thereon, and who does such work
hinisellor through his own employeus, provided that such.inmprove-
mentsarenotintendedorofferedforsale. If, however, the building
Or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that h e did not or im-
prove for purpose ofsale.).
71I, as owner Of the property, ;un exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
.
BUILDING USE
RES IND CON PB Other
0 ❑ ❑ 0 0
INDUSTRIAL WASTE INTER. 3000
. .
licensed contractors to construct the project (See 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves Ihuruon, and who
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for such projects with a mmractorts) licensed pursuant to
file Contractor's License Law. -
❑ 1 am exempt under Sec. , B.&P.C. for this
reason
'SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WONKERS'COMPRNSATON DECLARATION
1 herchy affirm that 1 IT ��FI,j�'' Ie of consent Insoil'-insure,
or a certificate of Wor rJs'ylytl�mon Insurance, or a certified
ZONING
ENG. SITE NO.
copy lher W /Se ,li2ga6
Policy No Company
yf Cetlified copy ism eby furnished.
`❑ Cedified copy/s Jed with the in tion division.
Applicant
vL"PROM
FIRE SPRINK
YE] NE3
ENERGY T-24
- v0 N[:3
MISC.- REFER TO ORD.
CER11FICATECIF EXEMP11ONFLOODZONE
WORKERS'
COMPENSATION INSURANCE
(This section need nal be completed if the permil is for file
PERMIT ISSUANCE 10.00
V N�
A.L.U.C.
Y N�
PLG. CONER. LIC. N0.
PLG..
TOTAL
hundred dollars ($100) or less-)
I ceilify that in the performance of the work for which this per.
mit is issued, I shall not employ any person in any Turner so as lo
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
l5'11
become subject to the Workers' Compensation Laws of California.
Date Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE *10 APPLICANT: If, after making this Certificate of Exw
APPLIANCE 5.00
PLAN CHECK
FEE
eanption, yob should become xabjenl 1u the Workers' Compensation
provisions of the Labor Code,'you must forthwith comply witlm
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT ITO 10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00,
SEISMIC FEE
3 Qd
CONSTRUCTION LENDING AGENCY
1 hereby affna that there is a rmstnmtion landing agency for
the performance of the work for which this permit is issued (Sec.
3097, Civ.CA -
EXHAUST HOOD (WITH DUCT) 5.00
-
MICROFILM
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
0
�� 7
VENTILATION FAN (SINGLE) 4.00
I certify that l haveruad thisapplication and state that the above
Information is correct. I agree to comply with all city and county
ordinances and state laws Glinting to building Construction, and
PLUMBING
801LER-CGMP13 H.P. Dr 100,000 B.T.U.1 6.00
hereby. authofoe representatives of this city seto enter upon the
above-mentioned property for inspection purposes.
g01 LER-COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
_
(We) agree to save, indemdify and keep harmless the City of
MISC. - REFER TO ORD.
"
Cupertino against liabilities, judgment{, casts and expenses which
may in any ay nccruc ug ^t sal City, in nmseBuence of the
ranting of mi permit.
�A'
PERMIT ISSUANCE 10.00
CONST. TAX
MECH. CONT. LIC. NO. TOTAL
TOTAL
!0
�e3
Sign"see ofAppleanl/ on lm-""
Dat
OFFICE COPY