17061 POST THIS CARD NEAR FRONT OF BUILDING - '
,. PERMIT NUMBER
CITY OF CUPERTINO 17061
INSPECTION DIVISION ' .
JOB INSPECTION RECORD
• ip, - - pPfi.ERrAtT EXPIRATW
JOB ADDRESSp/J,�(�O•"Ai�/lr/���/?4�lTTV ll `-C.J /1# LOT#} PERMIT/EXRES IF WOR K'
OWNER /'� `�v- - • CONTRACTOR , ' Y IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION�RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLEDINSP ECTION.
PREGUNITE -
TO COMPLY WITH THE APPROVED PLANS AND CITU OF PeRnIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING
NDERGROUND /SLAB •PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL _ BLD(; ELECT ELG. MEET
a9 0 ❑ El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 5 BUILDING PERMIT
WOOD FLOOR INFORMATION
•
PLUMBING VALUATION SIFT.
y
MECHANICAL "•'�� 1`-":•�(_�
ELECTRICAL PERMIITT-TO \1
FRAMING • ^ �, `�
INSULATION _ STORIES T.R
OCC GROUP RES.UNITS
PLACE NO SUBFL00R UNTIL ABOVE HAS BEEN SIGNED '
ROOF - NOTE:NO FINAL INSP.SHALL 8E MADE BEFORE $OFT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE,
ROOF SHEATHING - ws IND CDN PR ow.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ • ❑ ❑ ❑ ❑.
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO I PARCEL NO
TUBS 8SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY'. ACC,DATE ACC,FILE NO.
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO. I
INSULATION - PLUMBING- -
GAS TEST GAS
MECHANICAL
FIRE SPRINK ENERGY T 24
� ❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NvNE)
FLDOR]ONL A.L.D,C
EXTERIOR SHEAR - - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y❑ N 1 N❑•
" SHEETROCK - - GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING
.INTERIOR LATH • TEMPORAR APPROVALS BUILDING
SCRATCH AT ^' ELECTRIC ' PLAN CHECK
CO
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISM IC'FEE 3T,00
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY'PHONING 252-4505, ELECTRIC
^� H�
0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
' PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z ..
- SEE PERMIT FOR EXPIRATION DATE - '• MECHANICAL
IMPORTANT! . CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY '
• .A3UILDING PROJECT I DENTIFICATI ON PERMIT NUMBER
BU4LONGAPPLICATION & PERMIT 7061
Aoo�D ESS 20
50 � BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ;
..KimG ( PLAN CHECK VALIDATION
"mss n OTV. ELECTRIC PERMIT FEE
I I`U PHONE
N°mega rolls UTLETS-SWITCHES-RECEP .10.00/1.00 /
` ✓d W� LIC,NO, LIGHTING FIXTURES 10.00/1.00
ADORs
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
- - �e �J
V7 PHOrvE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR • PANELS (OVER 200 AMP) 20.00
ENGINEER LIC.No SIGNS TRANS. 3.00
ARCH.OR ENG, PERMIT VALIDATION
ADDRESS �"' [' SPECIAL CIRCUIT 5.00
-J(�x \VN'1 LlIL0 ZIP EMP.METER OR POLE INS. 20.00.
ADDRESSTs1s4GxL MOTORS - SEE FEE SCH.
� li 'dri
SERVICE CHANGE 20.00
Dai
,02 LICENSED CONTRACTORS DI[CLARATION '
¢ vw I hereby affirm that I am licensed underprovisionsof Chapler9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
�u ¢ H BLD ELECT, PLG. MECH.
r w z Professions Code,and my license is in full force and clfect.
o0 m G License Class Lic.Number
r m r J Data Contractor ❑ El 10
rc m¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT
F. o i - INFORMATION I
X
0 LL U I hereby.e ihima that I am exempt(roan the Contractor's License MISC.- ER TO ORD
LL0¢ Law for tire following reason(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION q/FT.
r Code:A n y ci ty or Will ly wh ich Her,uires u perm it to col rattle L alter,
ELEC.CONTE. - LIC.NO.
¢ o improve,demolish;ar repair:my structure,prior 4r its issuance,also ELEC. 9D I
O ¢ requires the applicant!or such permit to file a signed statement Ihot TOTAL
u w es m he is licensed pursuant to the provisions of the Contractor's License - PER TO
Fz > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
sio
X the basis forthea or adexempubje Any violation ofee civil 70315 STORIES TYPE CONSTR.
n ; - by any applicant fora permit subjects S5000.licam fee civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(my employees
❑ I,as owner at the properly,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 ;lid Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
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 5.00 Sp,FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided tial such improve-
�^ ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER4 (EA. 2.00
builder will have the burden of proving that he did not build or inn- BUILDING USE
prove for purpose f,at,.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with ❑ El ❑ ❑ ❑
licensed contractors to construct the I..wet(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner Of property who builds or improves fiction.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractora)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt order Sec. ,I1&P.C.bur this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have u certific.le of cona'en1 Io wl&insure, -
or a certificate of Workers'Compensation Insurance,or a cerlified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished FIRE BPRINK. ENERGY L24
Z Z ❑ Certified copy is filed with the city inspeclion division.
� 0 AVPlicant MISC.- - REFER TO ORD. Y [3 NE] y [-] N❑ '
Cr W C17RTIFICA'IT OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE - A.L.U.C.
W COMPENSATION INSURANCE PLG.CCNTR. LIC,NO. PLG.
CL 0 (This section need not be completed if Ilse Permit is for one - TOTAL y❑ <1 V ❑ N�
7) Z hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY ')
LL U mit is issued,1 shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
i Date APPlicam ALTER OR ADD TO MECH. 5.00 BUILDING o7� QIS
} m NOTICE TO APPIACANT: If,after raking this Certificate.IEx-
Z_) emotion,YOU
oU Should become subject to the Workers'Com ensation- provisionsof the Labor-Code,you must forthwith cm ply with APPLIANCE 5.00 PLAN CHECK
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE a DD
1 hereby affirm that there Is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the perl'ornnnnce of the work for which this permil is issued(Sec. MICROFILM
3097,Civ.cJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 '1
Lender's Name HEATING UNIT 100,000 B.T.U.)9,50
Lender's Address ELECTRIC
I certify that l have read this appliwl lar a nd slaw 11,41 the u hove VENTILATION FAN ISINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and sale laws relating to building construction. .
BOILER-COMP(3H.P.or10O,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. - 801 LER-COMP (Over 100,000 BTU(SEE FEE SCH. MECHANICAL
_
(We) agree to save• indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
PE -
may in any way accre uagainst said City in consequence of the
ranting of this permit. - MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of Applicant/Contractor Date � /V• ��/
OFFICE COPY