18676POST THIS CARD NEAR FRONT OF BUILDING,'
_
PERMIT NUMBER '
CITY OF CUPERTINO.R
INSPECTION DIVISION.' :
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JOB'INSPECTION RECORD
-ADDRESS '` V G�`r �` U1QIT# LOT#
PERMIT EXPIRATION`
{ '
JOB I--+�
f
.PERMIT -EXPIRES IF WORK
OWNER ,,'SIJ .� .e CONTRACTOR, VL�
IS`NOT-STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
INSPECTION '• DATE I INSPECTOR
IN0ECTION RECORD
FOUNDATION
,NOTE:' - '
ALL GRADING AND DRAINAGE SHALL BB INSTALLED
7,O'COMPLY WITH THE APPRCP S AND CITY OF
`�
LAST CALLED INSPECTION. ,
UFER' ,.
- -PERMIT VALIDATION •,
PR EGUNITE - -
'..,r:
CUPERTINO STANDARDS. - u
., •
�f .• ti ,,..� L .
-rte
V SSUAIkE LATE
cE Onre
,GARAGE SLABS -• ...
,POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
: 'UNDERGROUND'/ SLAB
PLUMBING - _ -city
_ _
ELECTRICAL
MECHANICAL
-
ELECT,
u c.� ELECT,
❑ ❑
PLa, MECR.i
VN— ❑
_
,.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING
' •�+.±
PERMIT
T+ INFORMATION
WOOD FLOOR
Vn WAIION
Q/E.T,
PLUMBING � � � ��
� �� .
MECHANICAL
ELECTRICAL
_
1 PERM
V, NiA
T TO
(_
FRAMING
INSULATION,-'
��peY. gs
+r ,
_ 36-4
ogles
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Tvcomsn+.
,i. .
-
[ICC GROUP
RBS, UNITS
PLACE NO-SUBFLOOR UNTIL ABOVE HAS BEEN. SIGNED
' ROOF ' -.
NOTE: NO FINALINSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
so. Pr. TLDOR An EA
TorA,-ACRenee
DIAPHRAGM --
"
BUILDING USE
ROOF SHEATHING
ITEs IND CON PB oma•,
El ❑,, ❑ ❑ -'❑
APPLY'NO ROOFING UNTIL ABOVE HAS'BEEN SIGNED
FINALS'- DATE INSP.
•.
AssEsso Rs PARCEL NO.
. r ROUGH '>
SANIN
' -
HACIr
,PLUMBING
ELECT. ENERGY' -"
TUBS &SHOWER PAN
PLUMBING ENERGY .
• NO.
PARCEL NO
MECHANICAL -
MECH. ENERGY,
ELECTRICAL - -
BUILDING ENERGY -
ACC OnrE
•
Acc. PILe No,
FRAMING - -
ELECT. FINAL TEST
INSULATION -
PLUMBING %"Z�-4Y rb
zoNINc
'ENG. SITE NO.
_
GAS TEST
GAS
` "' ...
MECHANICAL` .
PINE SPRINK--.
E] pN�,
ENERGY T.24,.
N[E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED •.
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
FLOOD ZONE
v � N�,-
- 'r I] �N❑
INTERIOR SHEAR
FIRE DEPT. -
SHEETROCK
GRADE *
FEE SUMMARY
EXTERIOR, LATH -
BUILDING -'
BU ILDING.",''
INTERIOR "LATH
TEMPORARY APPROVALS
SCRATCH COAT "
ELECTRIC
P12ANCHECK '.
FEE
...
'
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS,BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
'ARRANGE FOR INSPECTION BY PHONING 252-4505;
ELECTRIC
F�. ONE WORKING DAY. BEFORE 'REQUIRED INSPECTION.
PLUMBING
U
a PLEASE GINE JOB ADDRESS= WHEN'PHONING.
,
z - '"
SEE PERMIT FOR EXPIRATION DATE
MECHANICAL,
CONST. TAX
- IMPORTANT!
TOTAL
-VD
PLEASE READ REVERSE+SIDE BEFORE
CALLING FOR FINAL INSPECTION:
OFFICE COPY
• ' APPLICANT TO FILL IN IN WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING. PROJECT IDENTIFICATION
r. -
APPLICATION &PERMIT
BUILDING —ELECTRICAL=PLUMBING'=MECHANICAL
PERMIT NUMBER
(y, 1867,6-
BNILCRNG
ADDRESS
i✓f %1nn�//'
V N,
OwrvCR's•
"°mE (1 �•( '
S ✓S { ' ! /�rV / PHONE
OTY. - ELECTRIC PERMIT•' FEE
PLAN CHECK VALIDATION
-
- �.
CONTRACTORS
N,Af$�lE
OUTLETS,- SWITCHES -RECEP 10.0011.00
LIGHTING FIXTURES 10.00/1.00r,CNTR
\AN e, _ ,uc.Na'
'
'
DATE OFAPPLICATION '-
ADDRE ons
ADORE "i ',p qq � -(/
y .�//pr PHONE.<.AJQ%'//y/
PPLIANCES-RESIDENTIAL 4.00
PANELS 10,00'
ARRCHITECT I/d�l v
ENGINEER iT
' uc. NO. -
PANELS 200 AMP) - 20.00
PLAN CHECK FEE -P.C.NO.
-
SIGNSTRANS.,+ ,.3.00.', -
AARC"DDRE04 SS ENG. -
.
- SPECIAL CJIRODIT ., 5.00 -
PERMIT VALIDATION
EMP. METER OR POLE INS. ., 20.00
-zm
APPLICANT'S
ADDRESS -' - .•
MOTORS SEE FEE SCH. — -
SERVICE'CHANGE 20.00
-- r
LICENSED CONT RACTORS DECLA RATION,
1 hemhy aRlrnt that 1 ant licensed under pmv,slOns Of Chapter 9
(commune ing with Section 7000) of Division 3 of tire IHRoesS and
sc Hass � _3 � Lio. Number L L
LiceessionsCod v�td-fit licenseesiumbe oryy-��j��yy -
ISSUANCE DATE VVV
B
❑'
ELECT.
❑
PLG. MECH. -
❑
-
,)are A�/L
Datc'-9 �Crou'act., /y I
-
BUILDING PERMIT
OWNER BUILDER DECLARATION
I hereby affirm th5Dl am exempt from the Contractor's License
Law for the following risen. (See 7031.5, Bmrin.s.nd Pnol'essians'
Code: y or county which Structure permit construct,
INFORMATION
ER
MISC. — REFTO ORD ;
PERMIT ISSUANCE 10.00
'VALUATION
$(FT.
ELEC. CONTR. LIC.NO.
•
ELEC.
TOTAL
improve, demolish, or repuirany structure, prior l0 its isS'haBCt, also
e, dem prioto also
requires the applicant for such permit to lilt a signcdsnVanenl that
he is licensed pursuant to the provisions of the Contractor's License
-
PERM( TO
-
QTY. ,. PLUMBING PERMIT - FEE'
Law (Chapter 9(commencing with Section 7000) of Division 3 ofthc
Business and professions Code) or that he is exempt therefrom and
�
the basis for the alleged exemption. Any violation of Section 7031.5
-
ST RIES
TYP CONSTR.
by any applicant for a permit subjects the applicant to'acivil penally
ofRol more than five hundred dollars(8500r)
'n-
- ALTER -DRAIN -WATER (EA.) 5.00
0 'I, as owner of the property, or my employees with wages as
their role compensation, will do the work, and the shucl,¢e isnot
BACK FLOW PROTECT: DEVICE 4.00 AF,.
try
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, GOND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code The Contractor's License Law docs not apply to an owner of
,
FIXTURES - PER TRAP ' 5.00
GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
property who builds (it improves them[nl, and who does sack work
himself or through his own employees, provided that such i,imrove-.
merits are nor intended or offered for sale. It, however, tire building
or improvement is sold within one year of completion, The owner-
-
builder will have the burden of proving that he did not build or inn--
prove fo[ purpose of sale.).
0 I, as owner Of the property, am exclusively contracting with
. ..
GAS EASYSTEM -OVER 4 (EA) - 200
BUILDING USE
RES' IND' CON' PB Omer•
❑ O' 0 ' ❑ - 11
INDUSTRIAL WASTE INTER. 30.00
licensed -contractors to construct the project(Sec. 7044, Business
and Professions Code: The Contracloi s License Law does not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO. .
-
contracts for such projects with a cmitractor(9 licensed pursuant to
the Contractors license Law.
0 IJn1cXCmptander SCC. ,B.&P.C. Icor 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,
rice. FILE No.
' 'WORKFRS'COMPFNSA'1' ION DECLARATION
WATER TREATING EQUIP. 5.00
1'hercby'alfirm than ,have a certificate ofennsmll to Self -insure,
or a certificate of Workers' Compensation Insurance, or a certified
..
ZONING
ENG. SITE NO.
copy thereof(See. 3800, Lab.C).
Policy No, Company
_
0 Certified py'Is hcreb• Imished'
Q,-Certine is f'' will, thLe city inspcdim, division.
Appheamt-:
FIRE SPRINK
.y 0 N❑
ENERGYTY4
v [:)' NO
_
MISC_- - REFER TO ORO.
TE RTI FICA'l E OF IEXIEMP FION FROM WORKIE RS'-
PERMIT ISSUANCE 10.00 •fie
FLOOD ZONE
A.L.U.C:
. COMPENBATION INSURANCE
(This section need not be completed if the permit Is for one
Y EJ . N
"
Y ❑ NO,
PLG. CONTE. -LIC. NO..
-
PLc.'
TOTAL . D D
In ... mcd dollars IS 100) or less I
- -
I certify that in the performance of lire work for which this per-
Mit is issued, I shall not employ any Person in any manner so as to
QTY MECHANICAL PERMIT FEE
'FEE SUMMARY
BUILDING.
become subject to the Workers' Compensation Laws of California.
Date Applicant
- '
ALTER OR ADD TO MECH. 5.00
NOTICE T'O APPLICANT: If, 5fter making this L'erIifi,at, of (Ex-
emption, you should become soloed In tiro Workeri Canpeasation
provisions of the Labor Code, you most forthwith comply with
such provisions or this permit shall be deemed revoked.'
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10SMC.F.M.) 4.00
PLAN CHECK
FEE -
AIR HANDLING UNIT (OVER 10,000C.F.M.) 6.00.
SEISMIC FEE...
' CONSIFRUCITON LENDING AGENCY
.1 hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the peroureance, of the work Icor which this peewit is i.asuad (Sec.
3097, Ce.C.1..
A
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
-
Icertify that lhaveread this applicationand state that the above
information is correct. 1 agree to comply with all city and county
ordinances and stale laws relating to building construction, and
,VENTILATION FAN (SINGLE) '4.00
-
PLUMBING
/ Q
- BOILER - cGMP (3 H.P. or 100,0008.T. U.) 6.00
BOILER;COMP I0ver.100,000 BTU( SEE FEE SCH.
-
MECHANICAL
-
city es enter. upon the
hereby entioned representatives inspection
hereby entioned Property forinsp ofth Purposes:
(We) agree - to save, indemnify and keep harmless'Ihe City of
MISC.-- REFER TO ORD.
upertino against liutiiliti judgments, -costs and expenses which
may any way accnu against said City in consequence of the
CONST. TAX
-PERMIT ISSUANCE .10.00
m nn' "-
MECH. CONT. LIC. NO.
.1 '
MECH.,
..�
TOTAL-
_
lTOTAL
Signature of icant/Contractor . ate'.,
F. OFFICE COPY