18768 POST.THISCARD.NEAR FRONT'OF. BUILDING
PER MIT NUMBER
CITY 01 CUPERTINO
`INSPECTION DIVISION
18768 '
JOB-INSPECTION RECORD '
PERMIT EXPIRATION
JOBADDRESS IVnLCo ,S, D,o�/ _UNIT# •LOT#
` S PERMIT EXPIRES IF WORK,,.
owrvER 5'V� CONTRACTOR - IS NOT STARTED, WITHIN; ,
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE OR ISO DAYS FROM
NOTE: LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
,
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF -PERMIT VALIDATION
CUPERTINO STANDARDS. �0�+
GARAGE SLABS r - '
POUR NOCONCRETEUNTIL ABOVE HAS BEEN SIGNED C.(GGI
UNDERGROUND /SLAB
PLUMBING _ ,
ELECTRICAL r ',CI r I A V �'-ISSUANCE UATE
,MECHANICAL - - BLDG. ELECT, PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION $/FT.
PLUMBING
MECHANICAL • -
PERMITTO i
' ELECTRICAL
FRAMING
INSULATION 'STORIES TYPE CONSTR.
"OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' "' '
- SG FTGLOOH AREA TOTAL 4CFEHGE
' ROOF NOTE�NO'FINAL INSP.SHALL BE MADE BEFORE '
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING 'RES' IND CON . PB 00—
'APPLY
0-'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP., L 0 1:1 ❑ ❑<
ROUGH SAN.p ASSESSORS PARCEL NO.,
PLUMBING ELECT.ENERGY
`
+ .TUBS&SHOWER PAN ' � PLUMBING ENERGY TRACT NOPARCEL NO.
+ MECHANICAL MECH.ENERGY
ELECTRICALBUILDINGENERGY'. - ACC DATE ACC.FILE NO
FRAMING - ELECT.FINAL TEST '
INSULATION -ZONING ENG SITE NO.,
- PLUMBING .
GAS.TEST GAS' ' . -
MECHANICAL FIRE SPRINK ENERGY Taa.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. Y NV N0
'EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L.0 c-
'INTERIOR SHEAR- ' FIRE DEPT. Y Q_. NQ Y ❑ N❑
SHEETROCK GRADE , FEE SUMMARY
EXTERIOR LATH BUILDING
wTERIOR LATH TEMPORARY APPROVALS BUILDING'
.a SCRATCH COAT ELECTRIC ' - PLAN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE •.
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505;' ELECTRIC
�, ONE WORKING DAYBEFORE REQUIRED INSPECTION.-
0� P-LEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
• Z - - ,Q9.
` - SEE PERMIT FOR EXPIRATION DATE -
MECHANICAL
IMPORTANT! CONST.'TAXL'
PLEASE'READ REVERSE SIDE BEFORE TOTAL
CALLING FOA-FINAL INSPECTION.
OFFICE COPY `
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION - PERMIT NUMBER
APPLICATION & PERMIT
BUILDING
nDDRESs 8 7 6 S
DING - ELECTRICAL=PLUMBING' -MECHANICAL 3:
OWNER'S - PLAN CHECK VALIDATION
NAME / OTY. ELECTRIC PERMIT FEE
CONTRACTORS . OUTLETS-SWITCHES-RECEP 10.00/1.00 '
NAME
LIC.No LIGHTING FIXTURES - 10.00/1.00 -
• CONTRACTSR's +1i
15 PPLIANCES-RESIDENTIAL 4.00
4ADDRESS `T ,
2 PHONE PANELS -10.00 DATE OF APPLICATION
A HrtscTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADDRESS ENS. SPECIALCIRCUIT 500 PERMIT VALIDATION
ADDRESS .- O f`
- zIP EMP.METER OR POLE INS. 20.00 ,
APPLICANTS MOTORS SEE FEE SCH. �l✓7OtiC�G 1
ADDRESS
SERVICE CHA &13 20.00
S
woo LICENSED CONTRACTORS DECLARATION
BE o u I hereby affirm that 1 am licensed under provisions of Chapter 9 F ISSUANCE DATE
st C w (commencing with Section 7000)of Division 3 of the Business and - •-- I BLDG. ELECT. PLG. MECH.
H N i Professions Co an Inense is N lull fo /�� ".j
z o m - Licenu CIl M ass Lia Number_ AAI ,,,, v ❑ ❑ ❑
9 FD DateW-3 Conlon _I�I�ICA (�u�r�
P
r _ v BUILDING PERMIT
BE
u OWNER-BUILDER D[CLARA'fION INFORMATION
X 3 LL a I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
B.o Q Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
;; Code:Any city or county which requires a permit to construct,alter, PERMIT ISSUANCE 10.00 -
. <o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. ELEC.
ca -D u requires the applicant for such permit to file a signed sta oncnt that - TOTAL PERMIT TO
T
9 w he is licensed pursuant to the provisions of the Contractor's License
Hz> LawChapter 9(con7meocingwith Section 70000of Division 3ofthe
a HUI.Ross and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation ol'Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivilpcnalty. ALTER-DRAIN&VENT
-WATER IEA.) 5.00
of not more than five hundred dollars(8500).): '
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is But
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does Got apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
. himsel are notthrintends or offered for
If,edthat such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of Completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or am- - RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the properly,am exclusively contracting with - [I El
[Ilicensed'contractor, to construct the project(Sec. 7044,Business ILAWN..SPR INKLERS-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 builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iaa,exempt under Sec.-,R&P.C.or this WATER,HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
N'ORKE BS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I havea certificate ofconwnt to self-insure. ZONING ENG.SITE NO.
or a cert cult f or ri Camp n.Ilio Insurance,or a certified
copy Ihr�yCf f ).
Pole NF.= -1.+-
O ❑ Certifiedo Isere t FIRE SPRINK ENERGY T-24
Z Z ❑ Corti ' it • inn vision.
MISC.% REFER TO ORD. y[J IN Y E) No
Applicant
Ir - CERTIFI ATE OP ISXEAIPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSAT'[ON INSURANCE PLG.CONTR. LIC.NO. PLG. Y E] N Y ❑ NC]
CL 0 IThis section need not he completed if the permit is for one TOTAL _
::) Z hundred dollars(SI00)or Tess.) '
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL N mit is issued,I Shall not employ any,person in any manner so as to
O W becomusubject to the Workers'Compensalion Laws Of California. BUILDING
Date Applicant N ALTER OR ADD TO MECH: 5.00 r 9
>_ l6ia NOTICE TO APPLICANT: If,after making this Certi(icum of Ex-
F Z emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE !-
E5 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO I0=C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER IOMC.EM.) 6.00 SEISMIC FEE -�-
1 hereby affirm that there; is a construction lending agency I'or EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued IS". HEATING UNIT(TO
3097,Civ.C.L, 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATI NG UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC 1 '
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. im(ornmlion is correct.1 agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-ODM1P(3 H.P.or 100,000 B.T.U.1 6.00
hereby authorise representatives of this city to enter upon the BOILER-COMP IOvar 100,0013 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree' save, indemnify an keep harmless the City of MISC.- REFER TO ORD.
�Ln
ertino a st liabilities,judgme s, costs and expenses which PERMIT ISSUANCE 10.00 11 O!2 CONST.TAX
as in y ac e n [ ty 'n consequence of the
pent MECH.CONT. LIC.NO. MECH.
rorAL p�Ov TOTAL
sgnetu Applicant/'o actor - Uute A+�'•'�""•-'-�-� � ��O
OFFICE COPY