15296 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15296
INSPECTION DIVISION
JOB INSPECTION RECORD
• s
1 WL
'/ �-• _ PERMIT EXPIRATION
JOB ADDRESS _�(J f'd1 IN L't/ N//'�/f T�'G. C'": UNIT 4*__LOT#
_ PERMIT EXPI SIF WORK
OWNER � .�/�-- CONTRACTOR ..'/per Up •IS NOT STARE D 'WITHIN
INCT
SPEIO DATE INSPECTOR INSPECTYONRECORD 180DAYS OFPERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: "' LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION.
PR EGUNITE CUPERTIN0 STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ".•� '
UNDERGROUND /SLAB Alt) / / •�%
PLUMBING i
ELECTRICAL ANCE DATE
ME HANICAL L ,T. PLD. .MECH.
CrO NOT POUR FLOOR IIIL ABOVE HAS BEEN SIGNED CING PERMIT
INFORMATION
WOOD FLOOR VALUATION•y, SIFT. -
' PLUMBING -
MECHANICAL { L'
PERMIT TO
ELECTRICAL \
FRAMING "
STORIES TYPE CONSTH.
INSULATION M_
• - UCC GROUP RES.UNITS
,ems PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
/'.• ' SD,FT FLOOR AREA TOTAL ACREAGE
''j ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
�'' DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND El El CON PB 0111.,
❑
APPLY NO ROOFING'UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ASSESSORS PARCEL No.
ROUGH SANA
PLUMBING ELECT,ENERGY .•..l ' ? �' ) r �'
TRACT NO. PARCEL NO.
TUBS&SHOWER PAN PLUMBING,ENERGY
MECHANICAL - MECH.ENERGY .S IL'
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINALTEST A ZONING ENG.SITE NO,
'INSULATIONPLUMBING kG.
GAS TEST GAS
MECHANICAL .. 6 _ FIRE SPRINK ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y El "❑ El NO
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LU C.
� 6 .-
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ 1 N❑
k SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING oo L G^ BUILDING
INTERIOR LATH TE PORARY APPROVAL10 '
SCRATCH COAT ELECTRIC - PLAN CHECK ,
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE /^�
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
1 `r F 'ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
r z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE- MECHAN1cAL
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
tAE
DING PROJECT I DENTI FICATI ON PERMIT NUMBER
APPLICATION & PERMIT1 [ (�Ia) a7BUILDING —ELECTRICAL—PLUMBING—MECHANICAL PLAN CHECK VAL ATION
N DTV. ELECTRIC PERMIT FEE /JA
s OUTLETS-SWITCHES-RECEP 10.00/1.00LIC.NO. LIGHTING FIXTURES ' 10.00/1.00
Rs PPLIANCES-RESIDENTIAL 4.00
yf t y1 vRONE — PANELS 10.00 DATE OF APPLICATION'
ORCHITEcr PANELS (OVER 200 AMP). 20.00 PLAN CHECK FEE P.O NO.
ENGINEER
Lie.No. SIGNS TRANS. 3.00
ADDRESS END SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP rEMP.METER OR POLE INS. 20.0(
/
APPLICANT s
ADDDRESSDRESS - MOTORS SEE FEE SCH. /
/
SERVICE CHANGE 20.00
Foo LICENS1iU CONTRACTORS DECLARATIONv
a i I herehy ufrom that I am licensed under provisions o'Chapter!) ISSUANCE DATE -
y a a (commencing with Section 7000)of Division 3 of the Business and DG. ELECT. PLG. MECH.
Professions Co un y license is in full for iti d8f L ❑ ❑ ❑
Licens CI3 s _Lic.Nmnbc p� p
4 m r a Datc �=g0_=
h,H i {µ yV BUILDING PERMIT
`a — sem
a m ¢ a OWNFR-BUILDER DECLARATION
o d u - INFORMATION
W H 1 herebyaffirm that I an exempt from the Contractor's License MISC.— REFER TO ORD
u. m 1 VALUATION
FLLOa Law for the following reason.(Sec.701 L5,Business Professions PERMIT ISSUANCE rf9:00
Cade:Any city or county which requires a permit to construct,alter,
M Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ()Q 0
m LL. requires the applicant for such permit t0 file a Signed Statement that TOTAL yJd I— PERMIT TO
w he is licensed pursuant to the provisions of the Contractor's License
S
z c Law(Chapter 9(commencing whh Section 7000)of Division J of the
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
$ the basis for the alleged exemption.Any violation of5eclion 7031.5 STORIES TYPE CONSTH.
a ; _ by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00 �•
of not more than five hundred dollars(S5001)',
0 1,as..net of the property,or my emplo_yecs with wages as BACKFLOW PROTECT.DEVICE 4.00 y" OCC.GROUP - RES.UNITS
their sole compensation,will do Dm work,and the structure is nut
intended or offered for sale IS. 7044, Business and 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 Own,cm,and who docs such work FIXTURES,PER TRAP 5.00 SD.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
marts are not intended oroffeyed for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 .BUILDING USE
builder will have the burden of proving that he did not build or inn- RES IND CON PB Olber
. .
prove for purpose ofsalcJ. INDUSTRIAL WASTE INTER3000
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed emotmocuS to construcP the project(Sec.7044,Business LAWN SPRINKLERS-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 wil),ucontructorfsl licensed pursuunl to
3y 2, ')2 10
the Contractor's
License Law. SEWER-SANITARY-STORM EA.200ft/10.00
TRACT NO. PARCEL NO.
❑ tum exempt under Sec.—,B.te for this
reason WATER HEATER W/VENT 6.00
Owner Uma WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORK FRYCOMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 _
1 hereby affirm that 1 have a certificate ofconsetl to self-insure, - ZONING ENG.SITE N0.
r a certificate of.Workers'Compensation Insurance,or a certified _
vpy K 0, ploy
Policy N�o�.1�$(elpan y c.+
0 ❑ Certified copy is here 1 rnished. FIRE SPRINK ENERGY T-24
Z 2� ❑ Cert ific,0 Is f e it h ahe's city inspeclimn division.
O Applicant -/— Nom, MISC.- REFER TO ORD. Y❑ IN F] Y ❑ N❑
CC T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE .400 /.Z,- FLOOD ZONE A.L.U.D.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PL
- G.
Z (This section need not be completed if the permit is for one TOTAL
Y❑ N❑ Y❑ No
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to
U become subject to the Workeri Compensation Laws of Culitumiu. /pW
W Date x Applicant ALTER OR ADD TO MECH. 5.00 BUILDING eC:—
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
)... ? 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
f..1 such provisions or this permit shalt be deemed revoked. AIR HANDLING UNIT TO 10,000C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10,00DC.EM.) 6.00 SEISMIC FEE t7
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued ISee. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 3-C
Lender's Address ELECTRIC
1 certify Ihut I have read this upplicmion and state but the above VENTILATION FAN (SINGLE) 4,00 p
Irformalion n correct.1 agree to comply with all city and county EOILER-COMP13H,P.or 100,000B.T.U.) 6.00 PLUMBING �0
ordinances and state laws relating m building construction, and
hereby authariPe reprt.connive, of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. 6 MECHANICAL
above-mentioned property for inspection purposes.
CWe) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which' " CONST.TAX
nay in an way uccrmegainsl said City in consequence of the PERMIT ISSUANCE 3&.09
ranting L is ermiL MECH.CONT. LIC.NO. MECH.
' u ` TOTAL11 TOTAL
Sign rc of Applicant/Contractor ate If I
OFFICE COPY