15202 POST-THIS CARD NEAR FRONT+OF BUILDING PE RMIT NUMBER
CITY OF CUPERTINO . 15202
INSPECTION DIVISION
JOBTINSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS' / I LKiNSO�JVC' UNIT# _LOT# /
PERMIT EXPIRES IF WORK
.IS NOT STARTED WITHIN
OWNER - ! V ION h/ c� TORCONTRACTOR INS JCS--. 180 DAYS OF PERMIT ISSU-
INSPECTION DATE INSPECTOR INSPECTION RECORD
• ANCE OR 180 DAYS FROM
FOUNDATION r, G NOTE: LAST.CALLED INSPECTION.
•
LEER ALL GRADING AND DRAINAGE SHALL•BE INSTALLED
PREGUNITETO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALUATION
CUPERTINO STANDARDS:
GARAGE SLABS 1 ...-..-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,—�,
UNDERGROUND-/SLAB ? otif, 'S
PLUMBING - - pps�}J - E
ELECTRICAL - rf OSSU ELECT,ce DATE
MECHANICAL c ELECT PIED. MecH
I ` . h1w 281 �•� y � ,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED CItY Of CU, eTkillUBUNFORMAERMIT
WOOD FLOOR
TION
VALUATION SIFT,
PLUMBING
MECHANICAL
L . ✓
�^�PERMIT TO
ELECTRICAL
FRAMING STORIES TYPE CONSTR.
INSULATION.
UCC GHOUP yRES UNITS
jsRLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOR AREA TOTAL ACREAGE
ROOF ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -
DIAPHRAGM p THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING 5'-- - lwrab BUILDING USE
HCs • mo cory PR Otlnr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ID El
ASSESSORS PAHCEI.NO
ROUGH SAN.a /
PLUMBING -(_.=5I-71%) f ,/j, ELECT. N RGY '� —,/-? �.-
TRACT NO PARCEL NO
TUBSH PA -1_ JJ PLUMBING ENERGY
J.
MECHANICAL MECH.ENERGY
ELECTRICAL . - - BUILDING ENERGY ACC DATE ncc.FILE No+; .
FRAMING `Zo ELECT.FINAL TEST ZONING ENG SITE N0,
INSULATION PLUMBING
GAS TEST (Q' GAS
5F, eti 3HAS BEEN SIGMECHANICAL FIRE SPRINrc �ENERGY T 2
COVER NO WORK UNTIL ABOVE NED HEATING Y "[]
.
EXTERIOR SHEAR FLOOD ZONE A L U C
ELECTRICAL RELEASE "
❑ NO
INTERIOR SHEAR FIRE DEPT. [D NL
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH -2, S BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING ;
SCRATCH COAT ELECTRIC PLAN CHECK -
GAS tv 01FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYSEISMIC FEE �• ^.
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE -. MECHANICAL'
IMPORTANT! CONST.TAX .
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
I� APPLICANT TO FILL IN INFORMATION WITHIN F-ED LINES - USE BALL POINT PEN ONLY
_
BUILDING PROJECT IDENTIFICATION -� -PERMIT NUMBER
'y\ aGLDNG APPLICA-
TION & PERMIT
AnDIEss BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
522
k.C1 pGA: I lt\ O
OWNER's ,
PLAN CHECK VALIDATION
AME QTY. ELECTRIC PERMIT FEE
/ PHONE
NNT ACT Rs
NAOUTLETS-SWITCHES-RECEP 10,00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00 ,.
DDRESS CTOB's
AAPPLIANCES-RESIDENTIAL 4.00 '
AGGRES
------ -- PRONE PANELS - 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C:NO.
OR PANELS (OVER 200 AMP) 20.00
ENGIN -
E '1 1•, r c. o. NI.IJ� SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
. � E l SPECIAL CIRCUIT 6.00
EMP.METER OR POLE INS... 20.00 y 1 i,
APPLICANT cs MOTORS � SEE FEE SCH. (-`fv\>��1 2/, ��r1't'�•r'V '
RE
SERVICE CHANGE 20.00
00o LICENSED CONT6,hCTORS DECLARATION
,.
in u I hereby affirm that I am licensed under provisions of Chapter 9 Qi ISSUANCE DATE
y a n� (commencing with Section 7000)of Division 3 of the Business and yyxM� BLDG. ELECT. PLG. . MECH.
r y z proffessionscode:71.6 my license is in full fore,and effect
Z 0 m - License 1 Lia Number 4"lsCl
9 w Date_ Jpe{� Contractor
t_ j
¢ m s t '�/ - I BUILDING PERMIT
¢ a ¢ OWNIiR BUILDER DRCLARA'HON
o te u INFORMATION
X 3 y 1 hereby aft'irm that I am exempt from the Contractor's License MISC.- REFER TO ORD
to o Law forthe fallowingrcason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION S/FT.
Code:Any city or county which requires a permit to construct,alter,
_aC Q 50 improve,demolish,or repair any structure.prior to its issuance,also ELEC.CONTR. LIC.NO.
ELEC. ( C�W
O n requires lite applicant for such permit to file a signed statement that TOTAL 9V�a PERMIT TO -'
n w m he is licensed pursuant to the provisions of the Contractor's License / -
r Z Q Law(Chapter 9(commencing with Section 7000)(if Division 3 ofthe
1 4 o Business and Professions Code)car that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
M t- the basis for(lie alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
T by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than fivehundred dollars(8500)):
❑ ].as owner of the property,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 vs /
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 ��
Code:The Contractor's License Low does not apply to an owner of
property who buildsmor improves thereon,unit who does such work FIXTURES-PER TRAP 5.00 50'7.F?T,FLOOR AREA TOTAL ACREAGE
himselforthrough his own employees.provided(hat such improve- GAS-EA.SYSTEM•1 INC.4 OUTLETS 6.00 33
cents 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 w'I have the burden of proving thul'hu did not build of im- RES IND CON PB Other
prove powner of tileJ' INDUSTRIAL WASTE INTER. 30.00
I,as owner of the property,am exclusively .7044,Bu with ❑ ❑ ❑ ❑
licensed contractors to le Cmum the project(Sec. does or apes LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
toll Professions Code:The Conbuilds s License Law Joos not apply
to owner of property who builds tr improvesensed info who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts ati Jar such License
eala with a mnlraalur(s)licensed pursuant to
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. I
❑ It •xemptunder Sec. B.&P.C.For this WATER HEATER W/VENT 6.00
Ifreasto
Owncr r Dnte WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORK Ii RS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self-inwtm' ZONING ENG SITE N0.
or u certificate of Workers'Com enmtinn Insurance,nr u certified
copy themof(Sec.380Q Lab.0 '1 /�
Policy No. Company-AAV__fl�10-1-
Q 'p
fir. copy Shereb 1 rats d FIRESPRINK ENERGY T-24
Z Z 1/Certif pcnly S� �� p��Jy�till y�g t Peet ion division.
D Applicant l KlLh_t_LFe r .S.(.,� MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
m CDRTIFICATF.OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE /eZ, FLOOD ZONE I A.L.U.C.
11J > COMPF.NSA'1'ION INSURANCE PLG.CONTR. LIC.NO. PLG. 9
CL a (This section need not be completed if the permit is for one TOTAL S Y❑ N❑ V ❑ N❑
Z hundred dollars(S 100)or less)
U O 1 certify that in the performance of the work for which this per, OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H- mit is issued,I shall not employ any person in any manner so as to
0Ubecome subject to the Workeri Compensation Laws of California.Ul Date-Applicant BUILDING f�p
} 95 NOTICE TO APPLICANT: If,after making this Certificate of Ex� ALTER OR ADD TO MECH. 5.00
♦- ? eruption•you should become subject to(he Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Cade, you must fnrthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=11F.M) 4.00 �L
CONSTRUCFION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOC.F.M.) 6.00 SEISMIC FEE
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(Sec. MICROFILM
3097,Civ.C.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address ELECTRIC H EATING UN IT(OVER 100,000 B.T.U.)9.50
_
Icertify.that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct, I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-cUMP 13 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 9sya
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
'upertino against liabilities,judgmenla, costs and expenses which /7CONST.TAX
hay m any way accrue agar St jend City iNn consequence of the PERMIT ISSUANCE H
'ra ingofthispcnnf . MECH.CONT. LIC.NO. MECH.
F TOTAL
Signature of Applicanticantmctor
OFFICE COPY