18163 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 18163 -
INSPECTION DIVISION.
JOB INSPECTION RECORDI
. - PERMIT EXPIRATION
JOB ADDRESSr_/n 7 PERMIT EXPIRES IF WORK
DINNER y ,\ (6eA &,U CONTRACTOR'
IS NOT STARTEDWITHIN
INSPECTION DATE INSPECTOR INSPECTION R ORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. - t ;,r
GARAGE SLABS -. i .. _ P /''--. •1, r��
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND'/SLAB - ,Iul* F, G 1989
PLUMBING � - f,' J - � (tiTD W ULA(
ELECTRICAL •CI-y Of CGDO�IRO ISSUANCE DATE
MECHANICAL - ELuc ELEcr. PLC. MECR,
❑ LD ❑_ . ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING '
VALUATION $IFT.
' '
MECHANICAL
ELECTRICAL - 1,,IPERMIT TO
FRAMING - •� ;S/ec—
INSULATION STORIES I TYPE CONGER.
Occ CROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.
'- ROOF: - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SUPr FLOOR AREA TOTALACREACE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID.
ROOFSHEATHING - - RES IND ILDCON USEpa00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.p
ASSESSORS PARCEL NO.
- ' I
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
.INSULATION PLUMBING C.i ZONING FIN G.SITE NO.
GAS TEST - GAS '
.FIRESPRINK ENERGY T 24
MECHANICAL ❑ ❑ ❑ ❑
` COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` " Y "
PLoon ZONE ALUC.
EXTERIOR-SHEAR
ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. - 1 Y❑ IN Y ❑ No.
SHEETROCK. GRADE FEE SUMMARY
EXTERIOR LATHN BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FI NA LIS SIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505CN
,,' I�`xlti
ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSECTION. '
.z° PLEASE GIVE JOB ADDRESS WHEN MINING.' PLUMBING
SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL y�
CALLING FOR FINAL INSPECTION. g+ L6,?)
OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
UILDING PROJECT IDENTIFICATION PERMIT NUMBER
4� BNILGING APPLICATION & PERMIT 18163
OOREss p ,
v' ( I Vr /rf L4 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'5 PLAN CHECK VALIDATION
• NAMEy'$ r{(YHOhE OTV. ELECTRIC PERMIT FEE V 1YL1L1A...
NAME ACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
Lm.BO. LIGHTING FIXTURES 10.00/1.00
ADDRESS TORS APPLIANCES-RESIDENTIAL 4,00
^ PH°NE 6-J QQ PANELS 10.00 DATE OF APPLICATION 1-
ARCHrtecT - -
OR � PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.NG. SIGNS TRANS. - 3.00
ADDRE°Ss E.G. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP rrEmp.METER OR POLE INS. 20,00 _,I) 6
torESEAPPLICANT s
ADDRESS MOTORS . SEE FEE SCH.
SERVICE CHANGE . 20,00
w re z PA➢ V�vc<--�
r o o LICENSED CONTRACTORS DECLARATION .. ..
Pc at W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
G h S
4 a (commencing with 7000)of Division 3 of the politics,and
-'I BLDG. ELECT. PLG. MECH.
H H z Professions Code,and my license is in full force and effect. it IV .1 ❑ � ❑ ❑
O i 0 0 License Class Lie.Number
L H W Dote Conlractmr /�
m ,W u OWNER-BUILDER DECLARATION CI of Cupertin BUILDING PERMIT
w ; LL H . I hereby atfinn that I um exempt from the Contractor's License MISC.- REFER TO ORD
INFORMATION
✓' VALUATION $/FT.
R a_ o J Law for tlm following reason.(Sec.7031,5,Business and Professions PERMIT ISSUANCE 10.00 �, D
r, VT Code:Any city orcounly which refiiresa permit loconsruct•al¢q
¢ Q ¢� improve, or repair structure,Prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. •�� /-
O M requires the applicant for such permit to file a signed statement that - TOTAL o'E O V PERMIT TO
K
$ he is licensed pursuant to the provisions of the Contractor's License
i
Law(Cho ler 9(commencinwith Section 70000of Division 3 oftho
fi o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Y eC..
(C the basis for the alleged exemption.Any violation of Section 7031.5 STORIES I TYPE CONSTB.
u3 � By any applicant for a permit subjects theapplicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more titan five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00 OCC.GROUP BEs.UNITS
Sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 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 ar improves thereon,and who docs such work FIXTURES,PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build s int- BUILDING USE
prove for purpose of sale.). RES IND CON PB GO.,
INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,am exclusively.contracting with '
licensed contractors to a Contra the paced(Sec.7044,of apply LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions property
The Contractor's License Law does not apply
to contracts
owner of propoHy who builds.,improves rased pursuant
and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the Co is actor's h projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO PARCEL NO.
❑ lam exempt under Sec..,B&P.C,for this
reason WATER HEATER W/VENT 6.00
Owner Late WATER SYSTEM 5.00 ACC.OATE Ace FILE NO.
WORKERS'COMPENSATI(IN DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a cel-ifcme ofcansent to self-insure, ZONING ENG.SITE NO.
car a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec,3800,Lab.C.L
Policy No. Company
Q ❑ �e rtilicd ropy is hereby furnished. FIRE SPRINK ENERGY TP4
Z Z ,t>B'Certil'ic o+y file with the city inspection division.
O Applicant yF� MISC.- REFER TO ORD. JYE] N� Y ❑ NE]
~ rn 10 PERMIT ISSUANCE - 10.00
LU - CIiRI'IPICATIi OF EXE-10 ION FROM WORKERS' FLOo9 zDNE A.Lu.c.
W COMPCNSAI'ION INSURANCE: PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N� Y ❑ N�
hundred dollars(5100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL F- mit i5 issued,I shall not employ any person in any manner sit as to
O Wbecome subject to the Workers'Compensation Laws of Calinamia.
CL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE. TO APPLICANT': If,after making this Cendieme of H..
F 2 emption,you should become subject to the Workeri Compcnsmion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions.,this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGI7NCY AIR HANDLING UNIT(OVER 10MC.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 fscc. MICROFILM
3097,Civ.C.k HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 r U�
Lender's Addrcas ELECTRIC
• I certify that l hiveread this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct, I agree to comply with all city and county BOILEfl-CQMP 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby entiorim representatives forms inspection
this City to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property tarvesp ofth i purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may In any way accrue against said City in consequence of the
'ranting of this •mnil. e-�./� MECH.CONT. - LIC.NO. MECH.
��d /^�G-S? 9 TOTAL TOTAL , to
��
SI atureo Applicant�ractor Uate `7-
OFFICE COPY