10566 POST THIS CARD NEAR FRONT OF BUILDING, PERMITNUMBER '
CITY OF CUPERTINO 1 fi5�6
INSPECTION DIVISION
JOB INSPECTION RECORD -
r,,r�� PERMIT EXPIRATION
.i JOB ADDRESS �o�aL3dLF� AA UNIT# _•LOT#
PERMIT EXPIRES IF.WORK I
' OWNER pe-11b, AL CONTRACTOR E E' L', IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTIONRECORD 180 DAYS OF PERMIT ISSU- '
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION. .
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED'
TO COMPLY WITH THE APPROVED PLANS AND CITY OF reHn+rt VALIDATION
PREGUNITE - CUPERTINO STANDARDS. _
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'.UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - - ISSUANCE DATE'
MECHANICAL
BLDG ELECT, PLG. MECH.
!, . .❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR _ VALUATION s/FT.
PLUMBING'
MECHANICAL Ok Oc�7 Sip 6-o.S. U Q�
ELECTRICAL � 'E - » OI�lPERMIT TO • •
FRAMING
roRles TYPE coNSTH
INSULATION .
iz-s-strsh dy
OCC GROUP RES.UNITS
�•-- PLACE NO SUBF.LOOR UNTIL ABOVE HAS BEEN SIGNED
' so Er,FLOOR AREA TOTAL ACREAGE
. - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID,
BUILDING USE
ROOF SHEATHING REs IND CON PB Om,=
APPLYNO ROOFING UNTIL ABOVE HAS BEEN: El El SIGNED FINALS DATE INSP.—. ElASSESSORS PARCEL NO.
ROUGH SAMA
PLUMBING ELECT,ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN _ .PLUMBING ENERGY
MECHANICAL MECH. ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACC tRILE NO
FRAMING' - - ELECT.FINAL TEST
ZONING ENG.SITE No.
INSULATION PLUMBING '
GAS TEST GAS
FIRE SPRINK ENERGY T 2a
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NE ❑ N[]
FLOOD ZONE A UC.
EXTERIOR SHEAR ELECTRICAL RELEASE Y ❑ No Q No,
INTERIOR SHEAR FIRE DEPT.
SHEETROCK 1GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COATELECTRIC PLAN CH.
GAS FEE -
SI` NO TAPE OR PLASTER UNTIL`ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC SEE
I OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAUISSIGNED BY BUILDING INSPECTOR'. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
i O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z ffECCHAL +
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! x PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. _ -
OFFICE COPY, .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT-PEN ONLY
` a_ " ''BIUI LDING PROJECT I DENTI FIC TION PERMIT NUMBER- ..
BDLLDIND 'APPLICATION &"PERMIT
M 1 ��� �
(9/ BUILDING—ELECTRICAL—PLUMBING — ECHANICAL I
iso 9�/ o9a
N 'S PLAN CHECK VALIDATION
""M f OTY. - ELECTRIC PERMIT FEE
nd a M + a.UNE 1,x,3 s✓: �
CONTRACTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00
Nr
1 L �
rk)-er ` /1 C,No. a�p 3. LIGHTING FIXTURES 10.00/1.00 •.
CONTRACTOR'S JAPPLIANCES-RESIDENTIAL- 4.00
ADDRESS qq/� �f/
PHONE pL95 V/r4 PANELS - 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. O.
OR
ENGINEER '
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENO. SPECIAL CIRCUIT 5.00PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE,INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERV ICECHANGE 20.00 /
,02
0o LICENSED CONTRACTORS DECLARATION
¢'o 0 1 hereby affirm that I am licensed'under provisions of Chapter 9 CE DATE
¢ z
w
(Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
so y i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
z 0 m — License ClessCdl3f3a, o Lie.Number -
caw H w Dam' Contractor
H BUILDING PERMIT
ic >'¢ ¢ OWNER-BUILDER DECLARATION INFORMATION
wa: - MISC.— REFER TO ORD
g u 1 hereby afflr r that I am exempt from the Contractor's License VALUATION $/FT.
r .. 0 ¢ Law for the following reason.(See.7031.5,Businessand Professions PERMIT ISSUANCE .10.00
Code:Any city or county which requires a permit to construct,alter,
re to Q 0 Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC.
O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
o. w m¢ he is licensed pursuant to the provisions of the Contractor's License
H z a Law(Chapter9(commencingwith Section 7000)of Division3
4 0 Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
(E the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE GONSTfl.
to by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,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 ,
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 or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLODR AREA TOTAL ACREAGE
himself or through his own employees;provided that such improve-
. ments are not intended or offered for safe.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
• or improvement is sold within one year of completion,the owner-
builder will have the burden of proving thathe did GAS-EA.SYSTEM-OVER 4(EA.) 2.00 euaDlrvG USE
not build or im- RES IND CON PB 4 Omar
prove for purpose of sale.). INDUSTRIALWASTE INTER. .30.00
❑- I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑' ❑
licensed contractors to construct 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 with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lamexemplunder Sec. .B.&P.C.fortpis WATER HEATER W/VENT - 6.00 `
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to set Flnsure, : ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or u certified
copy thereof(Sec.3800,Lab.C.). ^
Policy No ompany ° - -
Q ❑ Certiiedcopy.is hereby furnished. I FIRE SPRINK ENERGY T-24
Z Z A Certified,copy is Bled with the city 'mspeelioo division. MISC.- REFER TO ORD. Y N Y N
C) Applicant ❑ "❑ ❑ ❑
F $ PERMIT ISSUANCE . 0 FLOOD ZONE A.L.uc.
CERTIEICATI30F fiXEA1PTION FROM WORKERS'
DJ > COMPENSAT'ION INSURANCE PLG.CONTR. LIC.NO.
CL O (Phis section need not be completed if the permit is for one AL % V❑ N❑ YE] N❑
2 hundred dollars IS 100)or ICs,.) r�
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT6$` Y F Q FEE SUMMARY
LL h mit is issued,I.shall not employ any person in any manner so as to VV
Ow become subject m the Workers'Compensation,Laws of California. BUILDING
Date Applicant ALTER OR ADD TO MECH.
NOTICE. TO'APPLICANT: If,after making this Certificate of F.x- -
f— ? emption,you should become subject to the Workers'Compensation APPLIANCE. .00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U Such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO l0,OD0 C.F.M.) .-490
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000GRM.) 6.00 SEISMIC FEE'
I hereby affirm that there is a construction lending agency for 25
EXHAUST HOOD (WITH DUCT) • —SBO ,
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 7
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
„r•' ordinances and state laws relating to building construction, and
e,( hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. ,MECHANICAL V
above-mentioned property for inspection purposes.
(We) agree to save, Indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX -
may in any way accrue against y in cons edce of the PERMIT ISSUANCE 49(00 /�- M
antingof ispermil. MECH.CONT. LIG NO. TOTAL -
D TOTAL
ig ore ofstiplicart/Cont Date
OFFICE COPY