14719 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
- CITY OF CUPERTINO 14719
INSPECTION DIVISION
. JOB INSPECTION RECORD /
PERMIT EXPIRATION
JOB ADDRESS • �6 �`'�•3 N (i{/O � UNIT# _LOT4
� � PERMIT EXPIRES IF WORK
� "
OWNER ��,.9- ,G C..L.Cc CONTRACTOR � Lo-0;-d jiJ (� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
UFER - - ALL GRADING AND DRAINAGE SHALL BE.INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. '
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
: UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - - - HLOG, ELECT rLG. MECH,
[I ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED r BUILDING PERMIT
INFORMATION
- WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL PMTD
ELECTRICAL -
FRAMING
INSULATION STORIES TYPECONSTR.
Occ GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 50,1T 1100FAREA TOTAL AGRFAGF
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
\ BUILDING USE
\ ROOF SHEATHING RES IND CON PB W.",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 1:1 0 11
ASSET SSORS PARCEL NO
ROUGH SAN.a
PLUMBING ELECT,ENERGY
T
TUBS&SHOWER PAN � - PLUMBING ENERGY RACT NO PARCEL NO
MECHANICAL MECH.ENERGY '
ELECTRICALACC DATE ACC.FILE NO
,BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG SITE�NO.
INSULATION .. PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T 24
MECHANICAL„
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y O N❑ ❑ N❑.
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE A.L,yc
INTERIOR SHEAR FIRE DEPT. YD N0 Y ❑ N
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH 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 BU ILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Iw- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z0 PLEASE GIVE JOB ADDRESS WHEN PHONING. .
- SEE PERMIT-FOR EXPIRATION DATE.- MECHANICAL ;
IMPORTANT! CONST.TAX
PLEASE READ.REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
......�- ��U33 �fl TLA Nll'CGPd[�L l_
APPLICANT TO FILIL IN INFORMAT N WITHI RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DEJIITI FICATION PERMIT NUMBER
BDILDIN APPLICATION & PERMIT q A (�
ADORE I4 9
't3 '�6 RQ BUILDING- ELECTRICAL-PLUMBING-MECHANICAL y,.-
OWNER'S W ��/C ��yy PLAN CHECK VALIDATION
NA E i'L 61 CITY. ELECTRIC PERMIT FEE
E=-_ /CLO / 253-
E TRACTOR'S
NAME- OUTLETS-SWITCHES-RECEP 10.00/1.00
:-�owooD _cam 53`(3
LIc.NO. LIGHTING FIXTURES 10.00/1.00
1, rGORE. SCD -Tjy'C:0 w pp LIANCES-RESIDENTIAL 4.00
ADDRESS / / /'E
„' u^ IR PHO PANELS 10.00 DATE OF APPLICATION
L V A CHITECT .PLAN CHECK FEE P.C.NO,
OR JPANELS (OVER 200 AMP) 20.00
�\y^ ENGINEER
uc,No. SIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
QZI EMP.METER OR POLE INS. 20.00
APPucarvrs MOTORS SEE FEE SCH. J
M /� n,, ^ U W DO✓ K� � E 20.00 n� I�d1
w o ADDRESS 1��
LICENSED CONTRACTORS DECLARATION b'
a L, w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
H w zo e si ode,and( t.ilI'� cis in full❑ n e L '
Z 0 w .].f_ySy_Lic.Number -
Q N r 0 to Contractor
¢ x s " 'Kl-i•11 BUILDING PERMIT
¢ ¢ w u OWNER-BUILDER DELLA A I - INFORMATION
w0 A I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
3 u y VALUATION $/FT.
F u D an J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Anycity orcounry which mquiresa permit tacanstfllCL alter, ELEC.CONTR. LIC.NO.
Q Q Q p Improve,demolish,or repair any structure,prior to Its Is's'uance,WW ELEC.
d W m LL requires the applicant for such permit to rile a signed statement that TOTAL PERMIT 0
he is licensed pursuant to the provisions of the Contractor's License -
F z a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
z O Business and Professions Cade)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢F S the basis far the alleged exemption.Any violation of Section 7031.5 I STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(4500).):
0 I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.urv1Ts
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 SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided tial such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS'-EA.SYSTEM-l1NC.40UTLETS 6.00
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 all- RES INDCON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE 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.
❑ l am exempt under Sec. .BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK RRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compe tion in run' or a certified
co thereof Sec.3800,Lab.C.)
1 0 ?' Ii�i/1-j/{�y/Fl�ompany
(] ❑ Certif1e c] apy is herthylm Ishet. � FIRE BPRINK ENERGY T-24
Cer Ic c0 y,�s�yly'q s�µ�,�y�c�y�,yl y�tyl 1 I 1 on.
Z p Applies tr l'X..SI r , / !�2-1.1 MISC.- REFER TO ORD. - Y ❑ N❑ Y❑ N❑
CC y CERT IFICATE OF EXEMPTION PROM WORKERS' IALTER
ERMIT IS UANCE 10.00 FLOOD ZONE A.L.U.C.
W >_ COMPENSATION INSURANCE LIC. PLG.
d o (This section need not be completed if the permit is for.one TOTAL v❑ N❑ Y ❑ N❑
0 Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per. MECHANICAL PERMIT FEE FEE SUMMARY
LL tmit is issued,I shall not employ any person in any manner so as to
U become subject to One Workers'Compensation Laws of California.
O i Date Applicant OR ADD TO MECH. 5.00 BUILDING
} 0 NOl'ICE TO APPLICANT: If,after making this Certificate of Ex-
♦- Z eruption,you should become subject m the Workers'CompensationPPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, YOU must forthwith conlPly with FEE
U such provisions or this permit shall be deemed revoked. IR HANDLING UNIT(TO 10=r-F.M.) 4.00
CONSTRUCTION LENDING AGENCY IRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency forXHAUST HOOD (WITH DUCT) 5.00 "
the performance of the wary for which this permit is issued(Sec. - y MICROFILM
3097,Civ.C.). /� ��lUHEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nam HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I cerlil'y that 1 have read III,application and ,are[hal 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEE FEE SCH. MECHANICAL 5
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER T( ORD.
Jign-ature
pertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 Z`- CONST.TAX
n any way accrue against said City in consequc ce of theg of this permit. - t ry LIC.NO. MECH.
4 4 �^- 1_ � TOTAL Z TOTAL
o pp¢ant onlructor^ UUte n I
OFFICE COPY