14720 POST'THIS,d/jRD NEAR:FRONT'OF BUILDING -
y T,,.q. PERMIT NUMBER
r CITY OF C�UPERTINO , - 14
INSPECTION DIVISION
JOB+INSPECTION RECORD' Qp
�. •" r_ - `��� �" / a �" PERMIT EXPIRATION w
a3 A1,'"-WO �- ,�v .
-- JOB ADDRESS /o( UNIT#- _LOT#
•''' •. , 7 PERMIT, EXPIRES IF WORK _
OWNER 7"T '•coNTRACTOR �d OD:i!): �r IS NOT' STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTIONS RECORD' 180 DAYS OVPERMIT'ISSU,,
FOUNDATION - - - ANCE OR 180 DAYS FROM" .
NOTE:, , LAST CALLED INSPECTION! •
UFER ` ' - ALL,GRADING AND DRAINAGE.SHALL BE INSTALLED ,
PREGUNITE ,TO COMPLY WITH THE APPROVED PLANS AND CITY OF. :'PERMIT VALIDATION
- ' CUPERTINO STANDARDS: • - I
GARAGE SLABS f . . ..r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED^
UNDERGROUND /SLAB
r
PLUMBING ' '
ELECTRICAL ISSUANCE DATE
. BLOc, E SCMECHANICALTPLG. ,MECR, I '
• DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ".^ ' - ,BUILDING PERMIT
INFORMATION
. ' WOOD•FLOOR - ` vALunnoN s,P,T.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL -
FRAMING T. '"/e'G.fJ•
INSULATION , _ - . .STORIES TYPE coNSTR.
- - OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• . - 50 FT;'F FLOOR AREA
TOTAL ACREAGE ..
ROOF - NOTE:NO;FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM ' THE CONSTRUCTION TAX IS PAID,
ROOF SHEATHING ,} - K REs.'•.wo I.LOCONNG USEPB o,i,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN.SIGNED FINALS DATE; INSP. ❑ ❑ ❑ ❑ '❑
ROUGH SAN.H
-� ASSESSOR S PARCEL NO, ^
' - '.
PLUMBING ELECT.ENERGY,
.+'TRACT.NO; PARCELNO
TUBS&SHOWER,PAN' PLUMBING ENERGY ,' "
' MECHANICAL'_.,. •" - MECH.ENERGY - - -
ELECTRICALBUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING,, _ ELECT.FINAL TEST
'ZONING. ENG.SITE NO..�
INSULATION - PLUMBING. - n
- GAS TEST GAS
• •
MECHANICAL 'FIRE SPRINK "ENERGYL]G
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING [j NO. ''Y ❑" "❑.
FLOOD ZONE A.�.U.C,
EXTERIOR SHEAR ELECTRICAL RELEASE :
"INTERIOR SHEAR - FIRE DEPT. _ 1 P❑ '"❑- Y ❑ N❑'
' SHEETROCK': + - GRADE .• i hD FEE SUMMARY
EXTERIOR LATH •' BUILDING.
.INTERIOR LATH TEMPORARY APPROVALS BUILDING,
SCRATCH COAT,••: ,: - 'i' ELECTRIC - .� . PCAN CHE K- t
FEE ^
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY "SEISMIC:FEE
OCCUPANCYOF BUILDINGISNOT.PERMITTED UNTIL'BUILDING,FINAL ISSIGNED BY BUIL DING INSPECTOR MICROFILM '
.. i . ,'. _
ARRANGE'FOR'INSP.ECT_I,ON BY PHONING.252-4505, '; ELECTRIC,-
ONE: ONE IN R
H WORKING DAY BEFORE REQUIRED INSPECTION.
PLEASE-GIVE JOADDRESS WHEN PHONING. �¢ PLuMBwG
B.
Z x. -.SEE PERMIT FO'R'EXNRATION DATE ,. MECHANICAL
IMPORTANT! CONST.,TAX4.
PLEASE READ REVERSE SIDE BEFORE w
.�
' �CALL'ING FOR FINAL,INSPECTION. , : .TOTAL ,.< ^�
OFFICE COPY '
APPLICANT IL fTW(QAT2Ni WITHIN RED LINES- USE BALLPOINT PEN ONLY
Ot BUILBING PROJECT.' NTI FICATION - PERMIT NUMBER
s APPLICATION & PERMIT
°° `so► 2'3 �° oL r RD_ .14720
BUILDING— ELECTRICAL—PLUMBING —MECHANICAL
rvnm[R5 �yQR) - PLAN CHEC K VALIDATION
,CL^ 1N ONE 3_ 00 OTY. ELECTRIC PERMIT FEE
LJ
CONTRACTOR'S' 1.
rvA (— �j OUTLETS-SWITCHES-RECEP 10.00/1.00
CAH CN
D. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS Es ' '5So7AcomA WAy APPLIANCES-RESIDENTIAL 4.00
_00
OQ CIT ONE - _ PANELS 10.00 DATE OF APPLICATION
ARCHITECT p - PLAN CH CK FEE P.C.NO.
GR (yl/ 363�7J 7� . PANELS (OVER 200 AMP' . 20,00
ENGINEEP
�. ' LIC.No. SIGNS TRANS. 3.00 •
ADDREOR SS ENG + SPEGIALCIRCUIT 5,00 PERMIT VALIDATION
IP I;q TEMP.METER OR POLE INS. 20.00
APPLICANT'S - - .I .
ADDRESS r- M TO SEE FEE SCH. l
��DLvoC� .QU,C, & Fl C ANGE 20.00 F3 1111
o o LICENSED CONTRACTORS DECLARATION 0 l 11 �o
a v F - I hereby affirm that I am licensed under provisions of Chi pler 9' - ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
vs< H, r BLDG. - ELECT. PLG. MECH.
r h z P ole�siyn o an my Fce .µµis in full fort f
Z O y - eGfl�L+c.Number ❑ ❑ ❑
4 m w Date Conlrado _
a n�f BUILDING PERMIT
¢ ¢a OWNER-BUILDER DECLAR TIO
A o a v INFORMATION
w ; u_y I hereby affirm that 1 am exempt from the Contractor's License IMISC.— 77t
u.Cl 4 Law fpr the following reason.(Sec.1031.5,BusinessanJ Professions VALUATION $/FT. ' -
I- - w .PERMIT ISSUANCE ,
Cole:Any city ar county which requires a permit to construct,,also
2 a. ¢Q improve,demolish,nr repair any smit tore,prior n its issuance,also ELEC.CONTR. LIC.NO.¢ reyurns the applicant for such permit to file a signed statement that PERMIT Twhe is licensed pursuant to the provisions of[he Contractor's License Mese1Z
rzi
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe
F¢ o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE f
¢L pN the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
A. ; by any applicant fora permit subjects the applicant lnacivil penalty ALTER-DRAIN&VENT-WATER (EA:) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the properly,or my employees wi.in wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will Jo the work,and Ile structure is not OCC.GROUP RES.UNITS•
intended or offered for'sale.(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
{v 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 SG.FT.FLOOR AREA TOTAL ACREAGE
. himself or through his awn employees,provided that such improve-
mentsarc not intended oroffered for Sale.If,however,the building GAS-EA.SYSTEM-I1NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) ' 200
builder will have the burden of proving that h - . - . .
e did not build or im- BUILDING USE
prove for purpose of sale.). - - INDUSTRIAL WASTE INTER. ' 30.00 RES IND CON PB Omar
30.00 as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct Ilse project(Sec. 7044,Business - LAWN SPRINKLERS-1 INC 5 V.B. 6.00 'ASSESSORS PARCEL NO.
and Professions Cade:,The Conlructor'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 lot such projects with a contractons)licensed pursuant to
the Contractors License Law, SEWER-SANITARY-STORM EA.200ft/10A0 TRACT NO, PARCEL NO.
❑ I am exempt under Sec.—,B.&P.C.for this
WATER HEATER W/VENT 6.00
reason
Owner Dute - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
.WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that 1 have a certificate of consent to sell'-imure,
or a certificate of Workers'Co...pensation Insurance,or a cerlificJ ZONING ENG.SITE NO.
Z-Z ❑y CertiOe�d co�py rsZhereb furnished. �
FIRE SPRINK ENERGY T-24
P: O
�11 UfX MISC.- REFER TO ORD. v❑ N❑ v ❑ N❑
LIZ H. C17RTIFICATE OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE ,10. FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PL f
IL Z( This section need not be completed if the permit is for one T .�� Y E] , N E] Y❑ .No
U O hundred dollars(8100)or less.) eb
I certify that in theperformance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. U mit is issued,I shall not employ any person in any,manner so as to
become subject to the Workers'Compensation Laws of California.
y. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex.
F ? emption,you should become subject to the Workers Compensation APPLIANCE PLAN CHECK
provisions of the labor Code, you must forthwith comply with FEE
U such provisions or this pernil shall be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MIC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lendi.ig agency for EXHAUST HOOD(WITH DUCT)
the performance of the w r for which this eimit is issued(Sc, MICROFILM
3097,.Civ.CJ ygI� HEATING UNIT(TO 100,000 B.T.U.) .-BAD
Lender's Nan "'���'��, HEATING UNIT 100,000 B.T.U.)9.50
' Lenders Address ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 1
information is correct. I agree to comply with all city and county
PLUMBING
ordinances and state laws relating to building construction, and BOILER-CUMPI3H.P.or 100,0008.T.U.1 6.00
hereby authorize representatives of this city to en4r upon the BOILER-COMP (Over 100,000 BTU'$EE,FEE BCH.
_
above-mentioned property for inspection purposes. MECHANICAL
(We) agree to mic, indemnify and keep harmless the City of MISC.- REFER TO ORD. .
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 1000 CONST.TAX'
ma in any way accrue against said City in conseyucnce of IS .
n g Of this permit W53. LIC.- LIC.NO. MECH,
TOTAL TOTAL
gnalurc of Applicant/Contractor Date
OFFICE COPY