15048 POST THIS CARD NEAR FRSNT qF BUILDING '
PERMIT NUMBER
CITYOF CUPERTINO
INSPECTION DIVISION 15048
JOB INSPECTION RECORD )
PI
� ) r(cR�
• - PERMIT E RATION
JOB ADDRESS 401,12-3N w,/_'c' YZ•U SPUNIT#F /O/�' _LOT# "
/• ' I PERMIT EXPIRES IF WORK
OWNER v - ` oN ' CONTRACTOR 0"pr J Jz s-rT ./ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU-
ANCE OR.180 DAYS FROM
FOUNDATION. 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.
GARAGE SLABS rf
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Ut.• "�'�
UNDERGROUND /SLAB - 1
' PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL Ruu; ELECT. I PI.G. MecR.
• DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED P� BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $ITT.
PLUMBING N �]
MECHANICAL Jv N ,l I=' cl-Nn
ELECTRICAL PEVM� To
FRAMING -
STORIES TYPE CONSTR I
INSULATION '
k
(ICC GROUP .RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO,FT ILOOR AREA TOTAL ACREAGE
. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM' THE CONSTRUCTION TAXIS PAID
BUILDING USE
ROOF SHEATHING Res IND coN Pe omr'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
_ ASSESSORS PARCEL NO.
' ROUGH SAN.N
PLUMBING �'�' 610 ELECT.ENERGY rvncr No rAvcELNo
TUBS&SHOWER PAN PLUMBING ENERGY '
MECHANICAL MECR ENERGY
ELECTRICAL- BUILDING ENERGY AGO DATE ACC.FILE No
FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO.
INSULATION IPLUMBING
GAS TEST GAS
. MECHANICAL TARE SPRINK ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ I Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL.RELEASE FLOOD ZONE A.L Uc.
INTERIOR SHEAR - - FIRE DEPT: it1�$e ' YE] N❑ 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 IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. MICROFILM
c"
ARRANGE FOR INSPECTION BY PHONING 252-4505, ;''I' ELECTRIC
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. I PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
�' MECHANICAL .
SEE PERMIT FOR EXPIRATION DATE -
CONST.TAX
IMPORTANT! ;?
PLEASE READ REVERSE SIDE BEFORE, .'
CALLING FOR FINAL INSPECTION. TOTAL S`1 �
'OFFICE COPY
+
APPLICANT TO FILL IN INFORMATION WITH�N,RED LINES USE BALLPOINT PEN ONLY
I LDING PROJECT I DENTIFI CA N _PERMITNUMBER
BUILDING /- �d3 .. w APPLICATION &.PERMIT
ADDRESS 0 15048
Space'•# BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
OwNER'a • PLAN CHECK VAL}p ATION
' "AME � DTV. ELECTRIC PERMIT � FEE �
AL .Coton 51.4-383-4800 �aq 0
"PHONE "1 / ✓
CONTRACTOR'S �L
'AME OUTLETS-SWITCHES-RECEP 10.00/1.00
399985
Urbari� Systems, Inc. LIC,NO, LIGHTING FIXTURES' 10.00/1.00
ADDRESSroRs PPLIANCES-RESIDENTIAL 4.00 ADDRESS O.. . 313-485-8477
2701 N. 1-94 Service Dr. PHONE PANELS ' 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO. .
oPANELS (OVER 200 AMP) ' ' 20.00
ENGINEER Assoc. In Architecture E9.462 `
LIC.No. , SIGNSTRANS. 3.00
ARCH.OR ENG - PERMIT VALIDATION
ADDRESS 11801 N. Tatlzn Blvd., Ste. '11D SPECIAL CIRCUIT 5.00
Phoenix AZ zip 85028 TEMP.METER OR POLE INS. 20.00
APPLICANTS 2701 N. I-94 Ser'ice Drive MOTORS SEE FEE SCH. -
_ ADDRESS
Ypsilanti, MI 48198 SERVICE CHANGE 20.00 /�/�'}'1(�p,
Doo LICENSED CONTRACTORS DECLARATION V
a U,U I hereby arm that I am licensed under provisions Of Chapter 9 Is DATE '
y< w (commencing with Section 7000)of Division 3 ofd t,h�[e[yBusiness and BLDG. 'ELECT. PLG. MECH.
F ❑i Professions Code,abd my license is in full force 877705 ❑ ❑'
o 0 A W License Cass Lic.Number 777
Date '-92 contractor
BODING PERMIT
M¢ ¢a OWNER-BUILDER DECLARATION
a" - REFER TO ORD ORMATION
w ; ae H 1 hereby affirm that I am exempt from the Contractor's License Misc.'- V LUATION 3/FT.
F uo ¢ Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
rta,¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. 'ELEC.
K ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
e. w m ac he is licensed pursuant to the provisions of the Contractor's License '
rzi Law(Chapter 9(commencing with Section 7000)o'Division 3 ofthe' 1 �NTER�C•Q IM
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ I- �. the basis for thealleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
u , by any applicant for a permit subjects the applicant One civil penalty ALTER-DRAIN'&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5000.) -
❑ 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.FLOOR AREA TOTAL ACREAGE
himself or through his own employees:provided that such improve-
ments are not intended or offered for salcAh-however,the building GAS-EA.SYSTEM-11NC.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 ofproving that he did not build or im- RES IND L CON PB -OdM1ar
prove for purpose of sale.). I N D USTR IA L W ASTE I NTE R. 30.00
❑ 1,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 contractor(s)licensed pursuant to
the Contractor's License Law.. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iamezemptunder Scc. ,B.&P.C.fnr this WATER HEATER W/VENT 6.00
reason
Owner .. ''Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATERTREATING EQUIP; 5.00
1 hereby affirm that I have a certificate of eonsent to self-insure, - ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereoM.3900,Lab.C.). See . tt led -
Policy No. -Camp any
O X Certified copy is hereby.fumishe /Jn1 FIRESPRINK ENERGY T 24
Z ❑ Certj op Is led with tt�h icy peclion divislo
� O APphcant �`•✓ E,� l= ��0 MISC.- REFER TO ORD. Y ❑ N❑ I Y ❑ -N❑
2 - CERTI FICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 - FLOOD ZONE A.L.0 C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG,
0-' Z (This section'need not he completed if the permit is far one TOTAL y,❑ N❑ Y❑ N❑
hundred dollars($100)or I.S.)
" L) 0 I Certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner so as to
0 U become subject to the Workers'Compensation Laws of California. p�
y Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING O
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex- _
F ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 - PLAN CHECK
provisions of the Labor Code,-you must forthwith comply with FEE
(� such provisions or this permit shall be deemed revoked.' - AIR HANDLING UNIT(TO 10,000GF.M.) 4.00 -
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction handling agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for whichthis permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
oformalion As correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 r
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 1004000 BTU)SEE FEE SCH. MECHANICAL 'I
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of III REFER TO ORD.
aper ino against 'Staff' 'es 'udgments, costs,and expenses which .PERMIT ISSUANCE 10,00 CONST.TAX
or
41his a cc net said City in consequence of the
MECH.CONT. LIC.NO. - .TDrnL TOTALSignapplicant/Contractor Date
OFFICE COPY