15061 POST THIS CARD NEAR FRONT OF BUILDING
'PERMIT NUMBER
CITY OF CUPERTINO 15061
INSPECTION DIVISION
JOB INSPECTION RECORD
• � � - PERMIT EXPIRATION
. , JOB ADDRESS A) UNIT# _LOT# -
(+- - PERMIT EXPIRES IF WORK
OWNER 0/LTS. �'TVF CONTRACTOR /(/ IS NOT STARTED WITHIN
INSPE ION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
_ NOTE: - • LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS • - CUPERTINO STANDARDS. - ,r •/- ��T
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /i.-:`.+ !�•P
. 'UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ' ISSUANCE DATE
MECHANICAL - - _ BLU, 'ELECT. PLG. MEc.
❑ E❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - QA, I BUILDING PERMIT
WOOD FLOOR
INFORMATION
- LUATION s/FT.
PLUMBING ". IM,
MECHANICAL, I;
ELECTRICAL, - u PERMIT TO -
_ FRAMING ` Cs-
INSULATION STORIES TYPE CONSrR
OCG GHCUP RES,UNITS 11
I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
• _ ROOF _ NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO,rr ELooa naeA TOTAL AcacncL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING " HES IDD CON PB On..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El 1:1 ❑
ASSESSORS PARCEL NO .
ROUGH SAN.q
PLUMBING - ELECT.ENERGY
• TRACT NO, PARCEL NO
TUBS&SHOWER PANPLUMBING ENERGY '
MECHANICAL MECH.ENERGY
._ ELECTRICAL BUILDING ENERGY ACC,DATE ACC,FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING -
- ZONING ENG.SITE NO.
GAS TEST.. GAS
- MECHANICAL FIRE SPRINK ENERGY 1 2
. _ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ "E) , ` ❑ "0'
EXTERIOR SHEAR ELECTRICAL RELEASE F�OOu¢orve ' n.i a a_
INTERIOR SHEAR. FIRE DEPT. Y❑ "� ° "�'
SHEETROCK GRADE FEE SUMMARY
_ EXTERIOR LATH - BUILDINGr /v'— ^� BUILDING AG
INTERIOR LATH TEM ORARY APPROVAL "
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE ,J =
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE y'
OCCUPANCY'OF BUILDING ISNOT.PERMITTEDUNTILBUILDMG FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY,PHONING 252-4505, ELECTRIC
O�' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
,.• Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
—,SEE PERMIT FOR EXPIRATION DATE — MECHANICAL ,
IMPORTANT!
CONST.rnx
PLEASE READ REVERSE SIDE BEFORE ' TOTAL 14P
- CALLING FOR FINAL INSPECTION. ••—�
OFFICE COPY'
PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' BUI LdI NG PROJECT I DENTI FICATION - - PERMIT NUMBER ,
RUILDINC /0 j WaAPPLICATION & PERMIT
ADDRESS!/ V 15061
.
AS N BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER PLANCHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
SPD Ts EYEEP.-
CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00
NAM..E//�� •
2r1� LIC.NO. LIGHTING FIXTURES 10:00/1.00
rorvrRAcrOR s HRYW y/ APPLIANCES-RESIDENTIAL - 4.00
ADOREss j q
Z3� C(1l(G vjj PRONE -1I PANELS 10.00 ' OATEOFAPPLICATION `
ORRDNrtECT -
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER ^
' uc.NO SIGNS TRANS. 3.00
AARCH.OR
DDRESS ENO SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APORrPLICSS ra
ADOREss - MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
w 0 o LICENSED CONTRACTORS DECLARATION S
a i W I hereby affirm first 1 am licensed under provisions of Chapter 9 ISS ANCE DATE
y a% (commencing with Section 7000)of Division'3 of the Business and - BLDG. ELECT- PLG. MECH.
r w Z Professions Code, p t 'cense a in full forces yJl
o i w o License C ass Lic.Number ❑ 11
Date Contractor
¢ x f BUILDING PERMIT
¢ cr n O OWNER-Bill LDER DECLARATION - INFORMATION
WI-' I hereby affirm that I um exempt from the Contractor's License MISC.- REFER TO ORDI IL
u u m _VAIpVHTION $/FT.
F _oJ Law for the following reason.(Sec.7031.5,Business Professions PERMIT ISSUANCE 10.00 &ATI
Code:Any city or county which requires a permit o construct,,also
¢ R¢ 0 improve,demolish,or repair any s[ructuro,prior[o its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a - DLL requires the applicant for such penal[m file o signed statement that TOTAL RMIT TO -
R
m he Is licensed pursuant to the provisions of the Contractor's License
Law(Chepter9(commencingwith Section7000)ofDivision3oflhe / . .
¢ Business and Professions Code)or that he is exempt therefrom and (2TY. PLUMBING PERMIT
f i D
' ¢ I- m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a 3 .- by any applicant for a permit subjects the applicant to a civil penalty .ALTER-DRAIN&VENT-WATER (EA.) 5.00 .
of not mare than five hundred dollars($5000.):' "
❑ I,as owner of the property,carmy 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 5.011 80.IT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
mentsarenotintendedorofferedforsale.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 IEA.)' -. 2.00 BUILDING USE
builder will.have the burden of proving that he did not build or im- RES INDCON PB Our.,
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 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 VAL 6.01) - - 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 SEWER-SAN V-STORM EA:200ft/10.00
the Contractor's License Law. - TRACT NO, PARCEL NO.
❑ 1 am exempt under See. ,B.&P.C.for this WATER HEATER W/VENT 6.00 '
mason-
Owner Dote 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 self-insure, -ZONING ENG.SITE NO.
or ii certificate of Workers'Compensation Insurance,or a certified _
Copy there 0,Lab.C.). `.,f '
Policy ereff••]]�B L��lg60,Lub. -7 if✓I I 'YY1 ,
0 [:]
copy is hereby font he� - FIRE SPRINK ENERGY T-24,
Z Z 1 i Certified-p� f11�{� to c �N�Spection division MISC.- REFER TO ORD. ❑ ❑ ❑ • ❑
UX rCpplicanlyv 6i� 11N//!!! - V N V N
LU CERTIFICATE TION PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.C.
C0 OF EFROM WORKERS'
W � � COMPENSAATIOTIO N INSURANCE - PLG.CONTR. LIC.NO.. PLG. - -
CL 0 (This section need not be completed if the permit is for one 'TOTAL .V❑ .' N❑ Y❑ N❑
Z hundred dollars(S 100)orlem) r
- V O I certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
(L F mit is issued,I shall not employ any person in any manner So as to
U become subject to the Workers'Compensation Laws of California.
w Date A Imam FELECTRIC
a pP ALTER OR'ADD TO MECH. 5.00 -
} US NOTICE TO APPLICANT: If,offer making this Certificate of Ex-
(_ Z eruption,you should became subject to the Workers'Compensation APPLIANCE 5.00 CK
provisions of the Labor Code,•you must forthwith comply with
V such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)X0C.F.M.) 6.00 EE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which thispermitis issued(Sec. HEATING UNIT(TO 100,000 B.T.U:) 8.00 M
3097,Civ.CJ. _
Lender's Name HEATING UNIT(OVER/00,000 B.T.U.)9.50 Lender's Address '
I certify that1 have read this application and dale that 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-60MO Over 100,000.BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree io.Save„indemnify and keep harmless the City of MISC.- - REFER TO ORD.
Cupertino against liabilities,judgmnts, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in an way accrue a t id fly in consequence of.the -
tinting t is permit.
� MECH.CONT., LIC.NO. MECH.
" � TOTAL
.Signs re-of Applicnt oTacor S /� �LTOTAL
Ute '
OFFICE COPY r.