15245 POST THIA&JARD NEAR FRONT OF BUILDING PERMIT NUMBER
CIW OF CUPERTINO 15245
i\ INSPECTION DIVISION ,
JOB INSPECTION RECORD
tS7� /d2s' f} .. PERMIT EXPIRATION
JOB ADDRESS�o/a J !UNIT# _LOT#
''// e}. LGn C- - p v,t1,6 - PERMIT EXPIRES IF WORK
OWNER Vo LV•R1� s Lr OR CONTRACTOR �p (/ C .IS NOT STARTED WITHIN '
SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE - CUPERTINO STANDARDS. •.^�`
GARAGE'SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED l? $8 T II a Mcc aloovcT P*r
UNDERGROUND /SLAB
PLUMBING - -
ELECTRICAL IssunrvcE DATE
MECHANICAL O BLDG ELECT.I PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR `
oUATION SIFT.
PLUMBING
MECHANICAL
o<
PERMIT TO
ELECTRICAL. .
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.rr iLooH AREA TOTAL ACREAca
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDING USE
_ ROOF SHEATHINGHES IND CDN PB On
AMPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑" ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.k
PLUMBING 7. ELECT.ENERGY -
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN - PLUMBING ENERGY
MECHANICAL MECH"ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE No
FRAMING ELECT.FINAL TEST COMING ENc.SITENO.
INSULATION - PLUMBING '
GAS TEST GAS
MECHANICAL FIRE SPRINK. ENERGY T"za
$''L1 Y ❑ .N❑ y ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' ,
EXTERIOR SHEAR ELECTRICAL RELEASE 2_ rLDOD zoNE A L u c.
INTERIOR SHEAR - FIRE DEPT. v❑ N❑ v ❑ NO
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 JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING,IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.' MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMSIN6
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 6�
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES.- USF LL POINT PEN ONLY
f,dLNLDING PROJECT 16ENTIF WON ., .PERMITNUMBER-
Ao' REss 10143 ht.wore APPLICATION & P MIT 15245
V II�a1 n t 10 _ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL f"
OwNne 14 ' - f PLAN CHECK VALIDAT N
,N/AME //II 15 OTY. ELECTRIC PERMIT FEE
U 0 fpr rHaNE'a' QQ ,
CONTRACTORS
rvAM UTLETS-SWITCHES-RECEP 10.00/1.00
• UCNa 6653 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR' i - 1
ADDRESS � APPLIANCES RESIDENTIAL 4.00
/�
PANELS ' 10.00 PATE OF APPLICATION
-
`/7l ARCHITECT '1 J S J .PLAN CHECK FEE PIC,NO.
OR C�O 6 PANELS (OVER 200 AMP) 20.00 �
ENGINEER
p(„uc.Na. 'SIGNS TRANS. 3.00
ARCH.OR ENG. - - PERMIT VALIDATION
ADDREss 7- •I g 2.1 /T SPECIAL CIRCUIT 5.00
Q t IxI ,zlP 6 EMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS. MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
C i
Q d
Fo0 o LICENSED CONTRACTORS DECLARATION
a u u 1 hereby affirm that I am licensed under provisions of Chapter 9 '
2 w D ISSUANCE DATE
y a y , (commencing with Section 7000)of Division 3 of the Business and BLDG. ECT. PLC. MECH.
R H Z Professions, do d my license o in full fore d ff 3
z O m -. License ClLicra, .Number
9 z-��- Dale ConUuc[o ```
s.X w a OWNER-BUILDER OECLARAll N ��ING PERMIT
wo a " - V9 FORMATION
3 LL N 1 hereby affirm thnt 1 um exempt from the Contractor's License MISC.- REFER TO ORD
LL O.ai Law for the followin reason.(Sea 7031.5,Businessand Professions /VALUATION $/FT.
E - m g PERMIT ISSUANCE 10.00 fOQ
Eco> � Code:Any city or County my which structure,
u tune,prior
to its hrirel,altNo 000
or ¢ a O improve,dmnolish,or repair any structure,prior to its issuance,also ELEC.CONTE. UC.NO. , ELEC. I)
n
C,M requires the applicant for such permit to file a signed statement that - - TOTAL
w m is
he Is licensed pursuant to the provisions of the Contractor',License _ PERMIT TO -
�� Law(Chapter 9(commencing with Section 7000)of Division 3 of the �..4r � Q
Business and Professions Code or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ��11f/{{ 1�/ VC,
Z
fC I-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TVPE'CONSTR.
a3 � byanyipplicanl for ape it subjects the applicant Fort civil penalty
oALTER-DRAIN -WATER IEA.) 5.00
f not more than five hundred dollars($500).):
6 as owner of the property;or my employees with wagesBACK FLOW PROTECT.DEVICE .4.00 OCC.GROUP RES.UNITS
their soo le compensation,will the work,and the structure is notet
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00
'C:2k Code:The Contractor's License Law does not apply to an owner of
property who builds Or improves and collo does such work FIXTURES-PER TRAP 5.00 50.FL FLOOR AREA TOTAL ACREAGE
11 himself or through his own employeesn,Provided that such improve-
d JI ments are not intended or offered for sale.if,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 '
or improvement is sold within one year of completion,the owner-.
builder will have the burden of proving that he did not build or it.- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose o fsaleJ. RES IND CON PB Other
❑ I,as owner of the,property,am exclusively contracting with INDUSTRIAL WASTE INTER. . , 30.00 ❑ ❑ ❑ ❑ ❑
licensed contract.,, to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
or - AssEBSoflS PARCEL Na.
and Professions Code:The Colt...l '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 projectsWith v conlraetor(s)licensed pursuam to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor',License Law. TRACT N0. PARCEL NO.
❑ lam exempt under Sea
reason , WATER HEATER W/VENT . � 6.00 t
' '
Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. .5.00
hereby affirm that I have o certificate of consent to self-insure, - -
or a certificate of Workers'Compensa' I usurpce,or a cer' aid ZONING ENG.SITE NO.
copy thereef(Sec.3800,Lah.C.
Policy No. Company
O ❑ Certi of py is he anyf mishe FIRE SPRINK ENERGY T24
- 2 ❑ Cer tic p file It 'io division. ❑ ❑ ❑ ❑
z O Applicun MISC. REFER TO ORD. V N V N
Ir - CERTIFICATE FEXEMPiION FROM WORKERS' PERMIT ISSUANCE 10.00 ' FLOOD ZONE A.L.uC.
LU'> COMPENSATION INSURANCE PLG.CONTE. - LIC.NO, PLG.
CI( This section need not be Completed if the permit is for one TOTAL Y❑ N❑ v ❑ N❑
hundred dollars($100)or less)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL mit is Issued,I shall not employ any person in any manner s0 as to
O w become subject to the Workers'Compensation aws of California.
0. Date - Applicant , ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,alter making This Certificate of F.x-
♦- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U Inch provislonsorthispennit,shall bedeemed,,,Dked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10MC.FM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the Performance of.the work for which this permit is issued(Sec. MICROFILM
3097,Civ,CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
It- I certify that I hint read this application and state that the above VENTILATION FAN (SINGLE) 4.00 .j
•• $ information is correct. I agme to comply with'ell city and county. .PLUMBING
tx ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
1 hereby authorize representatives of this city to enter upon the
, bove-m CCt,.R,d property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
a
�+ (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
aper' o,against liabilities,judgments, costs and'expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ma m yny way acct agains aid City in consequence of the, _ _ -
r tin fthis permit MECH.CONT. LIC.NO. MECH. 7`110
/ M
.TOTAL TOTALJ`+
Signature oficant/Contractor at
OFFICE COPY