15381 POST THISA&RD NEAR FRONT OF BUILDING
I ERMIT NUMBER
cl OF CUPERTINO ' 15381
INSPECTION DIVISION ,
JOB INSPECTION RECORD
% L'w PERMIT EXPIRATION
JOB ADDRESS VC /��3 N. . �/dC.F � UNIT# _LOT#
' - PERMIT EXPIRES IF WORK''
OWNER ;'�' N CONTRACTOR - ' IS NOT ,STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD " 180 DAYS OF PERMIT'ISSU.'.
EPREGUNITE
TION NOTE:' - '- ANCE•OR 180 DAYS FROM ,
- ALL GRADING AND DRAINAGE SHALL BE INSTALLED: LAST CALLED INSPECTION.
TO COMPLY WITH THE APPROVED PLANS AND CITY'OF' PERN+IT VALIDATION
CUPERTINO STANDARDS.SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p
'UNDERGROUND,/SLAB y
PLUMBING
ELECTRICAL f
. l U. ISSUANCE DATE
MECHANICAL,',., - - - y -y{ ( BLDG:' I ELECT. - 'PLG. „MECH ,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING'PERMIT
WDOD FLOOR - INFORMATION
PLUMBING
E�T.Rl'ESU
_ Y' SIFT,.
MECHANICAL. .,. - *41
ELECTRICAL" IT TO
FRAMING G C6Y 1 -INSULATION. rvPEcorysrR,.
RES UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
i$O.FT FLOOR AREA TOTAL ACREPGf
ROOF• NOTE:NO FINAL.INSP.SHALL BE MADE BEFORE.' '
DIAPHRAGM THE CONSTRUCTION TAXIS PAID _
ROOF SHEATHING. BUILDING USE
. _ RES IND CON Ps ar„d
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ ❑ ❑ Cl ❑
ASSESSORS PAq
ROUGH SAN.# CE-
L NO.
' PLUMBING r ,ELECT.ENERGY
TUBS&SHOWER PANPLUMBING ENERGY TRACT No. - PARCEL NO
MECHANICAL'- .. 'MECH.ENERGY
ELECTRICALACC DATE ACC.FILE NO.
BUILDING ENERGY
FRAMING t .ELECT,FINAL TEST `
' INSULATION - PLUMBING - ' 2ON1N0 ENG SITE NO.•�
:GAS TEST GAS
- MECHANICAL _ '�/ FIRE saRI"K ENERGY T.za I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING , ❑ "❑ [:] ""❑
EXTERIOR�SHEAR ELECTRICAL RELEASE TLooD Z07. P.L u.c. .
INTERIOR SHEARFIRE DEPT. . - v❑ . N❑ v ❑ ' -.NQ
-' SHEETROCK GRADE >. FEESUMMARY
EXTERIOR LATH - - • .BUILDING
INTERIOR LATH - - - TEMPORARY'APP.ROVALS `BUILDING
' - SCRATCH COAL ' , . ELECTRIC PLAN CHECK 4
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE *•1
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM, <
ARRANGE FOR=INSPECTION BY PHONING 252:4505, ELECTRIC
I-ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING
z PLEASE GIVE JOB"ADDRESS WHEN PHONING..
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL }
=IMPORTANTI CONST..TAX .
PLEASE READ REVERSE SIDE BEFORE I
CALLING FOR FINAL INSPECTION TOTAL ( ,,
OFFICE CO
APPLICANT TO FILL IN INFO ATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BPERMIT NUMBERUILDING PROJECT IDENTI FIC APPLICATION & PE T
OU 4DDRENG 15 3 81
°°REss
A. Wa[FE SPAC.f O/J BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
ER'a C PLAN CHECK VALIDATION
"nme ) OTV. ELECTRIC PERMIT FEE I
• fR A4I PHONE 1 �-� (��U74
NAME
CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00 •�
NAME
AA I.C.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR" 7Yel geeNF Ayf. PPLIANCES-RESIDENTIAL 4.00
ADDR Ess
00 t Vlj &,j4MNe PRoR yTdoa PANELS 10.00 DATE OF APPLICATION.
ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.,NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH,OR ENG. - 5,00 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT _
ZIP EMP,METER OR POLE INS. 20.00
APP'LCESS1 ~' MOTORS SEE FEE SCH.
A° Rl A '/
oo
SERVICE CHANGE 20.00 'y/'/7/0 0
mLICENSED CONTRACTORS DECLARATION / 1 ` A
a u u I hereby affirm that I am licensed under provisions Of Chapter 9 Y- ISSUANCE DATE
H 2 u (commencing with Section 7000)of Division 3 of the Business andBLDG. ELECT. PLG. MECH.
z
Professions Code,and my license is in full force and effect. Y ❑ ❑ ❑
9z oLicense Class Lie.Number
H w. Dale Contractor tJ it !'�
P Y F, N BUILDING PERMIT
¢ ¢ e 'OWNER-BUILDER DECLARATION INFORMATION
Aoi" MISC.— REFER TO ORD , -
w 3 0 w 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
F .. Oa Law for the followingreason.(Sec.7031.5,ermBusiness t tocand Professions PERMIT ISSUANCE 10:00
Code: e,Any dem y sh coun pair any reqStrucrSa ture,p permit o its issuance,
alser,o
6'/
at Q;� improve,demolish,or repair any Structure,poor t0 its isuana,also ELEC.CONTR. LIC.NO. FLED.
d E O'., requires the applicant for such permit IO tile a signed statement that TOTAL PERMIT Tf�
w2 he is licensed pursuant to the provisions of the Contractor's License L(,E�O
r.zi Law(Chapter 9(Commencingwiln Section 7000)ofDivision 3 ofthe FEE 1�vrG-oclo�p 1l/0000
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT
f 1 m STORIES TYPE CONSTR.
¢ $ the basis for the alleged exemption.Any violation ofeection malty
031.5
by any applicant fora permit subjects tile ant fee civil penalty gLTER-DflAIN&VENT-WATER (EA.) 5.00
of not more than five hundredproperty,
cloth.(my employees
❑ has owner at the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 oto.GROUP RES.urvlTs
inter sole compensation,will(S the work,and the structure is not
intended or offered for sole(Sec. 7044, Business and Professions DRAINS.FLOOR,ROOF,AREA,COND. 5.00
Code:The hContractor's build,or License Law docs net apply loan owner of
' property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 so.PT.—FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
ments are not intended or offered for sale.If,however,tine building
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 int- RES IND CON PS Omer
prov for purpose ofsale.). INDUSTRIALWASTE INTER. 30.00
I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCELNO.
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-OV ER 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.
❑ 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
OwncrO;&Af ap!7-412 D.R,31-IM WATER SYSTEM 5.00 ACC,-DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TR=EQUIP. 5.00I hereby affirm that I have a certificate ofconsenl to sell-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certifiedcopy thereof(Sec:3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z ❑ Certified copy is filed with the city inspection'division. MISC.- . Y ❑ N0Y ❑ IN
Applicantf' y PERMIT ISSFLOOD ZONE A.L.U.CCERTIFICATE OF EXEMPTION PROM WORKERS'UJCOMP17NSATION INSURANC17 -- PLG.CONTR. y� ryYF N❑C- (This section need not be completed if the permit is for one
2 hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to
O Q become subject to the Worker'Compensation Laws o1 California. BUILDING �G 0`Date Applicant ALTER-OR ADD TO MECH. 5.00
} W NOTICE: TO APPLICANT: If,after making this Certificate of Ex-
F ? condition,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
prov
isions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10,DWC.F.M.) 6.00 SEISMIC FEE Z1,27
1 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.C. HEATING UNIT(TO 100,000 B.T.U.) 8.00 l.
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMP I3 H.P.Dr 100,000 B.T.U.) 6.00
hereby au0mrim representatives of this city to enter upon the BOILER-COMP love,100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD. CONST.TAX
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00
ay in any way accrue against Said City in consequence of the
rantipg of this permit + MECH.CONT. LIC.NO, MOTEL
3-1741"� TOTAL 0
Signature of Applicant/Contractor Date
OFFICE COPY