15620 POST-THIS CARD NEAR FRONT. OF BUILDING
'+`/ • PERMIT NUMBER
CITY OF CUPERTINO 15620
INSPECTION DIVISION
JOB INSPECTION RECORD ) i
�•YJ . / U I f .PERMIT'EXPI RATION
JOBADDRESS-1���`3 NII wDL FL"' L)- UNIT# _LOT#
]� PERMIT EXPIRES IF'WORK�
OWNER �9-L TO OF'- ,vwj Al- CONTE ACTOR '��cR'/L/F•� lT IS NOT. STARTED.WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD lao DAYS OF PERMIT ISSU
FOUNDATION - �•NOTE: ANCE OR 180 DAYS FROM
- UFER � � � � � ALL GRADING-AND DRAINAGE SHALL BEINSTALLED LAST CALLED INSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SCABS
CUPERTINO STANDARDS.
�' -'- � '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ; i
PLUMBING f G' •'� �'.
ELECTRICAL - 'A, . klklo -ISSUANCE DATE t
' MECHANICAL ' •- - BLDG, ELECT, PLG. : MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR I%V INFORMATIOfIl,
PLUMBING
VALUATION IV SIFT.
• _. � � - V �. . .
MECHANICAL, I ,
ELECTRICALPERMITTO;-;---o,
FRAMINGlnR(O,� / . ., RU
INSULATION - sroRles TYPE CONSTR.
n OCC GROUP RES UNITS
..
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' I
.. ROOF • NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' 50.FT.FLOOR AREA TO'FAIL ACREAGE
DIAPHRAGM. THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - - RES IND CON PB Oorl -
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ ❑ 11 El . IDROUGH. SAN.N nssessoas PARCEL No.
PLUMBING ELECT.ENERGY.
iHACT NO
PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
_ MECHANICAL " -- MECH.ENERGY - - t
EL'ECTRICAL', " - - BUILDING ENERGY ACC.DATE ACC FILE NO
' FRAMING ELECT.FINAL TEST'"
INSULATION '. - - PLUMBING`
O ZONING. ENG SITE NO,
GAS TEST GAS -
` - MECHANICAL -FIRE SP PINK ENERGY T.aa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ NO
FLoaO zoNE. A.L u,c. .'
EXTERIOR SHEAR " ELECTRICAL'RELEASE
INTERIOR SHEAR - • " FIRE DEPT. '^'• .`' ❑ ^'❑ Y ❑ ' N❑
SHEETROCK "' • GRADE FEE SUMMARY
EXTERIOR LATH zBUILDING. BUILDING
.INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT I ELECTRIC ( ...PLAN CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY •SEISMI C FEE.
OCCUPANCYOFBUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING.INSPECTOR. MICROFILM `
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC.
• 1-- , ONE WORKING-DAY BEFORE REQUIRED INSPECTION. PLUMBING .,
z PLEASE GIVE JOB AD 'WH
,DRESSEN PHONING.
='SEE PERMIT FOR'EXPIRATION DATE - MECHANICAL
IMPORTANT.I CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. '
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
LDl NG P I,;2�NTI FICATI ON - PERMIT NUMBER
a -• APPLICATION & PERMIT q r�0,
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL -„- I (�
PLAN CHECK VALI ATION
O '
? NAME' ?3 6 QTY. ELECTRIC PERMIT FEE ///�/�•R /�,
_ E 101V (I ..
CONTRACTOR'S
NAM1E1 �y / 'OUTLETS-SWITCHES-RECEP '10,00/1.00
�/• /�•S: uc.No p}��p(7 LIGHTING FIXTURES 10.00/1.00
#4&ffVS �I aJe� PPLIANCES-RESIDENTIAL• 4,00
J PHONE / PANELS 10.00 - DATE OF APPLICATION
HOfP�/�'JHHITECT L - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
Er�N�rER - LIC.NOO,Ov SIGNS.TRANS. 3.00
ARCH. ENG. n .PERMIT VALIDATION
} SPECIAL CIRCUIT 5.00
- -
1175229 EMP.METER OR POLE INS. 20.00
APDL
ADDRESS Dt/Jeg� MOTORS 'SEE FEE SCH.
C'�
w31,4 .J ` a/alg 75.ug ISERVICE CHANGE 20.00
o Wio LICENSED CONTRACTORS DECLARATION
<u w, I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE"
H Q'y (commencing with Section 7000)of Division 3 of the Business and - - BLDG. ELECT. PLG. .MECH.
D i Professions Code,1) my license is in Cull Corcpanl effect/ - .❑ ❑ _ ❑
III 0o i = G License I s-� Lic.Number .IOLV.70
,�H, Omv Contractor X Q
a w u OWNER-BUILDER DECLARATION �Ta r 4,Q LDING PERMIT
MISC.- REFER TO ORD ``r I FORMATION
caa- 1 hereby affirm that 1 mn exempt from the Cons and Pr License , . VAD ON $/FT.
F la o,g Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
- Code:Any city or county which requires a permit to construct,alter, (..y(•�W.I`p�
2 ¢ G 0- improve,demelish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIG NO. ELEC.
K 0 a requires the applicant for Such permit to file a signet)statement that TOTAL �`'� - PERMIT TO
e. w m he is licensed pursuant to the provisions of the Contractors License "
Fzi Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
tt r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
ac'm by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN VENT-WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is no[
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
1 Code:The Conhnclor's License Law does not apply Ito an owner of +
property who builds Or Improves thereon,and who does such work FIXTURES-PER TRAP _L 6.00 SD.FT.
FLOOR AREA TOTAL ACREAGE
I himself or through his own employees,provided that such improve-
mentsare not intended or offered to,ogle.If,however,the building GAS-EA.SYSTEM-11NC.AOUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that h .e did not build or in- RES IND 'CON PR Other
r prove for purpose of sale.)' INDUSTRIAL WASTE 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 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 o contractor(s)licensed pursuant to SEWER-SANITAR V-STORM MEA.200ft/10.00
the Contractors License Low. TRACT NO. PARCEL NO.
❑ I um exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 - - -
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACD.FILE NO.
WORK E RS'COMPENSATION DECLARATION WATER TREATING EQUIP.. 5.00 -
[.�1 herebyr�affirm that I have a certificate ofconsent to self-insure,
.�j _ ZONING ENG.SITE NO.
O' chlM Compensation Insurance,or a certified ^
WFMSi ab.CJ.0 �/. -5. AF
Policy No Company LTy.
Q Certified copy is hereby furnished. '- FIRE SPRINK ENERGY T-24
Z Z ❑ Caroti cpp��y is Fit d w'th the city irepectmr.divoicm
O Applicant Il�UL.1'. MISC.- REFER TO ORD. -Y❑ N❑ Y ❑ .N❑.
~ w PERMIT ISSUANCE 10.00 FLOOD ZONE ' A.L.U.C.
� CERTIFICATE E EXEMPTION FROM WORKERS'
CL COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Z (This Section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars IS 100)0,less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mil is issued,1 shall not employ any.person in any manner So as to , d�
U become subject to the Workers Compensation Laws of California.
i Date n Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO•APPLICANT. If,after making this Certificate of lix-
F Z 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
5 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) -4.00
CONSTRUCTION LENDING AGENCY - 'AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE -7 46
1hereby 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
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(3 H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP )Over 100,000 BTU)SEE FEE SCH. MECHANICAL ,
above-mentioned property for inspection purposes.
( ) a ree to save, indemnify and k p I ales$ thelICity of MISC.- REFER TO ORD.
A
nags lialpfieiea os�pen5pl�h - CONST.TAX
�a e�eellee y gLen(KCfrMlff ah a PERMIT ISSUANCE 10.00
rami of s MECH.CONT. LIC.NO. MECH.
ignatn of pphe 0IPS Date rorAL TOTAL �aa
'OFFICE COPY