15643 POST THIS CAR NEAR FRONT OF BUILDING . 'PERMIT NUMBER
-CITY .N CUPERTINO
INSPECTION DIVISION "
JOB INSPECTION RECORD
• ld'Z - PERMITEXPIRATION
,JOB ADDRESS—�'9%�34 kt/d LFe Ad 'UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER c CONTR CTORL�-Q•, CT IS :NOT STARTED,WITHIN.I .
INSPECTION DATE INSPECTOR INS PEC ION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - NOTE: •ANCE OR 180 DAYS FROM
LIFER ALL AND DRAINAGE SHALL BE INSTALLED ,LAST CALLED INSPECTION.
LL
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. _
GARAGE SLABS ';.,,..-•"
POUR NO CONCRETE UNTIL ABOVE HAS B EN SIGNED
UNDERGROUND /SLAB -
PLUMBING -
, I
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDr• ELEcr,. PLG. MECH.
._ ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION, $rFT.-
PLUMBING
MECHANICAL
ELECTRICAL PERMITTO
FRAMINGc`••// '
INSULATION - STORIES, •TYPE CONSTR.
' OCC.GROUP HES UNITS
PLACE NO SUBFLOOR UNTIL-ABOVE HAS BEEN SIGNED
SO,FT.FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
i., DIAPHRAGM THE CONSTRUCTIONJAX IS PAID -
BUILDING USE
ROOF SHEATHING L .• RES NO CON PB GO—
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ • ❑ ❑ ❑ ' ❑
ROUGH SAN.p
ASEESSOHS PARCEL NO.
�
PLUMBING _ ELECT.ENERGY - TRACT NO. PARCEL No
TUBS&SHOWER PAN . PLUMBING ENERGY.
MECHANICAL .MECH.ENERGY
ELECTRICAL BUILDING ENERGY .. ` ACC DATE ACC.FILE NO
FRAMING' ELECT.FINALTEST '
20NING - ENG.SITE NO.
�. INSULATION - PLUMBING ,
GAS TEST . - GAS
MECHANICAL FIRE SPRINK ENERcv,T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ V ❑ N❑.
EXTERIOR SHEAR - ELECTRICAL RELEASE ROOD ZONE Al-U c_
INTERIOR SHEAR FIRE DEPT, Y ❑ N Y ❑ N❑
SHEETROCK' - GRADE FEESUMMARY
• EXTERIOR LATH BUILDING -
INTERIOR LATH . TEMPORARY APPROVALS. BUILDING
SCRATCH COAT ' ELECTRIClep PLAN CHECK
..` . .- - GAS+ FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
' OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM'
-ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING r
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE - 0
IMPORTANT! CONST.TAX,
PLEASE READ REVERSE SIDE BEFORE ' TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY.
I "
APPLICANT TO FILL-IN INFORMATION WITHIN REDLINES = USE,.BALL'POINT PEN ONLY
`SUI LD1 NG PROJECT I DENTIF CATION PERMITNUMBER
pu 1palNs l,o� Ab a , APPLICATION,& PERMI'I4 Ind
d 1-543
'OZ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL t' v
OWNER'S .. i PLAN CHECK VALIDATION
tNAME
" QTY. ELECTRIC PERMIT FEE I, .
F^ `,PHON _ C
M ncToRaN� UTLETS-SWITCHES-RECEP' 10.00/1.00
"LIC.No. jvv LIGHTING FIXTURES 10.00/1.00ACTOR'S ,• -
ADOREss APPLIANCES-RESIDENTIAL 4.00 ,-
N 4(/' PHONE :� - PANELS - -' 10.00 1 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
on PANELS (OVER 200 AMP) 20.00
ENGINEER ..
� LIC.No. SIGNS TRANS. 3.00 '
AOORESS ENG SPECIAL CIRCUIT r 5.06 PERMIT VALIDATION
ZIP" - EMP.METER OR POLE INS. 20.00
APPLICANTS z MOTORS SEE FEE SCH.
ADDRESS Fr
SERVICE CHANGE : 20.00 /d 0 ,
H
00 LICENSED CONTRACTORS DECLARATION -
�w I hereby affirm that 1 am licensed under provisions of Chapter 9
ISSUANCE DATE
v, <w' (commencing with Section 7000)of Division 3 of the Business and- BLDG. ELECT. PLG. MECH.
r 2 Professions Co�dy,_a d license is In full force a d effect.
o z=o License Class Lic.Numb r
F N F j '
Date ``'•_' Con(racto - I
a r - BUILDING PERMIT
¢ o w OWNER-BUILDER DECLARATION INFORMATION
w g c .1 hereby affirm that I am exempt from the Contractor's License 1 MISC.-- REFER TO ORD
u -VALUATION
uDj . Law for the following reason(Sec.7031.5,Businessand Professions
H _3 va g PERMIT ISSUANCE 10.00 '
Coda: e,dem y'or county which structure,
requires ne permit rioto its issuance,
also - -
'Q ¢¢Q improve,demolish,or repair any stracWre,prior to its issuance,also ELEC.CONTR. .UC.N0.c ELEC.requires the applicant for such permit to file a Signed statement that TOTAL PERMIT TO
u w m w he is licensed pursuant m the provisions the Contractor's License - '"
H2> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
sEo
,¢ r $ the basis for the alleged exemption.Any violation t too
malty STORIES TVPE.CONSTR.
a 3•-
by any applicant Cora permitsubjectsd.Ithe 0d.): ant too civil penalty ALTER-DRAIN VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).1: - `
❑ 1,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,CON D. 5.00 -
_ Code:The Contractor's License Law it...not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS' 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 iIn- GAS-EA.SYSTEM'-OVER 4'(EA.) 2.00 BUILDING USE
• ose RES IND CON PB Other
prove 1,aso nee of sale.). INDUSTRIAL WASTE INTER. - 30.00 O E ❑s ,- ❑
❑ d as owner rt the property,he exclusively contracting with
licensed contractor's to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Lew does not apply to antr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS'-OVER 5(EA.) 1.00
confronts Contractor's
h projects with a con[ractor(s)licensed Pursuant m
' the Contractor's License Law. - SEWER-SANITARY'-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ [am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT' 6.00
reason
4 Owner' Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO. r-
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hcroby affirm that I have a certificate of consent to self-insure, ZONING
or a certificate of Workers'Compcnsation,lnsurance,or a certified ENG.SITE NO.'
Copy the f( c.3V Lab.C.
Policy N 3olnPan,-
0
an, .',�x�fra(�
Q ❑'-Certified copy is herebyfrlrnin ed FIRE BPRINK - ENERGY T-24
z . Certified, copy is filed with-the'city inspection division. MISC- REFER TO ORD.
O APPl icunl `' Y N Y N
~.rn - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
Lid'� : COMPCERTIFICATE E EXEMPTION FROM WORKERS'
• W ' ENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG. '
CLI2 ❑
(This section need not be completed.if the permit is for over TOTAL Y❑ N Y .N ,
hundred dollars(8100)or less.)
00 I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
W P Fork Issued,1 shall not employ.any person in any manner so as to
0 become suhje t to the Workers'Compensation Laws of California.
�,y Date Applicant ' ALTER OR ADD TO MECH. .5.00 BUILDING ,
} 0 NOT CLO APPLICANT If,alter making this Certificate of Ex-
t F:z' emption,you sle.mid become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code;you must forthwith comply with AIR HANDLING UNIT 1.. FEES
U„ such provisions or this permit shall be deemed revoked. (TO 10,000 C.F.M.) 4.00
,,CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 -SEISMIC FEE
•I hereby affirm that there'isra constractloe.lending agmmy far 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.).'
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 , ELECTRIC
Lender's Address
1-certify that I have read this application and state that the above 'VENTILATION FAN (SINGLE) 4.00 -
inforniation•is correct. I agree to comply with all city and county - PLUMBING '
ordinances and state laws relating to building construction, and BOILER-COIVP(3H:P.Or 100,000B.T.U.) 6.00 -
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over t00,000BTU)5EE FEESCH. MECHANICAL 30
above-mentioned property for inspection purposes. - -
(We)+agree to save, iademnify.and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which NST.TAX
may in.any way accrue against said City in consequence of the PERMIT ISSUANCE 2-.00Ila--NIla
ranting ofthis permit. MECH.CONT. LIC.NO. , MECH.
.X - p TOTAL �, -
IS 2 /�cA/ f u Ix�13 3 0 TOTAL
Lhignatulle of Appbcanl/Conpltecor note -
OFFICE COPY