15673 POST THIS CARD NEAR FRONT OF BUILDING dERM,TND"RER'
CITY OF. CUPERTINO 15673
INSPECTION DIVISION
JOB INSPECTION RECORD l
PERMIT EXPIRATION
JOB ADDRESS vi oz U T41—LOT#
n
PERMIT EXPIRES IF.WORK.'
GO-rd COATS' SuOWNER A ' . IS NOT STARTED WITHIN
INSPECTION 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
PREGUNITE ' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "" " ✓
UNDERGROUND /SLAB A
PLUMBING !r ,.:
ELECTRICAL- ISSUANCE DAT
MECHANICAL LOG ELECT PLG. MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED City Ot M BUN GING,IRNPERMIT
WOOD FLOOR ' ATION
VALUATION $/FT.
PLUMBING - --
MECHANICAL - - .. '
ELECTRICAL ' - PERnm To -
FRAMING' -
L 5�r
'INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT FLOOR AREA TOTAL ACREAGE
- ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -
r-� DIAPHRAGM THE CONSTRUCTION TAX IS PAID _
BUILDING USE
ROOF SHEATHING RES IND CON PB 00-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 0 ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH:ENERGY
ACC unrE ACC.FILE No
ELECTRICAL
BUILDING ENERGY
'FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. ,
INSULATION - PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPR INK . ENERGY T.as
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v �- " r 1:3NO
' EXTERIOR SHEAR ELECTRICAL RELEASE FLooO ZONE A.i.0 C.
INTERIOR SHEAR FIRE DEPT: vryrv�
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
' SCRATCH'COAT ELECTRIC p. PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCv SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ,
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, s ELECTRIC 6
If ONE WORKING DAY BEFORE REQUIRED.INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
0` Z - +ti MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE — its .
IMPORTANT! ,` _ 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 "
r 3U1 LDI NG PROJECT IDENTIFICATION - PERMIT
M �1
' 12 .
NUMBER
AP?LIGATION & PERMIT .
aDDRE5O /
0BUILDING-ELECTRICAL-PLUMBING_MECHANICAL 1.56
73
OWNERS PLAN CHECK VALIDATION
AA 7OYONE /r GiT. ELECTRIC PERMIT FEE
N'Ame acTORs I/LIO 'Oj UTLETS-SWITCHES-RECEP 10v6Bfi,00 S
U L�J IL 4�/ LIC.No. :ZS LIGHTING FIXTURES 10-00N-60 ,(a
CONTRACTOR'S APPLIANCES 4.00 - -
aooREss
PHONE gIS4SnI J Z PANELS .10.00 DATE OF APPLICATION
ARCHITECT - .PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
I,P TEMP.METER OR POLE INS. 20.00
AMOTORS SEE FEE SCH.
ADDRESS ORESS •
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
a U I hereby affirm that I am licensed under provisions of Chapter 9 •'17 ANCE DATE
H<i (commencing with Section 7000)of Division 3 of the Business and _ LECT. PLG.- MECH.
7 rofessions Code and 1 license is in full for e' et. ❑ ❑
Z i W License Class y Lic.Number
Date Contractor
a m E BUILDING PERMIT
' E ¢ ¢
OWNER-BUILDER R-BUILDER DECLARATION
M e. INFORMATION
w0 u w I hereby affirm Dmt 1 am exempt Irom the Contractor's License MISC.- REFER TO ORD VALUATION
F u H Q Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE iQVO �a^
wy Code:Any city orcounty which requiresa permit to construct.alter,
Qto ¢ Improve,demolish,Or repair any sl NCture,prior to IIS Issuance,also ELEC.CONTR. LIC.NG- ELEC.
i -y D¢ requires the applicant for such permit to file a signed statement that TOTAL (p PERMIT TO
X
m he is licensed pursuant to the provisions of the Contractor's License
F-zi
Law(Chapter 9(commencing with Suction 7000)of Division 3 oflhe
¢ Business and Professions Code)or that lie is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ r$ the basis for the alleged exemption.Any violation of Section 7031.5 -STORIES- - TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of nal more than five hundred dollars($500).1:
❑ I,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,COND. 5.00
Code:'file Contractor's License Law does not apply to an owner of
Properly who builds or improves thereon,and who does such walk F IXTUR ES-PER TRAP 5.00 SO.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.SVSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- ' GAS-EASYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that h .e did not build or int, BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
` ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ 0 ❑ ❑ 0
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
Contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT N0, PARCEL NO.
D I um exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. - 5.00
I hereby affirm that 1 have a certificate of consent to self-insure, - ZONING or a certificate of Workers'Compensation Insurance,or a cer ificd ENG.SITE NO.
copy thereof(See.3800,Lab.C.)z�N�Tl-/
Policy Noi Company
0 ❑ Certified copy is here ,fur 'he FIRESPRINK ENERGY T24
Z
❑ Certifiedhoms iBedl a nspeclion division.
Z
Applicant LW�RRIJ�r\\ �IVL// MISC.- REFER TO ORD. Yo N Y C3 NC]
= - CERtWirA'I'F:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOO20NE A.L.u.c.
Lu > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z( This section need not be completed if tile ❑e permit is for one TOTAL Y N� Y C] NC]
hundred dollars(S 100)ar less.l
U O 1 certify that in the performance ol'the work for which this per- GTV. MECHANICAL PERMIT FEE FEE SUMMARY
U; H mil is issued,1 shall not employ any person in any manner so as to
U become subjecLm the Workers'Compensation Laws of California.
y
Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of lis-
? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.RM.) 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.C.). 'HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's NameHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 6
Lcodcr's Address
Icer.ify that l have read this application and Aute that the above VENTILATION FAN (SINGLEI 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 13 H.P.or 100,000 B.T.U.).6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(Wc) agree to save, indemnify and keep harmless the City of MISC.-t REFER TO ORD.
uperlino against liabilities,judgments, costs and expenses which - CONST.TAX
ay in 41illy way aocrue ag 'nst Said City in consequence of the PERMIT ISSUANCE 10.00
Pontin o 1 nal MECH.CONT, LIC.NO. MECH.
TOTAL TOTAL
Sig ate is Co actor Date
OFFICE COPY