15714 POST THIS CARD NEAR FRONT OF BUILDING PEEMIT NUMBER
CITY OF CUPERTINO 15714
INSPECTION DIVISION
r JOB INSPECTION RECORD
! j 1007 4 PERMIT EXPIRATION,
JOB ADDRESS 101-3 /• , UNIT# _LOT#
PERMIT EXPIRES IF WORK '
OWNER bI/�L1J 'pC CONTRACTOR S t:�d-tet IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERM1UT VAUDATtON
PREGUNITE CUPERTINO STANDARDS. '
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ?,.,y` IA�Q-iC{� - I
UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG CT PLG.El ❑MECR
❑_ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $JET.
PLUMBING .�n
MECHANICAL - U 0(0 vERn+IT Tcv.
ELECTRICAL
FRAMING' B� SO. Y
INSULATION .. STORIES
oRlEs rvPE coNsrR
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
_ $O,FT,Fl.00R AREA TOTAL ACREAGE '
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
' euILOINc USE
ROOF SHEATHING - RES IND CON PB ou•.••
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. N
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING - - ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECK ENERGY
ALC.GATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING p . ELECT.FINALTEST ZONING cNG.SITENO.
INSULATION PLUMBING
GAS TEST - GAS
FIRE SPRINK ENERGY T.]4
MECHANICAL Y C] N[J Y [:] NC]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOOD ZONE A L UC..
—
INTERIOR SHEAR . FIRE DEPT. v rvE] v L7 N[]
I
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING
INTERIOR LATH
TEMPORARY APP OVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK ^'
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ? EIIEcrRlc
LU
ONE WORKING DAY BEFORE REQUIRED INSPECTION. a"
+''+w PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
Y, CONST.TAX
IMPORTANT!
t ,,e
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
R'IUI LDI NG PROJECT IDENTIFICATION ` -PERMIT NUMBER /
BUILDING APPLICATION & PERMIT q `�1
ADDRESS W 0 - • E / �O b.. I J f
UILDING - ELECTRICAL-PLUMBING-MECHANICAL
Owry ER's PLAN CHECK VALIDATION
NnME QTY. ELECTRIC PERMIT FEE I
LDE sz
NAMERACTDRs UTLETS-SWITCHES-RECEP 10.00/1.00
6S C Lie NO. 53163 LIGHTING FIXTURES 10.00/1.00
ADDRESDDRESS NTH o 's APPLIANCES:RESIDENTIAL 4:00
A /r�D
3 S ^HONEr 2 02$ D PANELS 10.00 DATE OF APPLICATION
- ogcerrecT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.No.
ENGINEER
IV1 s PA
Wi Lc.No.C3 06'2S SIGNS TRANS. 3.00
ARCH.OR ENG., PERMIT VALIDATION
ADDRESSSPECIALCIRCUIT 5.00
�A IN rat. ig /CA.grkV
zz1f EMP.METER OR POLE INS. 20.00
aooAess Ts STR'M MOTORS SEE FEE SCH.
ZOO I colt) SERVICE CHANGE 20.00
'02
0o LICENSED CONTRACTORS DECLARATION l' `
a
0U 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w (commencing with Section 7000)of Division 3 of the Business and
G. ELECT. PLG. - MECH.
H N- Professions Cod and my license is in full fort d ft IS a ❑ ,❑
Is
i a o License Cass LIC.Numbs
w H w Dale Contracmr JUL
Q y E J t r 11BUILDING PERMIT
¢ ¢ ¢ OWNER�BUILDER DECLARATION
Er a v .I FORMATION
wg N 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD UUVVAtMWTION $/FT.
H u o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
�+ Code:Any city orcounty which mquiresa permit to construct,alter, w�f�l
KQ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also EL E O.CONTR. LIC.NO. ELEC.
o¢ requires the applicant for such permit m file a signed statement that TOTAL
he is licensed pursuant t0 the provisions of the Contractors License PERMIT TO
1 rzve Law(Chapter 9(commencing with Section 7000)Of Division 3 ofthe t'/1//�LQ� .Ytr/i,i Q�
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE /x
¢ 1-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
Ic by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(55001.1: _
❑ 1,as owner of,the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Occ.GROUP RES.uN1TS
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 does not apply to an owner of
property who builds Or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- - '
mems are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 '
Or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that h - .e did not build or im- BUILDING USE
RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively. 7044,lBu with ❑ ❑ ❑ ❑ ❑
licensed contractors:The Contractor's
the project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The who
builtor's License Law does not apply
to contracts
owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER'5(EA.) 1.00 .
the Cont for such projects with a conlmclor(s)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00
the 1 hooch License Law. TRACT N0. PARCEL NO.
❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
. WORKF-RS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING
r a certificate of Workers'Compensation Insurance,or u certified ZONING, SITE NO.
copy thereof fSec.3800,Lab.CJ./t
Policy No.-Company-
0
Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certife Is filed wi I the ci i eellon i
F O Applic,nt� `�r- i_i MISC.- REFER TO ORD. Y ❑ ,N❑ Y❑ N❑
rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.D.C.
LU CERTIFICATE COMPENSATION EXEMPTION FROM WORKERS'
IU needntbeco INSURANCE PLG.CONTR. LIC.No. PLG. Y❑ N❑ Y❑ N❑
Z) Z hundred
section neednot be completed if the permit Is for one TOTAL
hundred dollars IS 100)or less)
L) O 1 certify that io the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
U become subject m the Workers'Compensation Laws of California.
O'w BUILDING O
IL Date Applicant, ALTER OR ADD TO MECH. 5.00 S�
} 0 NOTICE TO APPLICANT: If,after making Workers'
rs'Compensation
sa Ex
Z emplio n you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK ,
provisions io the Labor Code, you deemed revoke comply with - FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00DQF.M.) 4.00
AIR HANDLING UNIT(OVER 1041MC.RM.) 6.00 SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance Of the work for whl r this permit is issued(Sec. MICROFILM
3097,Ce.C.I. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name / HEATING UNIT(OVER 100,000B.T.U.)9.50 1 .ELECTRIC
Lender's Addie' "
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 state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes: BOILER-COMP(Over 100,000 BTU)SEE FEE BCH. MECHANICAL
(We) agree to save, indemnity and keep harmless the City o1MISC.- REFER TO ORD. -
upertino against liabilities,j gments, costs and expenses which PERMIT ISSUANCE 10.00
tig dd CONST.TAX
a a way accrue a ai at said City in consequence of the
r iL / � MECH.CONT. LID.NO, , MECH. - 'I`y,
.f/a TOTAL TOTAL ( `FTs+
ureof Applican/Con acto Date
OFFICE COPY