15757 POST THIS CARD NEAR FRONT OF BUILDING -
♦ PERMIT NUMBER
CITY- OF. CUPERTINO
INSPECTION DIVISION ' 15757
JOB INSPECTION RECORD
// ��//�((''JJ�� Y�r PERMIT EXPIRATION
JOB ADDRESSL(3ZC0 /VI' WO G. /Q� UNIT,# _LOT# ' -
+ PERMIT EXPIRES IF WORK
OWNER �L�L / �, V e�Lr CONTRACTOR s} L(p(r IS NOT STARTED WITHIN .
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
.NOTE: 'LASTCALLED INSPECTION.
-
LIFER NOTE:
GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS 1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r. l•_ _ b
UNDERGROUND/SLAB /y 9i i
PLUMBING V '{ " ' 0
ELECTRICAL
ISSUANCE DATE
MECHANICAL - BLUG. ELEcr PLG. .MEC..
❑ ❑ VQ
❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- , I WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT.
-
MECHANICAL ''� �
ELECTRICAL PERMIT TO- p
FRAMING
INSULATION 5T RIES TYPE CONSTR
I - OCC.GROUP RE6 UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO,FT.FLOOR AREA TOTAL ACREAGE
ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
J' n ROOF SHEATHING HES ' IND ILOCOON usEPe onw,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ a; ❑ ❑ ❑
ASSESSORS PAR CELNO.
ROUGH SANA
PLUMBING - (�j ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY - ' TRACT NO PARCEL NO.
MECHANICAL - MECH.ENERGY
ELECTRICAL., BUILDING ENERGY -Acc DATE ACC FILE NO +
FRAMING. ELECT.FINAL TEST
ZONING ENG SITE NO.
INSULATION PLUMBING
AS TEST, GAS
MECHANICAL FIRE SPRINK ENERGY TQ9
OVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ N❑
" I. EXT IOR SHEAR ELECTRICAL RELEASE 'FL000ZONE A,LU,C
INTER OR SHEAR FIRE DEPTH °'❑ "❑ Y ❑ N❑'
SHEETR CK - GRADE FEE SUMMARY
EXTERIO LATH BUILDING
. INTERIOR ATH TEMPORARY APPROVALS BUILDING
SCRATCH CO T ELECTRIC - 'PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF UILDING IS NOT PERMITTED UNTIL BUILDI NG FINAL ISSIGNED BY BUILDING INSPECTOR, ' MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, i' ELECTRIC
"' ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING: PLUMBING I�
�I Z 'I i11i MECHANICAL -
f" SEE PERMIT FOR EXPIRATION DATE
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFbAE
CALLING FOR-FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT, PEN.ONLY
- ---MIILDING PROJECT IDENTIFICATION PERMIT NumBER
'( BUILDING APPLICATION & PERMIT
Fo REss 1.5757'
T. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL w..
OwNE 'PLAN CHECK VALIDATION
"orae t QTY. ELECTRIC PERMIT FEE v'
NaldT T .
s OUTLETS rSWITCHES-RECEP 10.00/1.00 j
LIC.No. LIGHTING-FIXTURES 10.00/1.00
r. DRESS 's x .t APPLIANCES-RESIDENTIAL 400
ADDRESS 7 -
NE �/. PANELS ' 1000 DATE OF APPLICATION �.
• cHHECT
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE- PC NO.
,
ENGINEER
sec.NO ISIGNSTRANS. 3.00
ARCWOR ENG. 6.00 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT ,
ZIP EMP.METER OR POLE INS.i 20.00
ADDRESS Ts - MOTORS - 'SEE FEE SCH.
njj (// GL SERVICE CHANGE - 20.00 ^✓/,L (/
moo LICENSED CONTRACTORS DECLARATION
u I hereby affirm that I am licensed underprovisions of Chapter 9 - ISSUANCE DATE '
H W (commencing wrlh Sectio 7000)of Divisioo•3 of the Buslgess and BLDG. ELECT. PLG. MECH
r i Professions C an icens Is m full fo {nd,BUp�p7CJ
z o vwi- Licen las - L¢ Number S,L3 I' - - ❑ ❑. ❑
O w w Date Contractor
K BUILDING PERMIT
Ic ¢ ¢ OWNER-BUILDER D ECLARATION.
INFORMATION
W V Y
a. oA MISC.- " REFER TO ORD
w,S 0 N I hereby affirm ingrI am exempt from the Con Uador's License VALUATION $/FT.
F'u0J Law for the followingreason.(Sec. uiresa,ermBusiness t tocand Professions PERMIT-ISSUANCE 10.00
Code:Any city or county which structure permit m construct,alter,
u, W< improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.N0. ELECT
n w m LL requires the applicant for such permit to file a signed statement that y TOTAL ,PERMIT TO -
he is liecosed,pursuant to the provisions of the Contractor's License -'
rzi Law(Chapter 9(ccmmencingwith Section 7000)of Division3ofthe " aG•• `'
st Business and Professions Code)or that he is exempt therefrom and QTY. 'PLUMBING PERMIT Q EE -
the basis for the alleged exemption.Any violation of Section 7031.5 _ STORIES TYPE CONSTR.
..d ; _ by any applicant for a permitsubjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.0 -
of not more than five hundred dollars($500).1'. `
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.'DEVICE .GROUP RES.UNITS
.' their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec.7044, Business.andProN.Sion, DRAINS-FLOOR,ROOF;AREA,CON D. 5.00
Code:The Contractor,,License Law does not apply na an owner of •"
property Who builds or improves thereoq and who does such work FIXTURES-PER TRAP 5.0 �� SO.FT,FLOOR AREA TOTAL ACREAGE
home are not hrough
ownemred for sale.
If,ed that however,
the
improve- GAS-EA.SYSTEM-11NC.40UTLET$ '6.00 •'
menL are not intended or offered for sale.IL however,the building -
or improvement is sold within one year of completion,the owner- GAS-EA:SYSTEM-OVER 4(EA.) 2.00 BUILDING OSE.
builder will have the burden of proving that he did not build or im- - RES• IND CON PB Omer
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-1 INC 5 V.B. -6.00 , L' 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 a contractor(9 licensed pursuant to'
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 a rRACTNO: PARCELN10.
❑" I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT, 6.00 '
reason
Owner Dale J WATER SYSTEM ' '5.00 ACC.DATE ACC.FILE NO.
_ WORKERS'COMPENSATION DECLARATION - WATER TREATING EQUIP. 5.00 -
I hereby affirm that l have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified I ,I ZONING- ENG.SITE NO.
copy there cc.3800,Lab.CJ. It
- Polk, Com9apy - - '
O Certify p) Is t r yfunuuhed. FIRE SPRINK ENERGY T-24
Z 2 ❑ Ceir cq� IIcd' with th y inspection division. -
p ' APGlican / //////=int- _ MISC. REFER TO ORD. r ❑ N❑' Y ❑ ,N❑
rn '�� PERMITISSUANCE' ,�. - FLOODZONE - A.L.u.c.,
Cr - CERTIFICATE OF F-XIiMPTION FROM WORKERS'
EU .> COMPENSATION INSURANCE•- PLO.COSTA. LIC.NO. PLG.
lL 0 (This Section need not be completed_if.the permit is for one TOTAL Y❑ N❑ 'Y ❑ N❑
03 hundred dollars($100)or less J' ^'
U'0 1 certify that in the performance`of the work for which this per- GTY. ' `MECHANICAL PERMIT FEE FEE SUMMARY
LL k- mitis issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
y Date Applicant - ALTER OR ADDTO MECH. 5.00 rELECTRIC
}'W NOTICE TO APPLICANT:;If,after making this Certificate of'Ex- ,
� ? emption;you should become subject to the Workers'Compensation APPLIANCE ,5.00
provisions of the Labor Code, you'must forthwith comply with Usuch provisions or this permit shall be deemed revok
ed AIR HANDLING UNIT(T010,000C.F.M.) -'4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 I;hereby affirm.lhat there is a construction IendinK agency for EXHAUST HOOD,(W ITH DUCT)' 5.00 "the performance oLlhe work for which this permit is issued(Sec.3097;Civ.C) - H EAT!N G UN IT(TO 100,000 B.T.U.) 8.00Lender's Name .HEATING UN IT(OVER 100,000 B.T.U.)9.50 '
Lender's Address
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) .'';t' 4.00 Pd
information is correct.1 agree to comply with all city and county PLUMBING •�
ordinances and state laws relating to building construction, and t BOILER-COME 13 H.P,or 100,000 B.T.U.) 6.00
hereby authorize representatives,of this city,to enter upon the BOILER-COMPIOver l00,0008TU1 SEE FEE SCH. MECHANICAL '
above-mentioned property for inspection purposes,
atgnatureofA
to save, indemnify an keep harmless theCity of . MISC.+ REFER TO ORD.
nst libilities,judge costs and expenses wich - CONST.TAXay accrue again , ' City'in co' uence of the PERMIT ISSUANCE 10.00 perit., MECH.CONT. LIC.NO. MECH. ,TOTAL TOTAL.pplicant/Contractor ate ' -
OFFICE COPY