15763 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF; CUPERTINO
15763
INSPECTION DIVISION
JOB INSPECTION RECORD
SIP
-�,OdS PERMI7EXPI RATION
JOB ADDRESS ��a '� W UNIT# _LOT# '
PERMIT EXPIRES IF WORK
OWNER 67(� rJN��-d'd CONTRACTOR _ IS NOT STARTED WITHIN
. INSPECTION DATE INSPECTOR INSPECTION RECORD leo DAYS OF PERMIT Issu: '
5 FOUNDATIONANCE OR 180 DAYStFROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED _
TO COMPLY WITH THE APPROVED PLANS AND CITY OF _ PERMIT VA(.IDATION
PREG UNITE CUPERTIN08TANDAR05.GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND./SLAB
PLUMBING - -
ELECTRICAL `I4• ISSUANCE UArE
BLDG ELECT. PLG. MECH. '
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED (�p�I�LDING PERMIT
jJ&FORMAT]ON
WOOD FLOOR VALUATION S/FT.
PLUMBING I
MECHANICAL
PERMIT TTO
I
ELECTRICAL - - 6�Z/ ..
FRAMING
srORIES TYPE CONBTH
INSULATION
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO.FT FLOOR AREA TOTALACREAGE
' ROOF NOTE:NO FINAL]NSP.SHALL BE MADE BEFORE
•�. DIAPHRAGM - THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING - RES. IND' CON . PB O,—
Cl
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El [I ElEl
ASSESSORS PARCEL NO,
ROUGH SAN.#
PLUMBING i ELECT.ENERGY
TRACT NO. 'PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY '
' ELECTRICAL
BUILDING ENERGY acc Dare ACC FILE NO
FRAMING - ELECT.FINAL TEST '
ZONING ENG.SITE NO.
INSULATION' IPLUMBING
GAS TEST . MBEEN
- '
qRE SPR INK ENERGY L}0
• HANICAL �.� N� v � NQ
COVER NO WORK UABOVEING
FLOOD ZONE ALUC.
EXTERIOR SHEARTRICAL RELEASE -
INTERIOR SHEAR DEPT. v N� v ❑ N❑
SHEETROCKDE FEE SUMMARY
EXTERIOR LATHDING
INTERIOR LATH TEMPORARY APPROVALSBUILDING
SCRATCH COATTRIC - PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 11 1 SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
IL .ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLPLUMBINGO� �PL'EASE GIVE JOB ADDRESS WHEN PHONING.
I' Z MECHANICA L
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION,
OFFICE COPY
APPLICANT TO FILL'IN INFORMATIONVITHIN RED LINES — USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION - PERMIT.NUMBER
Hot WING APPLICATION & PERMIT 1,.G� -63
ADDRESS � f 5 I 11
Ind - S BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
O PLAN CHECK VALIDATIONy
NAE qq ,f,�,{y� r OTY. ELECTRIC PERMIT FEE
Cl/J NGS= VS,4A) PITON L/
TRACTOR'S
NA •pp / ./ UTLETS-SWITCHES-RECEP -10.00/1.00 -
4Q LIGHTING FIXTURES 10.00/1.00 (/L
CONTRACTOR'S
ADDRESS /,,"� '/y /,, $j i;,'t APPLIANCES-RESIDENTIAL 4.00
T410 CO3�Et46 .PHONED _C-0�62i PANELS - 10.00 " DATE OF APPLICATION 'S
ARCHITECT PLAN CHECK FEE X.NO.
OR PANELS (OVER 200 AMP) 20.00
' ENGINEER
LIC.NO ISIGNS TRANS. 3.00 x =
ARCH.OR ENG I PERMIT VALIDATION .
ADDRESS - SPECIAL CIRCUIT 5.00
- ZIP EMP.METER OR POLE IN 20.00
TPILICA TS MOTORS EE FE
SERVICE CHANGE 000 "
F D.o h- LICENSED CONTRACTORS DECLARATION
Qw u I hereby affirm that I am licensed under provisions of Chapter 9 V�
w 2 i _ ISSUANCE DATE
¢ be
with Section 7000)of Division 3 of the Busj ess and
F H Z Professions Cod ad my license is in Intl forcpppd if cl� .BLDG. ELECT. PLG.' MECH.
0 2 w-
License,Class. LL_Lm.Numbe YO Yr - � i
O O H Dale Contractors
¢_ w a OWNER-BUILDER DECLARATION
�p'�" BUILDING PERMIT
MISC.— REFER TO ORD ,P - INFORMATION
Z:
3`c,� I hereby affirm that 1 am exempt from the Contractor's License '° .VALUATION $/FT.
u 0¢ Law for the following reason(Sec.7031.5,Business and Professions
r
;j w g. PERMIT ISSUANCE �'_- ,
Code;Any city or county which requires a permit o construct,alter, - -
¢¢'o improve,demolish;,or repair any structure,prior to its issuance,also ELEC.CONTR. .LIG N0: LEC.
n
K G u requires the applicant for such permit to file a signed statement that TOTq
w m he is licensed pursuant to the provisions of the Contractor's License ,.)PERMIT TO -
F z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the ELe G�
i O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
rc H $ the basis for the alleged exemption,Any violation of Section 7031.5 STORIES TYPE CONSTR.
= ,Is. by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(55000.):
❑ 1,as owner of the property,of 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 not
intended ar.offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 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 - 50.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 budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-,
builder will have the burden of proving thai he did not build or am- GAS:EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
, pro for purpose o('sale.). .� RES IND ' CON PB Otbe,
. . 'I 1,as owner of the property,am exclusively contracting with ' INDUSTRIAL WASTE INTER. 30.00 El 0 0
licensed contractors lo'construct the project(Sec. 7044,Business LAWN SPRINKLERS'-1INC 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 a contractor(s)licensed pursuant to '-
'- the Contractor's License Law. SEWER-SANITARY-STORM EA!200ft/10.00 TRACT No. PARCEL NO..
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 '
reason
Owner Date - WgTER SYSTEM 5.00' -
_ 'St , leapt ACC.OATE ACC.FILE N0.
WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUI '41W bZ;' 5.00 .
I hereby affirm that I have a certificate of consent to selEinsure, '
or a certificate of Workers'Compensation Insurance,or a certified I ZONING ENG.SITE NO.
Copy theteof(Sec.3800,L.I,C.).
' Policy No. Company
❑ Certified copy shereby furnished. - � FIRESPRINK ENERGY T-24
Z Z ❑ Certified 'copy is Bled with the city inspection division:
Applicant MISC.- REFER TO ORD, y� NO v � N�
\ - PERMIT ISSUANCE 10.00
�—
CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LU - - COMPENSATION INSURANCE .PLG.CONTR. LIC.NO. PLG.
CL Z( This section need not be completed if the permit is for one TOTAL - - Y N[3 Y ❑ NC3
hundred dollars(S HBH or less.) '
-U O 1 certifythat in the performance of the work for which this per- CITY MECHANICAL PERMIT . FEE FEE SUMMARY
LL J- mitis issued,1 shall not employ any,person in any manner su as
to
O Wbecome subject to the Workers'Compensation Laws of California.
y Date ApplicantBUILDING
- W NOTICE•TO APPLICANT: If,after making this Certificate ol'.Ex- ALTER'OR.ADD TO MECH. 5.00
F ?' emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLANCHECKprovisions 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=C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10ACC.EM.) 6.00 SEISMIC FEE
I- 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.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50
�( Lender's Address - -ELECTRIC 45
Icertify that l have read this application and stale that the above VENTILATION FAN.(SINGLE)•' 4.00 -
,-� - information is correct. I agree to comply with all city and county BOILER H.P.Or 100,0008.T.U.) 6.00 - PLUMBING -
ordinances and state laws relating to building construction,'and
hereby authorize representatives of this city to enter upon the BOILER-COMP IOVBr 100,000 BTULSEE FEE SDH. MECHANICAL
above-mentioned property for inspection purposes.
(We)�a recto save, Indent and keep harmless the City of - MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and-expenses which CONST.TAX
may in y way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
Z
tin f this permit. MECH.CONT. .LIC.NO. MECH. i
�[ ' 7/ Y - TOTAL -i TOTAL
IgNtUre of ApplicanteContraclor Date
\` OFFICE COPY