15765 I
POST THIS CARD NEAR ERO.NT QF,BUILDING
•�' � - �•� � ` ' PERMIT NUMBER - -I
CITY OF. CUPERTINO
INSPECTION DIVISION
JOB'INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS IU/ 23 ,V.A/ wOcs �y- UNIT# - LOT#
n� PERMIT EXPIRES IF WORK �
OWNER u Ca—ra J CONTRACTOR ULriQ,[}-N�7J S('141, GO, IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- '
FOUNDATIONANCE 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' 4 p
PLUMBING
ELECTRICAL ISSUANCE DATE
' MECHANICALBLo' ELECT. PL . NEC.
ppl .d ❑ G.❑ ; p
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - e ILDING.PERMIT
WOOD FLOOR U` 198 INFORMATION
VPLUATICIN T.
PLUMBINGot
1�`hhII
MECHANICAL 'Y1`7
PERMIT TO
ELECTRICAL
FRAMING
STORIES TYP CONSTR.
INSULATION
OCT,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' so IT.FLooRAREA TOTAL ACREAGE.
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE `
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB DTI",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E L ❑ ❑ L
ROUGH. SAN.0 ASSESSORSPARCEL NO.
PLUMBING ELECT,ENERGY
TRACT NO. PARCEL NO
TUBS a SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
_ .FRAMINGELECT.FINALTEST ENG
-
DINING
.SITE NO.
N1 INSULATION PLUMBING ,
GAS TEST - GAS
FIRE SPRINK ENERGY T 24
MECHANICAL '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING N L L NL
FLLOOOO D ZONE AJ_U C,
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR -1 DEPT, Yo NL .Y L NL,
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING -'
INTERIOR LATH TEMPORARY APPROVAL BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS
FEE
4� 0
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 7a
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
.I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC _
UJ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING"—"
O PLEASE GIVE JOB ADDRESS WHEN PHONING,
Z , � r MECHANICAL,
!` — SEE PERMIT FOR EXPIRATION DATE — '.%I
IMPORTANT!
0F coNST:rax
PLEASE READ REVERSE SIDE BEFORE
TOTAL
CALLING FOR FINAL INSPECTION..'
OFFICE COPY
APPLICANT•TO FILL IN INFORMATION WITH„(11 RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - - PERMIT NUMBER
8 ILOING Vallco Fashion Park #1018 APPLICATION.& PERMIT
ADDRESS 15 765
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
Ow E PLAN CHECK VALIDATION
NAME QTY: ELECTRIC PERMIT FEE
• PHONE -
CONTRACTOR'S
NAME - UTLETS-SWITCHES-RECEP 10,00/1.00
ULTRANEON SIGN CO LICtNo. '521415 ILIGHTING FIXTURES 10.00/1,00
ADDRESS
OR's 8871 Balboa Ave Ste. PPLIANCES-RESIDENTIAL - 4.00
CONTRAS
ipgoCA 92123PHONE PANELS "' 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P
OR .C.,NO.
ENGINEER
LIC.NO. - SIGNS TRANS. 3.00
ARCH.OR ENG, SPECIAL CIRCUIT 5.00 PERMIT VALI DATION
ADDRESS
ZIP TEMP..METER OR POLE INS. 20.00
AAPPLICADDRESS 8871 Balboa Ste RCn MOTORS - SEE FEE SCH.
San Diego, SERVICE CHANGE 20.00 � /�10 0
woo LICENSED CONTRACTORS DECLARATION
a I hereby affirm that 1 am licensed under provisions of Chapter 9 �'- ISSUANCE DATE
y ¢n (commencing with Section 7000)of Division,3 of the Business and ELECT. PLG, MECH.
H o i Professions Code,an nse is N full If 'f et, ❑ ❑
z o y License Clas Li C'Numh'r
9 m r � Dine_- Contractor
¢ y M J 1419R-co-.., UILDINO PERMIT
rc rt ¢ ¢ OWNER-BUILDER DECLARATION - NG PER N
o a U REFER TO ORD
F
g; N I hereby affirm that 1 am exempt from the Contractor's License MISC.- y ION. S/FT.
IL o a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 p01`
t m Code:Any city or county which requiresa permit to construct,alter, - l•
2 ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that ' TOTAL PERMIT TO
' w$ he is licensed pursuant to the provisions of the Contractor's License
H 2 i Law(Chapter 9(commencingwith Section 70001of Division 3 ofthe -
¢ Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ r$ the basis for the alleged exemption.Any violation o(Section7031.5 STORIES TYPE CONSTR.
A , by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(SS00)d'.
❑ 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. 70449 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 s0.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employces,provided that such improve-
inept.,
mprovemenu are nofintended.oroffered for sale.If,however,the building GAS-EA.SYSTEM-1'INC.4 OUTLETS 6.00 x
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- .RES IND CON PB Other
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with El ❑ ❑ ❑
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 property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) . 1.00
contracts for Such projects witlia contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00TRACTNO. PARCEL NO.
❑ I am 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.
WORKERS'COMPENSA'170N DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent In self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
Copy IhcmofsYSq..1 00.Lib.C.). C'1SIr..rr� '
Policy No. m
LL 7711 lL''AApany_L .-Benefi_tS-
O Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
-Z Z ❑' Cerlifi is with 11 • city inspection division. MISC.- REFER TO ORD.
Q Applican Y❑ N❑ Y ❑ N❑
CCy . . PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CL > GIiR RK F.RS'
11.1 ENSATION INSURANC1, PLG.CONTR. LIC.NO. PLG. . N❑ Y❑ N❑
d o (*This section need not be completed if the permit is for one TOTAL
D Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
U became subject to the WorkersCompensation Laws of California.
U i Date Applicant ALTER OR ADD TO MECH. 5.00 FELECTRIC
} DO NOTICE TO APPLICANT: If,after making this Certificate of Ex- '
L... ? emptiol,you should become subject to the Workers'Compensation APPLIANCE 5.00 'PLAN
provisions of the Labor Code, you most forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
1 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00
3097,Civ.CJ. -
Lender'sName HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50
Lender's Address
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 BOILER-COMP(3 H.P.or 100,000 B.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 (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any way accrue against.Said City in consequence of the PERMIT ISSUANCE 10.00
ranting of this p m MECH.CONT. LIC.NO. MECH.
7 TOTAL .TOTAL 70
r fApplican[/'onI..CIO Uate �- '
OFFICE COPY