15782 POST THIS C RD NEAR FRONT OF BUILDING
_ PERMIT NUMBER
CITY OF: CUPERTINO 1a78Z
'INSPECTION DIVISION
JOB INSPECTION RECORD '
O �f,PERMIT'EX01RINION -
JOB,ADDRESS '�.�/ •�� It)OILAZ_ �� . UNIT# _LOT#
' T PERMIT EXPIRES IF WORK
OWNER• /-f%A-7 / /.Q':�' ' CONTRACTOR I ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD ' teo DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER - 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
'
UNDER GROUND /SLA B
PLUMBING I,,, t�•_ .
ELECTRICAL ISSUANCEWATE
MECHANICAL - BLDCELECTILL. MLCH.
• E : '❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION ,$/ET.
PLUMBING p
MECHANICAL c V�
ELECTRICAL •• '� L3brrERMIT To
FRAMING. UG / ER/v2'IN ✓Lsz.
INSULATION I lurvSTR. .
Cbl YY`"'
OCG GROUP „ RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
1 SO,FT FLOOR AREA TOTAL ACREAGE ,
ROOF 'NOTE:NO FI NAL I NSP,SHALL'BE MADE BEFORE - -
'•. DIAPHRAGM -THE CONSTRUCTION'TAX,IS PAID
BUILDING USE
ROOF SHEATHING " RES;1 IND CON PB Om,•,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El 0 ED
ROUGH SAN.k ASSESSORS PARCEL NO.
PLUMBING ELECT.ENERGY •
. TUBS&SHOWER PAN - PLUMBING ENERGY TRACT No. PARCEL No.
MECHANICAL MECH.ENERGY
ACC•DATE ACE.FILE No
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST -
1 - PLUMBING ZONING END SITE NO.
INSULATION ,
GAS TEST- - GAS
MEDHANIDAL EIRE SPRINT( ENERGY T,24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
❑ N❑ 0 N❑
EXTERIOR SHEAR ELECTRICAL RELSE -�, FLOOD ZONE A u.c.
EA
INTERIOR SHEAR FIRE DEPT. Y NQ Y -N❑
• SHEETROCK I GRADE - FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY.APPROVALS BUILDING
• SCRATCH COAT ELECTRIC 'FEEN CHECK'
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY . ,.SEISMIC FEE TOL-Ii
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
.ARRANGE FOR INSPECTION BY'PHONING 252-4505, ELECTRIC gJ�,
F_ ONE WORKING.DAY BEFORE REQUIRED INSPECTION. ;I PLUMBING T
• o PLEASE GIVE JOB ADDRESS WHEN PHONING._ .
Z SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
14 d '
IMPORTANT! ' ' CON ST.TAX.
PLEASE READ REVERSE SIDE BEFORE
CALLING-FOR FINAL INSPECTION. TOTAL tea.
OFFICE COPY
\\ - APPLICANT TO FILL.,IN INFOR'AATION,WITHIN RED.LINES•-. USE_=BALL POINT PEWONLY
^tBUILD1 QIG PROJECTI DENTI FICATION - - .PERMIT NUMBER-- !
aDl q - APPLICATION & PERMIT
All
BUILDING -ELECTRICAL=PLUMBING-MECHANICAL
611 IF4
NAMERS $/ $% f PLAN CHECK VALIDATION
CITY. ELECTRIC PERMIT FEE
PMONE �O l ' F�J
C
I • I • y_
O TOR 9 ..,� ± ..
NAMEgCUTLETS-SWITCHES-RECEP, 10.00/1.00 „
LIC.NO. IGHTINGFIXTURES ill10.00/1.00
CONTRgCTOR'S /��
ADDREEI C PPLIANCES-RESIDENTIAL .•,4.00 '
L41241 QL/ es+ PHONE &'8' S PANELS ^ 10.00 p `DATE OF APPLICATION 1 '
ARCHITECTPLAN CHECK-FEE -,P.C.NO.
OINEER R PANELS (OVER 200 AMP)"" 20.00
ENG _
Pi /1 LIC.NO. .c SIGNSTRANS. 3A0 �,
h
ARCH,OR ENG. WQ rho' SPECIAL CIRCUIT,• . 500 ~PERMIT VALIDATION
q0 E55 Sr-,
g. d zip EMP.METER OR POLE INS 20.00
APPLICANT;
goOREss• ,' MOTORS 'SEE FEE SCH.
I;V �y _ SERVICE CHANGE '.2000
I Foo. . , LICENSED CONTRACTORS DECLARATION
s ¢is hereby affirm that 1 am licensed under provisions of Chapter 9 „
w< w ISSUANCE DATE .
(Commencing with Section 700e i of Division 3 of the Business and ELECT. PLG MECH.
F w z Professions Code,and my license is in full force and effect.
zO z m G License Class Lid.Number ,t ,
Date ' - -Contractor - ( �� ❑ ❑'
w a' OWNER-BUILDER DECLARATION- .gyp ILDING PERMIT-
' o a - VY— INFORMATION
!• w g I- d hereby affirm that 1 am exempt from the Contractors License MISC.- REFER TO ORD
u O¢ Law for the followink reason.(Sec 7031.5,Business and Professions - VALUATION $/FT.
t: - - - PERMIT ISSUANCE '
w w Code:A`ny city or wunty which requires a perms[to construct,alter, ��d -
r
I rt 2 st improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC NO. 90 '
} y w m'LL requires lhepppicanl for such permit to file a signed statement that _ ' TOTAL d'rj' PERMIT TO
he Ts licensed pursuant to the provisions of the Contrnefor's License ,
1Q Law(Chapter 9.(commeneing with Section 7000)of Divis10n3 of the - 1
4 O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
a I- the basis for the alleged exemption.Airy violation of Section 703 LS I ,STORIES TYPE CONSTR.
' i;� by any applicant fora permit subjects the applicantt.acivil penalty ALTER-DRAIN&VENT-WATER'(EA.) 5.00
1` of not more than five hundred dollars($500).):
Y.
j ❑ -I,.as owner of the property,Or my employees with wages as BACK FLOW PROTECT.DEVICE-
- 4`.00 OCc.GROUP, RES.UNITS
dieif sole.eompensu[ion,will do the work,and the structure is not
intended'or offered for sale'(Sce, 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND-'-.5.00
Code:The Contract.,',License Law does not apply to an owner of _
property who builds or Improves thereon,and who does such work FIXTURES-PER-TRAP
, '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.SYSTEM-1INC.4 OUTLETS 6.00 f
or improvement is sold within one year of completion,the owner- -
builder will have the burden of proving that he did not build or im- GAS-EA..SVSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). "-I INDUSTRIAL WASTEJNTER. 30.00 , RES IND CON s PB Other -
❑ I,as'owner of the property,an exclusively contracting with ❑y, ❑ ❑ ❑- '[:3licensed contractors to construct the project(Sec. 7044,Business - LAWN SPRINKLERS=I ANC 5 V.B. 6.00 . ASSESSORS PARCELN
and Professions Code:The Contractor's License Law does not apply 0.
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 contmetor(s)licensed pursuant to -
t eContractor's License Law. SEWER-SAN ITARY-STOR M EA:200ffll 0.00 s TRACT NO. PARCEL NO:
am exempt under Sea - ,B.&P.C.for this WATER HEATER W/VENT ' 6.00
reason 1'
Owner .Date WATER SYSTEM - - 5:00 ,ACC.DATE ACC.FILE NO.
WORKERS'COMPF.NSATION.DECLARATION WATER TREATING.EQUIP. 5.00 ,
I hereby ate of that Workers'
C mcertificateCompensation
In consent or self-insure-
or
ell-insure,or y thereof
of Workers'Compensation Insurance,or abeillfied I :ZONING ENG,SITE E NO.
Copy[hereof fSec.3 Co parryLab.0). -
Policy No. 'Company 1 •. - - - "
O ' ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-ZO
,Z Z ❑ Certified copy is filed with the city inspection division.
F O Applicant IMISC.- REFER'TO ORD. ,y❑ .N❑ Y ❑ N❑
65 PERMIT ISSUANCE l FLOOD ZONE A.L.U.C:
, CERTI FICA FE OF,EXEMPTION FROM WORKERS //
W COMPENSATION INSURANCE ' PLG.CONTR. ..uC.No. PLG. �]
d 0 (This„section need or be Completed if the permit is for one TOTAL 2 V❑ N❑ Y❑ INC]
w2 hundred dollars(8100)'or less.), -
UPg I certify that in the pefformancc f the work for which this per- OTY. MECHANICAL PERMIT - FEE FEE SUMMARY
U- I ton Ts issued,I hall not employany person in any manner s0 as to
Q U be 'ce Worker o pease' a ahlforpw
a LU
Dat pplicant l 1.'�—' ie' ALTER OR ADD TO MECH.' 5.00 �” BUILDING �/�Al
},0 NO E T A LICAN'f'. If,a ter ma ing this N Icate of Cx
t Z emption,you should become subject to the Workers Compensation - App LIANCE5. PLAN CHECK '
provisions of the Labor COde,.you must forthwith comply with FEE -
U• such provisions or,this permit shall be deemed revoked. f AIR HANDLING'UNIT(TO 10MC.F.M.) 4,00 '
CONSTRUCTION LENDING AGENCYAIRHANDLING UNIT(OVER 10p00QEM.) 6.00 E[j SEISM IC FEE •-
I hereby affirm that there-is a construction lending agency barEXHAUST HOOD(WITH DUCT) 5.00 -
the performance of the work to which this permit is issued(Sec. ,MICROFILM
3097,r's Na). • ' _ HEATING UNIT(TO 100,000 B:T.U.) 6.00
h Lender's Name T�
. Lender's Address _ "- HEATING UNIT(OVER 100,000 B.T.U.)8.50 ELECTRIC 7pp-
�9
',I certify that l have read this application and state that the above 'VENTILATION'FAN,(SINGLE) - 4.00 , -
I: mformatlOn is correct. I agree to comply wltli all city and county _ - A
ordinances and state laws relating to building Construction, and BOILER-COMPI3H.P.or 100,0008.T.U.) 6.00 PLUMBING a,
hereby.authorize representatives of this city m enter upon the '` MECHANICAL
above-mentioned roperly for inspection purposes. BOI LER-COMP(Over 100,000 BTUI SEE FEE;$C . '��L S�
(We) agree`to ave,.indemnify and keep harmless the City of MISC.- ' - .REFER TO ORD.
..
upertin0 against 'd illtieS,judgments, costs end expenses which pERMIT.ISSUANCE ¢g;gg 7J'- CONST.,TAX
may."id any.way a against said City in.Consecpmmce of the - '
IT e - MECH.CONT LIC NO .MECH. p
TOTAL 0 'Sa TOTAL
Ign u o Ap Contractor ate
OFFICE COPY . ..