15799 POST THIS CARD NEAR FRONT OF BUILDING.
— - PERMIT NUMBER
CITY OF. CUPERTINO 15799
INSPECTION DIVISION.
{ JOB INSPECTION RECORD,
cJ1� �Q-14— PERMIT EXPIRATION F
4 • JOB ADDRESS ld /�.3_ A/ OJel-,CE UnNIT# - ,-LOT# PERMIT.EXPIRES IF WORK
OWNER ',[dip 'yy g-- k21-P CONTRACTOR: '7e,�L T7,-4--r
- �j�.y,� cIS NOT STARTED WITHIN /
INSPECTION DATE INSPECTOR INSPECTION RECORD 980 DAYS OF PERMITISSU-.�
FOUNDATION - - ANCE OR 180 DAYS FROM ,
NOTE: LASTCALLE15 INSPECTION. '
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED I
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERMIT VALIDATION
CUPERTINO STANDARDS. - I
GARAGE SLABS+ -. - I .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -'J,r/. -WA -2 g
UNDERGROUND /SLAB
PLUMBING (r� ,• � atl•�
ELECTRICAL - ISSUANCE DATE
MECHANICAL .BLDG." ELECT. I PLG. .MECH
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WO BUILDING PERMIT
INFORMATION
jggjWOOD FLOOR qunnON aiRr.
PLUMBING
MECHANICAL !l1'
ELECTRICAL' - • V PERMIT TO
FRAMING, -
INSULATION STORIES TYPE COINS TR.
OCC:GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF NOTE:NO FINAL INSP:SHALL BE MADE BEFORE so.ET,FLOOR AREA TOTAL nc RFncE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID I
,ZION
Z _ flUILDI ON USE
ROOF SHEATHING -� urs IND CON PB Go-
-APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. D ❑ ❑ ❑'
ROUGH SAN.# - ASSESSORS PARCEL NO. I
PLUMBING - ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL , - MECH.ENERGY
ELECTRICAL. - BUILDING ENERGY i ACC Darr ACC FILE No.
FRAMING ELECT.FINAL TEST- zoNlNc ENG SITE No.
.. INSULATION PLUMBING ,
GAS TEST - GAS
MECHANICAL 'EIRE SPRINK ENERGY T.za
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y N v ❑ '• N❑
FLOOOZONE• A.L.U.C.+
EAR ELECTRICAL RELEASE Y N� - v ❑1 N❑�
INTI L.--0 AR FIRE DEPT.
SHE, 'RO GRADE - FEE SUMMARY
EXTE h.--.LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS , BUILDING.
SCRATCH COAT - ELECTRIC i HECK • ,
' GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY C FEE
OCCUPANCYOF BUILDINGIS NOT PERMITTED UNTILBUILDING EINALISSIGNED BY BUILDING INSPECTOR. FILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, RIC
H ONE WORKING.DAY BEFORE REQUIRED'INSPECTION: PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING. ,
Z. MECHANICAL
— SEE•PERMIT FOR EXPIRATION DATE .—
r IMPORTANT! ' • coNST.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY'
APPLIQAN'T TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDINO PROJECT IDENTI FICATI ON - `PERMIT NUMBER
DRSS APPLICATION & PERMIT
iow ADEBUILDING - ELECTRICAL-PLUMBING-MECHANICAL 15799 77A
OwrvER'S �j/f ( ��j PLAN CHECK VALIDATION
NAME /C!'I�/� OOCLJ aCrCGO .S
DTV. ELECTRIC PERMIT FEE
PHONE
J' CONTRACTORS
OUTLETS-SWITCHES-RECEP 10.00/1.00 73 -
NJ/ x ,3 LIGHTING FIXTURES 10.00/1.00 �
CONTRACTOR
s
ADDRESS PPLIANCES-RESIDENTIAL 4,00
ADDRESS
PHOrvE K1Z10 PANELS - 10,00 - DATE OF APPLICATION. -
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
On
a
ENGINEER
LIc.NO, SIGNS TRANS. 3.00
ARCH.08 ENG_ SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH.
• SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION � ��
a u w I hereby affirm 'lint I am licensed under provisions of Chapter 9 ISSUANCE DATE
vHi¢H (commencing with Section 7000)of Division 3 of the Business and BE G. ELECT. PLO. MECH.
0 Professions Code,and m license is in full force and effect EQr�a{ ❑
Z 0'v1� License Cl ss a /0y Lic.Number_/ F9-3-� (1
2Frm - D'cc� 3]4g t Contractor-
r
¢ m f J BUILDING PERMIT
¢ ¢ w
OWNER R-BUILDER DECLARATION Q
MISC.- REFER TO OR Brt'In INFORMATION
E:
;a. G I hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
F .. 0 4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE a
Code:Any city orcuunty which requires a permit Yo construct,alter,
ELEC.CONTR. LIC.NO.
¢ 4 p' improve,demolish,or repair any structure,prior to its issuance,also ELEC.
O¢ requires the applicant for such permit to file a signed statement that TOTAL eP�7-O PERMIT TO
A w m°' he is licensed pursuant.to the provisions of the Contractor's License ELEL7
F 2 a Law.(Chapter 9(commencingwith Section 7000)of Division 3 ofthe /
Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢H O the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty 7.
of not more than live hundred 6o11ms(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5,00
❑ 1,as owner of the property,or my employees with wages as - BACKFLOW PROTECT.DEVICE 4.00 OCC.caouP RES.UNITS
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,COND. 5.00
/ Code:The Contractor's License Law does not apply to as owner of
property who builds or improves thereon,and who does Such work F IXTUR ES-PER TRAP 5.00 $0.FT.FLOOR AREA TOTAL ACREAGE
merits are oti menhrough ds ownemployees,for sale.
If,ed however,
the
improve- GAS-EA.SYSTEM-1 6:00
mems are not intended or offered fnr sale If,mplevuq the howne r,
or improvement is sold within one year of lie did
the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2,00 BUILDING USE
builder will have fire burden of proving Ilial he did not build or int RES IND CON PB • Other
prove for purpose of the
INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively con44. ing with ❑ ❑ ❑ ❑ ❑
licensed contractors m construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
to Professions Code:The Contractor's License law does not apply
co an owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with a contramor(s)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT N0. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
mason
Owner Dule WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORKERS'CO E9'SA'r ION DIiCLARATION WATER TREATING EQUIP. 5.00
1 Isereby attain that have certificate of ec nsem to self:insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,LoInC I �r�N
Policy Na. CnmPany� AIA -
0 �17�[CATEOI:
urp' ed. ' ,FIRE SPRINK ENERGY TR4
zz Certithe pection Division. MISC.- REFER TO ORD.ZAP licaV ❑ N❑ Y ❑ N❑c I MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.0 C.
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit Is for One TOTAL Y❑ N❑ Y❑ N❑
:) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
1- mit is issued„I shall not employ any person in any manner so as to
0U become subject to the Workers'Compensulion laws of Calil'orda. - '
y DataApplicant ALTER OR ADD TO MECH, 5.00 BUILDING
} m NOTICI7 TO APPLICANT: If,after making this Certificate of Ex.
Z emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provisions 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
CONSTRUC'rlON 1.17NDING AGENCY AIR HANDLING UNIT(OVER 10, 00GEM.) 6.00 SEISMIC FEE '
I hereby affirm that there is a constraCion lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance,of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.0.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 7-O
Lender's Address
- 1 certify that I have read this application and stale that Ilio above VENTILATION FAN (SINGLE) 4.00
lr information is correct. I agree to comply with all city and county PLUMBING
g ordinances and state laws relating to building construction, and BOILER-OOMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city io enter upml the BAILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
1' above-mentioned property 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
matin is p' r ECH.CONT. LIC.NO. MECH.
.2 TOTAL TOTAL
IJW,GfcTApPficantJCcmtraCmr Dale -
OFFICE COPY /