15925 _ y
POST THIS RD NEAR. FRONT OF BUILDING • PERMITNumeeR.
.CIIT 0F, 7C.UPERTlNO 15925
INSPECTION DIVISION
JOB INSPECTION'RECORD .
t {Tl Q!' Sia✓«-' � �' 'PERMIT EXPIRATION
JOB ADDRESS rQl-a,3' A Wo�� /`D. UNIT# -LOT# pERM1T EXPIRES IF WORK'
1 .
OWNER CONTRACTOR CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE; INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNO_ ATION - ." ANCE OR 180 DAYS FROM
- NOTE: - LAST CALLEDINSPECTION. "
UFER ALL GRADING AND DRAINAGE SHALL QBE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE, CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED l ,�.••�a-;—`'•''1
UNDERGROUND /SLAB .
PLUMBING.
ELECTRICAL - ISSUANCE DATE !
MECHANICAL - - - - EEl ELEcr. PLc. . mecR +
❑ ❑ E ❑ v.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - ..BUILDING PERMIT
-WOOD,FLOO R INFORMATION
VALUATION, $IFT.
' ,PLUMBING � - - � � - ' � -
i
MECHANICAL s I
ELECTRICAL. n PERM TO
FRAMING ' - � .
J�� i
INSULATION
ILS TYPE CONSTR. 1
` '
� c,,GROUP qES UNITS
Y
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.SO.FT.FLOOR AREA t
• _ ROOF NOTE:NO FINAL INSP.SHALL 8E•MADE BEFORE TI,AL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHINGRES IND CON
USE PE Glee .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS .DATE INSP. ❑ ❑ ❑ ❑ ' ❑
n SEESSORS PARCEL NO
ROUGH SAN.a
PLUMBING - ELECT.ENERGY
TRACT NO. PARCEL NO:
TUBS 8 SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY Acc.DATE Acc.FILE No
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
"INSULATION � I PLUMBING
GAS TEST GAS
.. a MECHANICAL ' FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NI ° ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L.U.C.
INTERIOR SHEAR FIRE DEPT. T❑ N❑ Y ❑ N
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COATELECTRIC PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTEO UNTILBUILDING FI NA LISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, "'' ELECTRIC
. F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. ` ' PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - ;`. MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
„ APkICANT TO'FILL IN INFO ATION WITHIN RED LINES -USE §JkL POINT PEN ONLY.
--BUILDING PROJECT I DENTIFIC PERMITNUMBER . ;
BUILDING APPLICATION & PEWIT 159 Z5 .
nDgREFE �VG -ELECTRICAL—PLUMBING-MECHANICAL -
OWNIERRSS rl PLAN CHECK VALIDATION
NAME
•!__ DTV. - ELECTRIC PERMIT FEE I
co MER.�gq
alcroRS
UTLETS-SWITCHES-RECEP 10.00/1.00
'/-YG-.IIC NO_32LIGHTING FIXTURES, 10.00/1.00
ADDRessTDRs � -) — APPLIANCES-,RESIDENTIAL - 4.00
PHONE PANELS 10.00 - DATE OF APPLICATION ] I ,
ORRCwTECT. PANELS (OVER 200,AMM 20.00 PLAN'CHECK FEE P.C.NO.
ENGINEER
LIC.NO. - SIGNS TRANS. 3.00 -
ARCH.ORENG. SPECIAL CIRCUIT 5.00 r PERMIT VALIDATION'S
ADDRESS ,
IIP EMP.METER OR POLE INS,' 20.00
AvvuANrs - MOTORS SEE FEE SCH. t
SS
ADDREC
SERVICE CHANGE 20.00 - 97-7
o O LICENSED CONTRACTORS DECL ATIONBEu I hereby affirm that 1 am licensed under r visions of Chapter 9 E
¢ 2 w - _ ISSUANCE DATE
y (commencing a, Section 7000)of Divi' n of th• ess cl - BLDG. ELECT. PLG. MECH.
H 7 2 Professions Co a license is in fu o Eli
El Z1 ❑
z O y.— Lice i .las c - Lia Nu
9 Z —w ' Dale — C Cutr
BUILDING PERMIT
¢ ¢ a
OWNER-BUILDER DECLARATION '
o a u - INFORMATION
X ; u I- I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
wD¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION
Code:Any city or county whichmquiresapennit to construct,alter,
I[ K Q improve,demolish,or repair any structure,prior to itsIssuance,also ELEC,CONTR. LIC.NO. ELEC.
a D Q requires the applicant for such permit to file a signed ,element that TOTAL PERMIT TO
w he is licensed pursuant to the provisions of the Contractors License -
H i 4 buw(Ceandpro(commencingsionsode)or Section is exempttherefo and ",
y .2)/
M 4 o Business for Professions Come)or that he is exempt ofSecrefrom and CITY. PLUMBING PERMIT r' FE
2 I- $ by basis for the alleged exemption.Any violation of8ection 7031.5 STORIES TYPE CONSTR.
u ;_ byany applicant for vab.nd ddoleces,he0).)applicant oacivilpenalty ALTER-DRAIN&VENT-WATER IEA.) 5.
of not more than five hundred dollars(my em1: .• -
❑ I,as owner of the property,or my employees with wages as - BACK FLOW PROTECT.DEVICE 0 OCC.GROUP RES.UNITS
their sed or oferedf r will(S ,he work,and the structure is not
intended or offered for Luce (Sec. does not Business and Professions DRAINS-FLOOR,ROOF,AREA,CON 5.00 _
gor
s•
Code'The Contractor's License Law dues not apply 10 an owner of L
property who builds or improves thereon,and who h mous such work FIXTURES-PER TRAP so.FT.FLOOR AREA TOTAL ACREAGE
himself re of rote his own employees,provided leve such improve-
ments intended mroffered
onefor
yearsale.o If,however,the bolding GAS-EA.SYSTEM-1INC.40UTLETS 200
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 Omer I
prove for 1,aso neeose of the.). INDUSTRIAL WASTE INTER. 30.00 ❑ -0 ❑ ❑
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to Th
e
ntrathe pricense La. 1044,Business LAWN SPRINKLERS-1 INC5 V.B. '6.00 ASSESSORS PARCEL NO.
and Professions Code:The Con tmcdmr s License Law Ames not apply
,o anowner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with v mntrtractor(s1 licensed pursuant 10
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.
reason ,B.&P.C.for this WATER HEATERW/VENT 6.00
Owner _ Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby mfinn that I have a certificate of consent Io,el Ginsure, -
' or a certificate of Workers'Compensation Inslimuce,or a certified 'ZONING .ENG.SITE NO.
copy thereof(Sec.380 Lab.C.).
Policy No. mean
Q died - here flu Iud. FIRE SPRINK ENERGY TQ4
Z Z ert c y is ed h tet city inspection division. MISC.- REFER TO ORD.
O pphcant V N� V N�
~ mPERMIT ISSUANCE
2 Cli 'ATE EXEMPTIONFROM WORKERS' FLOGO ZONE A.L.U.C.
W > COMPENSATION INSNS URANCEC PLG y2l ❑ C:] ❑ ❑
d 0 ((his sEctim. need not be completed if the permit is for one !y K- TOTAL V_ NV N
2 hundred dollars IS 100)or less.) -
V O I certify that in the performance of the work for which this per. OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall no,employ any person in any manner so as to
U become subject,o the Workers'Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
�- N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you shouldbecome subject to the Workers Compensation APPLIANCE 5.00 r PLAN CHECK
provisions of the Labor Code, you must'forthwithcomply wits FEE
(�. such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's 3097,Cis
aHEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address .ELECTRIC
1 certily.11,311 have read this application and saute 11,31 the above VENTILATION FAN (SINGLE) 4.00
. information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, anm BOILER-COMP(3H.P.Or100,000B.T.U.) 6.00
hereby aulhorite representatives of this city m enter upon the BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(Wel agree to so, indemnify and keep harmless the City of MISC.- REFER TO ORD.
aper' age held ,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
in a y a� u1, gains, mid City in consequence of the _
ming Is per it. MECH.CONT. LIC.NO. MECH. j
TOTAL 1 TOTAL
Sur1aLWpprftffTJContracwr Dae
OFFICE COPY