15926 ..POST THIS RD NEAR FRONT OF BUILDING -
PERMIT NUM BEA
CI1T OF CUPERTINO 15926
INSPECTION DIVISION
JOB INSPECTION RECORD
PER EXPIRATION
JOBADDRESS 10/a_3 WhG &_ Rb UNIT# _LOT# '
n/7 _ / , PERMIT EXPIRES IF WORK
OWNER `j4G.�FP t�Q,9-i�-ic �/ CONTRACTOR C , IS NOT STARTED WITHIN
INSPECTION D TE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE 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
GARAGE SLABS CUPERTINO STANDARDS.
' -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r
UNDERGROUND /SLAB
PLUMBING - - !• ' jZT' (r
ELECTRICAL O• ISSUANCE DATE
MECHANICAL - BLDG r ECT PLG. MECH j
�9 ❑ 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED MIT
uQGLl1((FORMATION
WOOD FLOOR � vnwnnON sIET.
PLUMBING
MECHANICAL-
PERMIT r0
' •�
ELECTRICAL "�LBG
FRAMING
INSULATION STORIES TYPE CONs,TR, f
OCC GROUP 'RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,IT FLOOR AREA 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 -::om• ''
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. - 11 El El 13 .'
ASSESSORS PARCEL NO.
ROUGH SAN.fI
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN •' PLUMBING ENERGY TRACT NO. PARCEL No.
MECHANICAL 8 MECR ENERGY
ELECTRICAL. BUILDING ENERGY Acc.DATE ACC.PILE No
FRAMING ELECT.FINAL TEST,
ZONING ENG.SITE NO. ,
INSULATION - PLUMBING ,
GAS TEST GAS
MECHANICAL - FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ "❑ ° El "❑.
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOOZONE, -A.L Uc.
INTERIOR SHEAR• FIRE DEPT. Y❑ "❑ _ Y ❑ "❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH( BUILDING
INTERIOR LATH', - TEMPORARY APPROVALS BUILDING
SCRATCH,COAT ELECTRIC . PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYSEISMIC FEE
OCCUPANCY OFBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY'PHONING 252-4505, ELECTRIC
• Do, ONE WORKING DAY BEFORE REQUIRED INSPECTION; PLUMBING odI
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT'FOR EXPIRATION DATE - MECHANICAL
' IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ' a'' °
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFO MATION WITHIN RED LINES - USE LL POINT PEN ONLY
t BUI LDI NG PROJECT I DENTI FI - .PERMIT NUMBER -.
BUILDING APPLICATION & PEWIT '1 [(�
ADDRESS f I J J
a�lCok�• BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
,26
OWN S y.L , PLAN CHECK VALIDATION
Mu —/I � PHO
^� IZ� UTV. ELECTRIC PERMIT FEE
OMrRACTOR s 'OUTLETS-SW ITCH ES-R ECEP- ,10.00/1.00
LIC.No. LIG HL
NG FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS - C61 APPLIANCES-RESIDENTIAL 4.00
CONTRA ^
qszIl l HONE ?TL3Q31 PANELS IO.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE -P.C,,,NO.
OR. PANELS (OVER 200 AMP) 20.00 _
EN NEER -
.uc.NO .SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG SPECIAL CIRCUIT - S.00 PERMIT VALIDATION -
Ag3
zlpc4qli�o TEMP.METER OR POLE INS. 20.00
APPLICANTSMOTOflS � SEE FEE SCH. ((\/rJJ1"�,Lp_�
REES ///�, pp
IYIOU `SrI,V1lQ,Y� SERVICE CHANGE 20.00 7��9/p�
w0 o LICENSED CONTRACTORS DECLARATION
w
U bI hereby affirm that 1 um licensed uncle[provisions of Chapter 9 ISSUANCE DATE -
yz w (commencing with Section 7000)of Division 3 of the Business and
a u BLDG. ELECT. PLG. 'MECH.
r i Professions Code,�p license is in full Cor' an) f t ❑ Q
Z z_ o License4pss l Lic.Number g� :
r y J Dalc Contract. MLO!
a m g BUILDING PERMIT
¢ ¢ ef OWNER-BUILDER DECLARATION
¢ w EI - INFORMATION
"w ;u r I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD 1 -
w .VALUATION $/FT.
LL O a Law for the following reason.(Sec.703 1.5,Buslnessand Professions
j 0 Code:Any city or county which requires a permit to construct,alter, PERMIT ISSUANCE 10.00 -
a,wY ELEC.CONED. LIC.NO.
M ¢ p improve,demolish,or repair any structure,prior[o its issuance,also - ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL i PERMIT TO
A w m he is licensed pursuant to the provisions at the Contractor's License "'
Law(Chapteg9(commencing with Section 7000)ofDivision3ofthe
a Business and Professions Code)o[that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ Fo-- the basis foi-theallegal exemption,Anyviolation oCSection703L5 - STORIES TYPE CONSTR.
La 3'' 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($500).): '
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.0 OCC.GROUP 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.
Code:The Contractor's License Law does not apply to an owner of _
property who builds or improves thereon,and who does such work ;L FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1INC:40UTLE7Svtw.
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) .00 N BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer.
.
prove for purpose ofsaleJ' INDUSTRIAL WASTE INTER30
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
- licensed contractors to 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 docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts Cor such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. 'TRACT NO. PARCEL NO.
❑ 1 am exempt under See. ,BAP.C.for this WATER HEATER W/VENT 6.00 '
reason'
Owner Dote' (NATER SYSTEM I 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self-insure, - -
ZONING
or a certificate of Workers'Compensation Insurance,o u eerli fed
ENG.SITE NO. ,
copy the' 0, ab,C.)
oNo n
Policy Y
,0 O Certified copy la ereby furnish _ FIRE SPRINK ENERGY T24
Z Z % Cerci'ed copy is Ele its I 't s coon division.
MISC.- . REFER TO ORD.
— A lican - � _ Y N V N
~ iD - PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
'
OC CERTIFICATE OF EXEMPTION FROM WORKERS' a
W COMPENSATION'INSURANCE PLG.CONTR. - LIC.NO. PLG.
1 O (This section need not be completed if the permit Is for one TOTAL 1' �' Y❑ N❑ V ❑. N❑
=)'Z hundred dollars(S100)or lvxQ -
U O 1 certify that in the performance of the work for which this Per' OTY MECHANICAL PERMIT FEE FEE SUMMARY
EL I. mil is issued.I shall not employ any person in any manner so as to -
U become subject to the Workers'Compensation Laws of California. -
Date Applicant - : -BUILDING
a' ALTER OR ADD TO MECH. ,5.00
} m NOTICE TO APPLICANT: Is afterbaja making this Certificate sa Ex-
F Z empision you the L become Code, you[muse forthwith comply with
''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. AIRHANDLINGUNIT(TO 10,00DGF.M.)' 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency fur '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
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 'ELECTRIC
I certify that I have read this.p,lication and state that the above VENTILATION FAN (SINGLE) 4.00 ,fpq
information-Is correct, 1 agree to comply with all city and county - 'PLUMBING
ordinances and stale laws relating to building construction, and BOILER-WMPI3 H.P.Or 100,000 B.T.U.). 6.00 .
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. ' 'MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
:opdrtino against liabilities,judgments, costs and expenses which PERMITISSUANCE- 10.00 CONST.TAX
m "in any wa ace ue a if at said City in consequence of the
an ting of this mi �'I MECH.CONT, LIC.NO. MECH. _
il-tq TOTAL 'TOTAL
Signature o'Applicant/Contractor Date
OFFICE COPY