15931I*
POST THIS CARD NEAR FRONT OF BUILDING'+
'CITY OF CUPERTINO
INSPECTION DIVISION -
JOB INSPECTION RECORD
- ^ ' I', �i S'f% /V�_ -
JOB ADDRESS Lo A ?,2 3 U/d LIC�s "71 UNIT#
.
OWNER uM in/- 2.t1_7c_lCONTRACTOR '�[-T' ,q
PERMIT NUMBEB
5931
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS •NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION."
-
INSPECTION DAT INSPECTOR
INSPECTPN RECORD
FOUNDATION
-NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
LIFER
PREGUNITE -
PERMIT VALJDATION
;r •'
t'
' ISSUANCE DATE
GARAGE SLABS � �
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
LJ : LJGCa I_Y✓
UNDERGROUND/SLAB
PLUMBING -
ELECTRICAL
MECHANICAL
-
BLDG ELECT.
❑ ❑
PLG. 'NECK q
. ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION .
S/FT.
-
PLUMBING
MECHANICAL
ELECTRICAL •
PERMIT T
,I ERMiT
l�eC*•f •-
FRAMING
INSULATION - -
-
STORIES
TYPE CONSTR
-
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-
OCC GROUP
-RES UNITS
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
f+
SDFT FLOOR AREA
,
TOTAL ACREAGE
'
DIAPHRAGM
ROOF SHEATHING
BUILDING USE'
Q RES❑ N D ,
V ❑ ❑ El El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE
ROUGH
SANLf
sessoas PARCEL No
app
PLUMBING
ELECT, ENERGY
TUBS &SHOWER PAN'
PLUNKING ENERGY -
TO NO
PARCEL NO
,
MECHANICAL
MECH.ENERGY -
ELECTRICAL
BUILDING ENERGY
ACC. DATE -
ACC. FILE NO
FRAMING
ELECT. FINAL TEST -
INSULATION
PLUMBING -
2ONING
ENG SITE NO.
-
GAS TEST
GAS
MECHANICAL
FIRE SPRINK
N
ENERGY T24
Y ❑ N�,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE -
FLOOD ZONE
NE]
A U.C.
Y ❑ • N❑
INTERIOR SHEAR. •
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
INTERIOR LATH-
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC -
-
PLAN CHECK
FEE,
-
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505,
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O� PLEASE GIVE JOB. ADDRESS WHEN PHONING.
Z
-SEE PERMIT FOR EXPIRATION DATE' -
ELECTRIC
:PLUMBING
MECHANICAL'
CONST. TAX
IMPORTANT! '
PLEASE READ REVERSE SIDE BEFORE •'�
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY
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A`'°LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
B�I LDI NO PROJECT I DENTI FI ATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER ..I
' 15.9 31
BBUUIILLRDING
_ s P
a.l ('
A. s [tEl/V�l(�'/ �I.� CT!}•T
7 C /
PMONF
OTv. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
NOM fl4crofls-
471�97�
UTLETS -SWITCHES-RECEP 10.0011.00
o,
-
LIGHTING FI)STURES 10.00/1.00
nooness °Rs
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
NE
DATE OF APPLICATION .
OAC
on
ENGINEER
I.C. No.
PANELS PANELS(OVER 200 AMP) 20,00
PLAN CHECK FEEP.C. NO.
SIGNS TRANS. 3.00
ARCH,
DD 'E°Ss ENa.
SPECIAL CIRCUIT 5.0Q
PERMIT VALIDATION,
TEMP. METER OR POLE INS. 20.00
ZIP
'
jv----��
APPLICANT a
ADDRESS
S
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
•
U
LICENSED CONTRACTORS DECLARATION
-
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 70001 of Division 3 of the Business and
Professions Cole nJ my license is in lull fore •nue
License Cuss n Li C. Number
7�
ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
❑ ❑ ❑
Commmor _ -
Dale n� rat III
''
7V OWNER �•
BUILDING PERMIT
-BUILDER DECLARATIO
I hereby affirm that 1 am exempt from the Contractor's License
Law forProfessions
the nycitfollowingrount which requirsapenciness l to construct,
Code Any city or county which permit toconstruct,alter,
INFORMATION
MISC.- REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION-T$/FT.
ELEC. CONTR. LIC. NO. TOT-
TOTAL
improve, demolish, or repair any structure, prior to its issuance, also
Structure
requires the applicant for such permit to file a signed statementisLithat
he is licensed en the provisions of the Contractor's License
-
PERMIT TO
9 (conn)
of Division 3 mfthc
Law (Chapter 9 (commencing with Section is exempt
Business and Professions Code) or that he is exempt and
un5
QTY. PLUMBING PERMIT FEE
ectio'rom
the basis for the alleged exemption. Any violation applicant to action malty
by any applicant fora permit dollars(he0).)toacivil penalty
of not more than five hundred dollars (8500).):
STORIES
TYPE CONSTfl.
ALTER-DRAIN-WATER(EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, CONE). 5.00
intended or offered for Sale (Sec, 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
'
F IXTUR ES - PER TRAP 5.00
'
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
SD. FT. FLOOR AREA
TOTAL ACREAGE
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
ments are not intended or offered for sale. If, however, the building
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 EASYSTEM OVER 4 (EA) 200
- . •..
BUILDING USE
prove for purpose of sated'
❑ as owner of the properly, ant exclusively ling with
RES IND CON PB Omer
INDUSTRIAL WASTE INTER. 30.00
d
licensed contractors to construct the project La 7044, Business
. 7044,
Law does not apply
and Professions Code: The who
toan ofproperty who huildstrimproves thereon and who
sro improves
builds
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5(EA.) 1.00
ASSESSORS PARCEL NO.
trowner
contracts for such projects with a contructor(s) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ I am exempt under Sec.., B.&P.C. for this
reason
WATER HEATER W/VENT 6.00
Owner
p�O r� -Date
tit-vafas' 6 Y:NSATION DECLARATION
WATER SYSTEM 5.00
ACC.DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
1 hereby affirm that I have accelificalnofconsent toselGinsure,
or a Certificate of Workers' Compensation Insumnc or a cerli fact
copy Onereo (Sec 3500, L bCJJS�
ZONING
-
ENG. SITE NO.
Policy No ( 4 r
0 Certified copy is hereby famished.
Cl Cerfllled n i Ele it h n -' mpectlon division.
Applicant
FIRE SPRINK
Y ❑ NF]
ENERGY T-24
Y ❑ No
MISC. - REFER TO ORD.
CERTIFICAI'IIOF EXEMPTION FROM ORKERS'
PERMIT ISSUANCE 10.00
FLOOD20NE
A.LU.C.
COMPENSATION INSURAN T,
(This section need not be completed if the permit is for one
-
PLG. CONTR. LIC. NO,
PLG.
TOTAL
Y„_ N
Y [] N�
hundred dollars ($ 100) or less. )
I certify that in the performance of the work for which (his per-
mit is issued, 1 shall not employ any person in any manner so as to
QTY. MECHANICAL PERMIT F1
FEE SUMMARY
UILDING
become subject to the Workers' Compensation Laws of California.
Dore Applicant
\�J"
ALTER OR ADD TO MECH.
NOTICE 1'0 APPLICANT: If, after making this Certificate of fix-
-
emption, you should become subject m the Workers' Compensation
APPLIANCE 5.00 V
PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
FEE
M
AIR HANDLING UNIT (TO 10,000C.1.M) c,
AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
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.
3097, Civ.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Nan ne
Lender's Address
H EATI NG U N IT (OVER 100,000 B.T.0.)9.50
ELECTRIC
I certify that I have read this application unit state that the aboveVENTILATION
FAN (SINGLE) 4.00
- -
information is correct. I agree to comply with all city and county
ordinances and state laws relating In building construction, and
PLUMBING
B2LER-COMP(3H.P.or100,000B.T.U.) 6.00
BOILER -COMP IOvar 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
MISC. - REFER TO ORD.
(We) agree to save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, casts and expenses which
may in a way accrue against said City in comreq nc of file
' thspe IL
grant/-y�
^onlnl.,
CONST. TAX
PERMIT ISSUANCE
MECH. CONT. LIC. NO. MECH-0
-2, L,O0
TOTAL
1 oture of fpfcant
OFFICE COPY