15944 I
POST THI ARD NEAR FRONT-OF BUILDING .' PERMIT NUMBER
CI OF CUPERTINO 15944
.INSPECTION DIVISION
JOB INSPECTION RECORD
• - ^/ - T �,DlU ;�,N$ A- PERMIT EXPIRATION
JOB ADDRESS �()� 'r" WO�C J UNIT# _LOT#
/ (� //•• PERMIT EXPIRES IF WORK
OWNER L�'SS cs�� X10 U<C dT FCONTRACTOR CTh'R.di .S// �2LSC7 zc IS NOT STARTED WITHIN
INSP CTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION - NOTE:
LAST CALLED INSPECTION.
UFER - ALL GRADINGAND DRAINAGE SHALL BE INSTALLED
.. TO COMPLY WITH THE APPROVED PLANS AND CITY OF 11111
PREGUNITE CUPERTINO STANDARDS. .'
GARAGE SLABS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '1.. Gaya► JV. sl% -m _ --
UNDERGROUND /SLAB - /
PLUMBING W sve. S
ELECTRICAL ISS'u4NCE DATE
• MECHANICAL a U9 ELuc ELECT PL= MECH
❑ ❑ ❑
OO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 17-$!; '1 ISav �t BUIL PERMIT
_ INFORMMATION
WOOD FLOOR VAwAnoN
PLUMBING - - -
MECHANICAL
PENM11IT i0
ELECTRICAL :
FRAMING -
- - STORIES LUPE CONSTR.
INSULATION
OCC GROUP RES UNITS
PLAOE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' 90.IT fll.flOH AfiEA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
ail . DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PR 0c
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS IS SHOWER PAN- PLUMBING ENERGY
MECHANICAL MECH.ENERGY -
ACC,DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.,FINAL TEST ZONING ENG.SITE NO.
INSULATION PLUMBING '
GAS TEST GAS
FIFE SPRINK ENERGYU29
MECHANICAL Y ❑ N ❑ NO
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR :MIC
ICAL RELEASE - - FLOOD ZONE aL U.C.
INTERIOR SHEARPT. `' ❑ .N❑ L, N❑
SHEETROCK FEE SUMMARY
EXTERIOR LATH G BUILDING
INTERIOR LATH - - TEMPORARY APPROVALS
SCRATCH COAT _ PLAN CHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 17Q
"J ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
~o ' 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
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE ILA,LL POINT PEN ONLY
• '. BUI LDI NG PROJECT I DENT[FI N PERMIT NUMBER '
BUILDING PWIT APPLICATION & P IT - 159
[(]
0 1'23 �.� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ,, tJ J
OWNER'S PLAN CHECK VALIDATION
NAME I ' - BOE CITY. ELECTRIC PERMIT FEE
• LONE
rAme ncroRS OUTLETS-SWITCHES-RECEP 10.0011.00ka
,20
PNS G uc.rvo.G/0 ,3 LIGHTING FIXTURES ` 10.00/1.00 2�
CONTRACTORS
ADDRESS PPLIANCES-RESIDENTIAL 4.00
PHONE I_ Z PANELS —le-00 I DATE OF APPLICATION.
OORROHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC,NO ISIGNS TRANS. nn11 'S:00-/O —
ADDRESS ENG' SPECIAL CIRCUIT J'. 6:60 S-- PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICARTS IMOTORS. AN L+J --
ADDRESS SEE,FEE SCH. 6
SERVICE CHANGE 1 20.00 ,
O oLICENSED CONTRACTORS DECLARATION O S
F
LL,
c 1 hereby afl'itm that Ism licensed under provisions of Chaplet 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
m i Professions Co de,and�j�j'license is in lull for'•and cffe & ❑ IK ❑ ❑
o o— License C ass�_ G� _�1J�Lia Number
4 r Dote7. Contmdor r.,ACI� ,1
¢ x E 1 �`+� BUILDING PERMIT
¢ ¢ w 4 OWNER-BUILDER DECLARATION INFORMATION
MISC.—
w ;LL G I hereby aft itm that I um exempt from the Contractor's License VALUATION $/FT.
F u o va Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE
Code:Any city Or county which requires a permit to construct,utter,
¢ QQ2 improve.demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. L7, "
iL m¢ requires the applicant for such permit to file a signed statement that TOTAL �-
6 W he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Law(Chapter 9(commencing with Section 7000)of Division 3 of lire
s( Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ F $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permil subjects the applicant Intend penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($5001):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for side(SCC. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTALACREAGE
. menus re hot
hde ownemred for sale.
11,ed that however,
the
improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
mems are not intended or offered for sale.II',however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the ale.). of proving that he did not build or int- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec 7044,Business LAWN'SPRI CERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's s License Law docs not apply
to tr owner of properly who builds tr improves thereon,and who LAWN SPRI LERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorls)licensed pursuant In SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under See ,B.&P.C.for(his WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE - ACC.FILE NO.
WORK ERS'COMPENSATPON DECLARATION WATER TREATING EQUIP. 5.00
I hereby attire that I hove a certificate of consunl to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers Compensation Insurance,or a certified
copy thereppl 1$p�]]§§Qq,,O��Lab.C.l. , L ,,F
Policy l,12Z�.TTLlpan Y-A-67"VA
❑ Ce rti¢d copy fifi reby furnished. FIRE SPRINK ENERGY T-24
Z 0 ❑ Cerli Cop Is EI y inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Applicant- Y N V N
CCT CLL CATS OF ESI: I'[NR N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCEPLG.CONTR. LIC.NO. PLG.
Z (This section need C be completed if the permit is-"'�ne TOTAL V❑ N❑ V ❑ N❑
hundred dollars($100)or Ins.)
U Q 1 certify that in the performance of lira work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ I— mit is issued,1 shall not employ any persmi'in any manner so as to
U become subject to the Workers'Compensation Laws of California.
w Date AppliconlALTER OR ADD TO MECH. 5,00 BUILDING
} rail NOTICE 10 APPLICANT: If,after....king this Certificate of E..
♦— ? 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
V such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTIONLENDINCACENCY" AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lendingagency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT LTO 100,000 B.T.U:) 6.00 MICROFILM
3097,Civ.C.). �1 yy�a
Lender's No HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify Ihat 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information is correct. I agree to comply with Al city and county PLUMBING
ordinances and state laws relating to building construction, and 130ILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon Ilse BOILER-COMP lover IOQ000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes, -
(We) agree to save, indemnify and keep harmless the City of MISC.- " REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
fIhi permit MECH.CONT. LIC.NO. MECH.
_ _ TOTAL TOTAL
Sig a eof Applicant/ nl Icor Date
OFFICE COPY