15951 POSTTHISCARID NEAR FRONT OF BUILDING'
PERMIT NUMBER'
CITY OF CUPERTINO 15951
INSPECTION DIVISION
JOB INSPECTION RECORD ,
Edi PERMIT'EXPIRATION
LL JOB AD11 DRESS] �� a.� N,.' WOt-rt, D + /[�, '.
,-I l .UNVf-# _LOT# PERMIT EXPIRES IF WORK
owNEa �p CdN�I '1..0�r�-(3 jlt RACTOR f,7`s-1—r ISNOT STARTED WITHIN '�
INSPECTION DATE I-INSPECTOR INSPEOTION RECORD 180 DAYS OF PERMIT ISSU-''
FOUNDATION rNANCE OR 180 DAYS FROM 'i
OTE:
UFER � - - ALL GRADING AND DRAINAGE SHALL LASTCALLED INSPECTION.BE INSTALLED '
PREGUNITE TO COMPLY WITH THE APPROVED'PLANS AND'CITY OF - PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � � , - � -,
UNDERGROUND /.SLAB f
PLUMBING',. .:y.- 4-�.., ''•" )'• " 4
ELECTRICAL r - -
SAUANCE DATE
MECHANICAL BLOC' ELEc7. PLc. ,MecR. i
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR 4 INFORMATION
�)(eoLWATION $IFT,
PLUMBING - - '•_L
MECHANICAL mAv '
ELECTRICAL jWEHM IT To
' FRAMING . n:M �,�I i''I I Y c.:-! 6---)
INSULATION- - Way, STORIES PE CONST..
• - „DEC GROUT RES.UNITS
d^ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "
ROOF SO FTFLOOR REA IOTPL ACREAGE• . A
- .NOTE:NO FINAL IPSP.SHALL BE MADE BEFORE '
i DIAPHRAGM - '"` THE CONSTRUCTION TAXIS PAID -
BUILDING USE
` ROOF SHEATHING - ' RES IND CON PB om,.,',-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE . IPSP.;, '❑ El El ❑ ED
- _ ASSESSORS PARCEL NO.
. ' ;ROUGH sANs `. ,b,!-p,
PLUMBING „ ELECT.ENERGY ' if .J.,: 1 t•' '” /
TRACT NO PARCEL NO
TUBS&SHOWER,PAN PLUMBING ENERGY. ..
MECHANICAL - MECH.ENERGY
ACC.DATE ACC.FILE NO.
ELECTRICAL' BUILDING ENERGY . . .a
FRAMING' - ELECT.FINAL TEST
INSULATION PLUMBING "ZONING ENG,SITE NO.
GAS TEST GAS -
MECHANICAL - ', FIRE SPRINK ENERGVT-10
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEAriNc;' . ❑' " "❑ 1:1 "❑'
EXTERIOR SHEAR ELECTRICAL RELEASE FLooO zoNE A.Lyc,
INTERIOR SHEAR_. FIRE DEPT. °❑' "❑ ❑ "❑
SHEET.ROCK GRADE - FEE SUMMARY
EXTERIOR LATH - BUILDING r'
INTERIOR LATH - TEMPORARY APPROVALS IBui�Owc
SCRATCH COAT ' : ELECTRIC PLAN CHECK"
GAS .. FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OccURANCY SEISMIC FEE '
' OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBV BUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o�
ONEWORKINGDAY BEFORE REQUIRED INSPECTION PLUMBING a0 '
. z PLEASE GIVE JOB ADDRESS WHEN PHONING.
• "+ '' •MECHANICAL
=SEE PERMIT FOR, EXPIRATION DATE -
G IMPORTANT! CONST.TAX '
;} PLEASE READ REVERSE SIDE BEFORE "a
.7 LKS- TOTAL
' CALLING FOR FINAL INSPECTION.
OFFICE COPY
.APPLICANTITO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY .
' .-:.BUILDING PROJECT IDENTIFICATI ON 'PERMITNUMBER
BUILDINGD s APPLICATION & PERMIT 15951
AD �of „
LJJBUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
M ELECTRIC PERMIT FEE '
CONTRACTOR'S
NAE UTLETS-SWITCHES-RECEP 10.00/1.00
NnI/ uc.No.�/O LIGHTING FIXTURES 10.00/1.00 -
roNTRacToes I
APPLIANCES-RESIDENTIAL 4,00 -
PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
EN NEER
uc.NO, SIGNS TRANS. 3.00ARCKO
' '
_ ADDRESS G' SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. -20.00 -
APPLICANT'S
s MOTORS SEE FEE SCH.
ADDRESS
' SERVICE CHANGE 20.00 -
w09 r LICENSED CONTRACTORS DECLARATION
a Ez w 1 hereby affirm Dml I am licensed under provisions of Chapler 9 ISSUANCE DATE
< n (commencing ection 7000)of Division 3 of the Business BLDG ELECT. PLG. MECH,
F N z Professions C dL, license is in full fFATION
❑ ❑
Z,z w o Lice Cass Lic.NamIT -
Date Contra tar
N I- w m f - BU
ILDING PERMIT
¢ ¢o n OWNER-BUILDIiR DECLAgk� INFORMATION
F
5 S. y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL o v, Law for the following reason.(Sec.703 t.5,Businessand Professions pg%LUATION E/FT.
_ PERMIT ISSUANCE 10.00 17
Code:Any city or county which requires a permit to construct.alter,
BE ¢ ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.NO. ELEC.
i w m a, ¢quires the applicant for such permit to file a signed statement that TOTAL V ERMIT TO -
is licensed pursuant to the provisions of the Contractor's License
Hzi La (Chapter 9(commencing with Section 7000)ofDivision 3 ofthe
a' Buse ss and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT
Exc
¢ H m thelia for the alleged exemption.Any violation of Section 7031.5
malty STORIES TYPE CONSTR.
by Boyo Iicxnf fora permit d ollar,050pplicam wacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
' of no[mor hon five hundred dollars(5500).):
❑ I,as o er of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole comp motion,will do the work,and the structure is not
intended or often for sale (Sec.,7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conlracto' License Law does not apply to an owner of
property who builds or proves thereon,and who does such work F IXTUR ES-PER TRAP 5.OQ SEE FT.FLOOR AREA TOTAL ACREAGE
•; himself or through Meow mployees,provided final such improve-
mentsarenotintendedoro red forsale.If.however.the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within a year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of p ving that he did not build or im- .BUILDING USE
REB IND CON PB OtM1er
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ -
❑ I,as owner of the property,am elusively contracting with
licensed contractors to construct the pr -ct ISec. 7044,Business LAWN SPRINKLERS- 1 INC 5.V.B. 6.00 Ik SESSORSPARCELNO.
and Professions Code:The Contractor's Lice •Law does not apply -
to an owner of properly who builds or improv . hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contrumods)lice ' d pupmmM(n SEWER-SANITARY-STORM EA.200f1/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ lam exempt under Sec. ,B.& . for this WATER HEATER W/VENT 6.00
¢area
Owner [)ate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPP-NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of censenl to self-insure' ZONING ENG.SITE N0.
or a ceRifmata of Wjyr�•{L'.�amp�rs�?tion InsuraQ uc a certified
copy l Ifi($gt'7ya0 Nil, :1. � J/� / ' /•
Policy P nY 'r./ / /_ /`.'I l..i
0 ❑ RIF, copyes he furnished. FIRE SPRINK ENERGY T 24
ertif d y is 0led it • cit n 'on divisime.
zp Aplicanl MISC.- REFER TO ORD. Y � N� Y N�
CC - CF:RTIFICA EO EXEMPTION FROM WORKISRS' PERMIT ISSUANCE �' FLOOD ZONE a.L.0 t.
LU COMPENSATION INSURANCE PL .0 I PLG.CL V N� v N�
Z (This section need not be completed if the permit is for one TOTAL 6
hundr dollars lS 100)or less.)
(,.) O 1 cert ' that in the performance of the work for which this Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issu 1 shall not employ any person in any manner so as m
0 W become subje lite Workers'Compeasation Laws of California. BUILDING
y Date pplicant ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLI 1': If,after making this Certificate of F.7
- ? emption,you should beco inject to the Workers Coenpnesation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, must forthwith comply with FEE
f.1 such provisions or this permit shall be ed revoked AIR HANDLING UNIT(TO 10=C.F.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 for EXHAUST HOOD(WITH DUCT) 5.00
the performance of thew for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). . HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's No
Lender's Adss HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
dro
1 certify that I have read this application and state that,the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING •�
ordimm Lis and slate laws relating to building construction, and BOILER-COMP(3H.P.orlOO,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTu15EE FEE SCH. MECHANICAL
l above-mentioned properly 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 ac ue against said City i 'cons¢ coca of a PERMIT ISSUANCE 10.00
r i f t en st MECH.CONT. LIC.NO. MECH.
TOTAL
TOTAL
s, Sign ure o Applicant Contractor I Date
OFFICE COPY