15956 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15956
INSPECTION DIVISION
JOB INSPECTION RECORD A
,�/ 1,, P, /007-9- PERMIT.EXPIRATION
JOB ADDRESS �Q��3 ,I/` P�OL� � S'
'd UNIT# _LOT#
�/
.(� PERMIT EXPIRES IF WORK
OWNER WA-L_. L E0C)I< CONTRACTOR ?1B.e LeZ]'iQi L IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSP TION RECORD 180 DAYS OF PERMIT ISSU- s
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.
•R I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 7-2.,t, wj, e, fit, � -"\• !, `1 � _
UNDERGROUND /SLAB +
\ PLUMBING , -
ELECTRICAL Q ISSUANCE' ATE
j ELEC{ PLG, MECH
\ MECHANICAL �` • I ❑v ❑ ;
�. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ` IL
G PERMIT
INFORMATION
WOOD FLOOR VALUATION
" Y � .
' PLUMBING _
'1 MECHANICAL SIFT
` LECTRICAL PERMIT TO
FRAMING 4 �
INSULATION7 � w STORIES TYPE CONSTR.
dv1bet4r
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5O `T.FLOOR AREA TOTAL ACREAGE
DIAP41AGM THE CONSTRUCTION TAX IS PAID
RUILmrvc USE
ROOF SHEATHING RES IND CON PB ow.,
APPLY{NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.q ASsesso.S PARCEL NO
PLUMBING\ ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY "
ELECTRICAL BUILDING ENERGY Acc.Dare. ACC FILE No
' FRAMING . ELECT.FINAL TEST
INSULATION
PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS "
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ V ❑ N❑
EXTERIOR SHEAR{ - ELECTRICAL RELEASE FLooO ZONE ALUs.
INTERIOR SHEAR. FIRE DEPT. Y❑ N❑ Y ❑ N❑
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 OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED 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 °ERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.TAX
\ IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE rIT „�' TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'• BUILDING PROJE T IDEN TI FIC ION ;PERMIT NUMBER
.GILDING - Q(� APPLICATION & PERMIT •� [(]
ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I J J J
OWNER'aVIJL(:_0 rAJH(O#J PnRK CL6 PLAN CHECK VALIDATION
NAME
• Q OS T-1 ELECTRIC PERMIT FEE
LRSG '
A/ .J vV PNDNE
NAMMERya�croppR'sp Z UTLETS-SWITCHES-RECEP 10.00/1.00 old
IVe /1 dJ/u E[ e ev, uc.NO.&(OZ.9'2,4') LIGHTING FIXTURES 10.00/1,00 p
CONTRACTORS
l� A DRess /r� • APPLIANCES-RESIDENTIAL 4.bo
6v -ONEZ32--473.? PANELS tO.O DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP), 20.00 PLAN CHECK FEE �o.C;N0.
OR
ENGINEER
LIC.No, SIGNS TRANS. 3.00
moo Ess ENc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
aPPucarvr's MOTORS SEE FEE SCH.
A D
FRE5346 (,6 /QpF/jFL SERVICE CHANGE 20.00 "✓�
o o LICENSED CONTRACTORS DECLARATION 9Y 17- paw
Ie LWi u I hereby affirm that I am licensed under provisions of Chapter 9 p ISSUANCE DATE
yw (commencin with Section 7000)of Division 3 of the Business and
a n e BLDG. ELECT. PL❑G. MECH.
0 o z Professions Co�«s an,ryqyy}y license is in full fore n ec
t o m- License Class �-/V Lla Number 7
o m r j Uate - Contractor
a >! ♦ CV BUILDING PERMIT
le ¢¢
OWNER-BUILDER DECLARATION
o a u REFER TO OR INFORMATION
wy 1 hereby affirm that I am exempt from the Contractor's License MISC.-
3 u y p VALUATION $/FT.
H LL o j Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 49:00'
,n0 Code:Any city ormunly which requires a permd to construct,alter,
2 ca ¢ FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
O u requires the applicant for such permit to file a signed Statement that TOTAL !//� PERMIT TO
E
ro he is licensed pursuant to the provisions of the Contractors License L��
F z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe E
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
fie the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d3 _ by any applicant for a permit subjects the applicant loacivil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dodors(S500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCE-URO UP 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. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves Ihemon,and who does such work F IXTUR ES-PER TRAP 5.00 SD,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.Provided that such improve-
memsamnot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-i INC.4 OUTLETS 6.00
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- REIND CON PB Omer
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 11 EEl 1:1 ❑ 1:1❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contraclorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00
TRACT NO. PARCEL NO.
❑ tum exempt under Sec,-,B.&P.C.I'or this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACL.FILE N0.
WORKERS.COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sell'-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Comqpe�nsation 1 sums 4c ora ecr II ed
copy thereof GSe�.�(p�0�ii((��bb V / CAI-C!f S UL'F•'r
Pol!ey�Iol Cmh�any II+D Frti. (::XL
O �d Certified copy is hereby furnished. FIRE BPRINK ENERGY T-Z4
F ZO ❑ Certified copy is fled with the city inspection Division. MISC. REFER TO ORD. ❑ ❑ ❑ ❑
Applicant v N v N
mIr CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE a.L.U.C.
W ] COMPENSATION INSURANCE
PLG.CONTR. LIC.No. PLG.
1 Q This section need not be completed if the permit is for one TOTAL Y❑ N❑ I Y ❑ N❑
D Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I.- mit is issued,1 shall not employ any person in any manner so as to _
U become subject to the Workers'Compensation Laws of California.
w Date Applicant ALTER-OR ADO TO MECH. 5.00 PELECTRIC
- W NOTICE '1'O APPLICANT: If, he,making this Certificate of F.-
'not inn,
.-
emotion,you should become subject to the Workers'Compensation APPLIANCE 5.00
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10JWC.F.M.) 6.00
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance
er or once of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.1 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 6
Lender's Address
7 .
1 certify that I have read this application and slate[hal the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000BTU)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.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
' a Y Ip ay, Crue against said City in consequence of the PERMIT ISSUANCE 10.00
g fl pe tit. MECH.CONT. LIC.NO. MECH.
,2z -1 TOTAL TOTAL
SIFgna'treo Applim/Contractor Date
OFFICE COPY .