15957 POST.THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
r " ~ CITY OF CU.PERTINO 15957 .
INSPECTION DIVISION
JOB INSPECTION RECORD y
aell/ - PERMIT EXPIRATION
JOB AD DR ESS ��3 '•I �d�� /�� 'UNIT# '_'LOT# `
(� • 'PERMIT EXPIRES IF WORK
owNER coNrRAcroR �•_ <� 6�-. IS NOT STARTED WITHIN
INSPECTION DATE 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 PFHMIT VALIDATION.
CUPERTINO STANDARDS.
GARAGE SLABS - •••^"`
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _-1'.-+
UNDERGROUND /SLAB //
PLUMBING. .. a. 7 !•}•.` Jk b
ELECTRICAL - - ISSUANCE DATE
MECHANICAL . BLDG ELECT. PLG. Meo+.
❑ Elo ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
w,O. INFORMATION
WOOD FLOOR �, - P eQ vALUATTON s/PT.
PLUMBING ` OD
MECHANICAL J .
ELECTRICAL B �t\D, PERNur ro
FRAMING
INSULATION - src HIES TYPE coNSTH.
OCC.GfjPUP RES UNITS
I .
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'I.• ` ' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sO.P..PLoou AREA ro*AL ACR EAGE _I
DIAPHRAGM
THE CONSTRUCTION TAXIS PAID
BUILDINGUSE,
'
ROOF SHEATHING � RES IND, CON
PB oinri
C APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSL55ORS PAHCEL NO.
.ROUGH SAN.# ,
PLUMBING .. ELECT.ENERGY .
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No
MECHANICAL MECRENERGY • �'
ELECTRICAL (o, yyd. BUILDING ENERGY ACC DATE ACC FILE NO.
FRAMING _ -� •• ELECT.FINAL TEST - zowNc ENo.slre No.
INSULATION PLUMBING —�0- � .
GAS TEST GAS
MECHANICAL' - FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEMSIGNED HEATING t Y❑ N❑ V ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE ' FLOOD ZONE A U.C.
INTERIOR SHEAR FIRE DEPT.. Y ❑ N❑ I C N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH I TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC 'PLAN CH ECK
. . GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
'ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION'DATE'— MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ;f TOTAL:
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - - PERMIT NUMBER
APPLICATION & PERMIT 15957
R 555
BUILDING —ELECTRICAL—PLUMBING—MECHANICAL t'
OWNEmS PLAN CHECK VALIDATION
•
NAME
DTV. ELECTRIC PERMIT FEE
.U'O/SL � ✓ ONE
CONTRACTOR'S
rvnmE UTLETS-SWITCHES-RECEP 10.00/1.00
la—IC.NO. ILIGHTING FIXTURES 10.00/1.00
CONTRACTOR'SADDA s - PPLIANCES-RESIDENTIAL 4.00 '
CONTRACTOR
17C/ L �,� PHONE 1136'By4n PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.Na."
ENGINEEfl
I.C.No. SIGNS TRANS. 3.00
ARCH ORRESS ENG. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESNrs ?. MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 / ��
wo O LICENSED CONTRACTORS DECLARATION '
¢t v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE D TE
y a$ (commencing with Section 7000)of Division 3 oil the Business and - BLOC. ELECT. PLG. "MECH.
Roz Professions Cod and license is in full force a d elle t ❑ ❑
z o m — License Class Liv.Number >>
a —w Date —Z Controct0r
¢ y f _aAR - BUILDING PERMIT
¢ ¢o
OWNER-BUILDER 1 ATION INFORMATION
X ;LL m I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD yq LUATION $/FT.
R u m¢ Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
FyI Code'.Any city orcounty which requires a permit to construct,alter,
ELEC.CONTR. UC.N0.
u, ¢ 4 O improve,demolish,Or repair any structure,prior to its issuance,also ELEC.
n n O u requires the applicant for Such permit to file a signed statement that TOTAL PERMIT TO
-
w m he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000)of Division 3 Ofthe 6—
/ LO -
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r $ the banisher the ti
alleged exemption,An
g pAny violation Of Section 7031.5 STORIES - TYPE CONSTR.
a by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.)3:00
of not more than five hundred dollars($500).):
❑ 1,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 sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. .P
CoJe:The Contractor's License Law does not apply to a I owner of _
property who builds or improves thereon,and who Joe"such work FIXTURES-PER TRAP 8:90 FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve- O
., meats are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 '
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.0 BUILDING USE
builder will have the burden of proving that he did not build or int. S IND' DON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,ran exclusively contracting with ❑ ❑ ❑ ❑' ❑
licensed contractors to construct the project IS". 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 property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractions)licensed pursuant to
the Contractor,License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER Vft=MT 6.00 -
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofimnsent m self-insure,
or a certificate of Worker; ZONING Compensation Insurance,or a certified ENG:SITE NO.
f copy there0f(Sec...—000,ompany
r��2 _
Policy ere Company V '
O ❑ ified copy is hereby furnished. FIRE SPRINK ENERGY T.24
Z Z 5ME
wyth th it inspection division.
O AMISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
� - :MPT'ION FROM WORKERS' PERMIT ISSUANCE 46-80 FLOOD ZONE AL.U.C.
LU MATION INSURANCE PLG.CONTR, LIC.No. PLG.
CL 0 ('this section need not he completed if the permit is for one TOTAL Y❑ No , Y ❑ N❑
D Z hundred dollars(S 100)or less.)
f„) O I certify that in the performance of the work for which this per-r
MECHANICAL PERMIT FEE FEE SUMMARY
LL V- mil is issued.I shall not employ any person in any manner so as t0
U become subject to the Workers'Compensation Laws of California.
C. Date—Applicant Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} 0 NOTICE TO APPLICANT: If,after slaking this Certificate of Ex.emptim.you should become subject to the Workers'CompensationAPPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10DWC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency forEXHAUST HOOD (WITH.DUCT) 5.00
the 3097�Civ.C.). of thu work for which this permit is issued(Seo. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)Lender's Address ELECTRIC
I 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
ordinances and slate laws relating to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00
hereby aulhorite 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 m save, indemnify and keep harmless the City of MISC.- REFER TO ORD,
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ranting of this permit. MECH.CONT. - LIC.NO. MECH.
TOTAL TOTAL
Sign re of A cant/ connector Date
OFFICE COPY