15961 POST THIS CARD NEAR'FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO , 15961
INSPECTION DIVISION
JOB INSPECTION RECORD `
I � � _ � PERMIT,E XPIRATION '
JOB ADDRESS� O�`2� /V' OLFC-- UNIT# LOT#
_ PERMIT EXPIRES IF WORK '
OWNER , CONTRgCTOR •b �S /A/C , IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 1B0 DAYS OF PERMIT ISSU.
I. FOUNDATIONANCE OR 180 DAYS FROM ,
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDA TION -•
PR EGUNITE .CUPERTINO STANDARDS..
GARAGE SLABS-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ,,,,4 _..••_ •`--"^''
UNDERGROUND/SLAB !
PLUMBING_ CCC, �! . I . ,�•
ELECTRICAL ISSUANCE DATE
MECHANICAL - .. RL 1,—FC—LE—CT PLG. MECH,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ppI BUILDING
I INFORMATION.
WOOD FLOOR- VALUATION BIFT..-
PLUMBING 1,1 ry v� vi
'MECHANICAL Jud `�•
P VMIT TO
ELECTRICAL
FRAMING VEV
INSULATION - STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED o IT,FLOOR AREA rorALACReACE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -
BULLUI USE
ROOF SHEATHING - .Hes IND CON PB 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑, ❑ ❑
ASSESSOHSPARCELNO,HOUGH SAN.H
PLUMBING - ELECT ENERGY
TUBS&SHOWER PAN - - PLUMBNG.ENERGY TRACT NO. - PARCEL NO.
MECHANICAL MECH.ENERGY -
ELECTRICAL + BUILDING ENERGY, ACC,DATE ACC FILENO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING• zoNlNc ENc.SITE No.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T-14
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ "❑
ROOD ZONE A.L U C.
EXTERIOR SHEAR ELECTRICAL RELEASE +
t INTERIOR SHEAR FIRE DEPT. - Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE - - FEESUMMARY
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
OCCUPANCYOFBUILDING ISNOT-PERMITTED UNTILBUILDING FINAL L ISSIGNEDBY BUILDING INSPECTOR. . MICROFILMuJ '
ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC
ONE WORKING DAY.BEFORE'REQUIRED INSPECTION. PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
' - SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE . TOTAL
CALLING FOR FINAL INSPECTION.
T
OFFICE COPY -
APPLICANT TO FILL IN IN WITHIN RED LINES - USE'BALL POINT PEN ONLY
BUILDING PROJECT 1,D - 'PERMITNUMBER - y
- a DING APPLICATION & PERMIT q [(]
�( Q D • '^�A " BUILDINGELECTRICAL-PLUMBING-MECHANICAL f J J v q
,
OWNER'S yyy��/ X11""" .PLAN CHECK VALIDATION
NAME
s'0.{q- rQ OT(v. ELECTRIC PERMIT FEE ,
' / PHONE /\ I
CONTRACTOR'S
J NAMq�•n-. �'] r' �/ OUTLETS-SWITCHES-RECEP 10,00/1_.00
!, / /✓ h' �HG uc.No. - Jr*' LIGHTING FIXTURES 10.00/1.00 3�0 '
ADDRESS
APPLIANCES=RESIDENTIAL 4.00 '
AD/DRESS(('' '/ �L.//ds,
l/Q37�fQ� 7Tr . PHOrvE> PANELS 10.00 DATE OF APPLICATION
ORRCHrtECT PANELS�IOVER 200 AMP) 20.00 PLAN CHECK FEE P.C:NO.
ENGINEER
uc.NO. SIGNS TRANS: 3.00 '
ARCH OR
ADDRESS ENG. - SPECIAL CIRCUIT 5.00,3 S-'(T PERMIT VALIDATION
ZIP TEMP.METER_OR POLE INS. 20.00 -
ADDRESS
PLICANTS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE' *. 20.00
o o LICENSED CONTRACTORS DECLARATIONin �e�C•��' "
a L,w I hereby affirm that I.am licensed under provisions of Chapter 9 ISSUANCE DATE .
�
(oommencing with Section 7000)of`Divislon 3 of the Business and n Q n - - ELECT. PL❑G. MECH.
Professions Code,. my license is in full for ndd Ic - '
t o o> License a Lic.Number 6 J _ \
r Dale Contractor ke- - " oick
UILD G PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION
¢o w v - INFORMATION
w ; y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL O ra Law for the followin reason.(See.7031.5,Bushessand Professions VALUATION $/FT.
_ g PERMIT ISSUANCE .1&80 �
Code:Any city or county which requires a permit to construct,alter,
Q ¢ s-Q improve,demolish,or repair any struct are,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O r requires the applicant for such permit to file a signed statement that TOTAL (�
w $ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H z a Law(Chapter 9(commendngwith Section 7000)0 f Division 3 ofthe -
E o Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT . FEE
¢ r m the basis for the alleged exemption.Any violation of Section 7031.5 , STORIES TYPE CONSTR.
a3_ by any applicant for a permit subjects the applicant loaeivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(S500)J:
❑ 1,as owner of the property,Or my employees with wages as BACK FLOW PROTECT.DEVICE' 4.00
t . .,- OCC. RES.UNITS
their sole compensation,will do the work,and the structure is no _
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 thereon,and who does such work FIXTURES-PER TRAP i 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himse_. morals are not hrough
ownemployees,for
provided ever,hat the
improve- GAS-.EA.SYSTEM-1 INC.40UTLETS 6,00
or
improvement
are mol intended or offered for sale.If,mpleveq the bown-
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build.,.i FES,' IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ L as owner of the property,am exclusively contracting with ❑- ❑ ❑ _❑ ❑
licensed contractors 4o construct the project(Sec.7044,Business i LAWN SPRINKLERS-1.INC 5 V.S. 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 -
contraclsl'or such projects with a eontractons)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
reas❑ I am exempt under Sec. '- ,B.&P.C.for this WATER HEATER W/VENT 6.00 "
' on -
Owner Date- _ WATER•SYST.EM 5.00
ACC.DATE ACC:FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 1 5.00 '
I hereby affirm that I have a certificate of consent to self-Insure, ( , ZONING
oq ceyyffe �pfilVyik,compensation Insurance,ar a cortil'ied
PolicyENG.SITE NO.
cb 16+i/uTR�e,kE( b•.C,.
0o
No. CCompany `
O Certified copy is hereby furnished,.' ' FIRE SPRINK ENERGY T-24
ZZ� ❑ Certlf10o le +witl�t if:i�t�rspe cion_ MISC.- REFER TO ORD.
O Applicuet_L - Vi[E] N❑ V ❑� NE]
W CERTIFICATE OF EXEMPTION FROM WORKERS' -PERMIT ISSUANCE 10.00 FLOOD ZONE .A.L.U.C.
W > COMPENSATION INSURANCE - PLG.CONTR. - LIC.NO: - - PLG.
d O (This section need not be completed if the-permit is for one TOTAL %Y❑ N❑ Y❑ N❑
Z-. hundred dollars IS 100)Or ICss.)
.L) O 1 certify that in the performance of the work for which tHis per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
IL 1- mit is issued,I shall not employ any person in any manner so as In
U become subject to the Workers'Compensation Laws or California. e
0 y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT, If,after making this Certificate of.Ex-
? - emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10
U such provisions or this permit shall be deemed revoked 1000 D.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE "
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. MICROFILM
3097,cm.c.). HEATING UNIT(TO 100,000 B.T.U.), 8.00
Lenders Name HEATING UNIT(OVER 100,000B.T.U39.50 ELECTRIC
Lender's Address
I certify that l 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 stale laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby 'authorize representatives of-this city to enter upon the
above-mentioned property for Inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to Save, indemnify and keep harmless the City of MISC.- - REFER TO ORD. '
upertino agait t liabilities,judgments, costs and expenses which CONST.TAX
may in any t accrue agams said Ty in consequence of the PERMIT ISSUANCE 10.00
II ranting FS�P ermiL ,� �" MECH.CONT. LIC.NO. MECH.
ZKJY{91i�07P �/
TOTAL TOTAL
Signature of Applicant/Contractor Dam
OFFICE COPY