15983 POSE THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
1 .' *`CITY OF CUPERTINO 1593
'INSPECTION DIVISION
JOB INSPECTION RECORD �� J
PERMIT EXPIRATION '
JOB,ADDRESS � �a L�� � - UUNIT# -LOT#, � s�c�n/ PERMIT .EXPIRES IF WORK
OWNER '
° (�fl' � CONTRACTOR ��—� a ..s7 IS'.NOT 'STARTED WITHIN
.F - ,
INSPECTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS 6F.PERMIT Issu:
FOUNDATIONT" ANCE OR 180 DAYS FROM -.
NOTE: LAST CALLED INSPECTION.; '
LIFER„ - ALL GRADING AND.DRAINAGE SHALL.BE INSTALLED
TO COMPLY,WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION -
PREGUNITE i- CUPERTINO STANDARDS: _
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 7TM � '
UNDERGROUND /SLAB
PLUMBING - rhi��
ELECTRICAL �j�q 'y. ISSUANCE DATE . '
BL[JG ELECT: 'PLG. MECH.-
MECHANICAL - I(S- a�7/YY�Q 1
Ye lQl Q Ito
C, B ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BDIL
INFOORMRM PERMITATION
WOOD FLOORYALUATICN, $/FT.
PLUMBING "" w
MECHANICAL ��� '• '
PERMIT O
ELECTRICALAT,( p�q
FRAMING
STORIES TYPE CONSTR.
INSULATION '
OCC.GROUP RES..UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT.FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE -
DIAPHRAGM .•„- THE.CONSTRUCTION TAX:IS PAID
BUILDING USE
ROOF SHEATHING. . -HES [NO CON Pa, Om—
1:1 El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED `FINALS DATE INSP. 0 SR
_ ASSESSORS PARCEL NO.
ROUGH ' SAN*
PLUMBING' ELECT.ENERGY
TRACT NO.. PARCEL NO.
TUBS&'SHOWER�PAN PLUMBING ENERGY
MECHANICAL. MECH.ENERGY
' ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST zowrvc ENC.SITE No.
INSULATION PLUMBING '2
GAS TEST,. G'AS ' -
FIRE SPRINK ENERGY L1<
' - - MECHANICAL - _ v ❑ N❑ tr ❑ N❑
COVER NO WORK UNTIL ABOVE HAS-BEEN SIGNED HEATING'
. - ° FL000zoNE AL.0 c.
EXTERIOR SHEAR ELECTRICAL,RELEASE,
INTERIOR SHEAR
FIRE DEPT,' v❑ N
N❑ vL , ❑
SHEETROCK GRADE A FEE SUMMARY
EXTERIOR LATH ' BUILDING ^2 - _ BUILDING
INTERIOR LATH TEMPORARY•APPROVALS- +
ELECTRIC 'PLAN,CHECK
SCRATCH COAT
s. GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY . - - SEISMIC FEE ,
OCCUPANCY OF BUIL DING ISNOT PERMITTE D UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR'. MICROFILM
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505;' Ii ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. w PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z a,G4'I „ , ' MECHANICAL
SEE-PERMIT FOR EXPIRATION DATE +
IMPORTANT!, CONST:TAX
PLEASE READ REVERSE SIDE.BEFORE `est 1
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
E
DING PROJ T IDENTIFICATION ,PERM IT NUMBER
IN APPLICATION & PERMIT q ���^
I 3Amko_ 1 ', BUILDING-ELECTRICAL-PLUMBING -MECHANICAL F•PLAN CHECK VALIDATION
DTV• ELECTRIC PERMIT FEE �PHONE'S UTLETS-SWITCHES-RECEP 10.00/1.00
N LIC.NO LIGHTING FIXTURES 10.00/1.00
'SA' � L�tjq PPLIANCES-RESIDENTIAL 4.00
PHON A 416 PANELS 10.00 GATE OF APPLICATION
ARCHITECT
oRt PANELS IOVER200 AMP` 20.00 PLAN CHECK FEE P.C.NO.
E N ER
LIC.Rom SIGNS TRANS. 3.00
ARCH.OR ENG,
ADDRESS SPECIAL CIRCUIT5.00 PERMIT VALIDATION
Q Zip
EMP.METER OR POLE INS. 20.00 v
APPLICANT'S
ADDRESS `��7U MOTORS SEE FEE SCT.
5\�} SERVICE CHANGE 20. r9
Foo LICENSED CONTRACTORS DECLARATION
a 0 u 1 hereby affirm that'`um licensed under provisions of Chapter9 ISSUANCE DATE
w 4 w (commencing with Section 7000)of Division 3 of the Business and p G. ELECT. PLG. MECH.
H N i Professions Code d my license is in full force / V
20 i _W License Class__Lie.Numbers{/ ❑ ❑ ❑
I_ Datc Contractor
Q Y 2 J
ac ¢ w Ai OWNER-BUILDER DECLARATION AID BUILDING PERMIT
E
R:u w I hereby affirm that I'am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
u0q Law for the following reason-(Sec:7031.5,Business and Professions PERMIT ISSUANCE �J'. ALUATION $/FT.
�� Code:Any city or county which requires a permit toconstrucl,alter, 10.
Q Q ¢00 improve,demolish,or repair any Structure,prior to Its Issuance,also ELEC.CONTR. LIC.NOTELEflek
51�/�^-�
m, requires the'appllcant for such penult to file a Signed statement that TOTAL
a W' OW
y he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
HZQ Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe
E i o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
Ing-
r $ the basis for the alleged exemption.Any violation of Section 7031.5 S OWES TYPE CONSTR.
n ; by any applicant fora permit subjects $500).liwmtea civil penalty ALTER-DRAIN&VENT-
WATER IEA.) 5.00
of not more than five hundred dollars(my em1:
❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their Sole compensation,will(S the work,and the structure is onotns ,OCC.GROUP RES.UNITS
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
Properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such in.prove-
mentsarenolintended or offered for sale.If,howeveq the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder .will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Other
Cl 1,as owner of the property,am exclusively contracting with 1:1 ❑ F-1 13 El
contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:1'he 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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec.,B.&P.C.I'or(his
reason WATER HEATER W/VENT 6.00
Owner Dole WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORKERS'COMPF.NSA'TION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby infirm that I have u certificate of consent to scl Nusure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Ther of �b.Y.) -
Policy o an 4VQI__
O tilled copy Is hereby nurnished,
Z Z Cetlified copy is fled with the city inspection division. FIRE SPRINK ENERGY T 24
F OApplicant MISC.- REFER TO ORD.
v❑ N❑ v ❑ No
0: N CERTIFICATE 017 EX17MPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A,L,U,C.
LU > COW:NSATION INSURANCE PLG.CONTR. LIC.NO, pLG,
CL O (This scohis, need not be completed if the permit is for one TOTAL Y❑ NE] Y❑ N❑
Z hundred dollars(S 100)co less,)
U O I certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
O w become subject to the Workers''Compensation Laws of California. QO
IL. Dat` Apphc°nt ALTER OR ADD TO MECH. 5.00 BUILDING Eft
} W NOTICE 1'0 APPLICANT: If,after making this Certificate of six- -
? emptio 1,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
U' Provisions of the this
Code, you must forthwith comply with FEE
such p
permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=41F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.1 6A0 SEISMIC FEE I Ws 15
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 '
the performance of file work for which this permit is issued(Sec. MICROFILM
3097,Civ CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
1 certify shut 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 stale laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property fm-mspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEESCH, MECHANICAL
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
u
perItino against liabilities,judgments, costs and expenses which 12CONST.TAX
mny way acerae against said City in consequence of the PERMIT ISSUANCE 10.00 ,
rof is MECH.CONT. LIC.NO. MECH. 75
TOTAL TOTAL
' Ig t/Cool Dul
OFFICE COPY