17068 J.. .POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 17068
INSPECTION DIVISION
JOB'INSPECTION RECORD
I ^I T I . PERMIT EXPIRATION
JOB ADDRESS lo� \ UNIT# LOT# PERMIT EXPIRES IF WORK '
DwNER� `" corvTRAcroR O ?-ehnq l IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180'DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE OR 180 DAYS FROM,
NOTE: - "
UFER � - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS I, LI. IL j
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB L1
PLUMBING
ELECTRICAL an ISSUANCE DATE
MECHANICAL u IBLDG ELECTPLG. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING U
MECHANICAL i
ELECTRICAL PE«MIT TO
FRAMING lit t) I
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED L-tD
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE "'i,noB AREA TOTAL ACBEAct
• DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB O'F" '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
- ROUGH SANA
PLUMBING " ' ELECT.ENERGY
• TRACT NO � PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY '
ELECTRICAL BUILDING ENERGY :I A TE - ACC.FILE NO.
� '-7FRAMING ELECT.FINAL TEST ZONING ENG. No.
INSULATION _ PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T.24
I'I ' MECHANICAL N� Y ❑. N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 1:1
EXTERIOR SHEAR ELECTRICAL RELEASE ' FLOOD ZONE I A.L U
INTERIOR SHEAR FIRE DEPT.
YE] NED YL 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
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU -ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
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 TOTAL
CALLING FOR FINAL INSPECTION'.
OFFICE COPY
.*APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-.
BUILDING PROJECT IOENTI FICATION PERMIT NUMBER
APPLICATION & PERMIT � 7068_
7 0^ ^
emLDlrvc - - I Vh ?lSJ
AIS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
��I�-.3 W o L E !2
OINNER'S 'Q� PLAN CHECK VALIDATION
1
• ` T / Pr QTY: ELECTRIC PERMIT FEE '
PHONE
NONERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
af' Jc1�,/J 1 7rtdNo. Z�_ ��1 LIGHTING FIXTURES 10.00/1.00
f,ONTRAcronsAmon Pas APPLIANCES-RESIDENTIAL 4.00
5 k HONE (D3O D i PANELS 10.00 DATE OF APPLICATION
ORRCHITecr - -PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P;C.NO.
ENGINEER y
LIC.NO. SIGNS TRANS. 3.00
ARCH,OR ENG. - S.DD
AOGRESs PERMIT VALIDATION
SPECIAL CIRCUIT '1
- ZIP EMP.METER OR POLE INS. 20.00 .,(h,'Tf'�t 11'Ycc•I
ADDRESS MOTORS SEE FEE SCH. /ll?IL9{�lL�
ADDRESS -
- SERVICE CHANGE 20.00 ' I I I l i B9
o0
0
I r O o LICENSED CON"TRACTORS DECLARATION
v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE PATE
"' (commencing witll Section 7000)of Division 3 of the Business and
rn < A BLDG. -ELECT. PLG. MECH.
r N i Professions Code/rad�y cosi is in full for a�tL�f[�
License Clnss-4�-(t Lie Number '„y �3 , Ba,--
, . LI; El ElI XI El
Date Contractor
a r f-JiBUII.DING PERMIT
rc of4 OWNER-BUILDER DECLARATION
W U MISC.- R OR ' - INFORMATION
X g LL y I hereby,affirm that I am exempt from the Contractor's License VALUATION $/FT.
H u O J Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
Qimprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. '
n wOa, requires the applicant for such permit to file a signed statement that TOTAL'' PERMIT TO
m he,Is licensed pursuant to the provisions of the Contractor's License
Hzi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the f1-�11
2 4 o Business and Professions Code)or that ho is exempt therefrom and QTY- PLUMBING PERMIT FEE
M H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES - TYPE CONSTR.
n3- by any applicant l'or a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollar,($500).): -
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 DCC.GROUP_ RES.UNITS
their sole compensation,will do the work,and the structure is not -
intended or offered for sal&(Sec. 7044, Business:red Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 •�
Code. The Contractor',License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 R AREA TOTALACREAGE
menta are notthrugh intend e own offered
fors,safe.
if,ed however,
r,the
improve- GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6,00
mints are mens is sold or Offered roma o IL mpleveq the building
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that h - .e did not build or ire- - RES IND CON PB Other
prove far purpose of sale.). INDUSTRIAL W ASTE INTER. 30.00
❑ L as owner of the property,he exclusively contracting with ❑ El 11 E]Iiil contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
oil PPmrofessions Code.The Contractor's Licenses Luw docs not apply '
to antr cts for such
property who builds tr irupmves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such.mwprojects with a contractions)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor',Licenso Law. TRACT NO. PARCEL NO.
reason❑ l'am exempt under Sec. ' ,BAP.C.for this WATER HEATER�T - GL 6.00 'L-- a,00
Owner - Date WATER SYSTEM 5.00 TE ACC.FILE NO.
WORK F:RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cer'tificate'of consent to sell-insure, ZONING
or a certificate of Workers'Compensation Insurance,ora certified ENG.SITE NO.
copy thereof(Sec.3800,L.ab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z Cl Certified copy is riled ,with the city inspection division.
O Applicant _ MISC.- REFER TO ORD. 'Y❑ N ❑❑ YN[:]rn
LU 1 CER'T'IFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE ��• 11000 ZONE A.L.U.C.
UJ C04ENSATION INSURANCE. ONTR, LIC.NO. PLO. 1
cc1 Z (This section need not be completed if the peon It is for one TOTAL v❑ N❑ Y ❑ N❑
hundred dollars($100)orless
I
U O 1 certify that in the perform' the work fo[which thi pe QTY. CHANICAL PERMIT FEE FEE SUMMARY
U_ F mit is issued!❑ shall not crept y'ny pe n in u annex us to
U hecome ggable��J/o t1I��gg��''orke 'C e 't on
y
Date r�Cl(plicari ALTER OR ADD TO MECH. 5.00 BUILDING
} rn NOTICE TO APPLICANT: 1 , ter taking t)is Certificate Ex- -
L.. Z eruption,you should become bject to the Workers'Compe Bion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor C e,.you must forthwith comply with - FEE
U such provisions or this perm' shall be deemed revoked. AIR HANDLING UNIT(TO'10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1 .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 the work for which this permit is issued(Sec. MICROFILM
3097,CIv.C.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00 _
Lender's Name HEATI NG UN IT(OV E R 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
. information is correct. I agree.t0 comply with all city and county PLUMBING 7
ordinances and state laws relating to built9 construction, and BOILER-COMP(3 H.P.Or100,000B.T.U.) 6.00
hereby authorize representatives oUthis city to enter upon the BOILER-COMP loner 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property forinspectionpurposes. _
(We) agree to ,ave,'indemnify and keep hurruless the City of MISC.- REFER TO ORD.
" Cupertino 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
Signature of Applicant/Contractor Date
OFFICE COPY