17237 J •
POST THIS CARD NEAR FRONT OF BUILDING'
PERMIT NUMBER
CITY OF .CUPERTINO 17237
INSPECTION DIVISION
JOB INSPECTION RECORD
1 0 24 /`�I I'' W,O PERMIT EXPIRATION
JOB ADDRESS IT lV UNIT# �LOT -
PERMIT EXPIRES IF WORK
OWNER CIO v\C� M
I NTRACTOR (Lo :S/ IS NOT STARTED WITHIN
INSPECTIO PECTOR INSPECTION REC RD 180 DAYS OF PERMIT ISSUFOUNDATION NOTE: ANCE OR •180 DAYS FROM
UFER LASTCALLED INSPECTION.ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALIDATION
CUPERTINO STANDARDS.GARAGE SLABS �
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING FEB - A
ELECTRICAL. - - I:rJ•I �1� c- IOo LIKr:, '
ISSUANCE DATE
MECHANICAL BLOT, ELECT. Pu;,_ MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL - l 3 00-
00
ELECTRICAL FERN+rt ro
FRAMING ellf lot
INSULATION - STo Es TYPE CONSTR,
OCC.GROUP RF.S.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING - - D CONN USE
- NES IND COPB Olnnr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGHSAN.p ASSESSORSPARCEL NO
.; r -
PLUMBING ELECT.ENERGY -
TUBS 8 SHOWER PAN PLUMBING ENERGY - TRACT No. PARCEL NO.
MECHANICAL MECH.ENERGY -
ELECTRICAL - - BUILDING ENERGY ACC.DATE ACC.PILE NO,
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING zorvwG ENc.SITE NO.
GAS TEST - GAS -
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [:I N❑ V ❑ N❑
EXTERIOR SH EAR, ELECTRICAL RELEASE FLOOD Z7NE A.L U.C.
INTERIOR SHEAR - FIRE DEPT. • Y❑ N❑ Y❑ NE]
SHEETROCK - -
GRADE
' EXTERIOR LATH' BUILDING FEE SUMMARY
INTERIOR LATH - TEMPORARY APPROVAL BUILDING �YoO
SCRATCH COAT ELECTRIC - - PLAN CHECK
FEE
NO
„•_,�.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, TMj ELECTRIC �� '
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. n?
0 PLEASE GIVE JOB ADDRESS WHEN PHONING. '. PLUMBING
z
— SEE PERMIT FOR EXPIRATION DATE — 7jj ` MECHANICAL --��
IMPORTANT! �T!: CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL ,.
CALLING FOR FINAL INSPECTION. IU
OFFICE COPY
APPLICANT TO FILL''IN INFORMATION WITHIN RED LINES= USE BALLPOINT PEN ONLY
,J3UI LDING PROJECT I DENTI FICATI ON `PERMIT NUMBER
BUILDING APPLICATION &PERMIT
A°°REaa IVa BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 172 3 7
OWNER'S
NAME (� PLAN CHECK VALIDATION
l�lJlA I'
i 1 QTY. ELECTRIC PERMIT FEE 1
• I�' 1' PHONE .
NAMQRACTORs OUTLETS-SWITCHES-RECEP '10,00/1.00
�l N°. LIGHTING FIXTURES " 10.00/1.00 . '
CONTRACTOR'S
AODREss NUs4 PPLIANCES-RESIDENTIAL '4.00 +.
- �- PHONEA1.616 PANELS 10.00 DATE OWAPPLICATION -�
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP). 20.00 t
ENGINEER
iIC.N°. SIGNS TRANS. 3.00 -I)
ADDRESS ENG., - SPECIALCIRCUIT5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE'INS. 20.00
r aooeess s MOTORS SEE FEE SCH. ^'
SERVICE CHANGE' 20.00
CI a i O Y L Irk
H
00 LICENSED CONTRACTORS DECLARATION -
U U 1 hereby affirm that I am licensed under provisions of Chapter 9 - I�
H¢ w p p - ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT: PLG. '-MECH.
F N E Profession vnd Icensels lofull,for .. Ofsl ❑ ❑
z o m - License CI s a, Number
o - w Date
w H Contractor-ff� 6 A .
1 Or a .OWNER-BUILDER DECLARATION
BUILDING PERMIT
D ' - MISC.- city D INFORMATION
w ;' w Thereby effum that'l am exempt from the Contractor's License -
a- o¢ Law for the following reason.(Sec.703 LS,Business and Professions VALUATION $/FT.
w PERMIT ISSUANCE 10.00 000
Eco> � Code:Any county any structure permitriotoconsuanc ,alsolter, �VI 2 0
¢ ¢ ¢o improve,demolish,or repair any structure,prior to its issuance,x150 ELEC.CONTR. LIC.N0.• - ELEC. 13 ^_'
n S o u requires the applicant for such permit to file a signed statement that - TOTAL QQ "
cu m y he is licensed pursuant to the provisions of the Contractor's License - e t PERMIT TO
rZQ Law(Chapter 9,(commencing with Section 7000)of Division 3 oftlie,
E z o Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE �.
X I- w the basis for the alleged exemption.Any violation of Section 7031.5 STOR S TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,as owner r the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCG GROUP RES.UNITS
their sole compensation,will the work,and the structure is not
intended or offered for sale (Sc,. 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. .. 5.00 - SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended otoffered for sale.If,however,the building - GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,life 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.): RES- IND CON PS Omar
❑ d,as owner of the properly,am exclusively contracting with INDUSTRIAL WASTEA NITER. 30.00 ❑ ❑ ❑ ❑'
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I 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 contractors)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 .for this
reason WATER HEATER W/VENT 6.00
Owner Dale WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO:
WORKF-RSI COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 '
1 hereby affirm that I have a certificate ofeEmsent toself-Insua,
of a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
Copy h/o��fa1�eek�.j1$00,Lob.C.y.
Policy bYr_4 1A1 ompuny Nf�Ta414511,, A.)�
C , ❑ Certified copyps hereby furnished. FIRE SPAINK ENERGY T 24
Z Z
� O OCertifHMC � Dl tyInspection division.
Applicant
MISC.- . REFER TO ORD. Y ❑ ,N❑ Y ❑ N❑
CC $2 CERTI FICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U_C.
LU ION
0 (This Section need'nCOMFot beTcoomple ed RANCEif thepermit Is for one PLG.CONTR. LIC.NO." TOTAL Y E] N❑. Y❑ N❑
aLG❑
Z hundred dollars($100)or less.) -
U O .-1 certify that In the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE - FEE SUMMARY _
ly 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. D O
a Date Applicant - BUILDING
>_ m NOTICE TO APPLICANT: If,after making this Certificate of Ex- 1 ALTER OR ADD TO MECH. 5.00
eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the LaborCode, you most forlhwith,compiy with FEE
U such provisions or this permit shall be deem
ed revoked. AIR HANDLING UNIT(TO 1Op00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 7 SEISMIC FEE . ,s-0
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(Sce. MICROFILM
3097,Civ C.). H EATING UN IT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UN IT(OVER 100,000 B.T.U39.50 d,u'
'
Lender's Address - ELECTRIC
Jcertify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 -
iornnalion is Correct. I agree to comply with all.city and county PLUMBING
ordinances and slate laws relating,lo building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 '
hereby authorize representatives ec this city to enter upon the BQI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL 'hereby
property forinsp of
purposes. e
(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
By in,any y accrue against said Cit in consequence of fine PERMIT ISSUANCE 10.00
ranting of peon' . MECH.CONT. LIC.NO. MECH. -
a`I�J` TOTAL J TOTAL :S'0
Signature° pplt ant Con ractor Date f
OFFICE COPY