17340 POST '
THIS•CARD NEAR FRONT OF BUILDING =
.'PERMIT NUMBER'
CITY OF ''CUPERTINO �f!�
IIINSPECTION DIVISION •'' ` I V O
JOB INSPECTION RECORD i
s' Dai:
PERMIT EXPIRATION
JOB.ADDRESS •Z
_LQ( 3 N' D.- � UNIT# _LOT#
' ! I . PERMIT EXPIRES IF WORK
OWNER'r �/y. � t�' %,CONTRACTOR`` ��1 •� - IS.NOT STARTED WITHIN
INSPECTION DATE INSPECTOR, • NSPECTION RECORD 180 DAYS OF PERMIT ISSU-
i�'•. .FOUNDATION • •
NOTE, ,�. • , ANCE OR 160 DAYS FROM
LASTCALLED INSPECTION. .
UFER > 71 ALL GRADING AND.DRAINAGE SHALL'BE INSTALLED
PREGUNITE TO COMPLV.WITH'THE APPROVED PLANS AND CITU OF PERMIT VALIDATION .
'^ CUPERTINO STANDARDS.
GARAGE SLABS: "-•' - -3-
UNDERGROUND /SLAB
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED u - 3- -
UNDERGROUND /SLAB MAR U319W xiLT '
PLUMBING,. �`
cif4 a cls r-U^-�'f`
ELECTRICAL r ISSUANCE DATE
MECH ANICAL - - ( - I Dc ELECT. PLG. MECH,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PER IT
_ WOOD FLOOR ' INFORMATION
VALUATION- SIFT.
` PLUMBING
MECHANICAL -
PERMIT TU ,
ELECTRICAL
FRAMING - ' '!e.
STORIES %TYPICON T .
INSULATION „ •-
' .00C.GHOUI' RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORESW"'F000R nHEn •roTnL ncecnee
DIAPHRAGM v - THE CONSTRUCTION,TAX IS PAID
BUILDING USE
. ROOF'SHEATHING,. RES IND CON • Pe oon ''
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ '
ASSESSORS PA RCEL NO.
ROUGH SAN.N
PLUMBING' ELECT.ENERGY'
TRACT NO., PARCEL NO
. TUBSBSHOWER PAN. �� � - - PLUMBING ENERGY
MECHANICAL - MECH.ENERGY I
ELECT.R ICAL'• 'BUILDING ENERGY - - Acc GATE ACC.FILE No.
FRAMING.' ELECT.FINAL TEST
r ZONING ENG.SITE NO.'
INSULATION - PLUMBING' - ,
GAS TEST GAS'
• ' MECHANICAL FIRESPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING: + .ND El. " 1
EXTERIOR SHEAR ELECTRICAL RELEASE , FLOOD ZONE A.L•u,c.
INTERIOR SHEAR FIRE DEPT. •' .. v ❑ N❑ Y L�' No
. i. SHEETROCK :C GRADE _ - FEE SUMMARY
-• EXTERIOR LATH '' BUILDING _` ' . , -
INTERIOR LATH TEMPORARY APPROVALS 7BUIL•DwG
SCRATCH COAT - ELECTRIC .^ PLAN CHECK -
I GAS - FEE `
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ', SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTEO UNTILBUILDING FINAL ISSIGNE66Y BUILDING INSPECTOR. •MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252'4505; ELECTaIcI.
` ONE.WORKING DAY'BEFORE REQUIRED INSPECTION:,
I- PLUMBING �•��
oPLEASE GIVE JOB ADDRESS WHEN PHONING.
--SEEPERMITPERMIT FOR EXPIRATION DATE' MECHANICAL'
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR.FINAL INSPECTION:
OFFICE COPY
APPLICANT TO FILL 14 INFORMATION WITHIN REDLINES - USE BALL POINT PEN'ONLY '
fE
NUMBER „
BUILDINGPROJECT IDENTIFICATION ;'APPLICATION &'PERMIT
NO - 7340alZj � looBUILDING -ELECTRICAL-PLUMBING-MECHANICALOwNERa VALIDATION
NAME \\d �� QTY. ELECTRIC PERMIT FEEe\diPHDNE2y2 :y 4 'cDNTRAc7oR's UTLETS''-'SWITCHES-RECEP 10.00/1.00'uc.No. S37 y7 LIGHTING F I XTURES '10.00/1.00.CONTRACTDRS •'APPLIANCES-RESIDENTIAL (: 4.00ADDRESS �eN �? pp , PANELS, 10.00 PLICATIONPLAN LHECK FE P.C.NO.
ARCHITECT PANELS (OVER 200 AMP) 20.00 _ f
OR
- ENGINEER '
LIC:NO. _ SIGNS TRANS.' _ - 3.00. ..
ARCH.OR ENG. S.00 PERMIT VALIDATION ,
ARCHESR - SPECIALCIRCUIT, .t
21p EMP:METER OR POLE INS. 20.00
- APPLICANTS. IMOTORS - SEE FEE-SCH. -
ADDRESS
SERVICE CHANGE 20.00 -
Ds� poD
F D o
LICENSED CONTRACTORS DECLARATION
Q o 1 hereby affirm that].am licensed anderprovisionsol'Chapter9 - ,1 ISSUANCE DATE'
a (commencing with Section 7000)of Division 3 of the Busimas'and - DG. ELECT., PLG. MECH.
F z Professions Code rad my license is in lull fo3nd effe MAR
❑ ❑ ❑
Z o 0.- License 1: Lia Number ''77
OZ 0 Dute= Contractor•'M� -
H T t w BUILDING PERMIT
OWNGR-BUILDER DECLARATION' INFORMATION
E e-a
u D
A o MISC.
w a. u y I hereby affirm that I um oxempt from the i nss angors License - UA -; VALUATION T$/FT.
p¢ Law for the following reason.(Sec.7031.5.Business Professions PERMIT ISSUANCE 10.00
LLL -` Code:Any city or.county whichrequiresa permit toconstract lit •' x
QQ Q Improve,demolish,or repair any structure,prior to Its issuance.aI G ELEC.CONTR. `LIC.NO. - ELEC.
O u- requires the applicant for Such pernt It 10 file a signed U4lemen C that - P •.` TOTAL E PERMIT TO
w$ he islicensed pursuant to the provisions of We Contractor's License ,
Fzi Law(Chapter9(commencing with Section 7000)of Division 3 of the
el business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
r.$ the basis for the alleged exemption,Any violation of Section 7031.$ 5 RIES TYPE CONST .
a by any applicant torapermil subjects the applicantban civil penally
ALTER-DRAIN&VENT-WATER (EA.), 5.00 -
• of not more'ant ❑vc permit)dollars the applicant
'
❑ I,as owner of the properly,or my employees with wages as BACK FLOW.P,ROTECT. DEVICE - 4.00 OCC.GR+AREATOTAL
NITS
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,CONO. 5.00
Code:The Contractor's License Law does not apply to an owner of ` -
propertywhobuildsorimprovesthereon,and who does such work' FIXTURES-•P,ER TRAP, 5.00 aD.FLFLOCREAGE
rovidedthatsuchimprove- GAS-'EA,SYSTEM-1 INCA OUTLETS 6,11
ments are not intended or offered for sale.If,however,the ho lding .
y or improvement is sold within one year of completion;the owner- GAS-EA.SYSTEM-OVER 4 (EA.), 2.00 BUILDING USE
^CI' builder will have the burden of proving that he did not build or im- RES IND 'CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 '
❑,I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Busines's LAWN SPRINKLERS'-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Code:The Contractor's License Law does not apply
to an none,of property who builds'ur improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) -1.00 .
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SAN ITARY-STORM'EA.200ft/10.00 TRACT No, PARCEL No..
I the Contractor's License Law.
❑ lam exempt under Sea' .B.&I'.C.to. , r WATER HEATER W/VENT -- 6.00
reason `
Owner •lime WATER SYSTEM 5.00 1 -, ACC.DATE ' •ACC,FILE NO.'
WORKERS'COAIPENSATION DECLARATION ' ' WATER TREATING EQUIP. 5.00
'a 1 hereby affirm that I have a certificate of consent to self-insure, '20NING. ENG.SITE N0.
o,a certificate of Workers'Co pensmion Insurance,or a c'crtificd
• Policy hNB!N �'_ m �aYtO 11_CWeari T
Q ❑ Cettili a py l4 hertby,fnr i5 ed. FIRE SPRINK ENERGY T 24
Z Z` ertifie c is led• Om city inspection'division. • REFER TO ORD.
Applican •� _ MISC.-, Y❑ No Y ❑ No
H.v0-i PERMIT ISSUANCE 10.00 FLDDD ZONE A.L.U.C.
- 'C F.R AF KATE OP -XIIMPTION FROM WORKERS'
LU COMPFNSATION INSURANCE PI.G.CONTR. 'LIC[NO. PLG. •'Y❑ 'N❑ Y❑ NO
0- O IThis section need not be completed if the permit is for one _ _ TOTAL
:) 2 hundred dollafs($100)orlc11.)
U O- ' I certify that in the performance of the work for which this per- QTY �; MECHANICAL PERMIT .FEE FEE SUMMARY
LL.F. ran is issued,I shall not employ any person in any manner so as to
O W " become subject to the Workers'Compensation Laws of California. - ,BUILDING
Date Applicam " ALTER OR ADD TO MECH: 5.00
Iaia. NOTICE TO APPLICANT: If,after making this Certificate -
-�'z emption,yodshould become subject to the Workers'Compensation APPLIANCE 5.00 •PLAN CHECK
provisions of the Labor Code, you must forthwith comply with _ FEE"
such provisions or this permit shall be deemed revoked. . AIR HANDLING UNIT•(TO 10=C.F.M) 4.00
- '-ICONSTRUCTION LENDING AGENCYAIR HANDLING UNIT(OVER 10PIMCRM.) 6.00 ! 'SEISMIC FEE
'.hereby affirm that there is a construction lending agency for - EXHAUST HOOD(WITH DUCT). - 5.00 -
Ihe 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 ELECTRIC.
_ Lenders Address'' ^
I cattily slut l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 PLUMBING
. information is correct. I agree to comply with all city and county - BOILER-COUP(3 H.P.Or 100,000 B.T.U.) 6.00 '
ordinances and slate laws relating In building construction, and -
li rmby'authorize representatives of this city to enter.upon the BOILER-COMP(own 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. CONST.TAX
------
Co amino against 'utilities,judgments, costs uad expenses which PERMIT ISSUANCE 10.00
'in any way accroe'against said City in consequence of the '
m ( g of this permit,. /1 d - MECH.CONT. LIG NO. MECH: $ -
'nlill(�.`J_f�PaF 3`3. TOTAL TOTAL
Signature of Applicant/Contractor Dae _
OFFICE COPY