17459 POST THIS CARD NEAR FRONT OF BUILDING
' PERMIT NUMBER
CITY' 0F CUPERTiNO 174. 9
INSPECTION DIVISION ,
JOB INSPE ON RECO D
^ '' II PERMIT EXPIRATION
JOB ADDRESS /01I • WQ £- � o ;" NIT# .LOT#
PERMIT EXPIRES IF WORK
OWNERNTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU=
FOUNDATION,' - - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE,INSTALLED,
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF.' PERMIT VALIDATION .
- CUPERTINO STANDARDS.
GARAGE SLABS . , - 1 ' ,
�� • POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Jh io ; TL,�N �`
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL - City.ut Pope BLDG. ELECT I PLO. MECH.
❑ p3(' ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
ALUATION- S/F T.
- ' ' � .
' MECHANICAL '
ELECTRICAL PERMIT TO- -
FRAMING
INSULATION - - STOHIES TYPE CONSTR,
OCC GROUP RES UNITS
i
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED II
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sa.FT.11...AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
'BUILDINGUSE
ROOF SHEATHING RES IND CON PB . Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 1:1 Q. ❑ ❑ '❑
ROUGH - SAN.N , nssEssoas PARCEL NO
PLUMBING ELECT.ENERGY "
TUBS'&SHOWER PAN - PLUMBING ENERGYTRACT NO. PARCEL NO,� '
MECHANICAL MECH.ENERGY
ACC.DATE ACC.FILE NO,
ELECTRICAL `. BUILDING ENERGY -
,FRAMING ELECT.FINAL TEST
ZONING PLUMBING ENG.SITE NO
GAS TEST '' GAS "
MECHANICAL ' - .FIRE SPRINK ENERGY T.as
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING :Y ❑ ' No ' ❑ .N❑
EXTERIOR SHEAR � - •"' ELECTRICAL RELEASE ' FLDo o z ONE A,L.0 c'
INTERIOR SHEAR - FIRE DEPT. ❑ N❑ y "❑
SHEETROCK.` - GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH' TEMPORARY APPROVALS BUILDING
I'• SCRATCH COAT . ELECTRIC PLAN CHECK
GAS 'FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE
IOCCUPANCY OF,BUILDING ISNOTPERWTTED UNTILBUILDING.FINAL ISSIGNED BY,BUILDING INSPECTOR, MICROFILM
1.
LU' ARRANGE FOR INSPECTION BY PHONING 252=4505, ,, 1.
ELEcralc f C�
~O� 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 y�
CALLING FOR FINAL INSPECTION. w i
OFFICE COPY
AFWLICANT TO FILL IN INFORMATION WITHIN ,RED LINES.- USE BALL POINT PEN ONLY.
'BUILDING'PROJECT IDENTIFICATION :-, - - - u PERMIT NUMBER
UILDING.. f - -APPLICATION &'PERMIT`
ADDRESS
B / 1 ^y
(1/ JC�� .,. BUILDING—ELECTRICAL—PLUMBING1'���v
—MECHANICAL '''
ow.Eus - r PLAN CHECKVALIDATION ,
- NAME I�f+ xL�/'t WECKRa C, 1 2�•Q�� QTY. , ELECTRIC PERMIT FEE i I
CONTRACTORS .,
NAME OUTLETS SWITCHES-RECEP 10.00%1.00
fff�1^(SS (Ofifsr LICNO. LIGHTING FIXTURES 10.0.0/1.00
ADDRESS TORS SJ(j(s Ap' '1 r+pp PPLIANCES-RESIDENTIAL 4.00 - t
I[, J FHONrq�J-JPANELS - 1000 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE PO.'NO.
OR. ff(♦K!I'9d ` r' .PANELS (OVER 200•AMP) 2000
'ENGINEER JSQ(if�.'�J .r ` 1 90 93.0(), r '}
! r U.'NO. SIGNS TRANS:
ARCH.OR ENG.- q PERMIT VALIDATION
ADDRESS ; (, y c,.A7-JTY-( /T -r yr' SPECIALCIRCUIT 5.00
S�1 WA C J Cd ZIP % 3 EMP.METER OR POLE INS:; ,'1 , .2890 ^^
i` uu
APPLIANTS _ MOTORS - '.SEE FEE SCH. AA\ I / '�
ADOR ESS S R/`tC i -a IM02�--�`
Ii SERVICE'CHANGE :20.00 •"� '�
Foo LICENSED CONTRACTORS DECLARATION
Er z w I hereby affirm that I am licensed under provisions of Chapter 9 - `.�' ISSUANCE DATE -,
w
(commencing with Section 7000)of Division 3 of the Business andBLDG. ELECT' PLG MECH.
F H i Professions Code,an y license is in full Pomyy�p,�'fe�(..
Z, D m - License Class Lic..Number7 3 LJ t
Z -o
.
4 F Dine - Contractor � ❑ ' ❑
x E t BUILDING PERMIT -
't¢;¢ w,� OWNER-BUILDER DECLARATION _ ,INFORMATION
w3�'y I hereby affirm that I am exempt from the Contractor's License MISC.= - 'a REFER TO ORD
u o j Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
F
�_n el PERMIT ISSUANCE }0;80 -
Code'.Any city or county which requirese permit to construct, also _
Qp improve,demolish;Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. , "' ELEC. F
0
wD n requires the'applicant for'such permit to file a signed statement that n TOTAL �1�. PERMIT TO
m he is licensed pursuant t6 the provisions of the Contractor's License - !'
FZQ
Law(Chapter 9(6ommencingwith Section 7000)ofDivision 3 of the
E i o Business and Professions Code)or that he is exempt therefrom and. QTY. PLUMBING PERMIT FEE,
I-m' thebasis for the alleged exemption.Any violation of Section 7031.5 ' STORIES - TYPE CONSTR.
i3 by any applicant for a permit subjects the applicant to a civil penalty, ALTER-DRAIN&VENT-WATER.(EA.) 5.00 i '•
of not more than five hundred dollars($500)J: - " -
❑ I„as owner of the property;or my employees-with wages as BACK FLOW PROTECT. DEVICE .4.00 5' OCC.GROUP RES.UNITS, .
their sole compensation,'will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF;AREA,CON D. 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- ..
meats arehot intended or offered forsale.If,however,the building a GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the"owner- GAS EASYSTEM OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or am- - . -
,. .. BUILDING USE
RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER., '1 , 30.00 ,RES El F-1 'El El
l,as owner of the properly,am exclusively contracting with
. licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-.1 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 fca such projects with a conlractons)licensed pursuant to.
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 (,„TRACT NO. }, s PARCEL NO. .
❑: I Jai exempt under Sec. ,e.&P.C.t7fr this - WATER HEATER W/VENT + 6.00
reason -
Owner • Uatei WATER SYSTEM - 5'.00 µ
, 'ACC.DATE ACC,FILE NO:
WORKERS'COMPENSATION DECLARATION' .WATER TREATING EQUIP. '500
'I hereby affirm'lhal I hove a certificate of consent to self-insure, - - ZONING ,ENG.SITE N0:
or a certificate.of Workers'Compensation Insurance,or'u certified
copy thereof(Sec.3800,Lab.C.). _ - -
Pohcy No. ' Company
Qd. ❑ Certified copy is hereby forms ed - FIRESPRINK ENERGVT24'-
z 2 Certified ca�r9�is Bled,.wn the c' aspect cn division. -
� p Applin nt-- YL� , MISC.= ! _ REFER TO ORD. Y.Q N❑ ,YQ ' N❑
= In CERTIFICATE.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE � 10.00 FLOOD ZONE A.L.U.C.
W > ,COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG.
CL Q (Thn,section .coil nut he completed if the permit is for one
TOTAL V,�. N� Y N❑
z hundred'dollars 1$100)or,lessI
'.0 01 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT - FEE FEE SUMMARY' ,
I. mit is issued7l shall not employ any person in any manner so as to - .
become subject to the Workers'Compensation Laws of California. -
0 y, Date •t Applicant ;BUILDING
ALTER OR ADD TO MECH. 5.00 .
:} W NOTICE TO APPLICANT: If,after making this Ccitifmam if Ex- '
F 1Z eniption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 • PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
such provisions or this,permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.).6.00 SEISMIC FEE
1,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.G). - HEATING UNITi(TO,100,000'B.T.U.) 8.00
Lender's Name ' _ HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
' i Lender's Address - �(G•�/
T' Pcertify ilialIhave read this application and slate that the above _ VENTILATION_ FAN (SINGLE) f.," 4.00 -
information is correct. I agree to comply with all city and county, PLUMBING.
i ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
-- hereby authorize representatives of,this cit y.sesto enter upon the
above-mentioned property for inspection purBOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
^"\ po ..
(We) agree to save, indenmify and keep harmless the City of 'MISC:- REFER TO ORD. -
upertino agmnst liabilities,judgments, costs and expenses which pERMIT ISSUANCE 10 00 - CONST..TAX. .
may in any way accr a against aid City in consequenc of the .
rantl:�f thisrperm�.j -t pp MECH.CONT LIC.NO.,, MECH.
V/ 1 -(\ ZA 0 '1�L1Z 1 TOTAL, TOTAL
Signature of Applicant Contraor Dates -
- OFFICE CO 5-`..