17530 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 17530
INSPECTION DIVISION
JOB INSPECTION
� b IZ3 �E p INSPECTIONRECORD (U 39
PERMIT EXPIRATION
JOB ADDRESS I1D�"� kNUNIT#
LOT'# '
PERMIT.EXPIRES IF WORK
OWNERi, C�d CONTRACTOR �"�1L�V �C- IS NOT STARTED WITHIN,
SPE `'.
INC ION DA E 'INSPECTOR INSPECTION RECORD . 180DAYSOFPERMITISSU- .`
FOUNDATION - ANCE OR 180 DAYS•FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p +� ' 3
UNDERGROUND /SLAB PR 1W;
PLUMBING �j,L .� Q ;y rh It
//yy
ELECTRICAL yi�WDipoum ISSUANCE DATE
MECHANICAL . ELECT. PLG. MECR
❑ ❑ ❑ .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR -INFORMATION
VALUATION 'SIFT,
PLUMBING .
MECHANICAL
PERMIT TO
ELECTRICAL u
FRAMING
$iURIE$• TYPE CONSTR
INSULATION
OCL GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O I'1'.FLOOR ARIA TOTAI.ACREAGE
ROOF - NOTE:NO FINAL INSPI SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
• BUILDING USE
ROOF SHEATHING - � RES'. IND CON PB' Oiew
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
ROUGH SANA ASSE 55ORS PARCEL NO
PLUMBING ELECT.ENERGY"
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY Acc.OAie Acc.FILE NO
FRAMING ELECT.FINAL TE ST - ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST: ' GAS
FIRE SPRINK ENERGY T]A
MECHANICAL y
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - r N� r [:]. NE]
EXTERIOR SHEAR ELECTRICAL RELEASEEL000 ZONE ALUC
.
INTERIOR SHEAR FIRE DEPT. ' v ❑ NE] v "�
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
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.' MICROFILMLU ,
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING.
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL •dIO
- SEE PERMIT FOR EXPIRATION DATE -
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
BYI L.DI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING Z� F_ t✓� APPLICATION & PERMIT ^O
ADDRESS BUILDING -ELECTRICAL-PLUMBING-.MECHANICAL 3
OWNEH'5 � � /O ��Le PLAN CHECK VALIDATION
' NAME OTY. ELECTRIC PERMIT FEE
• PHONE
♦
-ONTRACTORs OUTLETS-SWITCHES-RECEP 10.00/1.00
S No: LIGHTING FIXTURES 10.00/1.00
ADDRESS TOR', - -ts4� APPLIANCES-RESIDENTIAL 4,00 ,
1124!6PHON / PANELS - 10.00 DATE OF APPLICATION ..
ARCHITECT PLAN CHELK FEE P.C.NO.
DR V/ /Z •hfOK6EN PANELS (OVER 200 AMP) 20.00
' SIGNS TRANS.. 3.00
A
RCH,ORE G. SPECIAL CIRCUIT 59� .00
PERMIT VALIDATION
ApDREss
EMP.METER OR POLE INS. 20.00 -
APPLICANT'S MOTORS SEE FEE SCH. 3
ADDRESS _ -6 y
'
rd p SERVICE,CHANGE 20.00 �'` VC
009 LICENSED CONTRACTORS DECLARATION ,.Ice- Pw `�
is u I hereby affirm that I am licensed under provisions of Chapter 9 r' ISSUANCE DATE
y'Z N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F o z 11 IF aiana Cod n� license Is in full for f ec1+ ply
z O'An- License Cass_ Lie.Number X APR ,J _ ❑ 16L
o Fw Dare��Conrmclor_iJ - '
¢ m 2 -a R o-11 - BUILDING PERMIT
re ¢ w OWNER-BUILDER DECLARATION INFORMATION
w5 u y I hereby affirm that I am exempt from the Contractor's License MISC.- ORD VALUATION $/FT.
s- .. o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Cade:Any city or county which requires a permit to construct,alter,
ac au
¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
as E 0 , requires lite applicant for such permit to file a Signed statement that - TOTAL PERMIT TO
n ae se he is licensed pursuant to the provisions Of ole Contractor's License
i.
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ I� o the basis for the alleged exemption.Any violation Of Section 7031.5STORIES TYPE CONSTR.
aim by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 '
off than five hundred dollars(8500).): -
1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 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 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 TOTALACREAGE
himselfo through his own employees,provided that such improve-
mu enare not intended or offered for sale.If,however,the building GAS-EA;SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00
❑ 1„as owner of the property,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 I'or such projects with a contractor(,)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 +
reason
Owner Dale WATER SYSTEM '5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE N0.
or a certificate Of Workers'Compensation Insurance,or a certified
copy Ihero ec=3�o;Lab.C.).� d• 7-•
Policy No �• ompany /5 .L
❑ Cerfif re Opy is h' by furnished. FIRE SPRINK ENERGY T-24
Z"Oy ❑ Certifie 1' d with the city inspection division. MISC- REFER TO ORD. ❑ ❑ ❑ ❑
Applicant v N V N
~ rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.O.C.
CERTIF 'E OF EXEMPTION FROM WORKERS'
Lu >_ COMP17NSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
d.D (This seclion.need not be completed if the permit is for one TOTAL ❑ N❑ Y❑ N[]
Z hundred ddlars(S100)or less)
U O 1 certify that in the performance o1'the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
w Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} US NOTICE TO APPLICANT: If,after making this Certificate of Ex- -
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 101000C.F.M.) 4.00 jr
U
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.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(See. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address _
I certify that I have read this application and state that the aboveJIVENTILATION FAN (SINGLE) - 4.00 C -
. information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER OOMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby-authorize representatives of this city to en ler upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL •OV
above-mentioned properly for inspection purposes. '
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which 'CONST.TAX
may in any way accrr .nst said City in consequence of the PERMIT ISSUANCE 10.00
ran I of a pe MECH.CONT. LIC.N0. MECH. "
�- 51 ur of pp /Contractor TOTAL .TOTAL1
Dle 00
OFFICE COPtl