18638 POST THIS CARD NEAR FRONT,OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 18638
INSPECTION.DIVISION
JOB INSPECTION RECORD'
'V♦7 ,-b PERMIT EXPIRATION
JOB ADDRESS J o't 2_3 N• Wa - UNIT# _LOT#
U yAP S PERMIT EXPIRES IF WORK
WNER
Oa. ACTOR a (e-c IS NOT STARTED WITHIN
INSPE CTION DATE INSPECTOR INSPECTION RECORD 180 DAYS,OF PERMIT ISSU- .
FOUNDATION - ANCE OR '180 DAYS FROM
NOTE:
' LIFER -ALL GRADINGAND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. I
PREGUNITE TO COMPLY WITH THE AP .ANS AND CITY OF. PERMIT VALIDATION ,
CUPERTINO STANDARDS. ,r !' ",
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED SEF
UNDERGROUND /SLAB
PLUMBING - � pwiply
ELECTRICAL . - ISSUANCE DA
I MECHANICAL - _Z n I �-,�^ - BLDcr� ELEcr. PLc. MEC.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR '�
VALUATION $IFT.
' PLUMBING -
MECHANICAL '
ELECTRICAL - PERMIT To
FRAMING "
`}��-'�I e ` of C-1 '
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE s°.vT.`coon AREA roTaL ACREAGE
DIAPHRAGM THE CONSTRUCTION'TAX IS PAID
BUILDING USE
ROOF SHEATHING - RES IND CON PB OIm,
APPLY NO ROOFING UNTFL ABOVE HAS BEEN SIGNED FINALS IDATEINSP. ❑ L L EASSESSORS'PARCEL NO
ROUGH SAN.#
PLUMBING ELECT:ENERGYTUBSBSHOWERPAN PLUMBING ENERGYIRACT No PAHCEprTo
MECHANICAL - MECH.ENERGY
ELECTRICAL r1-r,' BUILDING ENERGY ACC.DATE AGE.FILE NO
FRAMING ELECT.FINALTEST
ZONING ENO.SITE NO.
INSULATION / PLUMBING -
GAS TEST. GAS - -
MECHANICAL - FIRE SPRINK ENERGY T.pa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y F ^ N❑ ' � Qt-]
FLOOD ZONE A.L U.C.
EXTERIOR SHEAR - - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y❑ No v L NQ
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING '
SCRATCH COAT ELECTRIC .PLAN CHECK
GAS,
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING.IS NOT PERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC �U
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX 7.
PLEASE READ REVERSE SIDE BEFORE TOTAL73
CALLING FORFINALINSPECTION. 7G
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - .
„BUILDING M6JECP IDENTIFICATION PERMIT NUMBER
0U11DING as APPLICATION & PERMIT1 o J
C f�
���' Aapr1E5$ I
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL s,
OWNER'S PLAN CHECK VALIDATION
NAME (Wam,eN s QTY. ELECTRIC PERMIT FEE
' cozs-
'NONE
3g OUTLETS-SWITCHES-RECEP 10,00/1.00 S.
LIGHTING FIXTURES 10.00/1.00 -
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
AO RES
/ PHO E ,3-_ 1d2 PANELS 10.00 DATE OF APPLICATION '
ORCRI CT PANELS (OVER 200 AMP) 20.00 ' PLAN CHECK FEE P.C.NO.
ENGINEER
SIGNS TRANS. - '3.00
nooaess ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 �/- 2-
APPLICANTS
APPLICANTS MOTORS SEE FEE SCH. ` 1
ADDRESS �;
6 /�r. S! .69-- S-/2.1-1 SERVICE CHANGE pp 20.00 �'j-T ✓LL�
woo LICENSED CONTRACTORS DECLARATION
rt u U 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Ga lu (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
w Z Professions Code,and my license is in full farce and effect. ❑ ❑ ❑
0 2L W License Class Lic.Number
Date-Contractor a .,,.N
< Y PI OI cow" O BUILDING PERMIT
¢ Ic w a OWNIi R-BUILDER DECLARATION INFORMATION
ode' MISC.- REFER TO ORD
E
3 u.w 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
Yu0 J Law for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 -017
Iw04 Code:Any city orcounty which requires a permit to construct,alter,
¢ Q ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that ' TOTAL 73. 7o PERMIT TO
wm he is licensed pursuant to the provisions of tire Comrndor's License
HZQ
Law(Chapter 9(contmencing with Section 7000)of Division 3 ofthe
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
X the basis for the alleged exemption.Any violation of Section t,5
O STORIES TYPE CONSTR.
I- $
a3 � by any applicant fora permit subjects tire applicant fee civil penenally ALTER-DRAIN -WATER (EA.) 5.00
of not more than live hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW 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 docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP - 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
. himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is said 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 am- RES IND CON PB Omer
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,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 for such projects with a contractor(s)licensed pursuant to
the Co tractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner - Date WATER SYSTEM 5.00
- ACC.DATE ACC.FILE NO.
WORK IiRS'COMPENSA'IION DECLARATION WATER TREATING EOUIP. - 5.00
1 hereby affnm lhut 1 have a certificale of consent to sel Ginsum, . - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance•or a certified
copy thereof(Sce.3800,Lab.C.) µ��.,rms�d� ec�-,frs
Policy No. Company4ins /r. '.4c
0 Certificjl Copy is hereby furnished. FIRE sPRINK ENERGY T$4
Z Z C t" p 's filed with the city inspection division. MISC.- REFER TO ORD.
O A plicant Y ❑ N❑ Y ❑ N❑
~ wPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.
LU > CER'fI FICA i I
P EXEMPTON PROM WORKERS'
DJ _ CO ENSATION NSURANCE: PLG.CONTR. . LIC.NO. PLG.
Q. a (This action need not be completed if the permit is for one r TOTAL. Y❑ N❑ Y ❑ N❑
:D Z hundred dollars(S100)ar less.)
0 O 1 certify that in tire performance of tire work far 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
} rail NOTICE 1'0 APPLICANT:Jf,after muki ng this Certificate of Ex-
emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of file Labor Code, you must forthwith comply with FEE
(..1 such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000CF.M.1 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 [ELECTRIC
IC 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 + OFILM
3097,Cls.C.). -
Leader'sName HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00information is correct. I agreeto comply with all city and county Brdinances and state laws relating to building Construction, and - BOILER-COMP(3 H.P.Or100,000B.T.U.) 6.0(1hereby authorize representatives of this city to enter upon the BOILER-COMP (°VBr 100,000 BTUI SEE FEE'SCH. ANICAL
above-mentioned properly for inspection purposes.OVE) agree to save, indemnifymd keep harmless the City of MISC.- REFER TO'ORD.
upertino against iabilities,judg nt , costsa T.TAX
NSiVallp6
wa awrue u sail City in c 1 •yucnce of t e PERMIT ISSUANCE 10.00 -
f IL MECH.CONT. LIC.NO. MECH.
921 TOTAL TOTAL
Applicant/Contractor Date
OFFICE COPY
r .