18682 POST THIS CARD NEAR FRONT OF BUILDING PERp,ITNDMBEd
��. CITY OF • CUPERTINO . 8682
INSPECTION DIVISION
JOB INSPECTION RECORD ;
• �� ��' '�`( �p�����,�Ir��I �) �Z
1P RI/VAI T. XPIpATION
JOB ADDRESS_ SS y P_td_�UNIT# -_LOT# � /J
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 160.DAYS OFPERMITISSU-
' FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLEDINSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLV WITH THE APPROVED PLANS AND CITY OF - PEHMIr VAuuA ,ION
CUPERTINO STANDARDS.
GARAGE SLABSPARD
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB NOV U9,198q f k• I +�. 1
PLUMBING 1 L�
ELECTRICAL - - < n '
. C+I�" � ""?►110 �' ISSUANCE DATE
MECHANICAL - BLDG ELEcr. PLT,. •MECH.
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
VALUATION $/FT.
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
FRAMING
INSULATION ' STORIES.+ TYPE CONSTR.
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR-UNTIL ABOVE HAS BEEN SIGNED
SO.FT FLOOR AREA TOTAL ACREAGE
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM �, THE CONSTRUCTION TAX IS PAID
BUILDING USE
-
ROOFSHEATHING G RES IND CON PB O'l
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
AS5ESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO.. PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
• ELECTRICAL BUILDING ENERGY Acc,OnrE ACC FILE No
FRAMING - ELECT.FINAL TEST
ZONING ENO.SITE NO.
INSULATION �� PLUMBING
GAS TEST GAS .
MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
//•�� •
EXTERIOR SHEAR � ELECTRICAL RELEASE FLOOD ZONE A.L.0 C.r.
INTERIOR SHEAR' FIRE DEPT. Y❑ N❑ r ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALSV
BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK �<??
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC'FEE . 6'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. 'MICROFILM
e .
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC'
• o� ONE WORKING DAY BEFORE REQUIRED'INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z. = SEE PER FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX:.
PLEASE READ REVERSE SIDE BEFORE TOTAL S-6
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN 4NFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
BU I LDING PROJECT I IDENTIFICATION PERMIT NUMBER
aDILDING APPLICATION & PERMIT, Q e�
AppKSs ,� O G
V -SASE 413y. BUILDING -ELECTRICAL-PLUMBING -MECHANICAL „-
• OwNER'S - PLAN CHECK VALIDATION
"" E QTY. ELECTRIC PERMIT FEE
• �'wPHorvE pp n
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 ^5
NAME rr qq,�, /�q -
(�p ,A)e 4 ICUSS C.No.526q D LIGHTING FIXTURES 10.00/1.00 I(! r
CONTRACTORS qy�3 APPLIANCES-RESIDENTIAL 4.00
ADDRESS (J ft�g Q' f
D PHONl15 p Vy PANELS 10.00 DATE OF APPLICATION
OR
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.oRNc.-ZI �. �IC70Ky '✓A 'SPECIAL CIRCUIT 5.00 PERMIT VALIDATION-
ADDRESS
C zIp 03 EMP.METER OR POLE INS. 20.00
APPucprvr's MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 `
o o LICENSED CONT FACTORS DECLARATION ' �� V G
a v u I hereby affirm that I am licens<•d under provisions of Chapter 9 ( .Q ISSUANCE DATE
w a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. H.
r 89
z o LD Z Professions Code,and my license is in full force and effect. p ❑Lic.Number El '13pl`I
� {, g
w License Class H o Date ContractorContractory ' nS nllr,'.`Ino
- - J
Lc Q w a OWNER-BUILDER DECLARATION BUILDING PERMIT
0 rl O MISC.- REFER TO ORD INFORMATION
w 3 u_I- 1 hereby affirm that 1 am exempt from the Contractor's License
uoa Law for the followingreason:(Sec.7031.5,Business and Professions
PERMIT ISSUANCE 10.00 VALUATION S/ET.
� - Code:Any city orcounly which requires a permit to construct,alter, ^�
IC a, ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO: ELEC. f/
LLrequires the applicant for Such permit to file a signet]statement that TOTAL - PERMIT TO
K
$ he Is licensed pursuant to the provisions of the Contractor's License x '��
r z i Law(Chapter9(emnmereingwith Section 7000)of Division 3 cflhe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �L-
$ the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
t by any applicant for a permit subjects the applicant Ina civil penally gLTER-DRAIN& VENT-WATER IEA.) 5.00
of not more than five hundred dollars(S500)J:
❑ I,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(See. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The,Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00SD,IT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.Il;however the building GAS-EA.SVS7EM-11NC.40UTLET$ 6.00
1 or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or fm- GAS-EA.SYSTEM-OVER 4 (EA.) 2,00 RES �IND BUILDING USE
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,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCE L 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 cornractotls)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor's License Line. TRACT NO. PARCEL NO. -
❑ I not exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason'
Owner Date WATER SYSTEM 5.00
ACC,GATE ACC.FILE N0.
WORK Ii RS'COMPF.NSA1'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to self-ins re. ZONING ENG.SITE N0,
or a certificate oPWorkers'Compensation Insurance,or u certified
copy thereof(Sec.3800,Lab.C,4. -
Policy No. Compa(DQ
Q ❑ C tifie}�o y1Sl cry oy fu�hed, FIRE SPRINK ENERGY T-24
Z Z 1Q' Ce ifE y I Bled wi�I the city inspctioti division. MISC- REFER TO ORD. O
p..Icanl Y N V N
Hy ,/ r .>� PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
� % C.FTI FICA'fE °IiXEMI"PION FROM WORKERS'
L � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y N� Y ❑ NO
d 0 ' (This section need not be completed if the Permit is for one TOTAL
Z hundmd dollms IS I00)'m lass.) FEE SUMMARY
0.0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE
LL H mit is issued,I shall not employ any person in any manner so as m
U become subject to the Workers Compemalion Laws of California.
w Oat, Applicant BUILDING .
n ALTER OR ADD TO MECH. 5.00
} y NOTICE TO APPLICANT: If,after making this Certificate sa Ex-
emption,
x-
Z em vision you should become subject m the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provisions io the hisLabor
permit sh you must forthwith comply with - FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00012-F.M.) 4.00
• CONSTRUCTION LEDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE 6
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(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.001MICROFILM
3097,Civ.CJ. ,
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 above VENTILATION FAN (SINGLE) 4.00
information is correct I agree to comply with all city and county PLUMBING
ordinances and State laws relating to building construction, and BOILER-CUMP(3 H.P.or 100,000 B.T.U.) 6.00
. hereby authorize representatives of this city to enter upon Om g01LER-COMP Inver 100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) al�� 0"use, Indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertipb a most Iia hies,j Bgments, costs and expenses which CONST.TAX
may yt w5 rue ag nst said City in conse<luence of the PERMIT ISSUANCE 10,00
Ian 'Ihise mit - I G 1 MECH.CONT. LIG NO. MECH.
7 TOTAL TOTAL
'. Si sure of APP leant anlracto Date
OFFICE COPY