18717 POST THIS CARD NEAR FRONT OF BUILDINCk,��
J., PERMIT�NUMBER
8?17
CITY OF CUPERTINO
INSPECTION DIVISION
/
JOB INSPECTION RECORD
RECORD
JOB ADDRESS ` "�' '- '^BVI 1 t. (j�T# V �_LOT# �,/ PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR L il .IS NOT STARTED WITHIN'
INSPECTION DATE INSPECTOR _ INSPECTION hPUUKU 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER NOTE: LASTCALLED INSPECTION.
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PeRMAVALIOATION
CUPEknNO STANDARDS.
GARAGE SLABS + '-• l
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL ISSUANCE DATE
MECHANICAL RING ELEcrF PLO I MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
' WOOD FLOOR INFORMATION
VALUATION $SFT.
PLUMBING
MECHANICAL
ELECTRICAL - _ PPE+R�n1Ii.To
FRAMING � `.�.�• 1 P�G` .7
INSULATION SIURIES IYEE CONSTR.
'
OCC GROUP. RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
p'T` SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
l•�� BUILDING USE -
�/� ROOF SHEATHING Res - IND CON ve
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 11 ❑ `o
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING - ELECT.ENERGY
.TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL - MECH.ENERGY '
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL
FIRE SPAIN ENERGY T 2
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "E) ` "E]
^^�� FL00020NE ALUC
EXTERIOR SHEAR ELECTRICAL RELEASE i
INTERIOR SHEAR FIRE DEPT. Y ❑ "� Y ❑ "�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH,COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM �—
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC y ''
LU
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING. —"
- SEE PERMIT-FOR EXPIRATION DATE - MECHANICAL --- r,
IMPORTANT! ' CONST.TAX ,
PLEASE READ REVERSE SIDE BEFORE }. ' `' A TOTAL Jy
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN.ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADDRESS
2 73Z`J9f7/�� APPLICATION &,PERMIT 1 091 7
aooREss �tU 1 U r I
� BUILDING —ELECTRICAL—PLUMBING—MECHANIC/✓
INNER'$ ,r PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
ORPXONE `
CONTRACTORS �L!(/�f / UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
NSA �l66 ZZ LIGHTING FIXTURES 10.00/1.00 -
NO.
CONTR
ADDRESS
11B41,V1 94it Oce PPLIANCES-RESIDENTIAL 4.00 rl fit 2198
AOORE55 I[/ OSI P '/1109 '
Q PHON ,' 'PANELS 10.00 ATE F PPLI N
A CHITECT - PL
oR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.u0. SIGNS TRANS.
ARCH.OR ENG.
ADDRESS SPECIALCIRCUIT 5,00 \
21P EMP.METER OR POLE INS. 20.00 �•PERMI 1R1VALIDATION 1^ N
ADDRESS JA.l M��HLL P MOTORS SEE FEE SCH.
CEJ SERVICE CHANGE ' 20.00
'02 LICENSED CONTRACTORS DECLARATION , til CL( C! O �"
<U U I hereby affirm that 1 am licensed under provisions of Chapter 9' �. s env ISSUANCE GATE
z w (commencing with Section 7000)of Division 3 of the Business unit BLDG. ELECT. PLG. MECH.
F z z Professions Cod it my liicc rise is in full force a d •ifect. ❑ �jl ❑ ❑
z O= License Class Lic.Number �jSf
Oz
r w Ual Contra to
¢ y s /'� '�T i— BUILDING PERMIT
rc a w a OWNER- UILDER DECLARATION INFORMATION
K 0wU MISC.— REFERTO ORD
N g u-w I hereby afRrm,that 1 am exempt from the Contractor's License / VALUATION $/FT.
I- LL Oa Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE
Code:Any city or county whicllrequires a permit to construct,alter,
It
al Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
C¢ requires the applicara for such permit to file a signed statement that - TOTAL PERMIT.TO
E
`� w IN,is licensed pursuant to the provisions of the Contractor's License
His Law(Chapler9(commencingwilh Section 7000)Rf Division 3 of the ����Sf�,,
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more Than five hundred dollars(5500).): -
❑ 1,as owner of the properly,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 Out
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 docs such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
meats(or lot ugh intended
ownemployees,for sale.
If.ed however,
the
improve- GAS-EA.SYSTEM-1 6.00
merits are not intended or emplo ee sale.If,however,the building
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 am. RES IND CON PB OtM1er
Prove for purpose of sale.). INDUSTRIAL WASTE INTER: 30.00
C11,as owner of the properly,am exclusively contracting withEl El El 0 El
licensed contractors to construct the project(Sec:7044,Business LAWN SPRINKLERS. 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
LIZ Professions Code:The Contractor's License Law does not apply
to an ownerof property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contructons)licensed pur imat to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.—,BAP.C.for this WATER HEATER W/VENT 6.00
rcuson
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK Ii RS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00
[ hereby affirm that I have a certificate of consent t0 set(-insure' ZONING
ora certificate of Workers'Compensation Insurance,or a certified ENG.SITE N0.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z IwTifieit cap filed i0t )c city inspection division.
MISC.- REFER TO ORD.
O Applicant Y N v ry
Cr N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE a.L.U.C.
W COMPENSATION INSURANCE. PLG.CONTR. LIG.NO. PLG.
IL O (This section need not be completed if tile permit is for one TOTAL Y❑ NY❑ N❑
Z) Z hundred dollars 1$100)or less.)
0 O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE - FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation laws of California.
0 y Date Applicant - BUILDING
} N NOTICE'DO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F Z emplion,you should become subject to the Workers'Compensation APPLIANCE - _ 5.00 PLAN CHECK
provisions of the Labor Code, you nmst forthwitll comply with FEE
f, such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1ODMCF.ML) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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(Sec. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000B.T.1.1.19.50 ELECTRIC SL/
Lender's Addrc
I certify that I have read this application and slate!flat 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-COMP 13 H.P.Or 100,000 B.T.U.) 6.00 �� A
hereby aulhono, representatives of this city to enter upon the 'BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlioo against liabilities,judgments, costs and expenses whiell CONST.TAX
ay in any way ac(Ne against said City in consequence of the PERMIT ISSUANCE 10.00
r [ Rhisp i MECH.CONT. LIC.NOMECH.
_Z. TOTAL TOTAL U
Signature of ppliea /Contractor Date
OFFICE COPY
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