18797 J
P.OSTTHISCARD NEAR FRONT 1.OF BUILDING .' ERMIrNUMSER
CITY''OF CUPERTINO . Qn
INSPECTION DIVISION 1 879 I
JOB INSPECTION RECORD p p
•." _ r 1,(' / - Sp PERMIT EXPIRATION
JOB ADDRESS yam,(• -3 WG ` �� UNIT# _LOT#
• {gypp PERMIT'EXPIRES IF WORK
'OWNER U `�• CONTRACTOR, , ��. IS,,NOT".STARTED. WITHIN
V
INSPECTION DATE I INSPECTOR INSPECTION RECORD 7. 180 DAYS OF PERMIT ISSU:,
FOUNDATION. - 'ANCE OR 180 DAYS FROM
_ NOTE: LAST CALLED INSPECTION.
LIFER ' - ALL GRADING AND DRAINAGE SHALL BE INSTALLED.
PREGUNITE TO,COMPLY'WITH THE APPROVED P IIVVD�A_ND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS: � �7 - '
GARAGE SLABS'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED OGT I [ Tldtj
UNDERGROUND /SLAB
PLUMBING - - city,et,cupefto.
ELECTRICAL - - $ " ISSUANCE DATE
MECHANICAL - -, _ .BLDG. ELECT I PLC, MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
- - WOOD FLOOR VALUATION STET.
PLUMBING J +
MECHANICAL-
ELECTRICAL
ECHANICALELECTRICAL / .PERMIT TO -
FRAMING.
' INSULATION _ STORIES TVPECONSTR.
P'
` OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.ROOF NOTE:NO FINAL'INSP'SHALL BE MADE BEFORE sn.PT,FLOOR AREA TorAL ACRPAce
•�' DIAPHRAGM - THE CONSTRUCTION'TAX IS PAID,.
• , • "` . BUILDIV USE
ROOF SHEATHING r • _ .HES 'IND CON PB Om:,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED'" FINALS DATE' INSP. ❑` ❑ ❑ ❑' ❑
ROUGH SAN.q ASSESSORS PARC E L NO
PLUMBING ' ELECT.ENERGK - -
TUBS&SHOWER PAN- PLUMBING ENERGY TRACT No , PARCEL No
' MECHANICAL, - MECH.ENERGY,. .' +
ELECTRICALS - ' BULDNGENERGY ACC.DATE ACC.FILE NO.
FRAMING ' ELECT.FINAL TEST '
. INSULATION
- .t PLUMBING-' ZONING ENG.SITE NO.
GAS TEST - GAS
MECHANICAL ^E IRE SPRINK ENERGY T.za
` COVER NOWORK.UNTILABOVE HAS BEEN SIGNED 1HEATING -Y�❑ ND- :' ° ❑ "❑
FLOOD ZONE A.L,u C.
.. "EXTERIOR SHEAR ELECTRICAL RELEASE - '
INTERIOR,SHEAR - - FIRE DEPT.' .'I v ❑ N❑ 'v ❑• N❑;
SHEETROCK - GRADE ' FEESUMMARY
EXTERIOR LATH IBUILDING
.INTERIOR LATH - - � - � � TEMPORARY APPROVALS BUILDING
SCRATCHCOAT 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
IL ONE WORKING DAY'BEFORE'REQUIRED INSPECTION. PLUMaING
z� PLEASE GIVE JOB,ADDRESS WHEN P..HONING.
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL'
IMPORTANT! CONST.TAX`
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL'
OFFwICEICOPY
APPLICANT TO,FILL IN_INFORMATION WITHIN RED LINES,- USE BALL-POINT PEN ONLY
BUI LOI NIS PROJECT IDENTIFICATION - PERMIT NUMBER
BUILDING VL ae F4S :oa Pt• APPLICATION &'PERMIT, O
ADDRESS o
,:ar O/23 IUa IFR a20$'l BUILDING—ELECTRICAL—PLUMBING-MECHANICAL ,-'{j
OWNER'S 797 A
PLANCHECK VALIDATION
rvnmE , - e S 9 V., OTY, ELECTRIC PERMIT FEE
Dak SG4/4< z PHONE ZS 3,1370
CONTRACTOR'S V
yi •'
NAME �-• OUTLETS-SWITCHES-RECEP 10.00/1.00 `
51�I C �cc vi LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADD[R•ESS tow Gov , .Y/S pit PPLIANCES-RESIDENTIAL '4.00 .e
L J 7O J L PHONE p X S-D8d& PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE r P.C.N0.
OR PANELS (OVER 200 AMPI 20.00
ENGINEER
a uc No. SIGNS TRANS.' -'3.00
ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT 5.00 ^ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 ` I U - /
i• nooa sL MOTORS " - SEE FEE SCH. -
Ga NR,c p SERVICE CHANGE 20.00 j• n IkU-+
Foo LICENSED CONTRACTORS DECLARATION W., . /AOb
1
a ia'� 1 hereby affirm Dml I am licensed motto provisions of Chapter 9 u' D "' -
N e w N ISSUANCE'oATE
a n (commencing with Section 7000)oDDivision 3 of the Business and - BLDG. ELECT. '+PLG. MECH.
r.y i Professions Code,and my license is in full force and effect. ❑ ❑
Zo 0 m o License Class Lic.Number - - `
w Dnlc Contractor •• Cis
{ 7 198
¢ ¢w a OWNER-BUILDER DECLARATION - d �7 BUILDING PERMIT
- o¢ o • - INFORMATION
K
g LL y 1 hereby affirm that I am exempt from the Contractor's License MISC.— RE R•TO PRO I
u o a Law for the following reason.(Sec.7031,5,Business and Professions VALUATION
F -y g PERMIT ISSUANCE . 0 ]�� '
� w Code:Any cityor county which requires a permit to construct,alter,
¢ ¢¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC.
a o , requires the applicant for such permit to file a signed statement that TOTAL •�'
X $ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO -
H z a Co.(Chapter 9(commencing with Section 7000)Of Division 3 ofthe
i D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE / h
- ¢ m the basis for the alleged exemption.Any violation of Section 7031,5 :•STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER,IEA.1 5:00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT..DEVICE . 4.00
OCC.GROUP, REB: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 TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
menu are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-.11NC.40UTLETS�6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or in,- GAS-EA.SYSTEM-OVER 4(EA.). 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ 6 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 LAWNSPRINKLERS-OVER 5(EA.) 4.00
contracts for such projects with o contractors)licensed pursuant to '
the Contractor's License Law. SEWER-SANITARY-STORM EA:200100.00 TRACT NO. PARCEL NO.
O tato exempt under Sea ,B.&P.C.for Oris WATER HEATER W/VENT'
reason 6.00
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKFRS'COMPENSATION DECLARA'I'ION WATER TREATING EQUIP. - 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG SITE NO.
copy lhereof(Sce.3800,Lab.CJ.' -
Policy No, Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city inspection division. -
H O Applicant. - MISC.- - REFER TO ORD. Y ❑- N❑'• y ❑ N❑
CC w CERTIFICATE.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD70NE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. pLG. - _ -
CL O (This section need not becompletedif the permit Is for one TOTAL Y❑ N❑ Y ❑ N❑
::IZ hundred dollars IS I0ot or less.) e
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE- FEE SUMMARY
LL b- mil is issued,1 shall not employ any p son In an manner so as fo
O W becomee�su_b�je�ct_too the Workers'C�y�r aY L' s o ornla. -
Date -'I - Applicant. f p BUILDING.
}'vat NOTICE 1'O AINLICANT: If,W mkmg' Is Cent btc of Ex- ALTER OR ADD TO MECH. 5.00
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO'10,00DC.F.M.) 4:00 - -
CONSTRUCTIONLENDINGAGENCY 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,CN.CJ. HEATING UNIT(TO 100,000 B.T.U.) ,5.00
Lender's Name HEATING UN IT 100,000 B.T.U.)9.50
Lender's Address .ELECTRIC 9"r�
Ipcertify 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE$I:H. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments,.costs and expenses which CONST.TAX '
may in a y wa accrue against said City in consequence of the PERMIT ISSUANCE 10.00 -
mnting Ihl rmi MECH.CONT. LIC.N0. MELH:
0-��-8 9 OTAL TOTAL
A
p sen Contractor Date - jl
OFFICE'COPY