18900 ,; . POST THIS CARD NEAR FRONT'OF.,BUILD,ING� .�
CU ERTINO �� �+PERMiTNUM 9ER
C1TY� OF P
18900 INSPECTIO'N?DIVISION` a I
JOB INSPECTION RECORD s tj
7 ERMITE XPIRATION
' JOB ADD �.,V I�. j.••/� p2 LOT# .
'�- PERMIT:EXPIRES&IF WOR K' '
4 N, ,. owNER ' coNTRacioR n 'wL-T�L py, ISNOT.STARTED WITHIN
SPECTION DATE INSPECTOR INSPECTION RECORD 1 eo.DAYS OFPERN1iT IssU "
FOUNDATION °':' .,r : ,' - + .ANCE OR'180'DAVS FROM ',
NOTE:. . +'. ` BLAST CALLED INSPECTION. '
LIFER, . ., - - ,,
- � ALL GRADING-AND DRAINAGE`SHALL BE'INSTALLED , "• -
'PREGUNITE r•• .' e TO COMPLY WITH THEAPPROVED PLANS AND CITY OFPE MIT VALUATION
GARAGE'SLA9S • t . - +- CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
e
PLUMBING
- ELECTRICAL .'.i• ,e„ iy. i" 'y l issuANCE DATY
t MECHANICAL 'S , , - - „� . ' RLoc.- ELECT PLG MECH
' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED , : ul Qil,, BUILDING PERMIT
• WOOD FLOOR - INFORMATION
PLUMBING _ .r , , ull F. u ♦:vALunnoN s/ET.
MECHANICAL ) - n", £ ±
ELECTRICAL /yPE�RM Tro/./�/�) �i
FRAMING':, r ' ��'+�//�yZ
INSULATION ISEDRIEs TYPE corvstR
VI
OCC GROUP. 'RES UNITS .
PLACE NO SUBFLOOR.UNTIL ABOVE HAS BEEN SIGNED
I 11 ROOF � '• SOFT"FLOOR AREA 'TOTAL ACREAGE
NOTE:.NO.Fml_INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE.CONSTRUCTION TAX IS PAID
s BUILDINGUSE
ROOF SHEATHING .i at - n RES, IND CON -PR O
'APPLY'NO ROOFING:UNTIL ABOVEHASBEEN SIGNED -FINALS -DATE • INSP. ,
} ROUGH, SAN.0 rc•p ASSESSORS PARCEL NO
PLUMBING - • •• ELECT.ENERGY S_ „"+ s� • -
T , ' , TRACT NO. PARCEL NO
TUBS&SHOWER�PAN - PLUMBING'ENERGY`: '
(' MECHANICAL ' ' - r,' '- MECH.ENERGY'
ELECTRICAL 1,2F ; BUILDING ENERGY"L ACC onrE y ._ �ACC.FILE No.
" FRAMING'! _ s - ELECT-FINALTEST-" A -
INSULATION :i " PL'UMBING. "s r,' �. {CONiNc eNc:BITE No:
GAS TEST GAS'
• MECHANICAL' ' FIRE'sPRINK'. ENERGY.T 2
' COVER NO WORK,UNTIL ABOVE HAS BEEN SIGNED . 'HEATING ,.. , '. Y O c,N.O. Y O NEI '
'r 1.
EXTERIOR SHEAR..T(' .a ELECTRICAL RELEASE -,, .F DOD ZONE - ,I A.C.'U:C.
INTERIOR SHEAR
N� v.L•• N❑
SHEETROCK
EXTERIORLATH'' BUI COI NGS :FEE SUMMARY
,INTERIOR LATH=„ . , _TEMPOR`ARY APPROVALS;' ' ' ,+ BUII:DING
SCRATCH COAT -' t ELECTRIC
; 1 : PLAN CHECK [
GAS, s.; .1 FEEL. ..
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED. OCCUPANCY (';. •,s
SEISMIC C,F E E,
r ".
OCCUPANCY OFBUI LDI NG IS NOT PERMITTE D'UNTI LrBUI LDING F INALIS SIGNED BY BUI LDING INSPECTOR- MICROFILM ”
IN aL
`ARRANGE'FOR'INSPECTION BY•PHONING`252-4505,1 . ELECTRIC
o�. ONE WORKING'DAY.BEFORE REQUIRE.D,JNSPECTION
PLEASE GIVE JOBADDRESS'WHEN PHONING. "„": ' elNc' ;
PLUM
— SEE''PE'RMIT FOR EXRIRATION Dl1TE MEc 'ANicAL ' '
JMPORTANTI coINS T.TAX
PLEASE-READ REVERSE SIDE BEFORE TOTAL a
CALLING FOR FINAL INSPECTION
OFF.ICE,COPY H
APPLICANT•TO:FILL,<I_N INRORMATION'WITHIN.RED LINES.- USE BALL POINT PENONLY ;
•y BUILDINGIPROJECT hDENTIFICATION T'' .,. _ PERMIT NUMBER .! ;
APPLICATION & PERMIT
POOR ESE
BUILDING - - ,
- s - 1.8l 9 0��
EL
- BUILDING - ECTRICAL-PLUMBING=MECHANICAL ' . va (,�
a
OWNER$ - - ' v PLAN CHECKVALIDATION
AME -., %r.. n �./I QTY, -ELECTRIC PERMIT ,FEE i e `-
�'•' Y SOly` _ PHONE Z4 .G 4O
` y CONTRACTOR 5 -
NAIVE, y OUTLETS,-.SWITCHES-RECEP'.: 10.00/100 ', d
_rA W1 •' ,'i't uc10.00/1.00
� .ISS .No 8 LIGHTING FIXTURES 1000/100 1
' ADDREsAscr, cAPPLIANCES RESIDENTIAL,
86 2- PHONE
_ PANEL'S - " 1000 pi' '• "DATEOF APPLICATION r
eR• PANELS (OVER'200"AMP) 'J ' 20.00 PLAN CHECK FEE Pc.NO.,
SIGNS TRANS,t' "'- +'3.00
ARCH.OR ENG. - - _
AOOREss" �y,j{.... x ` SPECIAL CIRCUIT ,i SD0 "1 PERMIT VALIDATION '
r EMP.METER ORPOLE.INS ,' 2000
' APPLICANT'S C ^ '
gooREss MOTORS - : SEE FEE SCH
:.
V ;
SERVICE CHANGE
r o o' LICENSED CONTRACTORS DECLARATION - " _ �® I :�
a U U I herehy sffirm that 1 am licensed under provisions of Chapter J r/MC(/�
�ay IBSU E DATE - 1
y z w (commencing wlth,Section`7000).of Division 3 of the Business and 1 J 'J V ,BLDG., ELECT., • PLG. MECH.
"r w i Professions Code,and my licenses in.full force and effect.-. V 1
0 z m w License Class - 'Lie:Numtier �,( . �" �•
9 a= J Date + Contractor
OWNER-BUILDER DECLARATION .I LlQ�.Q/HQO. ' „BUILDING PERMIT
INFORMATION
w ;' - I hereby eft rm that I am exempt from the Contractor's License - MISC.,— REFER TO ORD ` -
HureOQ Law for the following reason.(See.7031.5,-Business and Professions nVALUATION S/FT..
'
Y Code:Any city orcounty whichrquiresa permit tocoustructalter, PERMIT ISSUANCE
e,demolishOr repair any structure, Z ���-
IC IL ¢,� Improv , ture,.prior to Ila issuance,also ELEC.CONTR. LIC.NO. •-
-� a requires the applicant for such permit[o file a signed statement that y TOTAL r(.J
>< m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
'` _ '.>s -
Law(Chapter 9(commencing with Section 7000)of Division 3 of the '%'��Q.QOi.
4 c Business and Professions Code)or that he is exempt therefrom and QTY. _' PLUMBING`PERMIT' r FEE �'✓CY�
¢ r $ - the basis for file alleged exemption.Any violation of Section 7031.5 -' h STORIES TYPE CONSTR.'
by any applicant fora permit dollar, S500h.he licam toacivil penalty STORIES,
5.00
of not more than flue hundred dollsre($500).):
❑ I;as owner of the.property-or my employees with wagesas _' BACK FLOW PROTECT..DEVICEM0�00p,
' .00
their sole,compenvatiori will do the work,and the structure is not - OCC.GROUP RES.UNITS
intended or Offered for sale (Sec:7044, Business and Professions „ DRAINS-FLOOR,ROOF,AR EA,C5 00 '< aCode'.The Contractor's License Law does not apply to an owner of property who builds'or improves thereon;mid who'does such work FIXTURES-'PER TRAP . . - - 5 00 so Pr FLooR AREA rorAL ACREAGE
himself or throw h his own em to -g p yeas provided Otatsuch impro e menti ane not intended oroffered for sale If,however,the building GAS-,EA.SYSTEM,-1 INC.4 OUT00 or improvement is sold within one yearof completion,the owner-builder will have the burden ofproving that he did not build or Im- t, GAS-EA.SYSTEM:OVER 4,(E .00 BUILDING USE
prove,for parposeof sale.). ; - INDUSTRIAL WASTE INTER; .00 ' 'RESy;INo CON PB. oma.❑ I,as owner of the properly,am exclusively coiitracimg with ❑ ❑.• ❑'.. ❑licensed contractors to construct,the piojed(Sec.7044,Business LAWN'SPRINKLERS-1 INC 5 V .00and Professions Code:The Contractor's License Law does not apply - - - - ' ASSESSORS PARCEL NO.to an.owner of property who builds or improves thereon,and who. LAWN SPRINKLERS-OVER,5.( .00 contracts far such projects with o conlractons)licensed pursuant tothe Contracmr's License Law. • SEWER-SANITARY-STORM EA: 0 00 TRACT NO., - PARCEL No.
❑ l am exempt under ,B.&P.C..for flu WATER HEATER'W/VENT 600
on
- Owner at, '•' WATER SYSTEM f - 500 f ••v. ry ACC.GATE ACC.FILE NO:! =
WORKERS'COMPBNSATION DECLARATION " WATER TREATING EQUIP,'' '� > 5.00 „
1'.1nereby affirm that I have a Certificate of consent to
or a certificate of Workers'Compensation,Insurance,or a certified s'. 'r 26NING. ENG.SITE NO. r
copy thereof(Sec.3800,Lab,CJ. .,q, r 'y A. '
i.' Policy No. - Company a .1 . o-,
❑ Certified copy is hereby furnished. ' { FIRE'SPRINK " ENERGY T24
•'Z Z' ❑ Certified copy' is Bled with [he city inspection division.
Applicant -. MISC. , 'REFER TO ORD '"I
O Y{..❑ N❑ Y ❑ N❑
y .CERT IFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE " 1000 FLOOD ZONE,. - -'A.L.U.C.
W r ' ' COMPF.NSATION,INSURANCF, PLCs CONTE. ❑c.NOa PLG,'
'd 0 (This section nced'not be completed sit rile Penni[ is I'or one • TOTAL �'V❑ N❑, Y❑ 'N❑
Z hundred dollars(in
or IessJ - P•• . i - - '
` U O 1 certify that in the performance of the work for which this per. DTV.' MECHANICAL PERMIT FEE , ` ' .FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to _ d s
,O'w become subject to the Workers'Compensation Lawsof California:' - ' -
y Date Applicant t ALTER OR ADD TO MECH. 5.00 BUILDING'.
} N NOTICE TO APPLICANT: If,after making this Certificate of lis- _
F ? ' eruption,you should become subject to the Workers'Compensation APPLIANCE'' 5.00 .' '*i' PLAN CHECK
provisions of tile m
e Labor Code, you!must forthwith coply,with - FEE:
- V such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY ' AIR HANDLING UNIT(OVER 10=C.F.M.)-6.00 L'�SEI§MIC FEEThereby affirm¢hat thereIs a structionllending agency for 'EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work Cor which this permit is issued(Sec. FILM3097,Civ.C.). , HEATING UNIT(TO 100,000 B.T.U.) 8.00Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)950 v' ELECTRIC
f I certify that I have read'this application and state that the abos'eVENTILATION 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, anJ BOILER-COMP(3 H. or 100 000 B.T.U.) 6.00
hereby.authorize representatives of this.city to enter Upon thP,e BOILER-COMP Over 100,000 BTU)SEE FEESCH , MECHANICAL-
above-mentioned property for inspection purposes
(We) agree;to save,indemnify andkeep harmless the City of MISC:- .: - REFER TO ORD _
H May
in
against liabilities,judgments, costs and expenses which ,PERMIT ISSUANCE 10.00 . CONST.TAX
ay in any way accrue a st said'City in consequence of the - .f • '
Lanni m' MECH.CONT., - LIC N0.'y^ ( l' MECH
�� — TOTAL TOTAL
a Signature of Appltcaut/Contractor .e .'Dale -
r
A.
OFFICE COPY,