18538 I'
POST.THIS CARD NEAR FRONT OF BUILDING, PIF RMIT'NI)M86R
CITY OF CUPERTINO 185$$
INSPECTION DIVISION
1 1I1I,�L JOB INSPECTION RECORD
JOB ADD RESS PERMIT EXPIRATION
UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER t V lJ" WR CONTRACTOR(,pjp'L� L,,1 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
'NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF e PennilT VALluniroN
CUPERTINO STANDARDS.
GARAGE SLABS I PAID 'LToI@. (}-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB SEP 11989
PLUMBING NN
ELECTRICAL City OfCUpBrtm ISSUANCE DATE
MECHANICAL SLUG. ELE'T I PLS, MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION srFT.
PLUMBING
MECHANICAL
ELECTRICAL •PERMIT TO
,1ry•+�
FRAMING - • Woe II
INSULATION STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So.Er FLOOR AREA TOTAL ACREAGE
!-� DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
RUILOI USE
ROOF SHEATHING I Hes IND CON Pe 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ Cl ❑ ❑ ❑
ROUGH SAN.H ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY p
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE AC c FILENO
FRAMING ELECT.FINAL TEST
M r Y
INSULATION PLUMBING ZONING ENG SITE NO.Y
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Yo NEI Yo NE]
.EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L U C
�
INTERIOR SHEAR FIRE DEPT. Y El N0 L N
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING -
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
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ItZ,co
. z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL Z T�
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT 18538
aDOR 5
' BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ,.
OWNERS - PLAN CHECK VALIDATION
NAE OTY. ELECTRIC PERMIT FEE
.ONE
CONTRACTOR
NAAMQRAciGRs OUTLETS-SWITCHES-RECEP 10.00/1.00
ND. LIGHTING"FIXTURES 10.00/1.00
CONTRACTOR oRs
AAPPLIANCES-.RESIDENTIAL 4'-00
CONTRA
ry PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
PANELS (OVER 200 AMP) 20.00 ,
ENGINEER AdA
sec.ND. SIGNS TRANS. 3.00 '
COR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
21P EMP.METER OR POLE INS. 20.00 lane Ll ^"
ADDRESS MOTORS SEE FEE SCH. VIJF'
ADDRESS
[s SERVICE CHANGE 20.00
0 4 i
,02 LICENSED CONTRACTORS DECLARATION FAID
a.w 1 hereby affirm that 1 am licensed under provisions o'Chapter') ISSUANCE DATE
r (commencing with Section 7000)of Division 3 of the Business and
way BLDG. ELECT. P' ME❑C
r N z Professions Code I I cense is in full force,�s,sr,T��'yy' II ❑ ❑
z 0 m License�ass/ q Lit.Number-
0
m L Ow Dater ^y'7O Contractor
a r E
¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT.
E: o a 0 INFORMATION
X ; H I hereby affirm that I am exempt from the Contractor's License MISC.- RE RTO ORD
LLo¢ Law for the following reason.(Sec.7031.5,HIINness and Professions PERMIT ISSUANCE 10.001VALUATION $/FT.
� - 0� Code:Anycityorcounty whichrcquiresapermillnconsirucLalteq
ELEC.CONTR. LIC.NO.
¢ at ¢ improve,demolish,or repair any structure,prior hl ifs issuance,alw ELEC.
o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
K
m he is licensed pursuant to the provisions of the Contractor's License - P
Law(Chapter 9(conunencingwith Section 7000)ofDivision3 ofthe IIJ
4 o Business and Professions Code)or that he is exempt therefrom and
¢ H ora the basis for the alleged exemption.Any violation of Section 7R31.5 DTV. PLUMBING PERMIT FEE
$ STORIES -TYPE CONSTR.
n � � by any applicant for it permit subjects the applicant to it civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five handled dollars($5000.):
❑ I,as owner of the property,or my emptoyeas with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do Ila 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 A�4
property who builds or improves thereon,and wilt)does such work FIXTURES-PER TRAP 5.00 I] e6 SO.FT.FLOOR AREA- TOTALACREAGE
himself or through his own enlpluyecs,provided unit suchiniprovm
�.� ments are not intended Oro] for sale.If,however,I he building GAS-EA.SYSTEM-i INC.4 OUTLETS 6.00
or improvemenl is sold within one year of conpiletion, the uwner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving Thal In,did not build Or am- RES IND CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00
❑ I,as owner of the prnperty,am exclusively contracting with Q 0 ❑ 0 ❑
licensed Contractors to construct the project(Sec.7044,Business - LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I lie Contractor's License Law dues not apply
to an owner of properly who builds or impnrves life n•on,and who LAWN SPRINKLERS-OVER 5 (EA.) 1,00
contracts Ibr such projects with a conticlor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt ander Sec. ,B.&P.C.tY)rtilis WATER HEATER W/VENT 6.00
Train,
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORK 1:11TCOAIPENSA'TION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm Ilial lime a eertificafe of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Wor cls'Col pensat inn Incl ,c0.or u certified -
copy thereof(Sec.38 0,Lab.0 .
Policy No. .ompan -
0 ❑/�Cerfilied copylS he eb finished. FIRE SPRINK ENERGY T"24
Z Z O)Certified to R ill III. kkY Inspection division.
O A nt_ _ _ _js�- MISC.- REFER TO ORD. Y [] N� Y [:] N�
~ yM
PERMIT ISSUANCE 10.00 s FLOOD ZONE A.L.U.C.
R CFRTIFICATE OF EXEPTI(. FROM WORKERS' Z
LU COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG.
1 O (This section need not be completed if the permit is for one TOTAL 4 L\� Y[3 IN V C] NC]
L Z hundred dollars IS 100)or less.)
U O I certify that in tile performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not enmloy any person many manner se as to
OW become subject to the Workeri Compensation laws of California. BUILDING
CL Date Applicant ALTER OR ADD TO MECH. 5.00
>_ W" NOTICE TO APPLICANT: If,after making this Certificate of fix- - _
F 2 emplion,you should become subject to the Workers Compalsat ion 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 10,0000.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 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
Lenders Name H EATI N G U N IT(OVER 100,000 B.T.U.)9.50
Lender's Address - ELECTRIC
I certify that I have read this application and shute that the above VENTILATION FAN (SINGLE) 4.00
�^ information n correct I agree to comply with all city and county BOILER•COMP(3 H.P.or 100,000B.T.U.) 6.00 PLUMBING
ordinances and store Taws relating to is city Constar uion, anti
hereby authorize representatives of This city to enter upon the above-mc tione(I property for inspect inn pulposus. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
"ofAic
sa a, indeou.iI n I keep Kann leis the Chy nl' MISC.- REFER TO ORD. -
a bilines, in: n .nts, costs nod a Cponces f tch PERMIT ISSUANCE .10.00 CONST.TAX
fly a clue again: it] City m cansuluemc of Ihu
D it. , MECH.CONT, LIC.N0. MECH,
- TOTAL' TOTAL 'i-I �
m oat clor Dal
OFFICE COPY