18261 POST THIS CARD NEAR FRONT OF, BUILDING
PERMIT NUMBER
• CITY 01 CUPERTINO 1 $261
INSPECTION DIVISION
JOB INSPECTION RECORD 77 i )/ \
L2 P `M�T�T.E'X�P"�,��R.A�+I'�f��1)
JOB ADDRESS P"Jl.l / UNIT# _LOT# PERM EXPIT RESIFWORK
OWNER V lC_ CONTRACTOR V`r74 `(j /�,�. �� .� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
'
LIFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THEAPPROVEDPLANS AND CITY OF PeRnut Vn.0AJloy..
GARAGE SLABS CUPERTINOSTANDARD& - �, I f3F AH✓I�4�rf
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL uANCE DA IE
MECHANICALcr. PLc mECR.
❑: ' ❑ 1. ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
' WOOD FLOOR INFORMATION
VALUATION
PLUMBING - _ ;,•�
MECHANICAL - -/
ELECTRICAL l ✓aY'� !�
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.SHALLBE MADE BEFORE
�) DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PR 0,1—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ' DATE INSP. ❑ 0 ❑ 0 0
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY rRACI NO. PARCEL NO
MECHANICAL , ' MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC PILE NO.
FRAMING ELECT.'FINAL TEST
INSULATION PLUMBING
ZONING ENG,SITE NO.
—A—
GAS TEST ) GAS
MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y 0 ND Y 0 No
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U.C.
INTERIOR SHEAR FIRE.DEPT.- Y❑ NO Y0 NO
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS 'BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE ORP LASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY . I I ISEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 0� 252-4505, ELECTRIC
R ,•ONE WOKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE JOB ADDRESS WHEN PHONING. cwneewG
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL'
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY !�
UBUILDING PROJECT IDENTIFICATION
PERMIT NUMBER
BUILLDING APPLICATION & PERMIT a� L+�
aooREss � I �]
S oIe S -J.52 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL '
Uvork.S PLAN CHECK VALIDATION
"AME•. DTV. ELECTRIC PERMIT FEE e n PHork.1SS-dqS / J `1•
CONTRACTOR'SM
Nqd9i�5sg -SWITCHES-RECEP 10.00/1.00
•�MYI74 LL LIG No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS APPLIANCES-RESIDENTIAL 4.00
CONTR
C. PHONE ,a 3' ..).% PANELS 10,00 DATE OF APPLICATION n
OORRCHITE T PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. '
ENGINEER
UC.NO. SIGNS TRANS. 3.00
ADDRESS E"G SPECIAL CIRCUIT 5.0Q RMI T VALIDATION
_ial J Avintt
ZIP TEMP,METER OR POLE INS. 20,00
AP.CRESS 's MOTORS SEE FEE 0.00
ADDRESS a CA
- SERVICE CHANGE � 20.00
w o o LICENSED CONTRACTORS DECLARATION - -
<2 U I hereby uffirm that I am licensed Under provisions of Chapter 9 ISSUANCE DATE
(commencing will,Seaton,7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
H i Professions Code,and m(Yn�icen se is in full force on'effcc s� ❑ ❑ ❑
z G Licensye Classsz$_ Lia Nu m her _
Z
r [)ate -7-JR -W-1-Contractor9s.�pagl.allLs
¢ L s {{ BUILDING PERMIT
¢ ¢w u OWNER-BUILDER DECLARATION INFORMATION
m ;u I- 1 hereby affirm that I am exemplTrum the Contractor's License MISC.- REFER TO ORD
a_ U. Low
for the hollowing reason.Ser.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
f mAE Code:Any city orcounty which requires a permit loconstncl,alter, ELEC.CONTR. LIC.NO.
¢ ¢O improve,demolish,,r repair any structure,prior to its issuance,also TOL ETC
O¢ requires the applicant for such permit to file a signed statement that TOTAL
nc P RMI T�TyOs/,�
E
$ he is licensed pursuant to the provisions of the Contractor's License 4®� // EA4N
= zi Law(Chapter 9(commeocing with Section 7000)of Division 3 oflhe 1.�/
a Business and Professions Code)or that he is exempt therefrom and GTV. PLUMBING PERMIT FEE d
¢ - 0 the basis for the alleged exemption.Any violation of Section7031.5 STORIES• TYPE CONSTR.
ii - by any applicant for a permit subjects the applicant too civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($5000:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole connpemsafion,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered far sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does ,at apply to an owner of
Properly who builds or improves thercnn,and who does such work FIXTURES-PER TRAP 5.00 SO,IT,FLOOR AREA TOTAL ACREAGE
himself or tlrtough his own employees,provided that such improve.
mems are not intended or oblefed for sale.If,however,the building GAS-EA.SVSTEM-I1NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will[nave the burden of proving that he did not build or am. BUILDING USE
prove for purpose of sale:), ' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
0 I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contraction to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC5 V.8. 6.00 ASSESSORS PARCEL NO.
and Pmfcsshms Code:The Contractor's License Law does not apply
to an owner ofproperty who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractoos)licensed pursuant 10
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 �� ACL.DATE ACC.FILE N0.
WORK I:RS'COMPENSATION DECI.ARATION WATER TREATING EQUIP. 5.0 4-4-00
I hereby affirm that I have a certificate of cmisenl m self-insure,
Or a certificate of Worker Compensation Insurance/,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800, an
Lab.C.I S,1MTrs
Policy No. Compy. qjw
O ❑ Cell ified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ➢( Certified cn�+y is filed wiVt the city inspection division.
O AIpTmant.Ak(L MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
CC rn PERMIT ISSUANCE 10.00 II��
LU CIiR'I'IFICCOWI E EXEMPTIONIONS PROMWORKIiRS' oa FLOOD ZONE q.L.U.C.
W � COMPENSATION INSURANCE PLC.CONTR. LIC.NO. PLG
CL O (This section need not b, completed if the permit Is for one TOTAL/ .fl0 Y❑ N❑ Y❑ No
::) Z hundred dollars(SHOW.,less.)
U O 1 certify that in file performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. F mit is issued,I Shall not employ any person in any manner so as I,
O ED become subject to the Workers'Compensation Laws of California.
n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ W NOTICE TO APPLICANT: If,after making(his Certificate of Ex-
Z emption,YOU should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith connply with - FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10900C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency Port 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 100,000 B.T.U.)Lender's Address ' ELECTRIC
I certify that i have read this application and state flat theahoveVENTILATION FAN (SINGLE) 4.00
it is correct. I agree to eonnply with all city and colony PLUMBING
ordinances and slate laws relating to building construction, and BOILER•COW(3 H.P.Of 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Ov,r100,00o BTU)SEEFEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save; indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMITISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
r' lingof thism-Anil. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
-1-ate 8/-
Signa re of Applicant/Contractor D Dale
OFFICE COPY