14627 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 14627
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS" �� (s'dR-.f S/, '•CC.,/�.G. UNIT# LOT# PERMIT EXPIRES IF,WORK
OWNER ,/�/ - ,�/ [y CONTRACTOR + '_ [ (.� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 188 DAYS OF PERMIT ISSU-
FOUNDATION - - - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION. ,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE .TO COMPLY WITH THE APPROVED PLANS AND CIT'OF PERMIT VALIUATION
CUPERTINO STANDARDS.
GARAGE SLABS'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT PLG, MECH
C] ❑ [o ❑ !
r DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION $TFT.
PLUMBING - � `
MECHANICAL PAID
ELECTRICAL reRMn TO
a
FRAMING STORIES TYPE CONSTR.
INSULATION
OI CDPB IRDCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so rr FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING I IRus IND CON PB Om,,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
455ESSURS PARCEL NO
ROUGH SAN'#
PLUMBING ELECT.ENERGY {
TRACT NO 'PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH,ENERGY
.ELECTRICALBUILDING ENERGY ACC DATE ACC.FILE NO.
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING
ZONING ENG.SITE NO.
��-
GAS TEST GAS
MECHANICAL FIRE SPRrNK ENERGY T 2
COVER NO WORN UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ Y ❑ N❑
I
EXTERIOR SHEAR ELECTRICAL RELEASE FL000 ZONE A,L U C
' INTERIOR SHEAR FIRE DEPT.
Y ❑ N❑ Y ❑ N Ej.
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING& -/ BUILDING -
. INTERIOR LATH TEMPORARY APPROVALS
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
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o� PLEASE GIVE JOB ADMESSWHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
:.
IMPORTANT! . CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL `1
CALLING FOR FINAL INSPECTION. /�••`
'OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'BUI LOI NO PROJECT I DENT[FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 14627
,r ADDRESS /
1 _71- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL c.
OWNER'S
N PLAN CHECK VALIDATION
a.
5 ELECTRIC PERMIT FEE
Nn
NgMrRAcroRPHOs UTLETS-SWITCHES-RECEP 10.00/1.00
L,c.N LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
_ a Es APPLIANCES-RESIDENTIAL 4.00
W� PHOrvE �a PANELS 10.00 DAT E O F APPLICATION
AOPRCHITPCr - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE" PC,NO.
ENGINEER -
LIC.NO. SIGNS TRANS. 3.00
neo its ens. SPECIALCIRCUIT - 5.00 PERMIT VALIDATION
ZIP rrEMP.METER OR POLE.INS. 20.00
ADDRESS MOTORS SEE FEE SCH. . u�
6)V
SERVICE CHANGE 20.00 � �
Foo LICIiNSIiU CONTRACT'Ok5 DECLARATION I
¢ i W I hereby affirm Thal l am licensed under provisions of Chapter 9 ISSUANCE DATE
,commencing with Section 7000)of Division 3 of the Business and
E. ¢ u BLDG. ELECT. PL MECH.
H w i Professions Co license is in full for _-
Za i w License CI s Lie Numher
yF
Date _ Conlructor
st Y s BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION - -
a o a INFORMATION
X ; at 1 hereby affirm that I am exempt from The Contractor's License MISC.- REFER TO ORD 5/FT.
LL o es Law for The following reason.(Sec.7031.5,Business and Professions VALUATION
- PERMIT ISSUANCE 10.00
Code:Any city or county which requiresa permiTmconstruct,alteq
za ¢ 2 improve,demolish,or repair any Structure,prior m its issuance,also ELEC.CONTR. LIC.NO. TEL '
wD¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
$ he is licensed PRISHumt TO The provisions of the Contractor's License
rZ> Law(Chapter 9(commencing with Section 7000)of Division 30fTlu, L
I i o Business and Professions Code)or Ihat he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ I- $ The basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
; _ by any applicant lot a permit subjects The applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollar.,(S500).):
❑ 1,as owner of the property,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 not
intended or offered for sale:(Sec. 7044, Business cul Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who tmdds 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 improvo-
merits are not intended Or offered far safe.If,however,the building GAS-EA.SYSTEM-111NC.40UTLETS 6,00
or improvement will have
is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of moving That he did OOT huild or in,- RES IND CON PB Other
prove for purpose of sated' INDUSTRIAL WASTE INTER. ' 30.00
❑ 1.d as owner of the Property,he exclusively contracting with
licensed contractors od to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
El
and Professions Code:The Contractor's License Law Anes not apply
to an owner of property who builds or improves Thereon,and who LAWN SPRINKLERS- IEA.) 1.00
contacts for such projects with a cnntractor(s)licensed pursuant To SEWER-SANITARY RM EA,200ft/10.00
the Contractor's License Law. TRACTNO. PARCEL NO.
❑ 1 H exempt under Sea ,B.&P.C.for this WgTEfl HEATER W/V NT �'�'� 6.00
reason
Owner Dam WgTER SYSTEM ' 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSA'FON DECLARATION WATER TREATING Qfttt 5.00
I hereby affirm That I have a certificate ofconsent In sclhinsuro,
or a ceirifclro.o ers fj�Cnm pens° 1 I rice,ar a c tifieA ZONING ENG.SITE NO.
copy th (/aTi d. LI///
policy
mn nnY "'S1
0 ❑ citified copy is tier•hy furnished, FIRE SPRINK ENERGY T-20
Z
Z erUfi py 1 TI ' 'i inspec a division.
F O A ,cam ( �- MISE.- REFER TO ORD. vy v NEI
� N 'I FICA'FE OF EXEMI9 ION FROM WORK ERS' PERMIT ISSUANCE 10.00 FLOODZONE AL.U.C.
L 1 CONIPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG
Z (This section need not be completed if the permit Is for one TOTAL N Y 0 N� Y [:] NE)
hundred dollars 1$100)or less.)
0 O 1 certify that in The performance of the work for which This per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
L I- mit is issued, 1 'hull not employ any person in any,Banner so as'I 1
become subject to the Workers'Compensation Laws of California.
0 y Date - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making This Certificale of rix.
Z emotion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you Bmsl forthwith comply with FEE
U such provisions or This permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MCF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.EM.) 6.00SEISMIC FEE
I hereby o1'@m that there is a construction Icnding agoney for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work I'or which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state Thai the above VENTILATION FAN (SINGLE) 4.00
... information is correct. I agree to comply with all city and County PLUMBING
ordinances and state taws relating to building construction, and BOILER-OUMP(3H.P,Or100,000B,T,U.1 6.00
hereby authorise representatives of this city to enter ,man the
above-mcmioned property for inspection purposes. BOILER-COMP IDVBr 100,000 BTU,SEE FEE SEH. MECHANICAL
(We) agree t0 save, indemnify anti keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
a I any way accrue against Said City in consequence oT'The
If
0f t Is ermi. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
t 1 Fla
Data
OFFICE COPY "-
i