1523 (2) POST THIS CARD NEAR FRONT OF BUILDING. i
PERMIT NUMBER '.
CITY OF CUPERTINO 15203
_ INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS F•1" $OUt.h--B1anby Avenue
UNIT,ft _LOT#
�— _' PERMIT EXPIRES IF WORK
OWNER PdTkS'ldeLane---, 'lCONTRACTOR ' IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- •
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE:
UFER 7 ALL GRADING AND.DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THEAPPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. rte-
GARAGE SLABS - / -1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB Q
PLUMBING
- O1�' ISSUANCE RATE
ELECTRICAL
B
MECHANICAL - LOc ELEcr. . PLG. MECH.
DO NOT POUfl FLOOR UNTIL ABOVE HAS BEEN SIGNED BUICDING PERMIT
INFORMATION. `4
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL ..
ELECTRICAL - PERMI .0
FRAMING /'t—I
INSULATION - STORIES rvcE CONSTR.
OCC GROUP - RES UNITS .
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -31-yJ
~^ SO,FT FLOOR AREA TOTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE FORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE
ROOF SHEATHING RES IND CON - PB Up-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE 1 SP. El El El 1:1ASSESSORS PARCEL NO
ROUGH SAN.N
LUMBING _ ELECT.ENERGY
TRACT NO, PARCEL NO.
TUBS 8 SHOWER PAN - PLUMBING ENERGY -
MECHANICAL MECK ENERGY
ACC DATE ACC.FILE N0,
ELECTRICAL BUILDING ENERGY -
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO,
' INSULATION � PLUMBING - � � ,
GAS TEST GAS - -
MECHANICAL FIRE SPRINK -ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y C] N❑ ❑ ND
EXTERIOR SHEAR FLOOD ZONE ALUC.
.E LECTR I CAL-RELEASE - Z�-
N� ❑ ❑
INTERIOR SHEAR FIRE DEPT. N
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK -
GAS ' 1 1
- FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGN ED.1 OCCUPANCY I ISEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING'M-4505, ELECTRIC
r^ F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMRORTANTI' 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
kBUILDING PROJECT IDENTIFICATION PERMIT NUMBER
.oloAEss ( 02SO S, RIA"Ot AU, APPLICATION & PERMIT [ O
CUO N BUILDING -ELECTRICAL-PLUMBING,-MECHANICAL J J
OWNER'S PLAN CHECK VALIDATION
" E DTV. ELECTRIC PERMIT FEE
CSIOE LnNre 170 PHorvEa9 -d3a
CNAME
ONTRACTORS^u�pSC gryl UTLETS-SWITCHES-RECEP 10.00/1,00 '
2 4LP Tl LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS leJOtl 'T}.4F- 41rLAMFOA
q APPLIANCES-RESIDENTIAL 4.00
fJT0 QSIZ PHONEae1 PANELS 10.00 DATE OF APPLICATION.
ARCHITECT PANELS 200 AMP) 20.00 PLAN CHECK FEE C.NO.
OR -
ENGINEER
uc.No. ISIGNS TRANS. 3.00
ADDRESSENG. PERMIT VALIDATION
ADDRESS
SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS
APPLICANT$ MOTORS SEE FE
' oREss
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION MAX
( U 6
< u u 1 hereby ffu. that I am licensed under provisions of Chapter 9 ISSUANCE DATE
waw (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H N z I'ro fessions Code nd my license is in fail force' d f c ❑ ❑
z O m- License as Lic.Number
Oa.
r° Date �08d5pp{{IX tLFYpctQ
a x XD,R Dt OT. BUILDR413 PERMIT
¢ ¢ OWNER-BUILDER DECLARAI ON
a o a u INFORMATION
K
; u_H I hereby affirm tlml 1 um exempt from Om Contractor's License MISC.- REFER TO ORD
LL O a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE' •10.00 VALUATION $/FT.
Code:Any city or county which requinsa permit io conslruct,alter,
Z ¢ Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ^ !n
O u requires the applicant for such permit to file a signed Statement that TOTAL eX PERMIT TO
K
$ he is licensed pursuant to the provisions of the Contractor's License �
Hii Law(Chapter 9(commencing with Section 7000)of Division 3 ofihe
Business and Professions Code)or that lie is exempt therefrom and STY. PLUMBING PERMIT FEE r'
¢ =$ the basis for the alleged exemption.Any violation,of Section 7031.5 1 STORIES TYPE CONSTR.
by any apphcrost for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.1 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW 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 and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improvesthereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLDOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such int building
men"'
are not intended or offered for sole.If,however,the building GAS-EA.SVSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of Completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- REB INS CON PB Other
prove 1,aso neeose of side.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively contracting with
licensed contractors to construct the project IScc. 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 LAWN SPRINKLERS-OVER 5(EM- 1.00
contracts for such projects with a contmctorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&PEC.for this WATER HEATER W/VENT 6.00
mason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No 9Company
Q ❑ Certified copy is hereby furnished. FIRESPRINK ENERGY T-24
�
Z 2 CerOf- li pifi, Inspection division.
FO AW'ican/� /l - Y� MISC.- REFER TO ORD. YE] 'N� Y � NE]
CC N CERTIFICATE0I7 EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE AT.U.C.
W > COMPENSATION INSURANCE PLO.CONTR. LIC.N0. PLG,
CL Z (This section need not be completed if the permit is liar one TOTAL Y❑ N❑ Y[:] NE]
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
1L f . mit is issued,I shall not employ any person in any manner so as m
O become subject to the Workers'Compensation Laws of California.
y Date Applicant rSEIE
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex. ALTER OR ADD TO MECH. 5.00
F Z cRplion,you should become subject to the Workers'Compmisatwo APPLIANCE 5.00
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER l0,000GEM.I 6.00
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.
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct. 1 agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (over 100,000BTU)SEEFEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
in 1, ,,any waynes acct a test said City in consequence of thehMECH.CONT. LIQ NO. MECH/ yTOTALTOTAL
m of nl/Contractor a lS�f
OFFICE COPY