14613 (2) POST R
THIS CAD'NEAR FRONT OF BUILDING
-� - nPERMIT NUMBER -
- CITY OF CUPERTINO
,x:14613
INSPECTION,DIVISION " `
JOB INSPECTION RECORD'. ;
�_�• ' PERMIT EXPIRATION
' JOB ADDRESS 0�.3 L$n%E" - LsUNIT# _LOT#
' ,i - • PERMIT EXPIRES IF WORK
owNER G 6 Gl. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION _ ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
•LIFER ALL GRADING'AND DRAINAGE SHALL BE INSTALLED ,
PREGUNITE' - TO COMPLY WITH THEAPPROVED PLANS AND CITY OF- PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND-
/SLAB
PLUMBING, 6
ELECTRICAL - - men ISSUANCE DATE
Ul
j
7MECHANICAL - M BCOG. ELECT. PLG. MECH.
4. io a � .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - C1 "° BUILDING PERMIT
_ - WOOD FLOOR p�, INFORMATION
PLUMBING c-• vAwATION S/FT,
MECHANICAL -� J�Pb,d??/ L!11 0/r �II� C
ELECTRICALM PERMIT TO
FRAMING,. S /Z d t'C'J���'•}
INSULATION - - STORIES a TYPE CONSTR.
.occ,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF :NOTE:NO FINAL INSP.SHALL BE MADE BEFORE, "' so,IT FLOOR Asea TorAL,AwEAce
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
tBUILDING USE
ROOF SHEATHING' RES IND 'CON PB O,or,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ❑ ❑ ❑ ❑ ❑
.. DATE INSP. - Assess.RS PARCEL NO.
ROUGH SAN.1
.PLUMBING ELECT.ENERGY"
TUBS 8 SHOWER P
TRACT NO, PARCEL NO.
N - PLUMBING ENERGY,
MECHANICAL ''- - - MECH.ENERGY '
ELECTRICAL y- ACC DATE . ACE.FILE No
BUILDING ENERGY ,
FRAMING - ELECT.FINAL TEST
INSULATION C PLUMBING zowwc ENG slTe No.
2 �9
GAS TEST - - GAS
awe' - d9 MECHANICAL FIRE sPRINrc ENERGY T 2
COVER NO WORK UNTILABIOVE HAS BEEN SIGNED HEATING " Y ❑ " N❑ ° ❑- "EI
EXTERIOR SHEAR - FLOOD ZONE a.L.0 c.
INTERIOR SHEAR , FIRE DEPT. '° ❑ N❑' Y ❑ N
SHEETROCK, - GRADE - FEE SUMMARY.
EXTERIOR LATHBUILDING
INTERIOR LATH
` -
_ TEMP
ORAR
BUILDINGAPPROYALS• f!t
G1
SCRATCH,COAT ELECTRIC ; PLAN CHECK �-
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS-BEEN-SIGNEO OCCUPANCY SEISMIC FEE j-
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. .MICROFILM ' l
Lu ARRANGE FOR INSPECTION BY PHONING 252.4505,
ELECTRIC 2.y Ay
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE,GIVEJOB ADDRESS'WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT,!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE a'
CALLING FOR FINAL INSPECTION. TOTAL L
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN-ONLY '
BUILQINC PROJECT IDENTIFICATION - - _ PERMITNUMBER"
ar,ILGING a Ino ,. a s pfE� APPLICATION & PERMIT A '1
ADDRESS A LF v
10,&3 i N. ShipleyAk BUILDING-ELECTRICAL-PLUMBING,MECHANICAL 6
NAMERS �(OrP/�-��•
I _ PLAN CHECK VA DATION
S;N -61411 Hct PHONE �Q�/�/ DTV• ELECTRIC PERMIT FEE J j7 ,
/ J
NAMQRA OR / UTLETS-SWITCHES-RECEP -10.00/1.00 l ( 1
LA ✓'OMB l7/Iory Lm.No. ���p0 LIGHTING FIXTURES 10.00/1.00
r-DDRESS ORs + n'OS car CA94 l/2 PPLIANCES-RESIDENTIAL 4.00
CONTR AC
•3•a SeV I PHONE 41rAj3-&At PANELS 10.00 + DATE OF APPLICATION'.
ARCHITECT C;�I PANELS (OVER 2OOAMP) .. 20.00 PLAN CHECK FEE P.C.NO.
OR
NGINEER
p- C� uc.NO. ��� SIGNS TRANS. - 3.00
ADDRESS oE"G' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. :20.00
APPLICANT'S /.q OMMOTORS -. SEE FEE SCH. - t
ADDRESS l / 'V/ •1
I SERVICE CHANGE l' 20.00 A
DECLARATION
1fJ 1`` Q
O o o LICENSED CONTRACTORS - OftlJ L Cu / �1E1 �U
le v I liereb .(firm that 1 am licensed under r visions.&CIm teri) \ Q4 Cup
¢ z w y n° s 1'.fl \ UI SSUA E DATE
vHi¢ (commencing with Section]00e i of Division 3 D(theect. es and BLDG. ELECT. PLO. MECH.
H H z License Professions Code,and my license is in full force and effect a nnnACtln
z o m - License Class Lia Number n• t v - �q�--11 �r/vyI
o w H � Dace Contractor '-1
a Y ' BUILDING PERMIT
a, w OWNER-BUILDER DECLARATION
MISC.- REFER TO ORD INFORMATION
w I hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
u O¢ Law for the following reason.(Sec.7031.5,Business and Professions
r - PERMIT ISSUANCE 10.00 0 I�
Code:Any city or county which structure,
tune permit o Consuance,aeq
K ¢Q p improve,demolish,or repair any s[TucNre,prior[o its issuance,also ELEC.GONTR, LIC.N0. EIEC:
O LL requires the applicant for such permit to file a signed statement that - TOTAL / PERMIT TO
w $ he is licensed pursuant to the Provisions of the Contractor's License '
Hzi
Law(Chapter 9(commencing with Section 7000).rDivilion 3 ofthe
E o Business and Professions Code)or that he is exempt therefrom and - M
W I- o[ he basis for the alleged exemption.Any violation of Section 7031.5 DTV. PLUMBING PERMIT FEE
STORIES TYPE CONSTR.
a 3 m by any upplicmtt for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($5000.); ALTER-DRAIN&VENT-WATER IEA.) .00 0
❑ 1,as owner of the property,or my employees with wages as ACK FLOW PROTECT.DEVICE 45.00 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 does not apply to an owner of
+ property who builds or,improves thereon,and who does such work - FIXTURES-PER TRAP 5.00 SG.FT,FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve.
�1 ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner GAS-EASYSTEM OVER 4 IEA) 200
builder will have the burden of proving that h . - . .
e did not build or im- BUILDING USE
prove for purpose of sale.). RES IND CON, PB Other
1,as owner,of the property,am exclusively contracting with INDUSTRIAL WASTE INTER.' 30.00 1:1 El ❑T El1:1li cued contractors to construct the project(Sec.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(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARV-STOR IEA-.2,O1t/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT
anon
Owner - Dme !' WATER SYSTEM - 5.00
A I\' ACC.DATE ACO.FILE NO.
WORKERS'COMPENSATION UBCLARATION WATER TREATING EQUfP. 0Q 5.00 1
n.1
1 hereby affirm that 1.have a pens tion of consent ors certificH _
or a certificate of Workers'Compensation Insurance,or a certified 'l , ZONING ENG.SITE N0.
copy thereoflSec C.I Lab.
Policy N panyy
-
0 ❑ Certified copy isFiled furnished. - FIRE SPRINK ENERGY T 24
Z Ot ❑ Certified copy iss Filed with the city inspection division-
O ❑ N❑ ❑.
� Applicant - MISC.- REFER TO.ORD. Y v N❑
H CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 Q FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. PO
CL Z( This section need not be completed if the permit is,for one TOTAL V❑ N�' Y [:] No
hundred dollars IS 100)or less.)
V O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE
FEE SUMMARY
U. Of mit is issued,1 shall not employ any person in any manners. to
0 W m
Q become subject the Workers'Compensation Laws of California.
-
Q. Date Applicant OBUILDING ':CE} 0NOTICE TO APPLICANT: If,after making this Certificate of Ex- R ADD TO MECH. 5.00
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked., AIR HANDLING UNIT(TO 10ADOC.F 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)b6M. 6.00 SEISMIC FEE
1 hereby at that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 1(5100
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 10R"9Wrb.*u0 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T:U.)Bt86 O
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SIN(1�IE). L'w •4.00
information is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. v
(We) agree to save, indemnify und'keep harmless the City of MISC.- - REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.0076- CONST.TAX
may in any Way accrue against said City in consequence of the
ranting of thls,p rmiL MECH.CONT. LIC.NO. MECH.
TOTAL, TOTAL 7
ugmmtqrJLfAPPIKarB0TContrautor Date
OFFICE COPY