15722 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
572
INSPECTION DIVISION '
JOB INSPECTION RECORD . '
• PERMIT EXPIRATION
JOB ADDRESS 104474/0J UNIT# _LOT#(7 PERMIT EXPIRES IF WORK I
OWNER LE '� CONTRACTOR IS NOT STARTED WITHIN
INS CTION 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 !
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLHMIT VALIDATION +
PR EGUNITE. - CUPERTINO STANDARDS. . i
GARAGE SLABS ,.._.--
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED + k4es7—
UNDERGROUND /SLAB o'k
PLUMBING
ELECTRICAL - ISSUANCE DATE
SLUG ELECT PLG. MECH.,
El ❑ ' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING Ppb
MECHANICAL r
` PERMIT TO
ELECTRICAL _ ��'y� i JL i
FRAMING -
INSULATION - MI IES TYPE CONSTR.
o<C.CROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOR AR EA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
Rw LDI use
ROOF SHEATHING RES IND 'c PBDm.:
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 ` ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING _ ELECT.ENERGY '
TRACT NO. PARCEL NO
TUBS&SHOWER PA PLUMBING ENERGY '
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE N0.
ELECTRICAL BUILDING.ENERGV
FRAMING ELECT.FINAL TEST - ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST _ - GAS
FIRE SPRINK ENERGY T,]a
MECHANICAL - v N� v ❑ m❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A L U.C.
EXTERIOR SHEAR ELECTRICAL RELEASE Y ❑ NQ v 0 NO
INTERIOR SHEAR FIRE DEPT.
SHEETROCK _ GRADE FEE SUMMARY
EXTERIOR LATH BUILDING.
INTERIOR LATH + TEMPORARY APPROVALS' BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEWSI;GNED, OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• � ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 41
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE '— MECHANICAL
IMPORTANT! covsr.Tnx .
PLEASE READ REVERSE.SIDE BEFORE TOTAL 5�
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
nao
APPLICATION & PERMIT -PERMIT NUMBER
U.HESBD![� &l COABUILDING -ELECTRICAL-PLUMBING-MECHANICAL 157
22
OWNEn'S
PLAN CHECK VALIDATION
NAME
• 1C /JI /� /v�� e NE CITY. ELECTRIC PERMIT FEE
y NOMERacroR's •/ UTLETS-SWITCHES-RECEP 10.00/1.00
'\ .P. #An5elaY' uc.No. k5'83 9 LIGHTING FIXTURES 10.00/1:00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
� aoDRESs q OA/YIU (�qS)!
?D ,J^ e l0I/fp PNONE3gp-VII PANELS 10.00 DATE OF APPLICATION
oPLAN CHECK FEE
ARCHITECT PANELS (OVER 200 AMP) 20.00
on
P.G NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.ss ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ,
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
w
00 LICENSED CONTRACTORS DECLARATION O
a U U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
to<w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F o Professions Code,and I license is in full force and effect ❑ ❑ ❑ ❑
zO,y, License Clas Lie.Number ?!d',279
Is w ate Contractorh/.,N4
a Y E BUILDING PERMIT
¢ ¢a OWNER.BUILDER DECLARATION
o a v INFORMATION
W
I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
u o a Law for the following reason.(Sec 703 1.5,Businessland Professions _
VALUATION .$/FT.
r - Code:Any city or county which requiresa permit to construct,alter.
PERMIT ISSUANCE 10.00
2 Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. ELEC.
wDLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License �La
Uzi Law,(Chapter 9(commencing with Section 7000)ofDivision 3 of the
i o Business and Professions Code)Or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE
¢ H $ the basis for the alleged exemption.Any violation of Secfioa7031.5 - STORIES TYPE CONSTR.
i ;_ by any applicant for a permit subjects the applicant toa civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5001.):
❑ I,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 and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 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 TRAP6 SQqp E,T�LOOR AREA TOTAL ACREAGE
• himself re through his own employees,Provided that such improve. 1T
or nts improvemenetnt is sold or within
ed one or year
e.o l complever,tion she the owner. GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 is
Or improvement is sold within one year of completion,build
owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.0 BUILDING USE
builder will have the burden of proving that he did not build or im- �_Eyt�❑ ❑N Pe 11 C1 prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.0 `
❑ I,as owner of the property,am exclusively contracting with
licensed 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
contr[lie Contracts' Licensctswithacomractor(s)licenscd pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's such
License Law.
❑ 1 am exempt under SEC.-,B&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE 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 IS c.3800,Lab.C.).Aos����
Policy N.Z Company
0 C1 Certified Copy is hereby furnished. FIRESPRINK ENERGY T 24
Z Cert�fiep co y is M 4;iS he ly inspection division. MISC.- REFER TO ORD. Y [I N� Y C] N[]
O Applicam
it CIERTIFICA'f1E OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE h9:C0 /atenFLOOOZONE A.L.u.C.
W COh1PENSATION INSURANCE PLG.CONTR, uC.NO. PLC ,/ _ ❑ ❑ ❑O (This section need not be completed if the permit is for one - TOTAL Y2 N Y N
Z handled doll..IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
u. mit is issued,I shall not employ any person in any manner so as to
O W become subject to[lie Workers'Compensation Laws of California. BUILDING -
y DateApplicant ALTER OR ADD TO MECH. 5.00 '
} to NOTICE TO APPLICANT: If,after making this Certificate of IEx-
? comfiort,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCC.F.M.) 6.00 SEISMIC FEE
1 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(Sea 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
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 _
information is Correct. I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COUP(3 H.P.of 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to
enter upon the BOILER-COMP (Over'100,000870)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection pufpoms.
(We) agree to save, indemnify and keep harmless tiro City of MISC.- REFER TO ORD.
upertino ainst liabilities,judgments, costs and expenses whichCONST.TAX'
ay in way Seer ainst said City in consequence of the PERMIT ISSUANCE 10.00
into this permit MECH.CONT. LIC.NO. MECH. "
TOTAL TOTAL /6
Signal re ofpp cant/ onfractor at
OFFICE COPY