18670 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
^; CITY OF CUPERTINO x'861"0
INSPECTION DIVISION '
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS UNIT# -LOT#
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- PERMIT EXPIRES IF WORK '-
` •� OWNER lz5i-(/2/G6- CONTRACTOR, - ININOT STARTED WITHIN .
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAY'S oF.PERMIT ISSU.
FOUNDATION I .ANCE OR 180 DAYS FROM,
NOTE: ' ;IsASTCALLEDINSPECTION.
UFER ALL GRADING AND.DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT-VALIDA now
PREGUNITE , CUPERTINO STANDARDS. }^-�-L `
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED_
UNDERGROUND /SLAB Pad twit~
PLUMBING .. . . ,+ ..
ELECTRICAL - ISSUANCE.DATE '
MECHANICAL' BLDG, ELECT,- , PLG H
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
`
WOOD FLOOR INFORMATION
'
' PLUMBING vnwnnoN .5/ET.
MECHANICAL •�':
ELECTRICAL
-►;��.
FRAMING -
INSULATION . - 7 7 STORIES TYPE COBBLER
OCC,GROUP HESjUNITS,
F -
PLACE NO SUBFLOOR UNTIL ABOVE HAS'BEEN SIGNED
SO.FT,FLOOR AREA TOTAL ACREAGE
�. ROOF - - NOTE:NO FINAL'INSR SHALL BE MADE BEFORE.
•� DIAPHRAGMS ' THE CONSTRUCTION.TAX IS PAID,
BUILDING USE
F ROOF SHEATHING - - . 'I HLS IND CON PB OR...
El 1:1
APPLY NO'ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS 'DATE INSP.
ASSESSORS PARCEL NO
ROUGH SANA '
PLUMBING - ELECT.ENERGY' .
TUBS 8 SHOWER PAN - PLUMBING ENERGY" - TRACT No. - PARCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY, - ACC DATE - ACC.FILE NO
FRAMING - ELECT.FINALTEST - ZONING ENG,.SITE No.
INSULATION PLUMBING
GAS TEST GAS
MECHANICALFIRE SPHINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N °
EXTERIOR SHEAR ELECTRICAL RELEASE.. FLOOD ZONE `,M' U.0
INTERIOR SHEAR FIRE DEPT. Y N❑ v 7 NQ'
SHEETROCK F GRADE FEE SUMMARY
r EXTERIOR LATH BUILDING '
INTERIOR LATH - TEMPORARY APPROVALS . BUILDING ' �!�"•••
I' - ELECTRIC - PLAN CHECK
SCRATCH COAT :
GAS FEE
NO TAPE.OR PLASTER UNTIL ABOVE HAS BEEN SIGN EDI OCCUPANCY SEISMIC FEE /z
r
OCCUPANCY OFBUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRIC '
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.," PLUMBING., r
J o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z. MECHANICAL •fr
- SEE PERMIT FOR EXPIRATION DATE -.
IMPORTANT! I . CONST.TAX !"
PLEASE READ REVERSE`SIDE BEFORE', TOTAL {IC
CALLING FOR FINAL INSPECTION.
OFFICE'COPY
APPLICANT TO'FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY'
PERMIT NUMBER
"• BUILDING PROJECT,IDENTIFICATION APPLICATION Sl PERMIT '
SO M
LDG w1
ADDRESS I• 6 O
x4367 CIA '/ CJ Ej^ZC /A/Z) BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S ill- • - PLAN CHECK VALIDATION
NAMF _ / OTV, ELECTRIC PERMIT FEE
• �/C I CC' �JnC ONE -
CO
NTRAc OUTLETS
-SWITCHES-RECEP 10.00/1.00
NAME L
LC No, LIGHTING F IXTURES .10.00/1.00
CCNTRACTORS - APPLIANCES-RESIDENTIAL - - 4.00
Aoo . . .- .
PHONE PANELS 10.00 DATE OF APPLICATION"
ARCHITECT ' PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER I'
- UC.NO. SIGNS TRANS. 3.00 '
5 DD PERMIT VALIDATION p
ADO ESR N _ SPECIAL'ICIRCUIT " _ • -y ',Gc
ZIP . EMP.METER OR POLE INS. - 20.00 1 �V
APPLICANT MOTORS SEE FEE SCH. .-.!
ADopss
SERVICE CHANGE 20.00 �L �•'
°w
00 LICENSED CONTRACTORS DECLARATION -
¢is U 'I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
wQ H (commencing with Section 7000)Of isi0n 3 Of the Business and BLDG. ELECT. PLG.-
r m z Professions Code,and my license is fulJl1,,orcea �and ct. SEP
.Z o w.- License AIna Lic urkbe f -. El El ❑'
¢ ¢¢ 09
V(!t/OWNF.R-BUIL .R DECLARATION BUILDING PERMIT
¢ w INFORMATION
ir MISC.- TO ORD `
w 3 LL H I hereby affirm that I am exempt from the Contractor's License _ VALUATION =$/FT..
LLo¢ Law for the following Sri .(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
E w Code:Any city or county which requires a permit to construct,alter, '
•'Q ¢Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
o u requires the applicant for such permit to file a signed statement that TOTAL p IT TO '„
Er
w he is licensed pursuant to the provisions of the Contractor's License r
(�e
F. Law(Chapter'9(commencing with Section 7000)of Division 3 of the an
a Business d Professions Code)or that hm e is exempt therefroand DTV. PLUMBING PERMIT FEE -
¢ o
the basis for the alleged exemption.Any violation of Section 7031.5 I ECO
STORIES TVPNSTR.
d3 � by any ap licant fora permit subjects the applicant tor,civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of of re than five hundred dollars($5000.):
,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,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 SO.FT.FLOOR AREA TOTAL ACREAGE,
mems are not
ngh tende or offend forsle.If,ed however,
the
improve- GAS-EA.SYSTEM-I INE 4 OUTLETS 6.00
Improve-
mems are not intended or offered for sale,If,however,the building .,
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- RES IND - CON PB Omar '
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00
❑ 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 i 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 conlractons)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00 - TRACT No. PARCEL rv0.
the Contractor's License Law. 1 i
❑ I 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'COMPE:NSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that I have a certificate of consent to self-insure, • _ ZONING ENG.'SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah.C.). -
Policy No.- Company
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city,inspection division.O Applicant MISC.- - REFER TO ORD. y❑ .N❑ y El NO
In CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10:00 FLOOD ZONE A.L.U.c.
, LU > - COMPENSATION INSURANCE PLG.OONTR.. :LIC.NO. PLG.
1 (This section need not be completed if the permit is for one TOTAL K❑ N❑ v ❑ N❑
. Z) Z hundred dollars($1 OD)or lcS,,) -
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
• LL F- mit is issued,I shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California. - BUILDING
w Date' Applicant ALTER OR ADD TO MECH. 5'.00 �.
NOTICE TO APPLICANT: If,after making this Certificate of Ex- '
♦- ? coalition,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER IO,DOOC.RM.) 6.00 SEISMICFEE
'.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(Sec. MICROFILM
3097,civ C.): HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name - HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC
Lender's Addre
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 s
1 •� information is correct.I agree to comply with A city and county BOILER-COMP(3 H.P.or 100,000B.T.U.),6.00
ordPLUMBING
!I
ordinances and state laws relating to building construction, and -`
hereby authorize representatives of this city to enter upon'lhe BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.-, REFER TO ORD.
Cupertino a amo liabilities,judgments, costs and expenses which CONST:TAX
ay a way accrue,against said t y in consequence of the _ PERMIT ISSUANCE 10.00
at r this permit I (� MECH.CONT. LIC.NO. MECH.
TOTAL „/ �. ' TOTAL 1//v
Sin on
re of Applicant/Contractor Date 1
OFFICE COPY.