14667 (2) POST THIS CARD NEAR FRONT OF BUILDING PERN,IT NDMBER
CITY OF CUPERTINO X4657
INSPECTION DIVISION
JOB INSPECTION RECORD
- i
`� �J ^�f PERMIT EXPIRATION
Al J
JOBADDRESS /0700
. 1.-4-.12,1- zJLv UNIT# _LOT# � -
- I PERMIT EXPIRES IF WORK
OWNER 6 a.2J L/r CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUN ITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF
PERMIT vn Dun nory
_ CUPERTINO STANDARDS.
GARAGESLABS � .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL SUANCE DATE
MECHANICAL- BL ELECT. PLG. MecR.
❑ ❑ 1
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - CRY BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT;
PLUMBING - - '
MECHANICAL - :<y0 e
ELECTRICAL PERMIT TO
FRAMING `
INSULATION - STORIES TYPE CONSTR,
OCC,GROUP Res UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 50.FT-FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON • PB oa
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. SE
ASSESSORS PARCEL NO,
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO., PARCEL NO
' TUBS&SHOWER PAN PLUMBING ENERGY I
MECHANICAL MECH.ENERGY
ELECTRICAL - - ACC DATE Acc.FaE No
BUILDING ENERGY
FRAMING ELECT.FI
ZONING ENG.SITE NO.
INSULATION PLUMBIN
GAS TEST GAS -
FIRE SPRINK ENERGY T�24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v "� v ❑ "�
C.
EXTERIOR SHEAR - ELECTRICAL RELEASE Q FLOODZONE aL I I
INTERIOR SHEAR � FIRE DEPT.
D Y❑ N❑ YL NO
SHEETROCK - GRADE - FEESUMMARY
EXTERIOR LATH _ BUILDING ,r p
INTERIOR LATH TEMPO RARY.APP ROVALS BUILDING
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
H ONE WORKING'DAYBEFORE REQUIRED,INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE,PERMIT FOR EXPIRATION DATE - MECHANICAL'
IMPORTANT! CONST.TAX
PLEASE READ REVERSE.SIDE BEFORE TOTAL 77 ^^
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY _.
BUILDING PROJECT 1 DENT[FICATION
PERMITNUMBER .
aD,LD,ND APPLICATION & PERMIT __ \
ADDRESS -14-667
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
LEANER$ I PLAN CHECK VAGIDATI�
NAME QTY. ELECTRIC PERMIT FEE' T.� fi7 dr /1
FHONE
CONTRACTORS
NAMe_ OUTLETS-SWITCHES-RECEP, 10.00/1.00
1-e!'I/�1LsM1 V'�^' LIGHTING FIXTURES 10.00/1.00 --
C.NO. \\
ADDRESS
PPLIANCES-RESIDENTIAL 4.00 -
AODRE55 '
PHONE PANELS 10.00 DATE OF APPLICATION'
ARCHITECT - PANELS (OVER 200 AMP), 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
" LIC No. SIGNS TRANS. 3.00
ADD ess ENc' SPECIAL CIRCUIT ' 5.00 PERMIT VALIDATION'
2,P TEMP.METER OR POLE INS. 20.00
APPucANTS MOTORS SEE FEE SCH. ��`1Cv-,'••~'_"'
ADDRESS
_ SERVICE CHANGE 20.00 „ /fid
Z LICENSED CONTRACTORS DECLARATION -/ 7 7
a iw 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Q (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH,
H N i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
p i w p License Class Lie.Number
J Date Contractor ,
a M a BUILDING PERMIT
M '
IxQ OWNER-BUILDER DECLARATION
a w u INFORMATION
wg n N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ygLugnON
F u 0 J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10 .- ..� S/FT.
i Code:Any city or County which requiresa permit to construct,alter, ")p nqr
Q p Q Improve,demolish,Or repair any Structure',prior to Its Issuana,also ELEC.CONTR. LIC.NO- ELEC. OCO
D R requires the applicant for Such permit to file a signed statement that TOTAL PERMIT T
o. w$ he is licensed pursuant to the provisions of the Contractors License
Hit Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
Q I_0 the basis for the alleges)exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e. by any applicant for a permit subjects the applicant toa civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ I,"as owner of the property,or my employees with wages us 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,CONE). 5.00
Code:The Contractor's License Law does not apply to an owner of
r property who builds 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 improve-
' mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC:4 OUTLETS 6.00
or o rprovem eat 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 Other
pr for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00
I,as owner of the property,am exclusively contracting with E) ❑ ❑ ❑ Elli ed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL rvO.
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 conlractor(s)licensed pursuant m SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑_I-gsmn-mvl d' c. ,B.&P.C.for this
on WATER HEATER W/VENT 6.00
'1 Owner ,Date 's
WATER SYSTEM 5.00
ZQ� ACC.DATE ACC.FILE NO.
WORKE,RS'COMPENSATI N IA.CLARATION WATER TREATING EQUIP. 5.00
I 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 thereuf(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished, FIRE SPRINK ENERGY T 24
Z Z ❑ -Certified copy is filed with the city inspection division. MISC- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UA.
LU
CERTIFICATE E SWIOTINS FROM WORKERS'
DJ COMPENSATION INSURANCI! PLG.CONTR. LOC.NO. PLC.
4L Z( This section need not,be completed if the permit is for one TOTAL Y C] N❑ Y[:] N❑
hundred dollars IS 100)or less.)
'U 01 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mitis issued,1 shall not employ any person in any mnnerso as to _.
U become subject to the Workers Compensation Laws of California.
U y Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICI'.TO APPLICANT: If,after making this Certificate of Ex- O
F Z 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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10A00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 - SEISMIC FEE
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. - MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UN IT(OVER 100,000 B.T.U.N.50
Lender's Address ELECTRIC
1 certify that I have read this application and state tbal the above VENTILATION FAN (SINGLE) 4,00
information is correct w
1 agree tq comply with all city and county - PLUMBING
ordinances and state laws relating to with
construction, and BOILER-COMP I3 H.P.Or 100,000 B.T.U.1 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless ire City of MISC.- REFER TO ORD.
upertino against liabilities judgments, costs and expvows which CONST.TAX
in any a cme ag ins) said City in conscyuence'of the PERMIT ISSUANCE 10.00
mntl oft is perm) 'a MECH.CONT. LIC.NO. MECH.
2-17
_ a TOTAL TOTAL �77 �O
p /CO Date
OFFICE COPY