17235 (2) POST THIS CARD NEAR FRONT OF BUILDING ' PERMIT NUMBER.
CITY OF CUPERTINO 17235
INSPECTION DIVISION
JOB INSPECTION RECORD
/0
01gq �£ �". i PERMIT EXPIRATION
JOB ADDRESS � 1y UNIT# _LOT# PERMIT EXPIRES IF WORK
il=l l=l Nr.O /S CONTRACTOR _ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. '
FOUNDATIONANC- OR 180DAVS,FROM
NOTE: LASTCALL'EDINSPECTION.
UFER " ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - - _ .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB n �i
PLUMBING FlJ '�C J-I�.
ELECTRICAL EB � ISSUANCE DTITE
MECHANICALBLDG ELECT PLG. MEC..
City of Cupe 'nf!� Q
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WINFORMATION
WOOD FLOOR
VALUATION
PLUMBING r'
MECHANICAL
ELECTRICAL ^p..� PERMIT TO
FRAMING - ` D • • -
INSULATION STORIES TYPE CONSTR.
OCC CROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS B N SIGNED
SO.IT (LOON uRl:n TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING NES IND CON PB oma,
APPLY NO ROOFING UNTIL ABOVE HA BEEN SIGNED FINALS DATE INSP. El
ASSESSOR FARCE L NO.
ROUGH SAN.#
PLUMBING ELECT.ENERGY. TRACT NO PANCEL NO
TUBS IS SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH:ENERGY
ELECTRICAL - BUILDING ENERGY ACC,DATE ACC PILE NO
FRAMING - ELECT.FINAL TEST
ZONING - ENG.SITE NO.
INSULATION PLUMBING
GAS TEST- GAS
EINE SPRINK ENERGY T-]A
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEE IGNED HEATING "�
EXTERIOR SHEAR - ELECTRICAL RELEASE ROOD ZONE . A,L UC.
INTERIOR SHEAR FIRE DEPT. Y❑ 00-L, NE]
SHEETROCK GRADE FEE SUMMARY
' EXTERIOR LATH BUILDING - U" BUILDING
INTERIOR LATH TEM.
WRY APPROVALS 411
!
M SCRATCH COAT ELECTRIC PLAN CHECK _
GAS FEE I..
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
o ONE WORKING DAY BEFORE 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 f
CALLING FOR FINAL INSPECTION. I
OFFICE COPY
`1 6I�-
APPLICANT TO FIL IN NFO�jMATION VJITHIN.RED LINES - USE BALLhPOINT PEN ONLY
BLS SDI NG RROJECT 1 DENTI FICATION . - `PERMIT NUMBER ..
1 ,ALLOWc '
Aoo DIN `�K APPLICATION & PERMIT
`,J
y BUILDING-ELECTRICAL-PLUMBING-'MECHANICAL s7
OWNER'S - PLAN CHECK VALIDATION
NAME _ OTY. ELECTRIC PERMIT FEE -
�/Q q Ed6/ c PHDNEWO-42 7107
CONTRACTOR'S
NAMEOUTLETS-SWITCHES-RECEP 10.00/1.00
.n,d ways /y ✓ 6-A,y/r77/1'f'do
L 00
G.NO LIGHTING FIXTURES 10,00/1.00
CONTRACTOR'S ,
A gEsyjp " & yT APPLIANCES-RESIDENTIAL 4.00
+JQ� I'NONE �71gj Gq PANELS - 10.00 DATE OF APPLICATION •..
CH TEC t - PLAN CHECK`EE P.C.N0.
OR
- . PANELS (OVER 200 AMP) 20.00 ,
ENGINEER ,
LIC:No. SIGNS TRANS. -' 3.00
ADDRESS AHc M.Un ErvG. SPECIAL CIRCUIT S,DD PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESSTS. .(~f r✓ MOTORS SEE FEE SCH. �• �NV�j'
5°1A /dBM A✓e SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION- oCLbIC-�L ___ '�'1.e01 _ i
¢ U u I hereby affirm that I am licensed under provisions of Chapter 9 - '
F Z w .� ISSUANCE DATE ,
(commencing with Section 7000)of Division 3 of the Business and _ BLDG. ELECT. PLG. MECH.
r H z Professions Copp a license is in full fort a effect .✓ _ ® ❑ ❑
- z o m - License Cl `� Lie.Number 'O
O Date T�` /-�q�t� ContractorMi0 0� 0 J tis
H ;5j FEB 15193"1
¢ a, f I BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION _ '
0 A ° INFORMATION
E:
3 LL H 1 hereby affirm that 1 am exempt from lire Contractors License M ISG._ - R F R RD
r u O¢ Law for the following reason.(Sec.7031.5,Businessmen Professions VALUATION $/FT.
PERMIT ISSUANCE 1���,
m Code:Any city or county which requirese permit to construct,alter, . w�
SR ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.
m¢ requires the applicant for such penult to file a signed statement that TOTAL ��„�
n w PERMIT TO
he is licensed pursuant to provisions of the Contractor's License
F z st Law(Cs slid 9(commencingProfessions
sCo )or Section is 00)exempt
the ofroaa and
C _
ea 4 o Business and Professions Code)or than bed exempt ecrefrom and QTY. PLUMBING PERMIT FEE vl
rc 1- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 .- by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred ilmlars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT, DEVICE 4.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who doessuch work FIXTURES-PER TRAP - 5,00 sO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
.cuts am net intended or offered for Sale.If,lmweveq the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 _
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER., 30.00 RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with _ ❑ ❑ ❑ ❑ ❑
licensed contractors to constructghe 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 contraelons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. - PARCEL NO.
❑ I am exempt under Sec. ,B.&P;C.for this
reason WATER.HEATER W/VENT 6.00
Owner - Date WATER SYSTEM r 5.00 ACC.DATE ACG.FILE NO.
WORK E-RS'COMPENSATION DECLARATION I WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sel Finsure,
or a certificate of Worked Compensation Insurance,or a certifiedZONING. ENG.SITE NO.
copy themof(Sce.3800,Lab.CJ.
Policy No. A Company
-
0 ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T-24
0
Z 13 'Certified copy is filed with the city inspection division. - ❑ ❑
� Applicant MISC.- REFER TO ORD. v ❑ N ❑ IN
v
y CERTIFICATE OF EXEMPTION FROM WORKERS" PERMIT ISSUANCE", .10.00 FLOOD ZONE A.L.u.C.
LL > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
c
Z (This section need not be completed if the permit is for one TOTAL Y ElN❑ Y,❑ N❑
hundred dollars($100)or less.)
O,
I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
y Datc Applicant - - - BUILDING
} 0NOTICE TO APPLICANT', If,after making this Certificate of Ex- ALTER OR AD TO MECH. 5.00
2 emption,you should become subject to the Workers'Compensation APPLIANCE5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with Q
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 - FEE 5
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE (
• I hereby affirm that there is a construction lending agency]or EXHAUST HOOD (WITH DUCT) $ 5.00
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,CieC.). HEATING UNIT(TO 100,000 B:T.U.) 8.00 ,
Lender's Name H EATI NG U N IT(OVER 100,000 B.T.U.)9.50
' Lender's Address' - ELECTRIC
x� 1 certify that I have read this'applicusioo 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 state laws relining to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
-
hereby authorize representatives of this city 10 enter upon Tire BOILER-COMP (Over 100,0.00 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which 'CONST.TAX
may in any way accrue gainit said City in ' equence of.the PERMIT ISSUANCE 10.00.
rand of iisp mi MECH.CONT." .. LIC.NO. - MECH. -�^G
TOTAL' TOTAL C7J
lure of Ap n ontrac[or IJate
7�
OFFICE COPY