18554 (2) POST THIS CARD NEAR FRONT OF BUILDING ✓
PERMIT NUMBE rv_
CITY OF CUPERTINO 18554 -
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS_I08� l�¢�VS—��r _ UNIT# _LOT# PERMIT EXPIRES-IF WORK'
OWNER p CONTRACTOR (j �� IS NOT STARTED WITHIN
INSPECTION - DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: ' LASTCALLED INSPECTION.
LIFER IALL GRADING AND DRAINAG[[�$1F�y,,•�E INSTALLED
PREGUNITE TO COMPLY WITH THE APPROI��'P�.M�S AND CITY OF PERnm VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB C&of UpeftoJ t
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL BLDG. ELECT. I LG. MEpr+.
t. . . .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION STET.
PLUMBING
MECHANICAL OS-
ELECTRICAL P�,(�J Ca J PERmnI o /
FRAMING �•«` T—.r CONSTR,
INSULATION - sr Rles TYPE CONsrrv,
2�3 I
L_ --_.-- OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sari FLoon ARLA TD+AL Ac++eACL
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ,
-I DIAPHRAGM THE CONSTRUCTION TAX IS PAID
n
RUI I.DI u5E
ROOF SHEATHING Res IND CON PB 0.1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE ' INSP.
A55ESSURSPAHGEL NU.
ROUGH SAN.W �o
PLUMBING ELECT..ENERGY
' O1^r^'On°"^' pq PLUMBING ENERGY rRAn No. PARCEL NO
TUBS P
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING-ENERGY ACC.DATE ACC.FILE NO.
FRAMING ELECT.FINAL TEST ZONING ENc.SITE No.
INSULATION - PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY i.74
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - �- "� N❑
EXTERIOR SHEAR ELECTRICAL RELEASE GLOOD roNC A L IT Cr
INTERIOR SHEAR FIRE DEPT. YE], N[ L DO.
SHEETROCK GRADE . FEESUMMARY
' EXTERIOR LATH BUILDING'
INTERIOR LATH O TEMPORARY APPROVALS BUILDING TQD
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1,
OCCUPANCY-OF BUI LOING IS NOT PERMITTED UNTI L BUI LDIN G FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
lu ONE WORKING DAY BEFORE REQUIREDINSPECTION. PLUMBING 3+O.uD
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
zMECHANICAL6_SO
— SEE PER FOR EXPIRATION DATE
IMPORTANT! ' CONST.TAX --
PLEASE READ REVERSE SIDE BEFORE TOTAL _ , �•�
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS
.10
8
D 18554
S /�� BUILDING- ELECTRICAL-PLUMBING-MECHANICAL a
OWNER'S PLAN CHECK VALIDATION
NAME QTY. - ELECTRIC PERMIT FEE
�. er r u s
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 3.,,00
KOH Aq M,-,s solQQuc.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
O�D EpSS TOR'. ;s T-- s� IIII �'y4 APPLIANCES-RESIDENTIAL 4.00
µq d O F/ PHONE T4�-�3 PANELS 10.00 DATE OF APPLICATION
ARRCHITECT PANELS LOVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER u0�6
uc.NO SIGNS TRANS. 3.00
ARCH.OR END, SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ADDREZIP EMP.METER OR POLE INS. 20.00
ADDRESS Ts MOTORS SEE FEE SCH. O Q
¢ SERVICE CHANGE 20.00
rD o 04 LICENSED CONTRACTORS DECLARATION
a o U I hereby'a(Orm chat I am licensed under provisions of Chapter 9 ISSUANCE DATE
haw (caro naming with Semon 7000)of Division 3 of the Business and BLDG. ELECT. PLG. ME
F m z 1'rolessions Code,and my license is in poll force and effect. '
z 0�, - License:Class Lie.Number pp� ,�pF
o z H 0 Dale Contractor y( 1 U`CU
Q X1 1A NO L
y f " ne,►�
¢ ¢ w 4 OWNER-BUILDER DECLARATION QB�h(IO BUILDING PERMIT
MISC.- REF ER TO ORD INFORMATION
w ;a I- 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION S/FT.
H .. o as Law for the following reason.(Sce.7031.5,Busincxs and ProfcssiOls PERMIT ISSUANCE 10.00 1f O
Code:Any city or county which ruyuiresu permit to construct.e0eq ^ 0
Lo
¢ 0 improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR. LIC.NO. ELEC. o/4
0¢ requires the applicant for such permit to file a signed statement that TOTAL �,OD PERMIT O
Es
m he is licensed pursuant to the provisions oftire Contractor'B License
Luw(Chunk,1)(conuncocingwith Section 70001.1 Division 3e-fthe
i 4 o Business and Professions Code)or that he is exempt therefrom and e. YIP
w r$ the basis for the alleged exemption.Any violation of Section 7031.5 OTV. PLUMBING PERMIT FEE
ST IES TYPE CONSTR.
u by any applicant for o permit subjects Ulm applicant loacrol Penalty
of not more than live honored dollars 155001.1: ALTER-DRAIN'&VENT-WATER (EA.) 5.00 _00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCG GROUP RES.UNITS
their sole compensation,will do the work,and the structure is nor
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,'ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law don'not apply to an owner of
property who builds or improvest¢rcon,and who docs such work 7 FIXTURES-PER TRAP 5.00 111.00 So.FT,FLOOR AREA TOTAL ACREAGE
. himself or through his own employees,Provided chm such improve-
ments arc our intended or offered for sale.If,howevcq tire building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvenront is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or ice
prove for purpose cfrle.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,um exCImlVCly contracting with
licensed contractors W construct the project(Sea 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 600 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply .
roan owner of property who builds or improves ncemon.and who - LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts lorsuch projects with:i contraeteRs)liccnsd pursuant io -
tile Contractor'%License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCEL NO.
❑ l no exempt under Sec ,B.&P.C.1'or fills WATER HEATER W/VENT 6.00
O'ner Date WATER SYSTEM, 5.00 ACC.DATE . ACC FILE NO.
WORKERS'COMPENSAT10N DECLARATION WATER TREATING EQUIP. 5.00
I hcrcby affirm that 1 have a certificate et consent to,cell-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Thereof(Sec.3800,Lab.C.).
Policy N'o. Company
O ❑ CertifieJn )'is hcrcby l urnishcd' FIRE SPRINK ENERGY T$4
Z 2 K C'ertificd rpYyyyy lilcdwith Ih city impaction division.
H 0 Applicant .cc.R/„t� _ Qq� MISC.- REFER TO ORD. VE] NE] V [:] IN
CC res CIi RTI FICATE OIr E E.MP'IION I:ROM WORK HRS' PERMIT ISSUANCE 10.00 (2, 1 FLOOD ZONE A,L.0 C.
'LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PL3
G. "J Qct
CL CL 0 IT his section need not be completed if the permit is lis. one TOTAL �' V E] N� y[D NC]
hundred do11...IS 100)or I...I
U _O 1 certify thal in the perforinaroc of The work forwhicb this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,1 shall not employ any Person in any manner so as to
U become subject to the Workers'Compensation Laws of California-
U a Date nplslrawst ALTER OR ADD TO MECH. 5.00 BUILDING 7 p D
} W NOTICE TO APILICA If,Tile,making this C'ertificatc of Ex-
? emption,you should become subject to The Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you trust Forthwith comply with FEE
U such provisions or this permit Shall be deemed revoked AIR HANDLING UNIT(TO 10)OODC.F.M.) 4.00
CONSTRUCTION I.ENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1, (40
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the per4vnt encs of the work for which this permit is issued(Sec.. MICROFILM
3097,Co.C.).. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender;Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 _ELECTRIC -011
1 certify [flat 1 have read thisapplioation:ted stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to Comply with all city and county VD PLUMBING 3 0. DO
ordinances and stare lows relating to building construction, and BOILER-CDMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives 01' this City to enter upon the �T
i above-mentioned property for inspection purposes. BOI LER-COMP (Over 100000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harn less the City of MISC.- REFER TO ORD.
upertino against Iiabilirim,judgments, costs and expenses which PERMIT ISSUANCE 10.00 2 D CONST.TAX
may in any way accrue against said City in Consequence of the Q
mor Ingo this permit. / MECH.CONT. LIG NO. MECH.
.,(�- ao 9-!v f TOTAL/ (i TOTAL ,2,1j�.
Signature pplieco /Con..Reis We
OFFICE COPY