18324 (2) POST THIS CARD NEAR FRONT OF BUILDING
ti PER-IIT NLIZG
• CITY OF CUPERTINO . 1 $324
INSPECTION DIVISIO
JOB I PE TION RaCDPERMIT EXPIRATION
JOB ADDRESS dT# _LOT# PER EXPIRES.IMF WORK
OWNER - CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERmIi VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS _1 PjL�-I vu,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB
PLUMBING PAID _ I
ELECTRICAL, A ISSUANCE DATE
MECHANICALDG.� ELECT PLO. mccR
SEP 11 o, . o . E'
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDlap BUILDING PERMIT
' .
O �� INFORMATION
WOOD FLOOR
PLUMBING - - 2 ?f VALUATION s/f T.
MECHANICAL �' ` / s-
��EeTr6° 1l�
� ELECTRICAL
FRAMING,
INSULATION ��—^--
STORIES TYPE CONSTR.'- �
OCC.GROUP RES.UNITS
PLACE NO-SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O.IT,FLOOR AREA(TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE .1� 7� k•-L DIAPHRAGM THE THE CONSTRUCTION TAX IS PAID
BUILOING USE
ROOF SHEATHING ' RES IND CON FB 0"",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑. ❑ ❑ ❑
ASSESSORS PARCEL NO
.ROUGH - SAN.N (jlC)5rl - �:v-,:=.� �'� = e..�i• -.
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'
D' ELECT,FINAL TEST,
ZONING F.NG.SITE NO.
INSULATION PLUMBING '
GAS TEST GAS' -
FIRESPRWK ENERGY T.24
MECHANICAL
-COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Yo,. No Y [:] N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLooO zoNe Aru c:
FIRE DEPT.
INTERIOR SHEAR
❑ No L7N❑
SHEETROCK GRADE , - - FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING (j�� so
SCRATCH
- - TEMPORARY APPROVALS
SCRATCH COAT . ELECTRIC PLAN CHECK r�
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC !`Ij
H0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING v
O PLEASE GIVE JOB ADDRESS WHEN PHONING. �`•i
Z - SEE PERMIT FOR EXPIRATION DATE'- -MECHANICAL
IMPORTANT! )CONST.TAX
PLEASE READ REVERSE SIDE BEFORE �I
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
Mi r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' BU LD1 NG PROJECT I DENT(FICATION
VEP441T NUMBER
BU LDING APPLICATION & PERMIT x 18324
Ao �s tj 'Ofei kve BUILDING -ELECTRICAL-PLUMBING-MECHANICAL s -
OWNNEER9 ��i
N ` PLAN CHECK VALIDATION
( t CITY. ELECTRIC PERMIT FEE
V PHONE 2&-Iq GV �� 3
CONTRACTOR'
sct �
NAM T r7 OUTLETS-SWITCHES-RECEP 10.00!1.00
J V, uc.No.�1 L7G� LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
AOOREss APPLIANCES-RESIDENTIAL 4.00
0S S!- tVV"OSA At \'
PROrvE WD�I q�11A PANELS 10.00 DATE OF APPLICATION
ARCHITECT0. PLAN(OVER 200 AMP) 20.00 ' PLAN CHECK FEE P.c.Na.
ENGINEER O',`In er
INrL LIC.No. SIGNS TRANS. 3.00
ADD ESS eNCI SPECIAL CIRCUIT 5.00 PERM
, T 9•
IT VALIDATI N
ZIP 1 EMP. METER OR POLE INS. 20:00 �. f1f`IIV I.I.V--Cjl
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
-D$,4' �Yh'+oS A SERVICE CHANGE 20.00
O ¢ 2
Foo LICENSED CON'I'BACT OBS DBCLABATION,
a o 1 hereby affirm that I am licensed under provisions of Chapter 9 S - ISSUANCE DATE
Z N (commencing with Section 7000)of Divisimm 3 ret the Business and BLDG. ELECT. PLG. MECH.
D Pral'cvians Cos and h�i license is in Lull f� Iqt SEP 1 D� M-'
xr� ( !!
z o m License Class_ Lic.Numb, _( �•' b
o m
¢ ¢ w � OWNIi R-B UILUIiR DECLA BA'fl BUILDING PERMIT
w ; I hereby affirm tlta, I am exempt from the Contractor's License ^
M ISG.- RD INFORMATION
F n o a Law fur the following reason.lSec.7031.5,Business and l'mfcssions PERMIT ISSUANCE 16'00 �Q VALUATION $/FT.
w � Ceds:Any eilyor County which requires a permit to construct,alter. - IT
¢ ¢ Q O improve,demolish,of repair any stmct Urs,plot In i[i is5la0CC,also ELEC.CONTH. LIC.NO. ELEC. DI
A o¢ requires the applicant for such permit to file a signet sutemem that TOTAL
u w m he is licensed pursuant to the provisions of the Contractors License J
-F z ¢
Law(Chapter')(commencing with See(on 7000)of Divisiou 3 of the
f i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ F m the basis for the alleged exemption.Any violation of S<ction]031.5 STORIES TYPE CONSTR.
I ate _ by any applicant for a permit subjects the applicant tea Civil pcwlty ALTER-DRAIN -WATER lEA.15.00
of not more Than five hundred dollars(55001.):
❑ I,as owner of the property,or try 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 of offered For sale (Se,. 7044, Busincsx and Profession, DRAINS-FLOOR,ROOF,AREA,COND. 5.00
J Coda'['he Contractor's License Low does not apply to an owner Of
Property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR 9AREA/(�,�,.O�OTAL ACREAGE
•
himself or otinthhis ownemployees,for she.if.edthatsuch improve x'74 lk 72-6
rets me notintendedor employees,sale.if. that such
cmproe GAS-EA.SYSTEM-11NC.40UTLETS 6.00
Ia au,manmenl is sold within one year of conhpletion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or an. BUILDING USE
prove for purpose of sole.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
0 I,as owner of the properly am exclusively contmcling will, El' 0 0 0
licensed contractors to construct the project(Sec. 7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's License Law does net apply
to an owner of property who builds or improves Ihercon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -x) 7 I�, _ A7
contracts for such projects with a contractorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 •JJ L
the Contractor's License Law. TRACT NO. PARCEL NO.
0 l am exempt under Sea. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have'a certificate of consent to self-insure.
Or a ee I feaI f Workers'Cmnpen li h Ins'/�.once,or. 'Rifled WOE ZONING ENG.SITE NO.
copy them{i`/HIc�3 fi Lab.C.)! /_ a /
Policy No. c/O pC impany'-D- lC MV f1-_ f1_t.} .
❑ CertiGd opy is Imteby fu 1, It r
FIRE SPRINK ENERGY T-24
Z 2 wa cnr,I dacopy 'f •d iRh 1, city nspcction division. MISC.- REFER TO ORD.
F O Applicant Y C] N Y � N
N CI9 KI'I'IC L01 -h eAl 1'TION PROM WORKERS' PERMIT ISSUANCE H3:6o la FLOOD ZONE A.L.u6.
LU 7 OMPENSAI]ON INSURANCIi PLG.CONTR_ LIC.NO. PLG.
d 0 (this seniors need not be completed if the permit is for one TOTAL I Y❑ NY❑ N
::) 2 hundred dollar.1S 10()o,less.)
L) O 1 certify that in the purforroance of(lie work for which Iiia per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any Hunner so as to
0 U become subject to tire Workers'Compensation Laws Of California.
U-1
} iUuApplcnt BUILDINGALTER OR ADDTO MECH. 5.00m 276r5T
• mss? emption,you should became subject to(he Workcri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of tiro Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he decreed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
i C'ONST'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.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 it/)c work Ibr which tlh i,a per is issued(Sea MICROFILM
3097,Civ.C.). /Q- HEATING UNIT (TO 100,000 B.T.U.) 8.00
LaWer's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Icenhy fiat lhavercad this application x n dsaae flat t he above .VENTILATION FAN (SINGLE) 4.00infoI,
ordinances
n correct. I agree m comply with all city and county BOILER H.P.or 100,000 B.T.U.) 6.00 PLUMBING - V�
Nirmatio ant ante laws relating to building construction,an ion, end sly
hereby attioed representative,to,ins of this city to enter upon the BOILER-COMP (Over 11X1,000 BTU).SEE EEE SCH. MECHANICAL �I
hereby m I oned property t alive, of this
ion purposes
(We) gree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upeni agai t Imbili ies, 'est/.cots, costs and expenses which PERMIT ISSUANCE CONST.TAX
may in any co y ucer a ai I sui l Cily m consequence of the W
Land sof lhia pcnnitMECR.CONT. LIC.NO. MECH.
'OJ� I
Signature of Apl ice t/L intra for TOTALTOTAL � g0 Umc
OFFICE COPY