15301 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15301
INSPECTION DIVISION
JOB INSPECTION RECORD
r/6U ' ✓�. PERMIT EXPIRATION`
JOB ADDRESS
UNIT# _LOT#
�/ PERMIT EXPIRES IF WORK',!
OWNER �'[[ CONTRACTOR VQLL,, 7 IS NOT.STARTED WITHIN
INSPECTIO DATE INSPECTOR INSP CTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCEOR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE 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 R
PLUMBING
ELECTRICAL
ISSUANCE DAIE
MECHANICAL BLDG ELECT I PLO. MED.,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION S/FT.
-
MECHANICAL-
ELECTRICAL e PERMIT TO ,
FRAMING / !a14
INSULATION STORIES TYPE CONSTR.
I
1
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED CO .
SO.FT FLOORAREA .TOTAL ACREAGE1
ROOF NOTE:NO FINAL INSP.SHALL BE MAR BEFORE•
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -•
HING BUILOINGUSE
ROOF SHEAT `
HES IND CON PB Go- I
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGHSAN.p ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGYp1f' -5,gglTRAIT ND PARCEL NO
MECHANICAL MECH.ENERGY p
ELECTRICAL BUILDING ENERGY ACC DATE Acc.FILE No
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING20NING ENG SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 7
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,Splee w Y❑ "❑ -`' Y E] NEI
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD LONE A.L 0C.
INTERIOR SHEAR FIRE DEPT. Y❑ "❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING S O
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY LSEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ELI ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL i
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU)Lbl NG PROJECT 1 DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 15301
AEgMES$
Gl BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
K--�
IT. "_
NoMpRAcrDBs OUTLETS-SWITCHES-RECEP 70.00/1.00
Vala uG.ND. LIGHTING FIXTURES 10.00/1.00
ADDRESSTORS �.y] PPLIANCES-RESIDENTIAL 4.00
` / PHONE PANELS 10.00
GATE OF APPLICATION
3 ARCHITECT p PLAN CHEEK7 P.C.NO,
7 DR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARC.OS Ervc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESS TS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
o ¢ z
H
00 LICENSED CONTRACTORS DECLARATION
a o I hereby of l'ine that 1 am licensed under provisions of Chapter 9 Lt/
1 $URN E DATE
H G H Professionmeeir,s
with Section 70so i of Division 3 0l the Busmen and BLDG. ELECT. PLG. MECH.
H a z Profession Code and�m icense is in full force and ❑ ❑ ❑
o
Z u , 0 License Clasl Lie.Number
Date L I
a Contractor
Qys
¢ ¢ w a OWNIi R-d UILDER DECLARATION BUILDING PERMIT
s o 0 0 INFORMATION
X ;0U. w I hereby aftinn that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
la t.oj Law for the following reason, 7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter,
m �¢ ei a p improve,demolish,or repair any structure,prior to its issuance, CONTR. LIC.NO.uvnce,also CLEC.
S m LL requires the applicant I'or such permit to file a signed statement that TOTAL
n w he is licensed pursuant to lite provisions of the Contractor's License PERMIT TO -
F z a Law(Chapter 9(commencing with Section 7000)afDivision 3 oflhe
4 Oo Business and Professions Code)or that he is exempt therefrom and
¢ 1- the basis for(lie alleged exemption.Any violation of Section 7031QTY. PLUMBING PERMIT FEE
.5 STORIES TYPE CONSTR.
i ;m by any vpph,,rel for a pernit subjects the applicmlt to a civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ I,as owner of Die property,or my employees with wages as LACK F LOW PROTECTDEVICE 4.00
their sole compensation,will do the work,and the structure a not . OCG GROUP RES.UNITS
intended or offered for sal,(See 7044, Business and Profession DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of '
properly who builds or improves thereon,and who does such work FIXTURES-PERTRAP '5.00 ' SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through'his own employees.provided that Such improve-
mentsamnolintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-7INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that h -e did not build or int- BUILDING USE
Prove for purpose ofsdie,). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 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's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
Contracts for such prcjec(.vwill,a contramons)licensed pursuant to .SEWER-SANITARY-STORM EA200h/10.00
the Conimctnis License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec ,B.&P.C.for Elis
reasonWATER HEATER W/VENT 6.00
Owner
Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSA'I ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a cerificate if,,)...in m eqf-insure.
or a certificate of Workers'Compensation Insurance,or a certified
ZONING ENG.SITE NO.
copy thereof US c.
Policy No. pehy" hed.
O ❑ Certified copy is hereby furnished.
Z 2 yEY Certified py1 J�s�til�ed with tic p• t n division. FIRE SPR INK ENERGY T04
H O Applicant�J1�.1. F-ac � �''1� MISC.- REFER TO ORD. Y ❑ N❑ Y p N� '
N CP-RI'1171CATIi OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.UA.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO.
CL o (This section need not he comPlcted if the permit is for one Y❑ N Y ry�
0 Z hundred dollars IS 100)or Icss.l
V O I certify that in the performance of the work for which this per. ^s� qq��sr
LL 1- mit is issued,I shall not employ any person in any manner V,as to OTY. MECHANICAL PERMIT 4 1- SEE FEE SUMMARY
Ow become subject to the Wetkers''Compersul ion Laws of California. MI
a D:nc Applicant ALTER OR ADD TO MECH. g BUILDING
} to NOTICE '10 APPLICANT': If,after making this Certificate of Ex-
F _ emption,you should become subject to the Workers'Compensation APPLIANCE fit, K0 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby afl'ion that there is i 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
Lender's Address HEATI NG UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING 1
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby enti oriec roperly n ms ct this city to enmr upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
hemb mentioned properly forinsp'If th purposes. �-
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which
may in any way accrue against Said City in corse PERMIT ISSUANCE 10.00 CONST.TAX
qucnce of the
Nal f this pen 'L M,cp Osa c T LIC.NO. MECH. ,
V(r`�f �f�rG\1(7`)1 TOTAL TOTAL
'i are of
pp 4W UaLL
OFFICE COPY