18321 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER f
CITY OF CUPERTINO 18321
INSPECTION DIVISION
JOB INSPECTION RECORD
• PERMIT EXPIRATION
JOB ADDRESS 4' o 5 4F ISN UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER —
CONTRACTOR_C(J .e ( IS NOT STARTED WITHIN
FNSP TION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLAN ND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
POUR NO CONCRETEUNDERGROUND /SLAB E HAS BEEN SIGNED JUL 1 E� 1
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL BLDG ELEcr PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION S/FT
MECHANICAL I
ELECTRICAL 'PER/p$��uT To
FRAMING f '-m -V4
INSULATION STORILS PE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I
EFORE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BSO.11 FLOOR AREA TOTAL ACRFAGF.
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING BUILDING USE
RES IND CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATEINSP. ❑ EJ El E-) E-1RO UGH SAN.p SSAESSORS PARCEL NO
PLUMBING ELECT,ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZON1Nc ENG.SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T?A
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING `' ❑ "❑ ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD>.ONE AL11c
INTERIOR SHEAR FIRE DEPT. ❑ N❑ v ❑ N❑
SHEETROCK GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ELI
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST. TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL A�
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON _ PERMIT NUMBER
8UHL.IING APPLICATION & PERMIT 8321
ADDRESS
8$'8DREss (,
45s FS7(f7� 4 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ii
OWNER'S PLAN CHECK VALIDATION
NAME _ //.x(- LNE
11 QTY. ELECTRIC PERMIT FEE
O `_ PHONE
NAAME Ac7oRs OUTLETS-SWITCHES-RECEP 10.00/1.00
g `__, PLM 6. uc.NO2Y'0 '24-3 LIGHTING FIXTURES 10.00/1.00
Ac
ADDRESS toRs Z5.,3 PPLIANCES-RESIDENTIAL 4.00
ADT
GiCZ ril/A D SIS PHONE o6 PANELS 10.00 DATE OF APPLICATION
OARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE D.C.NO.
NGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 7^ I of`-of`-9?ADOREss -
APPLICANT'S MOTORS SEE FEE SCH. (/
SERVICE CHANGE 20.00
0z .l A\ti�
Y�V
0 O O 1.ICF:NSIU CONTRACTORS DECLARATION PAD
a 1 hereby affirm that I um licensed under provisions of Chapter 9
N z N ISSUANCE DATE
lcommencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H m z Professions Code,and my license is in full force and effect ❑ a `„ ❑
z z m W License Class_flf. _).fi Lia Number Z-{O
Q x J Date27--_K= Contractor.CLLD�TQ T/ �, p�u P��wn.►1ww
a Ix wa OWNER-BUILDFR DECLARA'noN MiR CIII jqq BUILDING PERMIT
a O a" MISC.- REFER TO ORD INFORMATION
X g H 1 hereby affirm that I am exempt from the Contractor's License
r IL o v, Law for the following Teaser.(Sec.7031.5,Hirarvssand Professions - PERMIT ISSUANCE 10.00 vnwnnoN $/FT.
Code:Any city or county which requires a permit to construct,alter,
QQ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
requires the applicant for such permit to file a signed statement that TOTAL
a he is licensed pursuant to the provisions of tie Contractors License PERMIT TO
w, m Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe f^
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE V(ltd V�
a: H m the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES T PE CONSTR.
s- ; _ by any applicant for a permit subjects the applicant to a civil penalty
of not more than live hundred dollars(S500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
O 1,as owner of the property.or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.CROUP RES.UNITS
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
. property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTALACREAGE
himsellor through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1 INC.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 he did not build or inn- BUILDING USE
move for purpose of INDUSTRIAL WASTE INTER. 30.00RES IND N O
❑ as owner of the property,anis exclusively contracting 7044, 11 F-1 ❑ El El ling wish
dor
licensedd contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS- 1 INC 5 BOO ASSESSORS PARCEL NO.
and Professions Cade The Contractor's License Law does not apply V.B.
to antr owner of property who builds or Impmvus rased n, sua who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts ct such projects with a conlractorl sl licensed pursuant to
the Contractor's License law. SEWER-SAN ITAR V-STORM EA.2001[/10.00 TRACT NO. PARCEL NO.
❑ Inco exempt undar Scc. ,B.&I'.C.for thio
reason WATER HEATER ADVENT 6.00
Owner Date WATER SYSTEM 5.00 OO ACC.DATE ACC.FILE NO.
WORKI;RS'COMPfSNSATIONDIiCI.ARA'r1ON WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of conscnl to MGinsurc,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy thereof(Sec 3800,I.A.C.).
Policy No. Company
O ❑ Certified ropy is hereby furnished.
z Z A Cert i6ed ) y is+fj7cll with the lily mspectiOn division. FIRESPRINK ENERGY T 24
FO rap mam MISC.- REFER TO ORD. vE] NEI Y ❑ NE]
Ln CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ,z40� FLOOD ZONE A.L.u.c.
W COh1I'IiNSATION INS URANCIi PLG.C;HANDLING
LIC.NO. PLG.
O' O
IT section need not be completed if the permit is for one - TOTAL .ov Y N� Y ❑ N[]
Z hundred dollar,(5 100)or lc,,)
V O 1 certify that in the performance of the work for which this per- OTV. HANICAL PERMIT FEE FEE SUMMARY
W Umil is issued,e I shall of employ any person in any manner so in to
W become subject to One Workers'Compenmtion laws of Culil'nrnia.
a Dan Apply`°rat D TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificato of IN-
♦- Z emption,you should become subject to the Workers'Connpensnlion 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. UNIT(TO 10MC.F.M.) 4.00
CONS'rRUC'I'ION LENDINGAGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a canstrucsion lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of she work for which this permit is issued(Scc. MICROFILM
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Icertify thml have mad this application and state that One above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING )
ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) 6.00 / e0�
hereby aufhnrize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep ba-mless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against Said City in consequence of the PERMIT ISSUANCE 10.00
granting of this pe m i L MECH.CONT. LIC.NO. MECH.
/_'1�^ S ; 'Z-I q- Q TOTAL TOTAL 1
Signature of ApPncant/Contractor 1) + I �eOD
OFFICE COPY