15015 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMITNUMBER
CITY OF CUPERTINO . 15015
- INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 1r)0 ZZ Al, ;;2-O U7/�r�-C' �L ✓p UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER (l CONTRACTOR ��rf� IS NOT STARTED WITHIN
INSPECTION DAT INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF P1.111P1.111,117L
IFT VAIIAIION
CUPERTINO STANDARDS. .
GARAGE SLABS - +
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - _s
UNDERGROUND /SLAB - S. it
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL - BLDG. ELECT. PLG. • MECH
❑ ' E] ❑ ,,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
� w,
MECHANICAL
ELECTRICAL a PERMIT TO
FRAMING
INSULATION AD TYPE CONSTH.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL.ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So.ITFLIXIRAREA ioIALACHEACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
I' BUILDING USE
ROOF SHEATHING HES IND CON vB Dm"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ABBEBSOHS PgliC fa.NO
' ROUGH SAN.N
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL -5-413-gpj 960 MECH.ENERGY
' ELECTRICAL BUILDING ENERGY ACC DATE ACC,FILE NO.
FRAMING - ELECT.FINAL TEST '
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
FIRE SPRINK ENENGIT-]J
MECHANICAL J
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y �' "� ° Ej N[]
FLOOUZONE A.L UC.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. `" IN 1 ❑ .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 JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. kMICROFILM
LEI ARRANGE FOR INSPECTION N BY PHONING 252-450 , ELECTRIC
I-_
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL' lli
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
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT 15015
ADDRESS
-I�'Q Ill_ BUILDING - ELECTRICAL-PLUMBING -MECHANICAL T
NER'S PLAN CHECK VALIDATION
.: "A}M^E�(� I/J� QTY. ELECTRIC PERMIT FEE
� F�VF UC�QcypPHONE
/ANAME Acr°Rs UTLETS-SWITCHES-RECEP 10,00/1.00
LIC.No.27G64 LIGHTING FIXTURES 10.00/1:00
.� r-DRoes
ORxa PPLIANCES-RESIDENTIAL. 4.00
CONTRAS
I ( G NE -5E7 PANELS 10.06 DATE OF APPLICATION .
ARCHITECTPLAN200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
R
ENGINEER .
LIC.No. ISIGNS TRANS. 3.00
nooeEsa ENc. SPECIAL CIRCUIT 5.60 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS
S /1
AMOTORS SEE FEE SCH. ( �`•`.�,,..�
ORE
SERVICE CHANGE 20,00
o Ici
Foo LICENSED CONTRACTORS UECLARA'TION -
a u I hereby affirm that 1 um licensed under provisions of Chapter 9 ISSUANCE DATE
y a w (commencing with Section 7000)of Division 3 of the Bssusineand BLDG. ELECT. PLG. MECH.
F h z Professions Code,and my Hhhoc n f
is it) ff
Lill force and e "I. El ❑ 11z o Lica nsc Class�_g Lic.Number
o z r Dale S --Contractor7zwd W-
< BUILDING PERMIT
x ¢ 4
OWNER-BUILDER D17CLARATIONK o 0 o INFORMATION
m g LL y 1 hereby atom that 1 um exempt from the Contractor's License MISC.- REFER TO ORD
FUOJ Law for the following mason-(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 16.06 VALUATION
Code:Any City or county which requires a permit to construct,alter,
lea ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
ALLO LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u w m he is licensed pursuam to the provision of the Contractor's License
rzi
Law(Chapter 9(commencimgwith Section 7000)of Division 3 of the
Y x o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
of r $ the hasis for the alleged cmmption.Any violation of Section 70316 STORIES TYPE CONSTR.
by any applicant for a Permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than Five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GEOUP RES.UNITS sole compentuion,will do the work,and the slructa re n not
intended or offered for sale (Sec. 7044, Business and I'rofcssionsDRAINS-FLOOR,ROOF,AREA,COND- 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or inlprovs.•s thereon,and who doss such work FIXTURES-PER TRAP 5.00 Set FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
rmntsamnotintendedOroffered for sale.If,however.the budding GAS-EA.SYSTEM-l1NC.4OUTLETS 6.00
or improvement is sold within one year of completion, the ownory GAS EASYSTEM OVER 4 (EA.) 200
builder will have the burden of provmg that he did not build or im- - . - . .
BUILDING USE
Prove for Purpnsc ofsxle.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Other
ID 1,as owner of . .
IIIc property,am exclusively contracting with ❑ 1:1 El El licensedllicensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 00
•'Y and Professions Code:The Contractor's License Law does tint apply V.B.. . ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 MA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to
the Contractor's License Ldw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam 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'COMPFN'SA'FION DECI-ARATION WATER TREATING EQUIP.- 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure.
f
or a certificate or Worked Compenmtion Insoranco,2s u ceNificd ZONING ENG.SITE N0.
T copy thereof(Sec.380Q Lab.C.h S(1JIOS�7� /
Policy No. Company_pgG_�r'Jjs,q(O
Q ❑ Certified copy is hereby furnished. -
Z Z X FIRE$PRINK ENERGY T 2
fL OCertiOc copy�s tiled the ci '_Inspection division.
CC � Applicmll MISC.- REFER TO ORD. Y E] N❑ Y ❑ NE]
rn CIiRTIPICA FIKEMPTION FRO\ RKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
LU > COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG.
d ❑ (This section need not he L'ompleted if the permit n for one TOTAL Y❑ N 'Y ❑ N❑
Z hundred dollars lSl001 or less.) n
U O I certify that in the pedurmanre of the work for which this Per- QTY. MECHANICAL PER IT 4110 FEE FEE SUMMARY
LL l- mit is issued,I shall not employ any Person in any manner so as W
U U become I,hj,Lt to the Workcri Compensation Laws of Culifomia.
y Date Applicant ALTER OR ADD TO - BUILDING
} W NOTICE TO APPLICANT If,alter making This Certificate of Iix-
? eruption,you should become subject In the Workers'Compensation APPLIANCE 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. ' AIR HANDLING UNIT(TO 1 D.F.M.) 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10)"C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this Permit is issued(See, HEATING UNIT(TO 100,0(x1 B.T.U.) 8.00 MICROFILM
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify Ihal 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby aathorim representatives of the city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
shove-mentioned property for inspection purpuras.
(We) agree to use, indemnify and keep harmless the City of MISC.- 'REFER TO ORD.
upertino against liabilities,judgments, costs and expenses whichCONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 O
ting Of this perm' MECH.CONT. LIC.NO. MECH.
TOTAL 0 TOTAL
Signature dicam ontractor Date
OFFICE COPY