18567 (2) POST THIS CARD NEAR FRONT OF BUILDING
RMITNUMBEH
CITYCOF EUPERTINO P, 1 $567
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS—! _.("\.L _ JAIL 1 UNIT# _LOT#
�w^ P 9MIT/E PI}p EE IF WORK
• OWNER M ,ILA-L , <'' M CONTRACTOR , 1 /NOT( TANTE WITHIN
rI INSPECTION DATE. INSPECTOR INSPECTION RECORD 180 DAYS OF PERfAIT ISSU-
' FOUNDATION - - L ANCE,OR 180DAYSFROM
NOTE�, LAST CALLED INSPECTION. '
UFER - ALL•.GRADING AND DRAINAGE SHALL BE INSTALLED
PRETO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
GARAGE ITE SLABS CUPERTIN0 STANDARDS. •' ',
` GARAGE � ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - [ I ISSUANCE LATE
MECHANICAL - SLOG ELEcr PLG. MecR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VNLUAnDN 9/FT;
PLUMBING - - „f
MECHANICAL -
' ELECTRICAL [ '.PERMIT TO
'.. ... FRAMING .fix /�1KV, 'C•1, L
INSULATION sroTaesi TVP.coNsrR.
OCC.GROUP RES UNITS
PLACE NO SOBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM . - - - THE CONSTRUCTION TAX IS PAID -
' ,
- BUILDING USE
�.
ROOF SHEATHING. Res . IND -CON. PB Other
APPLY-NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' FINALS; DATE INSP. ❑ ❑' ❑ ❑ ''• ❑
ROUGH SAN.q ASSESSORS FARCE NO.
'PLUMBING ELECT,ENERGY rRncrmo. PARCEL No .
TUBS&SHOWER PAN PLUMBINGFNERGY'
MECHANICAL - - MECH„ENERGY
- ELECTRICAL BUILDING ENERGY ACCDATE ACC.FILE NO- -
FRAMING ELECT,FINAL TEST '
PLUMBING ZONING ENC,SITE NO. .
,INSULATION _
GAS TEST
- GAS , -
' i 'FIRE SPRINT( ENERGY T.7a
COVER NO WORK UNTIL ABOVEMAS BEEN SIGNED HEATING - ° ❑ N❑ ` ❑ ' NO
EXTERIORSHEAR -
ELECTRICAL_-RELEASE FLDODZONE AI..Uc,
INTERIOR,SHEAR FIRE DEPT[ v❑ N❑ v L7 No
SHEETROCK ' GRADE FEE SUMMARY
EXTERIOR LATH BUILDING' . - !
BUILDIN
G
INTERIOR' LATH ,,•, TEMPORARY APPROVALS
SCRATCH COAT - ELECTRIC PLAN CHECK
- ' GAS - FEE -
.. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANdY., SEISMIC FEE . .
OCCUPANCY OF BUI LOING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED'BY BUILDING INSPECTOR. MICROFILM
LU •ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICL pv.
ONE WORKING DAY BEFORE REQUIRED.INSPECTION: Pwn e1.
ING
0.1 o . PLEASE GIVE JOB ADDRESS WHEN PHONING.,'
r:
Z — SEE PERMIT FOR;EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX
PLEASETREAD REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
„ is
OFFICE COPY
APP LICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY /
" �ILDING PROJECT IDENTIFICATIONPERMIT NUMBER.• �•, � � �. � I
BUILDING $PPLICAT,ION.& PERMIT ' Ir
ADOREsn , �VS
�ey, Lx BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 18567
OWNERPLAN CHECK VALIDATION
= _ NAM OTY. ELECTRIC PERMIT FEE "
L PHONE
CONTfl TRACTOR e
- NAM p OUTLETS-SWITCHES•RECEP 10.00/1.00 i
CC. sec,N..,569"
o. LIGHTING FIXTURES 10;00/1.00
' CONTRACTOR � .SilAl4Y✓/I'(E- APPLIANCES-RESIDENTIAL a - '7 t, 4:00Pd.
ES » '
U PHONE PANELS . 10.00 \DATE`OF�PPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
on ANELS (OVER 200 AMP) 20.00
ENGINEER
^ sec.NO, SIGNS TRANS. '3,00
ARCH.OH ENG. 'PERMIT VALIDfION
ADDRESS SPECIAL CIRCUIT 5.00 l/
ZIP TEMP.METER OR POLE INS. 20.00 1
APPLICANT MOTORS SEE FEE SCH., ��dCJN'tot
ADDRESS ,
11
Q - S7�,jt. SERVICE CHANGE - 20.0 0�1.
FOO LICF:NSkiU COMPRACTORS DECLARATION y.
Quo I hereby affirmz that I am licensed under provisions of Chapter 9 N :.
tenmmencing wish Section 7000)of Division 3 of the Business and
ap - Btbd. ELECT. I NNATI MECH.
r i I'ml'essions COdo nd license Is in full tome'- 00-W License C ss Lie Number - -
F
Uate (.7_ / Contractor
F ,
_ _ x 2 ¢ OWNER-BUILDER DECLARATION - PERMIT
E p a,D "INFORMATION
w ; LL F • I hen by.affirn that I am exempt from the Ccntr:color's License MISC.- REFER TO O
FLLoa ' Law for the following reason,(See,7031.5,fHe,bwssand Pral'essions PERMIT ISSUANCE �� Vi - VALuaTION $/FT.
Code:Any city or county which requires a permit to construct.alter. 1.
ec rt Q 0 Improve;demolish,or repair any structure,prior to its issuance,also EC.CONTR. LIC.NO. ELEC. p v a
n wa'a requires the applicant for such permit to file a signed statement that [ TOTAL� ' 2 PERMIT TO
m he is licensed Pursuant to the provisions of Iho COmelClotn License .569 "�� ^ q
F, i" law(Chapter9(commencingwith Section 7000)of Uivision 3 of the ,
f i o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEEGa-
¢P-$ the basis for file alleged exemption.Any violation of Seclion 7031.$ STORIES TVP CONSTR.
a 3 - by any applicant for a permit subjects the applicant to a civil penally
of not more than five hundred dollars($500t): ALTER-DRAIN&VENT-WATER (EA.) 5.00
.. ❑ I,as owner of the property,or my employees with wages ae BACK FLOW PROTECT. DEVICE - 4.00 OCC.GROUP RES,UNITS
their sole eonmpensation,will do the work,and the structure is not
Intended or Offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Come c(or's License Law does not apply to an owner of '
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve -
rentsarenotintendedorofferedforsafe.Il',however,lire holding GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
of improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or M. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
RES IND , CON PB Other
prove 1,as owner
of the.). INDUSTRIAL WASTE INTER. 30.00 • ❑ ❑ ❑
❑ L as owner of the property,he exclusively comma ing with _
!iccnscd contractors to co Contra the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. ' 6.00 ASSESSORS PARCEL NO.
1.J Professions Codegrope The who
s License Lew Aeon not apply -
to contracts
owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 '
the Contractor's
far such projects with a comructoR s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
WC Contractor's License Law. - TRACT N0. PARCEL N0.
❑ 41PKIEPA-041
cmSec. B.d:P.C.I'or til is WATER HEATER W/VENT 6.00 '
OwnerD:do . - WATER SYSTEM •' 5.00 ACC.DATE ACC.FILE NO.S ,)ECLARATION WATER TREATING EQUIP. 5.00
I hereby afMn that I have a certificate Of consent to vel Ginsurre, '
or a certificate Of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO.
- copy thereof(Sce.3800,Lah.C.). •. -
Policy No. - Company - , -
0 ❑, Certified copy is hereby furnished. FIRE$PRINK ENERGYTZ4
Z Z' ❑ Certified copy is filed with the city inspection division. MISC- REFER TO ORD.a {_ O. Applicant Y ❑ N❑ . V ❑ At
� N CERTII'ICA'1'E 01'CX Ii M PTI ON FROM WORKERSI PERMIT'ISSUANCE 10.00 f FLOOOZONE -A.L.U.C.
ION
W >
(' PLG
Phis section need not be completed e I INSURANCE
the Hpermll is for one PLG.CONTR. - LIC.N0. IT
V❑ N❑ Y ❑ N❑
ao
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this r OTV MECHANICAL PERMIT FEE FEE SUMMARY
ly F-' mil is issued, I null not carp10y a{u�.�orsmh in any n' her so: to - -
OW become subject to the Workers'C�fr�y ns�ali
d . Date Applicant_/1/1D - BUILDING
} to NOTICE TO"APPLICANT: If,'""'3f(333RR( r�m���-.king this erlific to of Ex. ALTER OR ADD TO MECH. 5.00
? eruption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of lire Labor Code, you must forthwith comply with FEE
U suulh provisions or this permit shall be deemed revoked: AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER IOADOC.FM.) 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(Sec. MICROFILM
3097,Civ.C.): HEATING UNIT(TO 100,000 B.T,.U.) '8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC s bU '
I certify that I Ihave read this application an'
"methat the.Hart VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all Lily and county - PLUMBING
. j ordinances and slate laws relating to'building construclion, and BOILER-OOMP13H.P.or100,000B,T.U.) 6.00
hereby authoriLe representatives of this city to enter Inion the BOILER-COMP (Over 100,000 BTUISEE FEE SCH. . MECHANICAL
ahvo
omenfioned property for inspection purposes.
(We) agree to Save, indemnify and keep harmless lhe-City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 'CONST.TAX
may in y wny accrue ugains s City consequence of the
'numtin Itis per� MECH.CONT.' LIC. MECHL
s� TOTAL
TOTAL
Signature of App¢anl/Contractor Date
OFFICE COPY .