15310 (2) POST THIS CARD NEAR FRONT OF BUILDING ' A'
i - PERMITNUMBER T
CITY 0FCUPERTIN0
INSPECTION,DIVISION. 15310
JOB INSPECTION RECORD
Mvr�6 4 Y
PERMIT EXPIgATION
UNIT'# _LOT#
JOB ADDRESS ` l�P lot Lll✓/k.�';( ' r
.E
PERMIT EXPIRES;IF WORK
owNEa g, coNTRAcrOR { � IS ,NOT STARTED WITH CN
I P TION - DATE INSPECTOR INSP TI N RECORD • ?80"oAVS OF PI IT ISS�u.;�
FOUNDATION .. ANCE OR 180 DAYS FRj1
NOTE:-, �ASTCALLED INSPECTION.
UFER. ALL GRADING AND•DRAINAGE SHALL BE INSTALLED � tffia-
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERNI T VALIDATION T.+•
CUPERTINO STANDARDS.-''
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED w• f k- - ',
'UNDERGROUND /SLAB 4,,; .fir,•
- PLUMBING e , '
ELECTRICAL -
IssuANCE ugrE
MECHANICAL - - BLDG eELECT PLG. MESH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION.
PLUMBING
VALUATION S/f T.
MECHANICAL ' - '
PEO
ELECTRICAL - , , A "IT
,
FRAMING
INSULATION ire STORIES .,TYPE CONST 1,
• - ., OCC.GROUP ,�µyR ES UNIT
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' '\ `,
50 FT,F[OOR AREA 'TOTAL HLHENUE,•
'• ' •• ROOF; ' - NOTE:NO FINAL INSP.SHALL BE M ORE - - ^,
lie • DIAPHRAGM _ - _ THE CONSTRUCTION TAX IS PAID• .Ua ; , ;i ,Wit^
rj BUILDING USE
ROOF SHEATHING l �C,� -
RES IND CON ,PB OI,./
APPLY NO ROOFING UNTIL.ABOVE HAS BEEN SIGNEDFINALS DATE INSP.• ❑ {
ASSESSORS PARCEL N0-
- ROUGH SAN.Ii
PLUMBING ELECT.ENERGY I
TUBS&'SHOWER PAN PLUMBING ENERGY •'• -TRACT NO. PARCEL NO,•
'
MECHANICAL, MECH.ENERGY '�.w'#Pr::a.. " .` •,:r
.AcG.DATE "ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING - ELECT.FINAL TEST ,~%
ZONING ENG SITE NO'
INSULATION PLUMBING
, v
GAS TEST. - GAS,.-. (,• ,,,•„ - -;;.•a"FIR CtPPflNK: ENERGY T"24
MECHANICAL '.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "' Y "El `El 'NE.
FLOOD ZONE A.L,U.Q
- EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR ,., FIRE DEPT. Y.Q [I ;s.Y'L NQ
• SHEETROCK GRADE - + �'- FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH'- -- - ,TEMPORARY APPROVALS -,� BUDDING SCRATCH COAT: ELECTRIC PLAN CHECK '
..
GAS . FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY :
'SEISMIC FEE • ,
pelta-:.
OCCUPANCY'OF BUILDING ISNOTPERMITTEDUNTILBUILDING FINALIS'SIGNED BY•BUILDING INSPECTOR, . "A • "
" r .,MICROFILM°+ °.
c'
.` ARRANGE FOR INSPECTION BY PHONING 252-4505, I, EtEctalc' j
F ONE WORKING•DAY BEFORE,.REQUIRED INSPECTION. ,e.�uMtelNc
0 PLEASE-GIVE JOB ADDRESS WHEN PHONING.
•. Z - '• , MECHANICAL 00'P
SEE,PERMIT FOR EXPIRATION DATE —
: IMPORTANT! covsr.TAX
PLEASE READ REVERSE SIDE BEFORE: TOTAL,.
CALLING FOR'FINAL INSPECTION. '
" OFFICE COPY
APPLXANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY,
13U LDING PROJECT IDENTIFICATION .PERMIT NUMBER
+" BUILDING APPLICATION & PERMIT q q O
nooREss 1
7-1. $a ` Ln. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S 'PLAN CHECK VALIDATION
NAME (' - Z QTY. ELECTRIC PERMIT FEE
t'f PHONE 12 (S
NAMpRAcrDRs OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00 -
ADDREACTOR'S 1 J �^ •i •- -
" AopREss �" l� APPLIANCES-RESIDENTIAL 4.00 -
�. .PHONE PANELS r 10.00 J DATE OF APPLICATION r.
OORRcmTECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE ,P,crnlo.
ENGINEER LIC,NO, SIGNS TRANS. 3.00 _ _
ARC H.OR ENG. S OO PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT -
- " EMP.METER'OR POLE INS.. 20.00
ADDRESS is - MOTORS SEE FEE SCH.
ADDRESS ZIP
SERVICE CHANGE 20.00
LI 00 LICENSED CONTRACTORS DECLARATION -
a: u - I herebyaffirm that 1 am licensed under rovisions of Cha ter 9
Q Z w " p P ISSUANCE DATE + -
Q,a (commencing with Section 7000)of Division 3 o�fdthe Business and- BLDG. ELECT. PLG. MECH.
r w i Profeseio la Code, enL Is In full for ❑ ❑ ❑
Is O ut — License Class Lic.Numbs -� 64
9 z r'w Dale Contractor - -
a y E c .1 BUILDING PERMIT
¢ ¢Q OWNER-BUILDER DECLARATIO -
0 S- 1 o - - INFORMATION
S. ' 1 hereby of firm that 1 am exam t from the Contractor's License MISC.— REFER TO ORD
3 uY P - VALUATION $/FT.
Fuoj Law for the following reason(Sec.7031.5,Businessand Professions PERMIT IS 10.00 -
Code:Any city or county which requires permit to construct,alter,
aw ELEC.CONTR. LIC.NO.'
¢ ¢p improve,demolish,or repair any structure,prior to its issuance,also ELEC.. -
nO¢ requires the applicant for such permit to file a signed statement that _ , TOTAL - PERMIT O
K
$ he is licensed pursuant en the provisions of the )ofDivision
ivisContractor's 3 Licensee - -
r Lus nese and
Professions
Codeng )or Section is exempt
fttherefrom the
4 0' Business and Professions Code)or that he is exempt therefrom andOTY. PLUMBING PERMIT - FEE {
rE R $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
Lc by any applicant fora permit subjects the applicant to a civil penalty ALTER -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my,maployees with wages as - BACK F LOW PROTECT. DEVICE 4.00 OCC:GROUP RES.UNITS
their sole compensation,will do the work,and the structure rs not -
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 '
Code:'Mrc Contraelofs License Law`does not apply.to an owner of.
property who builds'orimpreIves thereon,and who does such work . FIXTURES=,PER TRAP,r 5.00 �, SU.FT,FLOOR AREA TOTAL ACREAGE,
r� himself or through Itis own employees,provided that such Improve- -
Parts are not intended oroffered for sale If however the building , GAS-EA.SYSTEM-11NC.40UTLETS 600
or improvement Is sold within'on,year of completion,tire owner- GAS-EA.SYSTEM-OVER 4(EA.) 2 OO euILDwG'uSE'
builder will have life burden of proving that he did not build or im RES " IND ,CON P8 Omar
USE-
prove for purpose of the.l. i - INDUSTRIALWASTE INTER. 30.00 '❑ ❑ - 11 ❑ Cl
❑ I,as owner of the property,am exclusively contracting with
' licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS- 1 JNC 5 V.B. 6.00 - ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
contracts for such projects with a contractor(s)licensed pursuant to -SEWER.-SANITARY-STORM EA.200ft/10:00
the Contractors License Law. TRACT NO. PARCEL NO. "
❑ I am exempt under Sec.—,136&P.C.for this WATER HEATER W/VENT .. 6.00 ' ' -
reason
Owner Date WATER SYSTEM' 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
'I hereby affirm that I have a certificate ofeonsent to self-insure, - - - ZONING ENG.SITE N0.
or arcertificate of Workers'Compensation Insurance,or a certified '
copy Ihe(gp ($e &
Policy N . Cn*M
CKts
O ❑ pertified copy is hereby furrishe,16 T FIRESPRINK ENERGY T 24
Z Z Certified coy {s,Glad w'�t1� �he��y lµppection di Islon - -
O Applicant—s-15 C'b�-C\Od-?1'1-Li MISC. REFE Y❑ N❑ Y ❑ N❑
CC rn PERMIT ISSUANCE 10.00 �'U� FLOOD ZONE A.L.U.C.
CERTIFICATE E EXEMPTION FROM WORKERS'
W COMPENSATION INSURANCE, PLG.CONTR. r LIC.NO.
CL 0 (This section need not be completed If the permit is _for-One AL Y❑ N❑ Y❑ N❑
O Z hundred dollars(S 100)or less.)
"U O 1 certify that in the performance of the work for which this ver- QTY. MECHANICAL PERMIT �t C FEE FEE SUMMARY
U, mit is issued,I shall not employ any person in any manner so us to
U become subject m the Workers'Compensation Laws of California:
O w Datc Applicant ALTER OR ADD TO MECH;, 5.00 BUILDING
m NOTICE TO APPLICANT: If,after making this Certificate of Ex=
}
> Z emption,you should become subject to 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 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency'for EXHAUST HOOD(WITH DUCT) 5.
the performance of the.work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000.B.T.U.)
Lender's Name - HEATING UNIT(OVER 100,000 B.T.U. ELECTRIC
Lender's Address
I certify that l have read this'application and state that the above I 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 BDILER-CO (3 H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOI LMP
ER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.: REFER TO ORD. ,
Cupertino against liabilities,judgments, costs and expenses which PERMITISSUANCE {p,g0 ,CONST.TAX
may in any way accrue against said City.in consequence of the
n this permit. MEC ONT. LIC.NO. MECH.
..?I II 0 �s����ys.-� TOTAL ��\J TOTAL
g at r Applicant/Contractor Date
OFFICE COPY ..