17446 (2) POST .THIS CARD NEAR FRONT,OF BUILDING
PER MIT NUMBER
CITY OF CUPERTINO '17446
INSPECTION DIVISION
JOB INSPECTIONR ECORD
I
"[/ - PERMIT EXPIRATION "
JOBADDR ESS�allL('7�(�(�p7>�.: -_UNIT# LOT# ! n! J I t y
PERMI7�EX4& I�WORK
GIN NEE
PLO. L a ,. a, CONTRACTOR IS NOT. STARTEDWITHIN
INSP CTION ATE INSPECTOR INSPECTION RECORD 180 Drivs ORTERMIIT ISSU-
FOUNDATION - ANCE OR 180 DAYS'FROM
NOTE: ' LAST CALLED INSPECTION. '
UFER - ALL GRADING AND DRAINAGE SHALL BE:INSTALLED
_ PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - 'PERMIT VALIDATION
CUPERTINO STANDARDS
GARAGE SLABS Al
NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED1
UNDERGROUND,/,SLAB / 'MAR Id p�yl
` PLUMBING Ti;' UR
L4ci
ELECTRICAL city '01 w wfii4
ISSUANCE DATE
MECHANICAL - BLDG.- ELECT. . PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING -VALUATION $iFT.
.�
MECHANICAL .
ELECTRICAL' - _ PERMIT TD
FRAMING � ! '
INSULATION _ STORIES TYPE CONSTR.. .
OCC,GROUP RES,UNITS,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF T NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' SO.Fr FLOOR AReA TOTAL ACR eAce
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - - Res IND, CON PB :,om
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS 'DATE INSP. ❑' ❑ ❑ ❑ ❑
ROUGH SAN.k 7
S
ASSESSORFARCELN 0,.
PLUMBING - ELECT.ENERGY
TRACT NO, PARCEL NO.
TUBS&SHOWER PANPLUMBING ENERGY', -
MECHANICAL MECH.ENERGY'
ELECTRICAL - BUILDING ENERGY. ' Acc.DATE Acc.FILE NO,
x.
:FRAMING ELECT.FINAL TEST ZONING ENc.SITE No.
. INSULATION PLUMBING
LAS-TEST GAS -
` •. MECHANICAL
FIRE SPRINK- ENERGY T 2
COVER-NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] "0' ❑ N[] `
.
' EXTERIORSHEAR - � ELECTRICAL RELEASE FLooDZONE A U,c.
-
'INTERIOR SHEAR FIRE DEPT. Y ❑ "❑ Y ❑ "❑
SHEET.ROCK - GRADE FEE SUMMARY
EXTERIOR LATHS BUILDING - - -
INTERIOR LATH , TEMPORARY APPROVALS BUDDING Ob
SCRATCH COAT' ELECTRIC - - - PLAN CHECK
GAS FEE r
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEF OCCUPANCY SEISMIC FEE J v
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING'252-4505, ELECTRIC;,
F
ONE WORKING DAY BEFORE REQUIRED'INSPECTION. PLUMBING, -, -
O� PLEASE'GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL -
SEE PERMIT FOR EXPIRATION DATE
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR;FINAL INSPECTION.' , . T 3
"a OFFICE COPY. ,
APPLI,,ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION •PERMIT NUMBER
BUILDING APPLICATION & PERMIT 1
ADDRESS LI 6
` I.�.QZTNO LN BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .,
OWNER'S
"AME lYC Gupet I) O PLAN CHECK VALIDATION
PTY- ELECTRIC PERMIT FEE
• E
-725-2S
LDNTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.0011.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
LONTRACTOR's ' APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION F
ORCHITECT PANELS (OVER 200 AMP) 20.00 - PLAN CHECK FEE P.C.NO.
ENGINEER
'LEC.NO. SIGNS TRANS. 3.00 '
AARCH 08 DDRESS ENG. SPECIAL CIRCUIT 6.00 PERMIT VgLIDgT10N '
zIP EMP.METER OR POLE INS. 20.00 4
ADDRESS MOTORS SEE FEE SCH. --2 ` r
ADDRESS - '
SERVICE CHANGE 20.00 JDe-�GR vee(
o o LICENSED CONTRACTORS DECLARATION
¢U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
aI a w (commencing with Section 7000)of Division 3 of the Business and MAR 2 , . ELECT. PLG. MECH.
H m i Professions Code,and my license is in full force and effect. J BLDG +❑ ❑ 11z O m - License Class _ Lic.Nwnher
9 z r D
Date
< Contractor y E J city of, upeAw BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION '
M d u - - INFORMATION
w 3 n 1- 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
m VALUATION $/FT.
Huoj
Law farthefollowing reason.(Sec.7iresa permit
to
Professions PERMIT ISSUANCE 10.00
Code: e,dem y demolish,
county whiny structure p prior
t o is i construct,alter, - O
Ea ,¢ p improve,Ve,demOhrh.O!repair any structure,Netnre.pDOr to 115ISSnaneL',aI50 ELEC.CONTR. LIC.NO. ELEC. 14
o
wD u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m he is licensed pursuant to the provisions of file Contractor's License t
r z i Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE W FFF
E o
IF the basis for the alleged exemption.Any violation of Section 7031.5 _ .STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars 1$5001.):
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 F IXTUR ES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
memsarenotimcndedorofferedl'ar sale.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 EASYSTEM OVER 4(EA.) 200 BUILDING USE
builder will have the burden of proving that h - . -
e did not build or be- . RES IND CON PB Omer
prove as owner of the
INDUSTRIAL WASTE INTER. 30,00 ❑ ❑ ❑ ❑
I,as owner of the property,he project
iv ly Sec. 7044,Bu with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 _ A55Ess0RB PARCEL No.
and Professions Code:The Con lmmor i License Law Jots not apply
to ancontracts
owner of property who builds tr improvesrnscd p,and who LAWN SPRINKLERS-OVER 5 (EA.) -1.00 '
the Contract rr's pe I,L with u cnntractol{s)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's she Se Law.
❑ I am ex I Ide ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Uute ( WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMP'NSATION DECLARATION WATER TREATING EQUIP. 5.00 -
1 hereby affirm that I have a certificate of consent to self-insure, - ZONING
or a cerlifico to of Workers'Compensation Insurance,or a certified t • ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. -
Policy No. Company
O ❑ Certified copy rs hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy'is Bled with the city inspection division. MISC.- y REFER TO ORD.
O Applicant Y EJ pN� Y 0 N
CC �
y C17 RTI FICATE OF I:XEMPTI ON FROM WORKERS' L
PERMIT ISSUANCE 10.00 FLOOD ZONE A. U.C.
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.' Y❑ N 0 Y, 1:1N
EI
Z Q. (This section need not be completed if the permit is for one - TOTAL
hundred dollars IS 100)or Icss.)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
L f mil is issued,I shall not'empluy any person in any manner xn as'to
O W become subject to the Workers'Compensation Laws of California.
y Date -Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 37 �/
>_ m NOTICE TO APPLICANT: If,after making this Certificate of rix. -
I.. 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 V-/{(0 1
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LANDING AGENCY AIR HANDLING UNIT.(OVER 10=11F.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(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.19.50
Lender's Address ELECTRIC
I certify that l have read this application and stale [,at the shove VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.Or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the SOI LER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify unit keep harness the City of MISC.- REFER TO ORD. - -
uperline Inst liabilities,judgments, costs and expenses which CONST.TAX
may i y way accrue ag ' said City in consequence of the PERMIT ISSUANCE 10.00
ran' gofthis permit. ^ �� MECH.CONT. LIG NO., MECH.
�l TOTAL TOTAL 37,5''0
SignyuyB of A icant/C tractor k Data
OFFICE COPY