15637 (2) POST THIS CARD NEAR FRONT OF BUILDING
' ` 'PERMIT NUMBER '
CITY OF CU.PERTINO 15637
INSPECTION DIVISION
JOB INSPECTION RECORD
QQ•' / PERMIT EXPIRATION
JOB ADDRESS a'1 'LON/UA- NV UNIT# _LOT# -
' .�• PERMIT'EXPIRES IF WORK
OWNER TpN ( O U CONTRACTOR ' per y �.�� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 1Bo DAYS OF PERMIT ISSU.,
FOUNDATION ANCE 0R'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 PERMITvnu DATION
CUPERTINO STANDARDS. - ,•„ f
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB .r
PLUMBING
ELECTRICAL Is9tiANCE DATE
MECHANICAL - - BLDG ELECT. PLG: MECH. ,
❑ ❑ ❑ i
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDPAID BUILDING PERMIT
WOOD FLOOR
INFORMATION
PLUMBING � (�VZAJ-LUNATION . SIFT,
MECHANICAL J�N•� �
ELECTRICAL (+'�rPERMT TO
FRAMING city Of CU BItIDOV/\ 44-&11 .Jr
STOHI/EE TYPE CONSTR,
INSULATION -
' OCC.GROUP RE UNITS .�
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.IT.FLOCH AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHINGREs wBUILDINGCON USE
PB
Dm.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCECNO
ROUGH SAN,#
PLUMBING - ELECT.ENERGY '
_ O. PARCEL NO,
TUBS&SHOWER PAN PLUMBING ENERGY - ' � TRACT�N •
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC,DATE , ACC FILE NO
FRAMING s- -, ( ELECT.FINAL TEST
ZONING • ENG.SITE NO.
INSULATION PLUMBING '
GAS TEST GAS -
MECHANICAL . FIRE SPRINK ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r❑ N❑ —�O- N❑
FLOOD ZONE' ALL.U.C.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y❑ -"❑ "Y ❑. N❑. .•,
SHEETROCK —'J- GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING , yj -
INTERIOR LATH TEMPORARY APPROVALS F
DING o '
SCRATCH COAT ELECTRIC CHECK 1 �'
GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - MIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL'BUILDING FINALISSIGNED BY BUILDING INSPECTOR: OFILMARRANGE FOR INSPECTION BY PHONING 252-4505, TRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMeInc
O PLEASE GIVE JOB ADDRESS WHEN PHONING:
Z. MECHANICAL
SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 3!a7_17 '
CALLING FOR FINAL INSPECTION.
OFFICE COPY
jl rPLICANT TO FILL IN INFORMATION WITHIN RED!LINES - USE BALL-POINT PEN ONLY
It BUILDING PROJECT IDENTI FICATION `' ' ..PERMIT NUMBER
.GILDING All & PERMIT
,PE "
AGDRESa /_ - - ''156:3 7••, ,
/'�flN A. ��, BUILDING.- ELECTRICAL-.PLUMBING-MECHANICAL
Oq�ER'S - - - PLAN CHECK VALIDATION
Np„S,n� �s0V DNE CITY. ELECTRIC PERMIT FEE
XS
CONTRACTORS;
NAME 0 UTL'ETS-SWITCHES-RECEP 10.00/1.00
JI(ti Use, PiIIrlDRA1 'uc.No.JU-7r.1 LIGHTING FIXTURES-- •,10.00/1.00
CONTRACTOR'S
a0OREss " - APPLIANCES--RESIDENTIAL 4.00 -
700ACCLON .JW .51-1HCNE d9s PANELS . 10.00
ARCHITECT DATE OF APPLICATION, S
on . - PANELS (OVER 200-AMP) 20.00 PLAN CHECK FEE PC.NO
ENGINEER , -
uc.NO. SIGNS TRANS. .a' 3,00
ADDRESS ADDRESS ENG. y PERMIT VALIDATION
SPECIAL CIRCUIT -5.00
ZIP EMP.METER OR POLE INS. ,20.00
APPLICANT S
r✓'^'
aDORIEoREss � - MOTORS'. SEE FEE SCH.
SERVICE CHANGE - 20.00
r o o. LICENSED CONTRACTORS DECLARATION
< U u : I hereby affirm that I am licensed under provisions of Chapter 9
n a A, (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
H H 2 Professions Co e,yjd4ny license is in full for �{� BLDG, ELECT. . PLG. MECH.
z O w
License Class - Lin.Numbs d- _ ❑. ❑ ❑ ❑
Fo y E w Date 6, �_1 Contractor 7
S,M + BUILDING PERMIT
lL w ,OWNER-BUILDER DEC A AP1 ON FORMATION
w3u m 1 heieby,affirm that I am exempt from the Contractors License - MISC. , REFEWTO ORD
u
u O¢ Law for the following reason,(Sec.7031.5,Businessland Professions . - ^ ION
t - -PERMtT•ISSUANCE ;:10.00
Code:Any city or county which requiresr,permit to construct,Bite -
Q,0C et �' improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - ., LIC.N0.' 'ELEC. \ 0
y N m•LL he
the appllCant for such permit ilicensed [o file v signed statement that - TOTAL \PERMIT TO ,
w- m e s censed pursuant to the provisions of the Contractor's License yy
H Z a
Law(Chapter 9(commencing with Section 7000)0 f Division 3 of the,
`(� Ux
E m er Business and Professions Code)or that he is exempt therefrom and QTY. ;, PLUMBING PERMIT FEL�1l - Cr "'" �
WFo the basis for the alleged exemption.Any violation ofSection 7031:$ _ STORIE TYPE CONSTR.
u g m by,any applicant for a permit subjects the applicant to a civil penally , -
ofnotmorethanfivehundreddollars(S5001J: I ALTER-DRAIN&VENT-WATER,IEA.) 5.00
I ..❑ I,as owner of the Property,or my employees with wages as - -
their sole compensation,will du the work,and the structure is not BACK FLOW PROTECT. DEVICE'. ''4.00 'OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
. Code:The,Contrach" License Law doe'no'apply to an owner of
- -
property who builds or improves thereon,and who does such work' FIXTURES-PER TRAP' ' 5.00 SQ.Fr.FLOOR AREA TOTAL ACREAGE
himself or thro ash own
employee S,provided that such improve-
in
e- . .
men's are not intended proffered for sale.If,however,the building GAS-EA.SYSTEM-VINC.4 OUTLETS 6.00
or improvement a sold within year of completion,the owner-
builder will It ve'he burden of proving that he did not build or iel-. GAS-EA.SYSTEM-,OVER 4'(EA.) 2.00 .BUILDING USE
prove for purpose oG SaleJ. - ' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I;as owner of the Property,am IN
cbaivcly contract"K.'s th - '❑ .❑ ❑ ❑ ❑
licensed contactors to-construct the project(Sec. 7044,Business LAWN SPRINKLERS-1'INC 5,V.B. 6.00 - ASSESSORS PARCEL N0.
Ina Professions Code honk ilds s License Caw does not vpply „
In
' owner of property who builds or improves'hercon.,an"In. LAWN SPRINKLERS=OVER,5(EA.) ' 1.00 '
contracts for such projects with a con true ho(s)
licensed pursuant m
the Contractor's License•Law.' , SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No.. PARCEL NO.
❑ .I man exempt under Sec, ,B:&P.C.for this •
reason WATER HEATER W/VENT 6.00 .'
Owner
Date 's WATER SYSTEM -- 5.00 s ACC.DATE Aec.FILE No.
.,7 WORKERS'COMPF-NSATION DECLARATION .WATER TREATING EQUIP. v"5.00 - -
Iherebyaffirmthatl'have.a certificate of consent to self-insure, - -
- or a certificate of Workers'�Compensation lnsuiance,of a certifiedZONING ENG.SITE NO.
copy thereof(Ste.3800,Lab.CJ.r�1-
y' Policy No.• • Company.-p-�_! �/��✓.VO
O ❑ Certified ropy is hereby famished. ^r
Z Z j�,,Cert'fie c pY is filed' with the-city inspection FIRE SPRINK ENERGY T29
..vision:
O Pplicanl' - ' MISC.- - "REFER TO ORD, t r ❑ N❑ Y ❑ N❑
CC C.R CATE OF EXEMPTION FROM WORKERS' 'PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.I1.C.
LU �:+ -COMPENSATION INSURANCE" r PLG.CONTH. LIC.NO. . .PLG.
CL 0 a(This section'need not'.be completed if the permit is for one .'+ - TOTAL 7 Y❑ N❑ Y❑ N❑
Z hundred dollars IS 100)or less I r ^•?' -
,U O ' '1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY'
LL {- mil is issued,1 shall not employ any person in uny,omma rso as m
,. 0 W become subject to the Workefs'Compensation Lawsof Californ ia._ BUILDING ' O�_�✓
y Date -- • Applicant- " :. ALTER OR ADD-TO MECH. ,5.00
} US NOTICE TO APPLICANT. If,after making this Certificate a F,x- _ --
"'F ?' emption,you should becorm,Subject to the Workers'Compensation APPLIANCE _ .5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE - y
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRI1CTfoN LENDINcacENCY ." AIR HANDLING UNIT(OVER 10000C.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(Sec. MICROFILM -
3097,Civ.C,): t - HEATING UNIT(TO'100,000B.T.U.) '•8.00
Lender's'Name
' Lender's'Address - HEATING UNIT(OVER 100,000 B:T.U.0.50 ELECTRIC
I certify that I have'read lh+s application and state that the above VENTILATION FAN (SINGLE) 4.00 -
mformation is correct I agree to comply with all city and county - PLUMBING
ordinances and state'lows relatng to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) '6.00
hereby authorize representatives for ins of this purposes
enter upon the BOILER-COMPf Over 100,000 BTU)SEE F EE SCH. MECHANICAL, '
_ above-mentioned property for inspection purposes. n
(we)I agree to Save,'indemnify and keep harmless the City of MISC.- ' 'REFER TO ORD. _
upertino against'liabilities,judgments,,costs and-expenses which - CONSTTAX _
sy in y way accrue against said City'im consequence of the' : .PERMIT ISSUANCE - 10.00 -
' ramin 'lh' rm+f MECH.'CONT LIC NO. 'MECH ���
TOTAL i TOTAL
mato fApplmant/Cont...... - f
OFFICE,COPY