18633 (2) POST THIS CARD NEAR FRONT OF, BUILDING PERMIT NUMBER
CITY OF CUPERTINO 18633
INSPECTION DIVISION
JOB INSPECTION RECORD
/ 71 PERMIT EXPIRATION JOB ADDRESS ( 60 ` `- �e� UNIT# _LOT#
II PERMIT EXPIRES IF WORK
OWNER co .NWj CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPRO` AND CITY OF PEHAIT VALIDATION
CUPERTINO STANDARDS. fj
GARAGE SLABS1.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -_
UNDERGROUND /SLAB ,i
• PLUMBING .. _ ; �lI
ELECTRICAL '. LE6T CERATE J
B OG EELECT YL(1. MECH
MECHANICAL ❑ E
r
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'BUILDING PERMIT
INFORMATION
WOOD FLOOR A 07A I XV VALOATIo SIFT.
PLUMBING
MECHANICAL A,
YEHMIi i T
ELECTRICAL.
FRAMING ,
' Si_OHIES iVPE CONSLR
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
III.rt r-LUau Alien LoiAL ACR Lnc;e
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
/ - BUILDING USE
ROOF SHEATHING - HES IND E3 El 0 PR ED El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ASSESSOHSPARf EL NO
ROUGH SANA
\ PLUMBING ELECT.ENERGY
IHncr No PARCEL No
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO.
GAS TEST GAS
FIRE SPH INK ENERGY T-24
MECHANICAL ❑ N[ [:) N(—]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .
FLOOD ZONE A.Lyc
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. `'[-] N ❑ N❑
�
SHEETROCK - ,J GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK L_
(v
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE I
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lui.- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE - �-
IMPORTANT! CONST. TAX '
PLEASE READ REVERSE SIDE BEFORE TOTAL 2
CALLING FOR FINAL INSPECTION.
OFFICE COPY /
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BIlILO1NG APPLICATION & PERMIT J, 18633
POOREBI v
/O O (� J-rG� j BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER' QTY. ELECTRIC PERMIT FEE S Q ZL(� �d' - PLAN CHECK VALIDATION
NAME ( ,1 I do
a, je4 I�lte� P L-34
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITEC PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEE
LOC.No. ISIGNS TRANS. 3.00
AMCH. ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDR 5 /i
ZIP EMP.METER OR POLE INS. 20.00
A..REa TS MOTORS SEE FEE SCH.
AOOREB �/�
b SERVICE CHANGE , 20.00 '^
woo LICENSED CONTRACTORS DECLARATION &� "`✓
a u u I hereby affirm that i am licensed under provisions of Chapter 9 ISSUANCE DATE
2 a (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLC. MECH.
IL,w i P,ofeseions Code,and my license is in full force and effect. ❑ ❑ ❑
z o ie- License Class Lit.Number Q
9 z F Dalt Contractor
a y s a BUILDING PERMIT
2 w a OWNER-BUILDER DECLARATION INFORMATION
w0
LL I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL o a Law 1'or the following reason.(See.7031.5.Bns
inessand Professions PERMIT ISSUANCE 10.00 vALUATIOON„` S/FT.
r -v,I Code:Any city or county which requires a Permit to construct.alter. � J �,
R Q 20 improve,denmlish,or repair any st nict Lire,prior to its issuance,Wso ELEC.CONTR. LIC.NO. 2•-lt ELEG.
- O R requires the applicant for such permit to file a signed slacntenl that TOTAL PERMIT TO
wm" he is licensed Pursuant to the provisions of the Contractors License
Fzi
Law(Chapter 9(commencing with Section 7000)of Uivisum 3 of the em0
4 Business and Professions Codd or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
o the basis for the alleged exemption.Any violation of Sectiun 7031.5
STORIES TYPE CO R.
dgm by any applicant for a permit subjects the applicanuo a civil penally ALTER-DRAIN -WATER IEA.) 5.00
0 t more than five hundred dollars(S500)J:
I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
t et sole compensation,will do the work,and the structure is not OCG GROUP PES.UNITS
X
intended of offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,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 FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
�\ hicuts or Through his own employees,s provided that such improve- _
J nnenu ore not intended or offered for sales however,the Multiuse-
cuts my GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not hold or im-
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
ontacts for such projects with it contracmifs)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 an,exempt under Sea ,B.&P.C.list this WATER HEATER W/VENT 6.00
R'a50n
Owner L Date Zr WATER SYSTEM 5.00
ACG DATE ACG FILE NO.
WORK ERS'COMPENSATION DIiCLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers Cmnl otisation Insurance.or a cerliticd
copy theraof(Sum.3800,Lab C.).
Policy No. Cnniparty
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with lire city inspection division. MISC.- REFER TO ORD.
O Applicant V❑ N❑ Y ❑ N❑
CC rn CERTIPICATEOF Ii XIiMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLODDZONE A.L.U.C.
11J > COMITNSATION INSIJKANC17 PLG.CONTR. LIC.NO. TOTAL v❑ N� Y❑ N❑
d O (This section need not be completed if the permit is for one
Z hundred dollars(S 100)or)css.)
U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,1 shall not employ any person in any Imannc,so as to
Ow become subject to the Workers'Compensation Laws of California. BUILDING
Dan• Applicant ALTER OR ADD TO MECH. 5.00
} ran NOTICE TO APPLICANT: 1f,after making this Certificate of Ex-
♦- 2 cmption,year should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with FEE (y
U such provisions or this permit that be decried revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONS'FRUC'I'ION LANDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE r S
I hereby affirm that Mucin is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
Elie performance of the work for which this permit is issued(Sec.
3097.CIv.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lemdcr,Address
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and stale laws relining to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
BOILER-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,judgmarts, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
rzanting o(ihis perm it, MECH.CONT. LIC.NO. MECH.
fir.,,. /__:0S 21 II TOTAL TOTAL z
Signature of Applicant/Contractor Date
OFFICE COPY