18453 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
' CITY OF CUPERTINO `'An- 18453
INSPECTION DIVISION r!�+:� ' vj
JOB INSPECTION RECORD
(y1'�/I A cif, E� �•"'19180 PERMIT EXPIRATION
JOB ADDRESS w`� `/3 I �• LOT#k PERMIT EXPIRES IF WORK
1 OWNER L/ CONTRACTOR ) / y� J IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS a f --V
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB �. A
PLUMBING
ELECTRICAL ISSUANCE UnrE3
e LOG ELECT PLG. MEDIA
MECHANICAL ❑ ❑ ❑ 'kL3Jz'
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL J
l FRAMING
STORIES rwEcorvsrR
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .
SO +* aooR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING
RES IND CON vE o.....,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ASSESSORSP IiCELNU
ROUGH SAN.#
PLUMBING ELECT,ENERGY
IRncr No PARCEL No
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
Acc.OATS ncc.FILE No
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE$PRINK ENERGY T.]4
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v E-1 N� [:] N❑
FLOOD/UNE A,L U.C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. v El NEll ❑ NO
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - TEMPORARY ALS BUILDING
SCRATCH COAT JELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY `SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
. O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
ZMECHANICAL 073,+ tI b
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 8453
ADDRESS }.
0 a VQ. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S JJ PLAN CHECK VALIDATION
NamE JS DTV. ELECTRIC PERMIT FEE
r C� pNE $3-C� 2 PAID
CON. ADTORs
NAME OUTLETS-SWITCHES-RECEP 10,00/1.00
S/w� NOVt,/ 3 0138
p uc,rvo,y sr6a LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
IPF WAP 9rATIO
er JePRONE 144-517PANELS 1 IO.00 OATATEOFAPPLICATION -
0FcwTEOTr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.0.NO.
OR
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
ARC.,OR ENG. SPECIAL CIRCUIT S,QQ PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00 l--s D
APPLICANTS MOTORS SEE FEE SCH. f
aoDRess
SERVICE CHANGE 20.00 .A
o o LICENSED CON"f RACTORS DECLARATION
o G I hereby affirm that I ren licensed order provisions ol'Chapter 9 -
ISSUANCE DATE
¢ zi (counneream,wnu Section 7000)of Division 3 of tie Business and
BLDG. ELECT. PLG. MECH.
r w i Piceiro Ions Code,and liccnLi is in full fore a411y-.1eJ ❑ ❑ ❑
z m - Licensc CPys_G Lp_Lic.Number�•/_J_!_!7_zr
. -0
L o Datc A_�1_j(,�/gC1 Contractor
¢ Y J
¢ e w ¢ OWN['R-BUILDI!R DECLARATION /;SSOp. BUILDING PERMIT
D REFER TO ORD INFORMATION
w 3 u y I hereby alfirm that I ren exempt from the Contractor's License MISC.- VALUATION SIFT.
en u_m as Law for the following reason.(Site.7031.5.Businessand Professions PERMIT ISSUANCE - 10.00
f 'ASF Code:Any city or county which requiresa permit to construct,aIle', ELEC.CONTR. LIC.NO
e ¢ O
A w improve,demolish,or repair any structure,prior to its issuance,also . ELEC.
to
-O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m he is licensed pursuant to the provisions ol'the Contractor's License
Fzi
Law(Chapter 9(commenciagwilh Section 70000 of Division 3 ofthe
-¢ Ilume,ss and Profession,Code)or that he is exmnpl therefrom and DTV. PLUMBING PERMIT FEE
¢ r O the basis for the alleged exemption.Any violation of Section 7031.5 TORIES T E CONSTR.
u ; � by;my applicant fora permit subjects the applicant o u civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not Ionic than five hundred dollars($500).):
IDI,as owner of the property,or cry employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.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,CONO. 5.00
Code:'rhe Contractor'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 FLDDH AREA TOTAL ACH EAGE
. himself or through his own employees,provided that such imOrove-
mernsarenet intendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement I,sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
Proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB omer
❑ I,as owner of the property.mar exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to em stmet the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 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 o centurions)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO, PARCEL NO.
❑ I am exempt under See. .B.&P.C.for this WATER HEATER W/VENT 6.00
re.sur
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORK ERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby alfirm that [ have a cerhiicme W consent to self-insure. ZONING ENG.SITE NO.
or a eetlilicate of Workers'Compensation Insurance or a certified
copy thereof(Sce.3800,LaDCA
Policy No. C...Party
O ❑ Certified copy is hereby fumished. FIRE SPRINK ENERGY T 24
Z Z r1'Certifapy jz bled he city inspection division. MISC.- REFER TO ORD.
O Applicant (A{/ - Y❑ "❑PERMIT ISSUANCE Y E] "❑
F- y 10.00 FLOOD ZONE A.L.U.c.
LU > CISR'fI FICATIi l' EXEMPTION FROM WORKERS'
UJ _ COM11PIiNSATION INSNS URANCIi � PLG.CONTR. LIC.NO. PLG.
(L O TOTAL Y❑ "❑ Y ❑ "❑
1'I'his action need mol be mmplcteA it the pcnnd is for one
Z) Z hundred dolla"($100)or le".)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H not is issued, 1 doll not employ any person in any manor,so as to
U hec'olne subject to the Wor1c,,Compensation Laws of C.11foorid. BUILDING
O w Dutc Applicant
a ALTER OR ADD TO MECH. 5.00
} m eNOT mptio Ii TO APPLICANT: 14 after tusking this Certificate se-Iix-
F-. ? emptlo n you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you them Ibrevoke comply with FEE
I U such provisions or this permit shall be dcrmcd revoked. AIR HANDLING UNIT(TO 10,000QF.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C,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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 -
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 a , ELECTRIC
Lender's Address
l certify that l have,cad lhm,ppllcdtlor runt, m,for,the above VENTILATION FAN (SINGLE) 4.00
inlormation is correct, 1 agree to comply with all city and county LUMBING oWimance, dud state laws relating to building construction, and BOILER H.P.. .Or 100,000 B.T.U.) 6.00
hereby aulhorirc representatives of this city to enter upon toe BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnif#and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 /Z r� CONST.TAX
my in any way accrue against said City in consequence of the
maml�tispM ' I� MECH.CONT. LIC.N0. MECH.
ne�--'✓ �� g TOTAL2 eoO TOTAL
Signafnre Applicant/Contractor UJUP
OFFICE COPY