15261 (2) POST THIS CARD NEAR FRONT OFF BUILDING VEd MIi NUMBER
CITY OF LrI�Q�R INN 15261
INSPECTION DIVISION
JOB INFECTION RECORD f
�{ PE RMIT EXPIRATION
JOBADDRESSKDO r� /7C.�.Q/%% ./� UNIT,'*--LOT#
/. PERMIT EXPIRES IF WORK
OWNER d fl.)NCY AJ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION1� ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER 5—,11— ^ ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF rtgnut VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS � /
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /� /vl/}TI�✓ D
UNDERGROUND /SLAB ry An
PLUMBING
ELECTRICAL J .�s unlvet onre
MECHANICAL n cr rtc. mecN
City p :0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR 40 VAA
.�L�U
:,A
��TION srFT.
PLUMBING — 3 )
MECHANICAL
ELECTRICAL ��11 A� vaaERna�t TU
FRAMING
INSULATION STORIES TYPECONSTH
.00C.GHUuI' RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED, - ~'
�: :. - so.Fi u.00H nuln nnnl.noa:Aat
ROOF NOTE:NO AL;NSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
Nes INBUILDINNG USEru onua
ROOF SHEATHING Al
APPLY NO ROOFING UNTIL ABOVE HAS BEENSIGNED FINALS DATE INSP. El 0 El nss0ssoivE rnHc El E
No
ROUGH SAN.a
PLUMBING 'ELECT.ENERGY
TRnCr NO PARCEL NO
TUBS&SHOWER PAN ' — L PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL �•a � Q,' BUILDING ENERGY'
FRAMING _ \bAa ELECT.FINAL TEST
IzoNlNc ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
t FIRE SrRINK ENERGY L)J
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .HEATING ` ❑ N❑ ❑ NQ
1 EXTERIOR SHEAR ELECTRICAL RELEASE tl 000 zoNe A--
�
INTERIOR SHEAR FIRE DEPT. 11 Y ❑ No IL
N
fr—r.
SHEETROCK GRADE - ° ° U 0, LLQ FEE SUMMARY
EXTERIOR LATH i BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING -�
SCRATCH COAT ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- `._-- Z, _ - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.OFFICE COPY
Ai —
APPLICANT TO FILL IN INFORMATION WITHIN REDIONES - USE BALL POINT PEN ONLY
-BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
pBUILDING ..6 AOPLII ATION & PERMIT 15261
xD 3� ER Q• D. BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
/ wNER'S 4- PLAN CHECK VALI ION
NAME ' QTY. ELECTRIC PERMIT FEE
PRONE
CONTRACTOR
NAE UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LID NO. [/LIGHTING FIXTURES 10.00/1.00
ADDRESS DNRRAcroR's PPLIANCES-RESIDENTIAL 4.00
A
PHONE ANELS 10,00 S DATE OF APPLICATION
ARcerscr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE I'.GNO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
AooNE ss ENG. SPECIAL CIRCUIT 6.QQ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
AAPPLICACEDESS rs MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 ((/
La 00 LICENSED CONTRACTORS DECLARATION /L�Q
a it U I hereby aflirm [],at I am licensed under provisions of Chapter 9 ISSUANCE DATE
yzw
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F n i Professions Code,and my license is in full force and effect.
z O m - License Class Lic.Number .
oF o Date Contractor
y f P =0 BUILDING PERMIT
m
a OWNER-BUILDER DECLARATION INFORMATION
wo a D REFER TO ORD
y I hereby affirm that I am exempt from the Contmclor s License MISC.-
wo ¢ Law for lire followingreason.(See.7031.5.Businessand Professions PERMIT ISSUANCE 17M rloN S/FT.
r - Code:Anychy orcounty which requires a permit to construct,alter, wJ-1.
TE Q p improve,demolish,or repair any structure,prior to its issuance,alSO ELEC.CONED. LIC.NO. ELEC. m��a,,rr 0 �' v
D u requires[he applicant forsuch permit to file a signed statement that TOTAL V ups PERMIT TO
w Y
d w m he is licensed to rsuanl to the provisions of the Contractor's License � p A /
Pe
Law(Chopter 9(ent,tie racing wit h Section 7000)o f Di vision 3 Of t he /�Cl�T6o
Business and Professions Code)or that he is exempt therefrmn and DTV. PLUMBING PERMIT FEE
¢ Do thc basis for the alleged cxcmplica,Any violation of$ection 7031.5 STORIES TYPE CONSTR.
Ate�01- by any applicant fur a permit subjects tean,licanno.civupenahy ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wagesas ACK FLOW PROTECT.DEVICE 4.00
their Sole compensation,will do the work,and the structure is not OCC.GROUPRES.UNITS
intended or offered for sale (Sea 7044, Business and Prnfessiuns RAINS-FLOOR,ROOF,AREA,COND. 5.00
-a,-` Code:The Contractor's License Law does not apply to an owner of
properly who builds or inhprnves thereon,and who does such work XTURES-PER TRAP 5.00 a 50.FT.FLOOR AREA TOTALACREAGE
:T 'nself or through his own employees,provided that such improve
is are not intended or offered for sale If,however.the had, n, GAS-EA.SYSTEM-I INC.4OUTLETS 6.00
•.'ar rovement is 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 nu[build or im- RES IND CON PB Our,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the Project(see 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
an J 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 contractors)licensed pursuant to
I the Contractor's License Law. SEWER-SANITARY-STORM V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
f C5,l an,exempt under Sec.-.BAP.C.fur this WATER HEATER W/VENT 6.00
f reason
Owner DVV
at' . WATER SYSTEM 5.00 Acc.onrE ACC.FILE N0.
WORKERS' MPENSAIION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby Whit, that I have u certifcwe ol'asment to self-insure,
or u certificate of Workers'Compensation Insurance,or it ZONING certified ENG.SITE NO.
copy Ihercol'(Sec.3500,Lab.C.).
Policy No. Cmnpm,y
O ❑ CcrilicJ<oPY'is hmchy furnished. FIRE SPRINK ENERGY T 24
Z Z 0 Certified copy Is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
h- mPERMIT ISSUANCE (� - FLOOD ZONE A.L.U.C.
CL CERTIFICATE OP EXEMPTION O TIFROM WORKERS'W �_ COAIPI NSATION INSURANCE PLG.CONTR. LIC.NO. PLG. O.p
O
(this section need not be completed if[he permit is for one TOTAL Y❑ NE] Y ❑ N❑
Z hundred dollars($100)orlesJ
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any nhanner so as m
U
U become subject to the Workeri CompensING
ation Laws of California. 3014,4
Oil Date Applicant ALTER OR ADD TO MECH. .5.00 BUILD
} to NOTICE'1'0 APPLICANT: If,after making this Certificate of Fs-
cat
s-
ca tion,you should become subject to the Workers Colnpensatm, APPLIANCE 5.00 PLAN CHECK
provisions of tire Labor Code, you must forthwith comply with FEE
U such Pnrvlelons or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IO=CF.M.) 4.00
C0NS"rRUC"r1ON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby,affirm that there is a construction lending agency lit EXHAUST HOOD(WITH DUCT) 5.00
The perfornwnec of the work I'ur which this permit is issued(Sec. MICROFILM
3097,Cie CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nome HEATING UNIT(OVER 100,000 B.T.U.) pw
Leader's Addmss ELECTRIC
I verity that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4,00 's...
inforemlion is correct. 1 agree to comply with all city,and county PLUMBING
ordinances and nate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
!" rt lu'od, authorio, representatives of this city to enter upon the BOILER-COMP(Over 100000 RTU)SEE FEE SCH. MECHANICAL
i. ariO-.. ,ntj i d property for inspection purposes. ✓
(We) agree ro save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino againstsliabilitics,judgments, costs and expenses which /� CONST.TAX
may in any ay ace a against aid M City in consequence of the PERMIT ISSUANCE 1
•ranting of sperm'. MECH.CONT. LIC.NO. TOTAL (27 _ TOTAL J�
I na APP lit/ Dale r
OFFICE COPY ��
ELECTRIC SERVICE NOTICE P.G.B E.COPY
BUILDING INSPECTOR'S NOTICE
• CITY OF C,UPERTINO `.{j �7 ��•-y�
t / 19
To
You ore hereby authorized to Connect electrical service for,p
I� Owner or Tenant C.Uoo r I/NG V/IP�n
fNo,of Wires Size of Woes Size of Switch 1.2
Moro,Load Voltage Phase-
Heat,ng
hase Heating Load K.W. Voltage
31Z/t t1"le q -
Light 110 New Service Reco�aect
No.of Metersl{11 Hea, 120-Three Wire More Service
No.of Add.Meters Power Three Phase Move Meter
Qr r ELECTRICAL INSPECTOR �`�'T