15438 (2) POST THIS CARD NEAR FRONT OF BUILDING '
•' , � PERMIT NUMBER ,
. CITY OF CUPERTINO •, 15438
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS UNIT# -LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR 6RB 2JC-v. IS NOT STARTED.WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - ANCE OR 180 DAYS FROM*
NOTE: LASTCALLED INSPECTION.
.UFER ALL GRADING AND DRAINAGE SHALL'BE INSTALLED +'
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PH T VALIDATION.
CUPERTINO STANDARDS. -
GARAGE SLABS 1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ' IssArvCE DATE
'
MECHANICAL e4gck/ ELE - . PLG.- MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED. - BUILDING PERMIT
- INFORM TION
WOOD FLOOR VALUATION 41FT,
PLUMBING '.
MECHANICAL
ELECTRICAL rEHMIT To..
FRAMING
INSULATION
STOR Es TYPE CONSTR,
� - ,
UCC GROUP. RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FC FLOOR 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. PB Q'L""
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ -❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA - - - -
PLUMBING ELECT.ENERGY,
TUBS&SHOWER PAN PLUMBING ENERGY THACT NO, PARCELNO,
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY. ACC.DATE ACC-FILE NO
FRAMING - ELECT,FINAL TEST .
INSULATION PLUMBING zomwc ENG SITE NO,
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEDHEATING ` ED NEI " ❑' NE]
FLOOD LONE AL,U C..
EXTERIOR SHEAR; - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. - v[:] "❑ v ❑ "❑
SHEETROCK IGRADE - FEE SUMMARY '
EXTERIOR LATH BUILDING
.INTERIOR LATH T TEMPORARY APPROVALS BUILDING
SCRATCH,COAT ELECTRIC - PLAN CHECK -
GAS FEE
NO TAPE OR-PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. ,MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC }
F 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
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN'ONLY.
.
BUILDING PROJECT (DENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT 1 [ A �O
' SUI�DIrvc I J B� o
ADDRESS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
I NAME OTV. ELECTRIC PERMIT FEE
`/" -J V PHONE
CONTRACTORS
NAMEOUTLETS-SWITCHES-PIECED - 10.00/1.00
LIC,NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 '
PANELS 10.00 DATE OF APPLICATION .
oonnCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,C.NO.
ENGINEER -UC.NO. SIGNS TRANS. 3.00
AR. ENG. PERMIT VALIDATION
ADDRESS
SPECIAL CIRCUIT 5.00
_ I• -
21P EMP.METER OR POLE INS. 20.00
APPLICANT'S - MOTORS • SEE FEE SCH. '
ADDRESS
SERVICE CHANGE 20.0071 -
_ V
,09 LICENSED CONTRACTORS DECLARATION L it.
a U w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H < n (commencing with Section 7000)of Division 3 of the Business and p 11 ,BLDG: ELECT. PLG. MECH.
H i Professions Code,aodfny license is in full fort 7 a ❑ ❑
2 D.A Licenses CC33�� Lic.Number -
9 w Date- -Contractor
P
,Y_t Q;:�J BUILDING PERMIT
¢ o i u-. OWNER-BUILDER DECLARATION INFORMATION
E:
;¢ y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL 0¢ Law for the following reason.(Sec.7031.5,Bu'simssmrd Professions PERMIT ISSUANCE1000 VALUATION S/FT.
�' - -' Coder Any City or county which requires a permit u,construct,alter, .
ELEC.CONTR. LIC.NO,
11
na ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC. �i��
a wO u requires the applicant for such permit to file a signed statement that TOTAL L..1 PERM( TO
'm he is licensed pursuant to the provisions of the Contrac(or's License
E 4 o
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe p/Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ( ""
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any more
five permit subjects $500)he plicunl loo civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than Doe hundred dollars(my employees
❑ Las owner at the property,or my employees with wages as BACK FLOW PROTECT.DEVICE ' 4.00 OCC.GROUP RES.UNITS
their sole compensation,will Jo the work,and the structure is not
intended or 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
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve.
mems are not intended or offered for 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-EA.SYSTEM-OVER 4 IEA.) 2.00 -
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Omer
❑ I,as owner of the property,am exclusively contracting with ❑ 1:1 13 ❑ El
licensed contractors to constfuct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does 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 SEWER-SANITARY-STORM EA.200h/10.00
the Contractors License Law. TRACT NO. PARCEL NO,
❑ ham exempt under Sec.-,B.&P,C.for this WATER HEATER W/VENT 6.00
reason
Owner Date - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent Io self-ins,..
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). -
Policy No. Company
0 Certified copy is hereby furnished, FIRE BPRINK ENERGY T24
Z ZO $�Certifiedfi7letL will t c city inspection division. MISC.- REFER TO ORD. V [] NF] V [) N[]
n4�canl q
~ !n PERMIT ISSUANCE 10,00
LU - CERTIFICATE IE EXEMPTION PTINS FROM WORKERS' FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.N0, PLG.
CL D (This Section need not be completed if the permit is for one TOTAL• V❑ NE:] V [:] N�
hundred dollars(S 100)or less.) -
U O I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY -
LL F mit is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers Compensation Laws of California.
CL Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
- m NOTICE TO APPLICANT: If,after making this Certificate at Ex'
F 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
U - such provisions or this permit shall be deemed'revoked. AIR HANDLING UNIT(TO 10=11F.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
L'ender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 '�
LCddC,'s Address ELECTRIC_
I certify that I have read this application and statC.lhat lhcabove VENTILATION FAN'(SINGLE) 4.00
imor natioo is correct. I agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building ironMrumion,'and BOILER-COMPI9H.P.or.100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter Inion the BOILER•COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-menlmncd property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uPerrino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay In any way ru against said Cit In consequence of the -
rantingofthis r [ MECH.CONT. LIC.NO, - MECH.
SZ 8 TOTAL TOTAL
IgnalfficofAppl' an Con ctor Date - -
OFFICE COPY