15294 (2) POST THIS CARD NEAR FRONT OF BUILDING
• '� �? - PERMIT NUMBER
CITY OF CUPERTINO 15294
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION -
JOB ADDRESS �d(S� /y�i✓tyt- A:, ..
UNIT#: 'A_LOT# PERMIT EXPIRES IF WORK
OWNEE CONTRACTOR. ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCEOR 180 DAYS FROM
NOTE: LASTCALLE D INSPECTION.
LIFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUN ITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vALmnnaN
GARAGE SLABS - CUPERTINO STANDARDS. ! Y
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE•uA TE "
MECHANICAL BLDG ELECT. PLO. MECR I
1� ❑. Di. 1:1 .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ^ eUILDLNc PERMIT
F� INFORMATION
WOOD FLOOR _ VALUATION $JET.
PLUMBING
. MECHANICAL UTY
ELECTRICAL A PEy TTO
- FRAMING � '
INSULATION STORIES TYPE CONSTR,
DCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O.FT 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 owe-, '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 1:1 0 0 11
ASSESSORS PARCEL NO.
ROUGH 'SAN.#
PLUMBING ELECT.ENERGY -
TRACI NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY -
ELECTRICAL BUILDING ENERGY - ACC.DATE ACC PILE NO
FRAMING - ELECT.FINAL TEST '
INSULATIONPLUMBING' ,ZONING ENG.SITE NO.
. .GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING , it "[] N0
EXTERIOR SHEAR JELECTRICAL EL'E FLOOD ZONE A.L.0 C.NLJ�-{
Y .
• INTERIOR SHEAR FIRE DEPT. YC] N❑ L:
SHEETROCK GRADE FEE SUMMARY
. EXTERIOR LATH BUILDING BUILDING C Ojj
INTERIOR LATH TEMPORARY V LS
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 ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC.
�• H� ONE. WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
o PLEASE GIVE JOB ADDRESS WHENPHONING.
p-. Z • MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL aZ��S
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
a BU I LDING PROJECT IDENTIFICATION - -PERMIT NUMBER. -
,Q aDILOINc APPLICATION & PERMIT 15294
AooREss
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
/ ✓K HONE �Q(y�
+ NAAMERAcTOR iO s UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
ADDRESS
:00
NTRAoR's
PPLIANCES-RESIDENTIAL 4
PHONE* PANELS - 10.00 DATE OF APPLICATION-
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE C..NO.
OR,
ENGINEER -
' sec.NO, ISIGNS TRANS. 3.00 _
ARCH.OR ENG. - PERMIT VALIDATION ,
ADDRESS SPECIAL CIRCUIT 5.00 _
. ZIP TEMP.METER OR POLE INS. 20.00 n
APPLICANTS - MOTORS' I. SEE FEE SCH.
'
ADDRESS /
SERVICE CHANGE 20.00
-E 0 O LICENSED CON TRACTORS`DECLARATION
s
4 i 1 menti affirm that I am licensed under provisions of Chapter 9 UANCE DATE
¢n (commencing with S my l 700e i of Division 3 of the Business and r' IAO ECT. PLG. MECH.
I- 7 i Professions Cole,and my license is in full force and effect. ❑
Z O License Class Lie.Number
4 Z H w Date Contractor
¢ m F UILDING PERMIT
¢ ¢ 4 OWNER-BUILDER DECLARATION -
o i LI MISC.- REFER TO ORD
INFORMATION
E:
;,�w I hereby affirm that I am exempt from the Contractor's License
o ¢ Law for the following mason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
PLL Code:Anycity orcounty which requiresa permit toconstruct,alter, x}�
my ELEC.CONTR. LIC.NO. V p
¢rc ¢ o improve,demolish,or repair any structure,prior Signed
its issuance,also ELEC. �-
i -y O LL requires the applicant for such permit to file a signet statement that TOTAL PERMIT TO
w m he is licensed pursuant to the provisions of the Contractor's License
Fzi
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /1-T�U I/
4 o Business and Professions Code)cur that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
A. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(55000.):
O I,us owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is mol OCC.GROUP RES.UNITS.
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's Incense Law docs not apply to as owner of _ '•
q property who builds of improves thereon,and who does such work FIXTURES-PER TRAP 5,00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or mrc through his own employees,provided that such improve. GAS-EA.SVSTEM-l 6.00
mems anot intended or offered for sale.If,however,the building
or insproverncnt is sold within one year of completion,the owner GAS-EA.SYSTEM OVER 4(EA.) 2.00
-p builder will have the burden of proving that he did not build or an- - BUILDING USE
•"a •+'• prove forpurpose of sale.). INDUSTRIALWASTE 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:lite 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 conlractorts)licensed pursuanl to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO,
❑ l am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby air nn that I have a certificate ofconsent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(See.3800,LA CA
Policy No. Company
ie
O ' ❑ Cerlildcopyisherebyfurnished. FIRE SPRINK ENERGY T-24
Z 2' O Certified, copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
~ !2 ° PERMIT ISSUANCE 10.00
LU - CIiR'1'IPICATIi OP1iA1ION INS FROM WORKERS' FLOOD ZONE A.L.u.G.
CL COMPENSATION INSURANCE PLG.CONTR. LIC.NO. - PLGCL .
D 2 .(This lection red not be completed if the'permit is for one TOTAL Y❑ N❑ Y❑ N❑
hundred dollars is 100)or Icss,)
V O 1 certify that in time performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY
UL H mit is issued,I shall not employ any person in.any manner so as to
O w become subject to the Workers'Compensation Laws of Calilirrnia.
Is. Date Applicant BUILDING. /
} N NOTICE TO'APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
� ? emplion,youshould becomesubjeet to the Workers'Compensal ion APPLIANCE 5.00 PLAN CHECK ^ r
provisions of the Labor Code, you must forthwith comply with cp J �-
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE ar
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE
1 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 Addi H EATI NG UN IT(OVER 100,000 B.T.U.)9.50
Lender's Names ELECTRIC
I certify that 1 have read this application and state[hat the above VENTILATION FAN (SINGLE) 4,00
informationcorrect. I agree to comply with all city and county BOILER-COMP(3 H.P.of 100,000 B.T,U,) 6.00 PLUMBING
ordinadinanccessand stole laws relating to building construction, and
above-hereby entioed representatives ins inspection
this city es enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH, MECHANICAL
-
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upeitino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue agains suid City in consequence of the
toting I' his perin'L MECH,CONT. LIC.NO. MECH. Q
TOTAL TOTAL
- Signal •ol'Appl' ant/Contractor Dat - - '
OFFICE COPY