17115 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMaER
CITY OF CUPERTINO 17115
INSPECTION DIVISION
JOB INSPECTION RECORD .
PERMIT EXPIRATION
JOB ADDRESS_ 2-�S u`�' ` ` L UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER 1,J SD1.� CONTRACTOR �Kj'S IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER NOTE:
GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED,PLANS AND CIT'OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB F}
PL GING,
ELECTRICAL ISSUANCE DATE
MECHANICAL - - BLOC,. ELECT I PLC I MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
INSULATION - STORIES ./VVE CONSTR
FICC.GROUP RES UNITS
PLACE NO SUJIFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT FLOOR AREA TOTAL ACREACL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDINGUSE
ROOF SHEATHING � +es INo CON
ory Pa on...
DA
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS TE INSP. � ❑ ' ❑ ❑ ❑
ROUGH sAN.q, ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TRACT 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 zON1NG SE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.ae
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` yi
❑ "❑ ` ❑ N
FLOOD ZONE AL UC
- EXTERIOR SHEAR ELECTRICAL RELEASE '
INTERIOR SHEAR FIRE DEPT. ❑ "❑ S ❑ "❑
SHEETROCK GRADE - 6 FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO PAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuFgNCv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BU ILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505J�l
ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTIPLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORETOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT I17115
ADDRESS '1 ,/ �//J
IIOr '7-� lel L . C1-�Sr PI . BUILDING-ELECTRICAL-PLUMBING-MECHANICAL S�
OWNER'S
PLAN CHECK VALIDATION
` NAME So PI 1HGNE933-1400 QTY. ELECTRIC PERMIT FEE
NNMERAcroRs O LETS-SWITCHES-RECEP 10.00/1.00
�45
ADDRESSACT LIC.NO. 4(05"(, LIG ING FIXTURES 10.00/1.00
DDD RADrOR's PPLI CES-RESIDENTIAL 4.00
J A7 HsrLIGI PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT_ PANELS ( VER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENRGINEE
LIc.NO, SIGNS TRA 3.00
ARCH.OR ENG, - PERMIT VALIDATION
ADDRESS SPECIAL CIRC IT 5.00 ^� 1 �q
ZIP EMP.METER O POLE INS. 20.00 4'� TU J
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS p,
SERVICE CHANGE 20.00 zo
09 LICENSED CONTRACTORS DECLARATION
3 v I hereby affirm that I an licensed under provisions of Chapter 9 ISSUANCE DATE
H<a (commencing with Section 7000)u(Division 3 of the Business and BLDG. ELECT, PLG. MECH.
H m w Professions Code,and my license is in full force aannd g0'eel xxx
0 i H o License CSla$��1a Lic.Number_ e_ Jwf(Plo
9 m H Dat. O/� Contractor •$
a m f BUILDING PERMIT
¢ as OWNER-BUILDER DECLARATION
a i v INFORMATION
E
g H I hereby affirm that I ani exempt from the Contractor's License MISC.- REFER TO O
FKP
U0< Law forthe followingre.son.(Sec.7031.5,Busincesund Pro(essinns PERMIT ISSUANCE 10.00 VALUATION $/FT.
iw i Code:Any city orcuunty which requires a permit to construct,alter,
¢ ¢ ¢0 Improve,demolish,Or repair any structure,prior to its nominee.also
ELEC.CONTR. LIG NO. ELEC.
i u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
'x$ he is licensed pursuant to the provisions of the Contractor's License
F z a Law(Chapter 9(comnienctmgwith Section 7000)of Division 3 Giffin, ,
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
CE 1-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES PE CONSTR.
t ; by any applicant for a permit subjects the applicant ma civil penally
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as CK 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 NEA.
,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law docs not apply to:in owner of
property who builds or improves thereon,and who docs suchwOrk R TRAP 5.66 SO.FT,FLOOR AREA TOTAL ACREAGE
)• himself or through his own employees,provided that such ini: ,, -
mentsarenotintendedorofferedforsale,If,however,the building M-1 INC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- EM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose of sale.), ASTE INTER. 30.00 RES IND CON PB Other
❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ 0 ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPR INK L S-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cod.:The Contractor's License Law does not apply
10 an owner of property who builds or improves thereon,and who LAWN SPRINKLEfl OVER 5(EA.) 1.00
T- contracts forsuch projects with a contmctor(s.licenser)pursuantm SEWER-SANITARY-STO EA.200ft/10.00
the Contractors License Law. TRACTNO. PARCEL NO.
I) ❑ [am exempt under Sec. ,R,&P.C.for this
Y7 reason WATER HEATER W/VENT 6.00
9 Owner Date WATER SYSTEM 5,00
ACC.DATE ACC,FILE NO,
O
Y WORKERS'COMPIiNSq'I'ION DECLARATION WATER TREATING EQUIP. .00
I hereby affirm that I have a certificate of Ccusem to self-insure,
ZONING ENG.SITE N0.
or a certificate of Workers Compensation Insurance,or a certified
copy thereof(Sce.3800,Lab.C.). Ofl
Policy N.QIV32-4 Company_-5 r;,)/' ./Jeff/
O ❑ Certified copy is hereby furnisl ed
FIRE SPRINK ENERGY T24
Z Z Epi is at fi opy is file) with the city inspection division. MISC.- OR
O Applicant 44 Y � N� V� N�
H y CERTIFICATE017 EXEMPTION FROMNORKGRS' PERMIT ISSUANCE
PLOoo 2orvE •A.Tifir U.C.
LU COMPFNSWION INSURANCE
PLG.CONTR. LIC.No. PLG. -
d 0 (This section need not be completed if the permit is to,one TOTAL Y N Y N
:3 Z hundred dollars($100)or less,)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so i s In
become subject to the Workers'Compensation Laws of California.
y Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? eniplion,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 he deemed revoked. AIR HANDLING UNIT(TO 1Op00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I herchy affirm (hut there is a cun8tructi6 lending ugency,for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 3,60 ,O
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I lave read this application and state Ihal the above VENTILATION FAN (SINGLE) 4.00
. information is correct.1 agree to comply with all city and county PLUMBING
ordinances and stale laws relating 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 O
above-mentioned property for inspection purposes. n
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
open) against liabilities,judgments, costs and expenses which PERMIT ISSUANCE Ia UJ �a. CONST.TAX
may i any way accrue against said City in consequence of the
runts g of f 'pe nit. MECH.CONT. LIC.NO. MECH.
Torg
_ TOTAL
8i nature o AppIicant Contractor�)ate '2
a (�
OFFICE COPY