18300 (2) --jPOST THIS CARD NEAR FRONT OF BUIL'DING.''
• P hIIT NUMBER ,
CITY 'OF CUPERTINO - c
INSPECTION DIVISION . 8300
=
' JOB INSPECTION RECORD
PERMIT EXPIRATION ••
J BADDRESS v" ' "' `""� '� " UNIT#'••-
_ r /1,f, ' PERMIT EXPIRES IF WORK
1, OWNER _ 204TRACTOR'.` • te_jrZ�/ - - IS NOT STARTED'WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ' -
ANCE OR 180 DAYS FROM
+NOTE: LAST CALLED INSPECTION: •
LIFER ALL GRADING AND DRAINAGE,SHALL BE INSTALLED "
- TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATI
PREGUNITE ON
•• CUPERTINO STANDARDS.
.GARAGE SLABS , V• dti • �T,
POUR NO CONCRETE-UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB C!'`"r L
/y
' PLUMBING /�Q'
ELECTRICAL 4S UANCE DArE- /
MECHANICAL':` .BLDG LECl, PLG. Men.-
❑,' 1 ❑ ❑
'DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - euaowc PERMIT
INFORMATION'
WOOD FLOOR,
"'I VALUATION SIFT.'
PLUMBING - -
MECHANICAL-- re1111lT TO -
ELECTRICAL ,„ +, -
L
FRAMING - r• O/ I�C •JJ'C�
_ STORIES TYPE CONSTR„
INSULATION
• - ' - UCC..GROUP RES,UNITS
PLACE NO-SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
_ SO,It,11.0011 AREA '101ALACNEAGI,
- 'ROOF- NOTE:NO FINAL INSP.SHALL BE MADE BEFORE - T-
DIAPHRAGM •THE_CONSTRUCTION TAX IS PAID
BUILDING u
ROOF SHEATHING HES- INsT:
' D CON � VB Otnv i
.,APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' FINALS DATE. INSP.' ❑ '
ASSESSORSPARCEL NO
ROUGH SANA r.
PLUMBING ELECT.ENERGY
TRACT,NO. PARCEL NO 1
TUBS,&SHOWER PAN - - PLUMBING ENERGY = +
MECHANICAL MECH.ENERGY -
ACC.DATE ACC FILE NO.
I ELECTRICAL - BUILDING ENERGY '
'r FRAMING', - ELECT.FINAL TEST ' zoNlNc ENG.SITE NO.
INSULATION PLUMBING
GAS'TEST - GAS,
FIRESPHINK- ENEGGYT-2J -
' MECHANICAL''
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y NE] ❑ N❑' /
I'LDOUZONE .AC'U.C.
- EXTERIOR SHEAR. ELECTRICAL'RELEASE •
INTERIOR SHEAR FIRE DEPT. v N� .. ❑ _rv❑ ,
• SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH- - TEMPORARY APPROVALS - BUILDING
SCRATCH COAT .•'� ELECTRIC •'LPLAFEEN.CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE Ste.
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSSIGNED BY BUILDING INSPECTOR: MICOFILM
I
R
..,
ARRANGE'FOR INSPECTIOK.,BY'PHONING 252-4505, eLecTRlc
U, '
ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMeINc' 'i.
O� PLEASE GIVE JOB ADDRESS WHEN'PHONING
Z 'MECHANICAL
— SEETERMIT FOR EXPIRATION DATE
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR,FINAL INSPECTION.
OFFICE COPY ', .
/ _PPL�ANT�-PT.0's"ILL-IN INFORMATION'WITHIN RED LINES -USE BALL POINT PEN ONLY.
�. BU LDIN G ROJEeT I DENTIFICATI ON PERMITNUMBER '_-
BUILDING APPLICATION & PERMIT O 00
ADDRESS ^y U
R 6l I7 ^ SSG BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWN R'B -7 -3
PLAN CHECK VALIDATION ,
"AME tl�/L� 13
y61T DTV. ELECTRIC PERMIT FEECON
• VIIUNE /^�/�
F
NoOBA
NAME. .CTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00
• 4
LIC.NO, LIGHTING.FIXTURES10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 '
ADDRESS
' PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE , P,C.N0.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
,uc.rvU. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
AUOREss ;' SPECIAL CIRCUIT � 5.00 a ,
• ZIP TEMP.METER OR POLE INS. 20.00 J^• DvfA�C(.��
ArvucANrs - MOTORS' SEE FEE SCH. .lQ�
ADDRESS i L,
SERVICE 20.00
.s w 02 LICENSED CONTRACTORS DECLARATION 1
"/i-A.1
¢ UI hemby.aH IT...that I um licensed under poo nion,of Chapter 9 - SUANCE DATE-
H G H (,o nunocing with Seel ion 7000)Of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r o,z professions COJe,and my license is in full force and effect J ❑ ❑ ❑
ZO - LIeCnS Class Lia Number U •]:
o Date Contractor
a y E •• - BUILDING PERMIT
¢ ¢ w a OWN.R-BUILI)BR DECLARATION INFORMATION
X. 3 10
I herby oft irm that I um exempt from the Contractor's License
MISC.- ' D
1004 Law for the following reeson.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION . S/FT.
� - Code Any cityorcaunty whichrequiresaterout toconstruct,alter, -
2 2 ¢ 0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. z ''
-10 LL requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractors Licen,c �•.�j
Fzi
Law(Chupler9(commencingwilh Secthu17000)ot Divisien3ol'the
a Business and Professions Code)or that he Isexernpt therefrom and QTY. PLUMBING PERMIT FEE
fx10
¢F p The basis for the alleged exemption.Any violation of Sechun 7031.5 STORIES TYPE CONSTR.
a ;°�' by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 m
• of not more than five hundred dollars($500).1:
0 I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP "RES.UNITS
their.Sole compensmion,will do the work;and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA;COND. 5.00
Code:The Contractor' s Licctuc Law Joe,not apply'to an owner of
,,(,),City Who ballds Or improve,tloGvot,and who fees sacb work FIXTURES-PER TRAP 5.00 SOFT,FLOOR AREA TOTAL ACREAGE
himself re through his own erred lots,provided thus such improve- .
himself o throuut gh
his or n offered lot sale,rovided that s,the building GAS-EA.SYSTEM'-1 1NC.4 OUTLET$ 6.00
or improvement 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 riot build or inN' RES IND WN PB Omer
IT for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
C,C I,as owner of tire property,am exclusively contracting with El 1:1 1:10
li n,ed contractors to construct the project ISec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:1 he Contractor's License Law does not apply _
to an owner of property who builds or innproves Thcnon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 r,
contracts for such prejccls with a conlrnctor(x)licensed pursuant lu
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
O l an)exempt under Sec.-,_ B.&PC lo, WATER HEATER W/VENT 6.00
.
rens�yQ
Ow yam- D' - - - WATER SYSTEM 5.00 v ACC.DATE ACL.FILE NO.
O_ WORKBRS'.COMPI:NSA I ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a carlilicate or conunt to sclhinsure, ZONING ENG.SITE NO.
or a ceTlifncatc'of Workers'Compensation ITISUMI1N,or n certified ZONING
copy thereof(Sec.3800,Lab.C.). ;(
Policy ND: Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z 2 0. Certified copy is bled with the city in,ptitba divmsirl' ' MISC.- REFER TO ORD.
O Applicant Y❑ N❑ I Y ❑ N❑
= ' CERTIFICATE OF FXEINPTION['RONI WORKERS' PERMIT ISSUANCE . 10.00 FLOODZONE AAKU,O.
W > ' CObTITNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL D (fins ,Petted need tint be celnploud it tire penult I, I.. ....o TOTAL Y C]. NE] Y [:] N❑
Z:) 2 Inmdrl-d dollars IS 100)or Ie,,J
•U O 1 certify that in the perfonnunec Of the work for which This per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is issued, 1 shall not employ any person in any manner so as to
U become subject to the Worker,'Compen,ation Law,of California.
O w Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /•1
} 0NOTICE 10 APPLICANT: If,after..king this Certificate of nix-
? mnption,you Should become auhject to the Workun'Com pencut inn APPLIANCE 5.00 PLAN CHECK
provisions of the'Labor Code, you must forthwith comply with FEE
U ssmh provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10A00CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.EM.) 6.00 - SEISMIC FEE SO
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) '5.00
the perfonnunec of the work for which finis permit is issued(See: HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.0 L
•
Lender's Name HEATINGUNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender',Addles, `
I certify that I have read tlds application and state that tine above I VENTILATION FAN (SINGLE) 4.00
information is correct 1 agree to comply with all city and c(Only PLUMBING
ordinances and state-laws relating to building construction. and BOILER-ODMPI3 H.P.or 100,000 B.T.U.) 6.00
� e� hereby autherice representatives of Ibis city to enter upon-the BOILER-COMP(Over 100,000 ETU)SEE FEE SCH. MECHANICAL
99 above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City oI' MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses whichpERMIT ISSUANCE 10.00 CONST.TAX
mo in any way,accore against said City in consequence o8 the
a ting OI'.lh is perm', MECH:CONT. LIC.NO, MECH.
4 7 _ - TOTAL TOTAL
Ignamrcof Applicant/Contractor late
OFFICE COPY