18358 (2) ;f ' POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER.
CITY OF CUPERTINO 1838
INSPECTION DIVISION
ry �y'
JOB INSPECTION RECORD
JOB ADDRESS /`'� 2 �- " - L4- NIT# _LOT# PERMIT EXPIRATION
PER i I •WORK
OWNER N �• V C/•��✓��C�TRACToa IS NOT STARTED, WITHIN'
INSPECTION DATEINSPE TOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
UFER ALL GRADING AND.DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED'PLANS AND CITY-OF PERMIT VALIDATION
PREGUNITE' '" CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
_
UNDERGROUND /SLAB ' RAW
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL JUL z BEW ELECT I PLG. mk
❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - et Ipdm - BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $/FT.
PLUMBING CX.
MECHANICAL - I
ELECTRICAL PERMIT Tott
FRAMING ( f3G,l I SI v al
INSULATIONSTORKS TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 FT FLOUR AREA TDTAL/+CHEPGI:
. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE �,..v op
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB DI,,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E ❑ ❑ ❑ El
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING @V'�" ( ELECT,ENERGY
TUBS&SHOWER PAN' PLUMBING ENERGY ' TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY -
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING - C5 ELECT.FINAL TEST
ZONING' ENG SITE NO.
INSULATION � � � PLUMBING
GAS TEST GAS .
FIRF.SPHINK ENERGY T44
MECHANICAL Y ❑ No v ❑ N0
COVER NO WORKUNTILABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U C
�
INTERIOR SHEAR FIRE DEPT. E] NYL NE]
SHEETROCK - O GRADE FEE SUMMARY
EXTERIOR LATH BUILDING /
INTERIOR LATH - TEMPORAR APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
1 GAS FEE f, }c
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE. ?s
E
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING.INSPECTOR. MICROFILM
'
,. ARRANGE FOR INSPECTION BY PHONING 252-4505, h � l b • ��
F ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. u PLUMBING
o�. PLEASE GIVE JOB ADDRESS WHEN PHONING.
I
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL y �.
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL !�
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
? BUILDING PROJECT I DENTIFICATI ON PERMITNUMBER
U, DING APPLICATION & PERMIT
D0REa5
,ozei j 4r Y 2P- BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 18358
OWNER'S
PLAN CHECK VALIDATION
NAM /4 Al 17EI /
1/JyI.�Dh PHON1;Zs1' 3.62 DTV. ELECTRIC PERMIT FEE
CONTRA TORS
� S OUTLETS-SWITCHES-RECEP 10.00/ 00 2TnmaN?-R0C (Vt4
LIGHTING FIXTURES 10.00/1.00 a
f,ONTRACTOR'Se
ADDRESSC \�yC^L• 4Dg .�1/� APPLIANCES-RESIDENTIAL 4.00
J/s1 1V,7Li ITV G PHONE 5E42, PANELS 10.00 DATE OF APPLICATION '-
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
ll{ O t4 uc.N C //4 SIGNS TRANS. - 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
0020 TEMP.METER OR POLE INS. 20.00
APPLICANTS - MOTORS SEE FEE SCH. ( /
ADDRESS
/028 0 r� SERVICE CHANGE 20.00 +A
o o LICENSED CONTRA RS DECLARATION
a u w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a (commencing with Section 7000)of Division 3 of the Business and B G. ELECT. PLG. M*F w i Professions Code,and my license is in lull force and effect. •p 4 El 11o z w o License Class Lic.Number
Date Contractor
aYf
a:
IS 4 OWNER-BUILDER DECLARATION BUILDING PERMIT
o a o INFORMATION
Fw I hereby affirm that I am exempt from the Contractor's License MISC.- O ORD.
a, LL o J Law for the following reason.(Sec,7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Ewi� Code:Any city or county which reyuiresa permit toconslrucpnller, 'Z'bD �� 730
4 O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. I /�
u w m u requires the applicant for such permit to file a signed statement that TOTAL 1S0 PERMI TO
he is licensed pursuant to the provisions of the Contractor's License
r i Q
Law(Chap ler 9(commencing with Section 7000)of Division 3 of the P ^
4 c Business and Professions Code)or that he is exempt therefrom•amd OTY. PLUMBING PERMIT FEE /ase d dl �0 L
r $ the basis far the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ; _ by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(S500)T: ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE - 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and lire 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 dues not apply to an owner of j
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5. V SQ.FT.FLOOR EA TO AL ACREAGE
himself or through his own employees,provided that such improve- �D
.. GAS 6.00
' ..rents are not intended or offered for sale.if,however,the building
or improvement is sold within one year of conmletiou, (he owner- GAS-EA.SYSTEM OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or en- BUILDING USE
prpve��for purpose ofsale.). RES IND CON PB Other
fug
I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contraclars to construct the project(Sec:7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 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 contractor(s)licensed pursumnt to
the Contractor's License Law. D TRACT NO, PARCEL NO.
❑ I am exempt under Sec...B.&P.C.for fills WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm (hat I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah.CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T44
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant V❑ N� V [:] N[:]
CC _ CERTIFICATF.OIe EXEMPTION I°ROM WORKERS' PERMIT ISSUANCE 10.00 Z,Qn FLOOD ZONE A.L.U,C.
W > COMPFNSATION INSURANCE PLG.CONTE. LIC.NO. PLG, ❑
d O (This section need not be completed if(he permit Is for one TOTAL;2_�.D D V❑ ❑N V N[:1
Z hundred dollars(5100)or less.)
U 0 I certify that in the pertormmrce of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY
IL F mil is issued,I shall not employ any person in any manner so as to
O W become subject to lite Workers Compensation laws of Califonlia.
e. Dam Applicant ALTER OR ADD TO MECH. 5.00 U' BUILDING FVQ
} m NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
I. ? cornice,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE 3 4 tQ
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10)000OF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE X33
I hereby affirm (hut there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work hr which this
permit is issued(Sec, MICROFILM
3097,Civ.C.L - HEATING UNIT(TO 100,00 .T. .) 8.00
Lender's Name HEATING UNIT(OVER 100, 16 -91/ s 91
Lender's Address � ELECTRIC VV
I certify than I have read this application and state that lho above VENTILATION FAN (SING E) 4.0
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and 80ILER-CUMP(3H.P.Or100,000B.T.U.) 6.00
hereby aulhori" representatives of this city to enter upon the 801 LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL , Ov
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against Said City in consequence of the 0
uninguflhispennit' MECH.CONT. LIC.NO. - MECH.
TOTAL TOTAL Sia
Sigre natuol'Applicant/Con[radnr Dam d-I'D l
OFFICE COPY