18531 (2) POST-THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 18531
INSPECTION DIVISION '
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDR ss_� 3 1tiA VE�`_ I- -'V� UNIT# LOT# I 1 11 1 e
/ PERMIT EXPIRES IF WORK
OWNER.. e-O Lid SLl CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I 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
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS A 7 4 y
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IRMO
UNDERGROUND /SLAB
PLUMBING U11 t U Wv� .J •l�1; I � p(L:�(,1 4�y,
ELECTRICAL
ISSUANCE DATE
MECHANICAL �P., r.- - _ BLDG ELECT . PLG. mtcR
Yr �❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOORINFORMATION
PLUMBING - VALLUVALUATIONSIFT.
MECHANICAL - � S U
P[R I T T
ELECTRICAL
FRAMING
INSULATION y IL FSTORIES T.YPY CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:Nd'FINAL INSP.SHALL so. T FLOOR ARIA TOTnL ACREACL
DIAPHRAGM THE CONSTRUCTION TAX-1 AID
BUILDING USE
ROOF SHEATHING I RES IND CON PB Oma,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
" ROUGH .N
ASSESSORS PAR CEL NO
SAN
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
•
TUBS 8 SHOWER PAN PLUMBING ENERGY ,
MECHANICAL MECH.ENERGY
ACC.
ELECTRICAL BUILDING ENERGY ACC DATE FILE N0.
FRAMINGELECT,FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ Y ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
' EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING IDD
SCRATCH COAT ELECTRIC - PLAN CHECK -�•r
GAS FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE I
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING-252-4505 `- ELECTRIC �I
o� ONE WORKING DAY BEFORE REQUIRED'INSPECTION., aL.UMBIING
Z PLEASE GIVE JOB'ADMESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL
IMPORTANT! CONST.TAX
q
PLEASE READ REVERSE SIDE BEFORE fir' TOTAL )!/
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT 1 DENTI FICATION
PERMIT NUMBER
BUILD
AOORLSs G APPLICATION & PERMIT ` 18531
n� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWry R PLAN CHECK VALIDATION
NAM r QTY. ELECTRIC PERMIT FEE
✓C� CNE J - 3�
CONTRACTOR'S
NAME tot' X41
--/ 0 OUTLETS-SWITCHES-RECEP 10.00/1.00
( fD
LIC.No. fms:_JC LIGHTING FIXTURES 10.00/1.00
ADDRESSTURs. APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C,N0.
R. PANELS (OVER 200 AMPI 20.00
ENGINEER -
LIC.NO SIGNS TRANS. 3.00
AARCDDRK OR ESS ENG, SPECIALCIRCUFF 5,00 PERMIT VALI DATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS
S
AMOTORS SEE FEE SCH.
pRE ,
SERVICECHANGE PAID 20.00
Foo -
LICENSED CONTRACTORS DECLARATION p � �Il I V Vl��'-V
a v v I hereby affirm that I am licensed under provisions of Chapter 9 V } `? 8J ISSUANCE DATE
y rt w (commencing with Section 7000)of Division 3 of the Business and - I BLDG. ELECT. PLC. MECH.
F w i Professions Code,and my license is in full force and effect. pdl,r r ❑ ❑
0 0 L se- LicenClass Lic.Number ^' O BQ
F w Date Y !s l:Contractor
to to ¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT
o T o - INFORMATION
w g LL F 1 hereby aflirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
m '�„ VA LIIATION $/FT.
eo¢ Luw for the following rcoson.(Sec.7031.5,Business msd Professions PERMIT ISSUANCE 10.00 li
H W W J - Code:Any city orcoumty which requiresa permit to construct,alter, /I
¢ ¢G p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. b
e wC u requires the applicant for such permit to file a signed statement that TOTAL 7410 PERMIT TO
e4 y he is licensed pursuant to the provisions of the Contractor's License
> La..(Chapter 9(commencing with Section 7000)of Division 3 oftheRoo
ier Business and Professions Code)or that Ice is exempt therefrom and QTY. PLUMBING PERMIT FEE CYMB
So F the basis for the alleged exemption.Any violation of Section 7031.5 STORIES ItYPE CONSTR.
n3by any yY�plicamfnru permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00 _
of npyfnore than five hundred dollars(5500).):
W I,as owner of the property,or my employees with wages as BACK 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 DRAINS-FLOOR,ROOF,AREA,COND. 5.00 "
Code:The Contractor's License Law does not apply to an owner of
. property 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 awn employees,provided that such improve-
mentsarenotintended or offered for sale if however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
Or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA1 200
builder will have the burden of proving that h - . . .
e did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the property,ant exclusively contracting with , El El 0 13
licensed contractors to construct the pmlem(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. '
and Professions Cock: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 pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exetg Lander ec. �' ,B.&P.C.fort is WATER HEATER W/VENT 6.00
reason I
Owne ' Dute ' WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK Ii RS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby atl'rm that I have a certificate of consent to self-insum, 20NING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,Or a certified
copy thereof(Sec,3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is riled with the city inspection division.
~ O Applicant MISC.- REFER TO ORD. Y 0 N 'v ❑ N�
w PERMIT ISSUANCE 10.00
Cr CERTIPICATIiOF PENiAGMPTION sSUROMWORKF:RS' Pn.0o020rvE A.L.U.C.
W > COh1PIiNSATION INSl11tANCli PLG.CONTR. LIC.rv0. pLG. I
1 O (Phis section need not be completed if the Permit is for one TOTAL 'Y N Y ❑ N�
Z) Z hundred dollars IS 100)or less.)
0,0 1 certify that in the performance Of the work for which his •r TV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued.I hall not employ an on in any man s to
U M1ecom c hu Workers' o ab n ..,of ifo Ia.
O i Date tf Applio ALTER OR ADD TO MECH. 5.00 BUILDING • �D
} to NOTIC T AI'I'LICANT: I a ter ma g t its ertificate of lix-
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 10PMC.F.M.) 4.00
CONSTRUCTION u:Nnwc nCliNcv AIR HANDLING UNITIOVER 10,000 C.F.M.16.00 SEISMIC FEE t S
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 Name HEATING UNIT 100,000 B.T.U.)9.50 'D
Lender's Address E LECTR ELECTRIC
I certify that I have read[his applicat inn and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state 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 100,0013 STU)SEE FEE SCH. MECHANICAL
above-mentioned,property for inspection purposes.
(We) agree to Savo, Indemnify a keep harmless the City of MISC.- REFER TO ORD. -
upertino against liaM ities,j g Ns c and expenses which CONST.TAX
ay in any, ay uc rue ag s said I consequence of the PERMIT ISSUANCE 10.00
timing.o Pf 1. MECH.CONT. LIC.NO. MECH.
/ L( TOTAL TOTAL 3p/
Sig nature of Applicant Contractor q [e
OFFICE COPY