11518 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO151 8
INSPECTION DIVISION
JOB INSPECTION RECORD
IDyloO �ineVi ll YPi PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT# '
PERMIT EXPIRES IF WORK
OWNER T CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION foo th ANCE OR 180 DAYS FROM
UFER �J �=(R A?ifp,4 LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
ata _
POUR NO CONCRETE UNTIL ABOVE HAS B N SIGNED
UNDERGROUND /SLAB i
PLUMBING. f�
ELECTRICAL ISSUANCE DATE
_ MECHANICAL BLDG. ELECT,T
IIPLLGG', MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ,p ILDING PERMIT
WOOD FLOOR r I INFORMATION
VALUATION S/Fi.
PLUMBING -7 ��
MECHANICAL /
'ELECTRICAL ,,11 J�PERMIT To
FRAMING -+y �E yy,�,bf7-d'Ai
INSULATION STORIES TYPE CONSTR.
V - OCC.GROUP RES,UNITS
a
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
� ROOF SO.FL FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
auaolNc use
Vp� O-/r�6 - RES IND CON PB Other
APPLY NO ROOFING NTIL ABOVE HAS BE GNED ❑ E:l 0 ❑ ❑
ROUGH ASSESSORS PARCEL NO.
'
PLUMBING - y
GAS TEST I - - - TRACT No. PARCEL No.
MECHANICAL I I 15
ACC.GATE ACC.FILE NO.
ELECTRICAL - .2 0' FINALS DATE INSP.
FRAMING ' 1 SAN 0
INSULATION I Ib _ zoNlNc ENG.SITE NO.
PLUMBING
11 GAS
MECHANICAL FIRE SPRIrvR ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . Y ❑ NO Y ❑ N❑
FLOOD ZONE A.L.U.C.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. / - Y[] NF] Yo N�
SHEETROCK FEE SUMMARY
SHEAR INTERIOR BUILDING -
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS JELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR; MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
r. H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING j
. z PLEASE GIVE JOB ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE,— MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORElammom TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY ..
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ROILD14G 1�0 APPLICATION & PERMIT 11518
AOD ERddille W., BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
/ OWry R'spDr2_/f PLAN CHECK VALIDATION
�V TV. ELECTRIC PERMIT FEE
vISON
NAME acro s OUTLETS-SWITCHES-RECEP 10.00/1.00 y
Lie.NO, LIGHTING FIXTURES 10.00/1.00 J
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
/ ARDHITeC*, PLANCHECK'FEE P.C.NO.
rY OR PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.No. SIGNS TRANS. 3.00
AROHREss E"G' SPECIALCIRCUIT 5,00 PERMIT VALIDATION
LJ�QZIP fTEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEIeftM6F
AU _
MSERVICE CHANGE 20.0 p• g�
woo LICENSED CONTRACTORS DF-CLARATI N U r1N
a -u I hereby affirm lbnt I am licensed under provisions of Chapter 9 ISSUANC DATE
N¢ w (commencing with Section 7000)of Division 3 of the Business and CI O BLDG. ELECT. PLG. MECH.
H y i Professions Code,and my license is in full force and effect. Y ❑ (My If(time In�
z o m License Class LIZ.Number ""j `§
9 z r wo Date Contractor
¢ x s I BUILDING PERMIT
¢ ¢w a OWNER-BUILDER DECLARATION INFORMATION
DA " MISC.- REFER TO ORD
X a- 0a. y I hereby affirm that I am exempt from the Contractor's License VALUATION SIFT.
H 9 O a Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE 10.00 Q r
Code:Any city or coun ty which requires a perm it to construct,alter, _ 79 ��
a ¢¢Q improve,demolish,or repair any structure,prior tD its issuance,also FLEE.CONTR. LIC.NO. ELEC. vV
ca D LL requires the applicant for Such permit to file a signed statement that TOTAL (X^`v`�.., PERMIT TO
' whe is licensed pursuant to the provisions of the Contractor's License �s /
HZQ Lae(Chapter 9(commencingwith Section7000)ofDivision3ofthe
Business and Professions Code)or that he is exempt therefrom slid DTV. PLUMBING PERMIT FEE
It the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
o1 more than five hundred dollars(S500t)
01,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their site 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 our apply to an owner of
Property who builds car improves thereon,and who docs such work FIXTURES-PER TRAP5.0 Q Qi SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
I the budJin GAS-EA.SVSTEM-11NC.4 OUTLETS 6,00
meals are not intended.,offered funds,If, 8
or improvemem is sold within one year of Co..pletion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that Ise did not build or im. RES IND CON PB Omer
prove for purpose of sale.). 1 N DUSTR I AL W ASTE I NTE R. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7144,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to all owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVE A.) 1.00
contracts for such projects with a cent mctorts)licensed pursuant m
the Contractor's License Law. SEWER-SANITAR V-ST .'200ft/10.00 TRACT NO. PARCEL NO,
❑ lam a [under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 '
x reason19P6
Owner Dat (( WATER SYSTEM \ 5.00 ACC.DATE ACC.FILE NO.
WORK BRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, Icapefto
ZONING
or a certificate of Workers'Compensation Insurance,Or a certil'icd ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
C Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
Applicant V E] NE]❑ V [:] NE]~ in PERMIT ISSUANCE 10.0 0 1
CC - CERTIFICATE OF EXEMPTION FROM WORKERS' CC FLOOD ZONE A.LU.C.
LU > COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG.
d O (This Section need not be completed if the permit is for one TOTAL Q Y❑ N❑ Y ❑ N❑
Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F• mit is issued,I shall not employ any person in any manner so as U)
U become subject to the Workers'Compensation Laws of California. �p
0 i Date - Applicant ALTER OR ADD TO 5.00 BUILDING
} m NOT CE TO APPLICANT: If,after making this Certificate of 1:
F ? 10
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 to ftC12CWdb6.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10ACC.F.M.) 6.00 SEISMIC FEE Q
I hereby affirm that there is a construction lending agency for %rEXHAUST HOO 100 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CiYC.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 p�--��
Lender's Name HEATING UN IT IOVER 100,000 B.T.U.)9.50 ELECTRIC pU
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 /- �p,D
information is correct.1 agree to comply with all city and county PLUMBING J- -
• ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.Or 100,000 B.T.U.) 6.00 _
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL p26 1-/
above-mentioned properly for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertin . is liabilities,judgments, costs and expenses which CONST.TAX
may i accrue ag inst sai ity in c sequence of the PERMIT ISSUANCE 10.00 0
grief o ermiL H.CONT. LIC.NO. Id ECA. _
TOTAL R uv TOTAL S 3 7
e pelican Con acto Date
OFFICE COPY