10819 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION 10819
JOB INSPECTION RECORD
Bldg, #47 Nurses Station PERMIT EXPIRATION
JOBADDRESS 19447 Pruneridge Avenue UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER Hewlett Packard - CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - ��
ILACE
CAL ISs ANC DATE
ICAL - BLDG. ELECT. PLG. MECH,
V+ _' L] . ❑
POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED R e� BUILDING PERMIT
WOOD FLOOR 1�`Z 1 Il "-'INFORMATION
VALUATION SIFT.
G BOO
ICAL �11y OS CuP
CAL ` PERMIT TO � /
4*(—.J P/zz-4
STORIES TYPE CONSTR.
ION
OCCGROUP RES.UNITS
O SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT.FLOOR AREA TOTAL ACREAGE
�j DIAPHRAGM '
BUILDING USE
RES IND CON PB Olney
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑' ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO, PARCEL NO,
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN #
ZONING ENG,SITE NO.
' INSULATION PLUMBING
GAS F
_ FIRE SPRINK tIEHGY R24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING CYE:] ' NF] - Y ❑ NE]
LATH-.INTERIOR- ELECTRICAL FL0002ONE A.LU,C. i
LATH�EXTERIOR FIRE DEPT: Y[D "❑ Y❑ "❑
SHEEIROCK - GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING
SNEAF•EXTERIOR
TEMPORARY APPROVALS BUILDING
FIREWgLLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
U
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LUUNE WORKING DAY BEFORE REQUIRED INSPECTION. s
PLUMBING
PLEASE EASE GIVE JOB ADDRESS WHEN PHONING. S
— SEE PERMIT FOR EXPIRATION DATE— MECHANICAL
„ CONST.TAX `
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL 4 J
•\ OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
` 19UILDING PROJECT I DENTI I TIQIC 11111,
PERMIT NUMBER
BUILDING A I A ION & PERMIT
ADDRESS
( Q U UILDING - ELECTRICAL-PLUMBING-MECHANICAL 1081
OWNER'S PLAN CHECK VALIDATION
1 "AM QTY. ELECTRIC PERMIT FEE
C PHONE
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
- B LIC.No.3 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR PPLIANCES-RESIDENTIAL 4.00
ADDH Ess
PHorvE 7• PANELS 10.00 DATE OF APPLICATION
ARCHITE T
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
ARCH,OR ENG. PER MIT VALI DATION
SPECIAL CIRCUIT
ADDRESS 5'00
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTSMOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
M LICENSED CONTRACTORS DECLARATION
a U U I hereby affirm that I am licensed under provisions of Chapter 9 IBSUAN DATE
Z Iu (commencing with Section 7000)of Division 3 of the Business and SLOG. ELECT. PLG. MECH.
F w i Professions Cod and m cense is in full foreS, .yjf ct.
Z i w m Licen Clas �� Lic.Number-f?
�Q�- El
a P•w Dale " Con tractor�llJ
Q y f r 4" BUILDING PERMIT
E m w a OWNER-BUILDER R-BUILDIiR DECLARATION INFORMATION
MISC.- REFER TO ORt",a'xI ; y I hereby affirm ilial I am exempt from the Contractor's License V u ATION $/FT.
F l. oa Law forlhe following reason.(See.7031.5,Businessand Professions PERMIT ISSUANCE 10.0 .t„ n ,,1D01-
Code:Any city or county which requires a permit to construct,alter,
2 G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O LL requires the applicant for such permit to Fide a signed statement that IT
OTgL PERMIT TO
a w S w he is licensed pursuant to the provisions of the Contractor's License
H Z Q Law(Chapter 9(commencing with Scction 7000)of Division 3 ofthe
F m Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
BE I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER IEA.) 5.00S '
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00
(licit sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
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 F IXTUR ES-PER TRAP 5.00 BG.PT.FLOOR AREA TOTAL ACREAGE
( himself or through his own employees,provided that such improve-
ments are not intended oroffered for Sale.If,however,the building GAS-EA.SYSTEM-1 INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
L
will have the burden of proving that he did not build or im- BUILDING USE
Drove for purpose of sale.), INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB OILer
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS FARCE L NO.
and Professions Code:The Contractor's License Law does not amply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contmctols)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00
TRACT NO. PARCELNO.
❑ I um exempt under Sac.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACL,FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate ofconsen(to selGinsure, ZONING
or a certificate of Workers'Compensation InsuXe,of a certified ENG.SITE NO,
copy theryof a 320,j.3b.C.1. •- Fr+e'e If ufw
Policy Nr{ nyN
O IK Certifiedcopyishcrcbyfurnishcd. FIRESPRINK ENERGY T-24
z,Z O Cc
copy is ❑ it-with the city inspection division. MISC.- REFER TO ORD.
^^ // Aapace Y❑ N❑ Y ❑ N❑
~ y PERMITISSUANCE 10.00
i - CF-RTIFICATEOPF-XEM ION FROM WORKERS' FLOOD ZONE A.L.u.c.
UU � COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLO,
a. Z( This section need not be completed if the permit is for one TOTAL m(.v Y❑ N❑ Y❑ No
hundred dollars(S 100)or less.)
L.) O 1 certify that in the performance of the work for which this per- FEE SUMMARY
LL H mit is issued.I shall not employ any person in any manner so as to GTY. MECHANICAL PERMIT sy FEE
become subject to the Workers'Compensation Laws of California.
O w y BUILDING
Go Date ICA Ncant ALTER OR ADD TO MECH. 5.00 , J�
to NOTICE TO APPLICANT: it,after making this rs'Coimpe of lix-
Z emvision you should become subject to the Workers'Compensation APPLIANCE 5. 0 PLAN CHECK
provisions io the Labor Cit Shall
you must forthwith case Ply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT ITU 10pOD C. M.) 4.00 ,,„nn�\1
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.4)16,00 r•s SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) _0.00
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
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city anti county PLUMBING L/
ordinances and stale laws relating to building construction, and BOILER•COMPI3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city es anter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCM. MECHANICAL
above-mentioned property for inspection purpoxs.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cu Lino against liabilities,judgments,costs Bad expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ma in any way a ;me against said City in consequence of the
gra
in of this pe t. MECH.CONT. LIC.NO. MECH.
3 lo 44- TOTAL TOTAL .�ZO L
Si too Ap lica on actor ate -
OFFICE COPY