14818 (2) I
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF •CUPERTINO 14816
INSPECTION DIVISION
JOB INSPECTION RECORD
- ^^]] ,/ PERMIT EXPIRATION
JOB ADDRESS /�5'�7 7"Rl/nlL�',C/ybt` �`'1✓c UNIT# � LOT#
/ JJ �/,may PERMIT EXPIRES IF WORK
OWNER Z&7" Q �`�' CONTRACTOR ".Q.,Q2Q./.( L;�,ca a7ie �c.� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
LEER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF . PEHMi1 VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED !/=30- W C . *� X,
UNDERGROUND /SLAB QLAItT
• . PLUMBING y• �l CN (/.ri `^'"//`^'"//,7w,79'-
ELECTRICALU•�'j-8'� �j..- i(L•4 tT yLOG ISSUANCE DATELECT E MECH
MECHANICAL �6 , �7��gyL I
�,Lv_ �c��r• pR ❑ O ❑' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED j X1.8$ R YCT Cu BUILDING PERMIT
.}��. �, INFORMATION
WOOD FLOOR /fy 4. Nf� �5�: /h: VALUATION $/FT.
PLUMBING
MECHANICAL /N
ELECTRICAL PERMIT TO
FRAMING
w
INSULATION - STORIES TYPE CONSTR
UCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO,FT aooR AHeA TOTAL AcncnDE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID +.
BUILDING USE
ROOF SHEATHING I I IRES IND CON Pe om.'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.q ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS BSHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
_
INSULATION., PLUMBING ZONING ENOSITE NO.
GAS TEST GAS
MECHANICAL FIRE$PRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ ` ❑ N❑
ELOOD ZONE A.L UC.
EXTERIOR SHEAR ELECTRICAL RELEASE ,J -
❑ No YL7 AlfINTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUI LDI NG IS NOT PER MITTED UNTIL BUILDING FINAL 15 SIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
~o�. ONE WORKING DAY BEFORE REQUIRED INSPECTION. - PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
• PLEASE READ REVERSE SIDE BEFORE 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
BUILDING APPLICATION & PERMIT 14818
ADDRESS
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME I¢, OTy, ELECTRIC PERMIT FEE
ONE
CONTRAL OH'B
NamE
C,it) UTLETS-SWITCHES RECEP 10.00/1.00 -
LIC.NO. LIGHTING FIXTURES 10.00/1.00
ADDRESS TOR's - PPLIANCES-RESIDENTIAL 4.00
I2 t' AA, PHONE _0'?W PANELS 10.00 DATE OF APPLICATION
ogcmrecT PANELS (OVER 200 AMP) 20.00 - PLAN CHECK FEE P.C.NO,
ENGINEER
LIC.NO: SIGNS TRANS. 3.00
ADDRESS ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00
• ADDRESS MOTORS EE FEE SCH.
a00RE55
SERVICE CHANGE 20.00 '1
.- Oo LICENSED CONTRACTORS DECLARATION
a E,w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 orthe Business and
�n ¢ INK
a BLDG. ELECT. PLG. MECH.
r N i Professions Cole,and m license is in full force�a�µµ{{L cj rQ0 ❑ ❑ ❑
ZO i m o License Class 1.le.Number�j., f/ ,
F m r J Datc__ 1Contraclor fL 1 C �,
BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION - INFORMATION
MISC.- - REFER TO ORD
w ;e N wforthereby collo that I ant exempt from the Contractor's License VALUATION $/FT.
u o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 - '
Se improve,
e,dem y demolish,
conn pair any structure permit riot n is issuance,
also
2 at a O improve,demolish,or repair any structure,prior 10 its issuance,also ELEC.CONTR. LIC.NO. ELEC.
u
0 , requires the applicant for such permit t0 file i1 signed statelncut that TOTAL PERMIT TO
K
m he is licensed Pursuant to the provisions of the Contractor's License
r Z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe -
f 4 o Business and Prolkssiuns Code)or that he is exempt therefrom and (ITY. PLUMBING PERMIT FEE
¢ I- m the basis for the alleged exemption.Any violation of Secl ion 7031:5 STORIES TYPE CONSTR.
u3 - by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do(he 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 - S0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
mems are not intended 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.
builder will have the burden of moving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. .3000 RES IND CON PB Omn
.
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to.emstmet the project(Sec, 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,unit who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. " PARCEL NO.
01 I
O um exempt under Sec. ,B.&P.C.for thisreason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM ' 5.00
ACC.DATE ACC FILE N0.
WORKIi RS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of commint(o self-insure.
or a.certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.0.).
Policy No. Company
❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY TZ4
z Z O Certified copyyy filed ith 11 city inspection division.
Fp
Applicant- __ _� MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
N �- CIiRTIFICAT(/fi�OF IiXEAt N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L;U,C. -
LL �. COMPF:NSATIO IN
PLG.CONTR. LIC.NO, PLG.
CL Zr (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
O hundred dollars($100)or[us,.) s
I 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 to
Ow become subject to the Workers Competuation Laws ol-California.
a Date Applicant BUILDINGALTER OR ADD TO MECH. 5.00
>_ W NO]]CE TO APPLICANT: If,after making this Ce«ificate of EK-
Z_ em tion,you should become subject to the Workers'Compensation I.- provisionof the Labor Code,you must forthwith comply with APPLIANCE 5.00 PLAN CHECK
E5 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 FEE
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10A000.F.M.) 6.00 SEISMIC FEE '
I hereby affirm (hat there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is ismed(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.UJ8.50
Lender's Address ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct I agree to comply with all city unit county BOILER PLUMBING
ordinances and state laws relating to building construction, and (3 H.P,Of 100,000 B.T.U.) 6.00
hereby authorize representatives of this city es enter upon the BOILER-COMP IOVBr 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property forinsp ofth i purposes.
(we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue agaipst said City in consequence or the
granting of(I crmil' MECH.CONT. - LIC.NO. MECH.
�✓ q-12MECH.
TOTAL TOTAL
Signature of Applicant/Contra o Date
OFFICE COPY