17386 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF . CUFIERTINO,. ' ..
1738
, . INSPECTION DIVISION,
JOB INSPECTION RECORD
.• PERM~_IT.EXPIRA.TION
J08 ADDR ESS_Z��3L!"'�>=`i ��� UNIT# _•LOT# '
1 PERMIT'EXP.IRES'I F-WORN
DINNER p p ,`. I!I .' CONTRACTOR A IS NOT STARTED WITHIN-
DINNER
DATE- INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT,.ISSU.
FOUNDATION ANCE OR 180 DAYS F,ROM',
NOTE: LASTCALLED INSPECTION.
UFER '�Zy ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGONITE .TO COMPLY WITH THE APPROV D PLANS AND CITY OF . PLHMIT VALIDATION
CUPERTI - STAND DS. -
.GARAGE SLABS 1 , 0 ' A. . _ •� '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIO 0 L L77.
r
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL• ._L ('. ISSUANCE UA TE Y
MECHANICAL, r " ,+\ ';} eLuc•, cLECT. rLG:� ML�CJN..
• DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ° •� BUILDING PERMIT
,WOOD.FLOGR - _ INFORMATION
.�
PLUMBING VALUATION SIFT.
' �
'MECHANICAL —L L- U ✓�3.' - . ' ^v 0'
ELECTRICAL-
RMIT TU
I4. , •� +—
FRAMING �
INSULATION --
STOHICS TYPE CONSTR,
,. 'OCc.GHOUr REs,UNITS
00
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
5
ROOF �. - NOTE�NO FINACINSP:'SHALL BE MADE BEFORE jv �o' TOTAL ACRLAGL
I� DIAPHRAGM ' THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Hes IND .CON PIT
APPLY,NO ROOFING,UNT,IL ABOVE HAS BEEN SIGNED, FINALS,, DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH' SAN.q ASSESSORS PARCEL NO.
PLUMBING ELECT.ENERGY '
TUBS ,BSHOWER PAN .PLUMBING ENERGY- TRACT NOPARCEL NO,
MECHANICAL - - MECH.ENERGY . - , . '
ELECTRICAL -Acc.DATE ACC.FILE NO:
BUILDING ENERGY :'+
FRAMING _ - ELECT.'FINAL TEST
'ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS TEST GAS .. .' �•'
MECHANICAL 9.• FIRE SPHINK ENERGY T.2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING , N❑ `-❑ "❑
ELECTRICAL RELEASE " FLOOUZONE A,L.U,C. '
' EXTERIOR SHEAR '.- '
INTERIOR'SHEAR ��.'' FIRE DEPT.• _ Y❑'.''N❑ v ❑ N❑�
` SHEETROCK. GRADE,'' - . FEE SUMMARY
_
EXTERIORLATH - - BUILDING'
INTERIOR LATHTEMPORARY APPROVALS ' BUILDING
SCRATCH COAT - ' `, ELECTRIC . ', ' _. PLAN CHECK " L '
c - GAS' w FEE
NO TAPE OR PLASTER.UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE0
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL.BUILDING FINAL IS SIGNED,BY BUILDING.INSPECTOR� MICROFILM
Lu ARRANGE FOR INSPECTION BYPHONING252-4505; ELECTRIC.
Z"
ONE WORKING DAY BEFORE REOOIRED INSPECTION rJ A. PLUMBING
PLEASE , ?3.
GIVE:JOB ADDRESS WHEN PHONIN
MECHANICAL• "
' .=_SEE PERMIT FOR EXPIRATION DATE � . + �
IMPORTANT! CONST:Tax U= �l-6
;PLEASE.READ REVERSE SIDE BEFORE. `
CALLING.FOR FINAL INSPECTION. TOTAL SD�,
OFFICE COPY ':
APPLICANT TO FILL IN INFORMATION WITHIN-RED LINES - USE BALL POINT PEN,ONLY
'-BUI LDI NG PROJECT I DENTI FICATION. - - ' -PERMIT NUMBER
BUILDING APPLICATION & PERMIT: //�1
t ADDRESS. - _ , . .. .17-386
q� T.V 1I/�1 V
7.203 (. I E •� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S ��j - • PLAN CHECK VALIDATION'
NAME - d . , ` P-7I QTY.t ELECTRIC PERMIT - FEE ' p
/4 L .PRONE i PA I� 90
NO RACTORS " p
AMc . _ UTLETS-SWITCH ES-,-R ECEP 10.00/1.00
/•��4!/I/ `•+�/ Llcso 2_; J LIGHTING FIXTURES ' - 10.00/1.00
s
C,ONTRACTOR's. nftlo P�� I� '
ADDRESi 1 APPLIANCES-RESIDENTIAL 4.00
6SI�rB/ PNOrvE PANELS 0.00 DATE OF APPLICATION
An CHIT ECi20.00�7�.,I ' PLAN CHECK FEE P.C.-NO_' "
OR `-i* •+UI•xrAD� kl� PANELS (OVER 200 AMP) , -
ENGINEER
LIC.ND. SIGNS TRANS. • . 3.00
ARCH•0/ilENG. - -- PERMIT VALIDATION
AppREss SPECIAL CIRCUIT t 5.00 - _ _
CYOSS O/ V EMP,METER OR POLE INS. 20.00
APPLICANTS 9S-/.� -' - MOTORS SEE FEE SCH.
aoDREss .PE*_Vig 11M _ - e
i� .S� �`•'. SERVICE CHANGE 20.00
X o_ LICENSED CONTRACTORS DECLARATION, - FAro
' au G I hereby uffvm that I am licensed under provisions o(Chapler 9 - I
z w - -�, _ ISSUANE DAT
(commencing with Section 7000)r f Division 3 of the Business and C
V ty BLDG. ELECT. PLG. MECH.
y i
Professions Cod d my licens Iv b 11 force and el feel IJ r-u IJ�.� ,..,/
z0 i m O f¢cn' Class LI Number s'�3�.'�._ •• 10 �'• 1571 .
m r Date/ Cont actor • � /�./ � 1% JLT
S, w ¢ wNDf.R DI-cI.A11ATION Cit' ni n11�^f�I (1 BUILDING PERMIT
w °A " " MISC.- REFER TO ORD -INFORMATION
3 w y I hereby off rm that I am exempt from the Com rector's License
rw04 Law]or the following reason.
(Sec.7031.5.Business and Prol'essiuns. pEflM1T ISSUANCE 10.00 �vp VALUATION §/FT.
N0 - Code:Any city Or county which rerluiresa permit to construct,alter,
- F
rt Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.- LIC.NO, ELEC.S 355
a
D¢ requires the applicant for such permit to file a signed statement that
TOTAL/Z3,.��
wmm hail(Chapter
pursuant to(lie provisions of tire COnl Contractor's 3.1the - - - ERMITTO
Hz ' Law(Clmp7cr9(co,ions Code)lir Section 7000)of Divisiefornnd
M4 o Business and ire alleged Codd or the he is tionof therori 70 1.5 DTV. PLUMBING PERMIT FEE - V -
¢ H o the basis for The alleged exemption.Any violation of Section 707L5 I - STORIES - TYPE CONSTR.
Is °_o by any ore1am fora permit subjects S500o.he licannikacivil'penulty' ALTER-DRAIN -WATER IEA.) 5.00
of not more Than five hundred property,
o fmy c...h
❑ Sa as owner at the property,Or my employees auct wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
(heir sole cumpetiwtlOn,will I.the work,and tiro elmcuve is not
intended or offered for sale (Sec. 7044„11usiness and Professions ,_DRAINS-FLOOR,ROOF:AREA,COND. .5.00 _
Code:The Contractor's License Law does net apply to an owner of ,, '
- property who Imilds or improve,thereomand who does such work FIXTURES-PER TRAP: .5.00. - Ba Fr,EL ORA EA TOTALACREAGE
himself or through his own employees,provided that such improve. - 4V' �4[egL
ments are not intended or offered for sale.it,however,the building GAS-EA,SYSTEM-1
or Improvement is sold within one year of completion,the owner10
-
builder .will have the burden of proving that he did riot build or ie,- GAS-EA.SYSTEM-OVER 4(EA.) 2,00 BUILDING uSE
Prove for purpose of sale.l. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,as owner of the properly,am exclusively contracting with. - ❑ ❑. 1 1:1 O
licensed'contractors to construct the project i Sec. 7044,'Rusiness LAWN SPRINKLERS-'1-INC 5 V.B. 6.00
sad Prefcwrins Code:The Cunlractnr's License Law docs not apply ASSESSORS PARCEL NO.
- to an owner of property who builds or improves thereon,and who ILAWN SPRINKLERS-OVER 5 IEA.) 1.00 -
contracts for such projects with a con(ractor(s)licensed pursuant BI
tSEWER-SANITARY-STORM EA.200ft/10.00
he Contractor's License Law. TRACT NO, PARCEL NO.
❑ tum exempt antler Sec. ,B.&P_C.for this WATER HEATER W/VENT - 6.00
mason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DI7C LARATION WATER TREATING EQUIP. 5:00
.I herebyate re, that I have a ce Compensccleation
Of Insurance.
or set rUsure„
or.a certificate of Workers'Compensa7ian Insurance,or a certified _ - ZONING ENG.SITE NO.
copy I hereof Sec.3800,3g00,Laby_'__''��
Policy sere any _ .
Q .�r Certi Hed c y is her y furnishe
!' l FIRESPRINK ENERGY T44
Z_ 2 - ❑ Cert il'ie py is EI with tNL ins cL t•Aivision. MISC.- REFER TO ORD. '
O Applicant Y 0 N 0 •Y NCC �
CC y .. "PERMIT ISSUANCE 10.00
- CICR'1' (. :%EMPI'1 N IsROM11 WORK EKS' FLOOD ZON E. A.L.U.C.
LU > eNSATION INSURANCE PLG.CONTR. - LIC.NO..• .PLG..
4• -(This section Beed mol be completed if lhc'pcim it is for one •'� TOTAL V Cj N[:J V [3 NE
:D 2 hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT' - FEE FEE SUMMARY .
LL F , mit is issued,I shall not employ any Person in any manner so as to
QU become subjecins the Workers'Compensation l:uw,s of Cali tornia. -
y Date 'Applicant ALTER OR ADD TO MECH. - 5. = BUILDING 15Z/f
' } to NOTICE 'f0 APPLICANT: If,after making this Cenl(Icate of Ex- JL.
H 2 enlption,you should become subject to the Workers'Compensation APPLIANCE ,5. 0 PLAN CHECK
provisions of the Labor Code, you must forthwith comply.willi - FEE
U such'pro,aions or lb is permit shall be dee reed revoked. ' AIR HANDLING UNIT(TO 10SWE.F.M.) 4.0 "
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.EM.) 6.001 SEISMIC FEE
2465
I herehy affirm that there is a construction lending agency for EXHAUST.HOOD(WITH D T) 5
lire performance of the work for which this permit is issued(Sec. .00 MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,0 8.00 ! -
Lcndcr'sName
Lender's AAJress ' H EATI NG UNIT(OVER IO B O
ELECTRIC
I certify Shut l havercad this application andsmte that the above VENTILATION FAN'(SINGLE 4.00 -
information is correct. I agree to comply with all city and county PLUMBING
ordinances and stare laws relating la.building construction, and BOILER-CDMP(3 H.P.or 100,000 B.T.U.) 6,00 '.
hereby authorize representatives ec of this purposes.is city to enter upon the
sp
above-mentioned properly for BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
h
(We) agree to save,' indemnify and keep harndess the City of MISC.- • - REFER TO ORD.
upertino against,liabilities,judgments, costs and expenses which a- PERMIT ISSUANCE 10.00 CONST.TAX 67,.E ,(2.
may way accme against said City in consequence.of The ' ,
'tg al't 's pont' ] MECH,CONT: LIC.NO. MECH.
TOT
AL, TOTAL 1 �S
S p n f r c7 I a -
OFFICE COPY