18220 (2) POST THIS CARD-NEAR FRONT OF BUILDING ' S
Y „ PFR611T NUMBER
CITY .N. CUPERTINO Q
INSPECTION DIVISION
V,2 O,
JOB INSPECTION RECORD Y'
'�' PERMIT EXPIRATION
.. JOB.ADDRESS 223 + � I.l-d r7- 'p-d UNIT# {
' LOT S
,,��`` -' `•
*PERMIT EXPIRES IF WORK
'OWR
NE -ll` L` CONTRACTOR CCn y .� ��• v ' ' IS NOT.STARTED WITHIN
INSPECTION: DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR'180 DAYS FROM
NOTE ' s i. LASTCALLED INSPECTION.
UFER' ALL GRADING AND DRAINAGE,SHALL BE INSTALLED'
PREGUNITE "' { TO COMPLY WITH THE APPROVED PLANS AND CITY-OF I .HKVT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - �•����/r!/� f�
POUR NO CONCRETE UNTIL ABOVE'HAS BEEN SIGNED
UNDERGROUND /SLAB 44%
P L'U M B I N G', -
ELECTRICAL lssunrJcE DATE
MECHANICAL BLOC. 'ELECT. ,PLG, MecR
'. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
. WOOD FLOOR ' " _ '.- .INFORMATION
PLUMBING VAL.ATION SIFT.
- f' �N D
MECHANICAL - .; •'. v�6011DD
ELECTRICAL - - t PERM I TO y�
.. .. . FRAMING
INSULATION
STORILS TYPE CONSTR.
.,._r•• � - -
- - - OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL-ABOVE HAS BEEN SIGNED
sn IT,ILOOR APLA TOTAL ACREAcf .
'ROOF NOTE:NO FINAL INSP:SHALL BE MADE BEFORE
DIAPHRAGM .THE CONSTRUCTION TAX IS PAID
.BUILDING USE
ROOF SHEATHING - - NEs •1Nu CDN PB Do,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ,,jINALS,':�«rr,'; , ,DATE,'. .... .. INSP: _ ❑ El ED 1-1
'ROUGH - SAN.q. ASSE SS OHS PAHCL I.NC.,
� "
PLUMBING - - ELECT.ENERGY
TRACT NO PARCEL NO.—
TUBS 8 SHOWER PAN PLUMBING ENERGY '
MECHANICAL ,MECH.ENERGY,' -
ACC.DATE ACG F ILE NO.
'ELECTRICAL, ' - BUILDING ENERGY" • -
FRAMING: ELECT.FINAL TEST
20N1Nf.
•' INSULATION `'' '� � - PLUENG.SITE NO.MBING'. •
1 '
GASTEST _ GAS -- '
FIRE SPRINK ENERGY Lp4
' '7'' MECHANICAL - `
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y "E ° ❑ NO'
FLOOD ZONF. A.L,II C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR, - - FIRE DEPT. Y ❑[ "❑ v L N❑
SHEETROCK 4 GRADE 'q - - FEE SUMMARY
' EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY PPROV LS ' BUILDING Rpm
} 9CRATCH.COAT ELECTRIC - - PLAN CHECK
. GAS ,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEMSIGNED JOCCUPANCY - SEISMIC FEE,
OCCUPANCYOF B UILDING IS NOT PERMITTED UNTJ L BUILDING FINAL IS SIGNED BY BUILDING INSPECTORS : MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ` ONE WORKING DAY-BEFORE REQUIRED INSPECTION:,-. PwMBIn'G ' '.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. •'
— SEE PE'RMIT'FOR'EXP,IRATION DATE L . MECHANICAL
IMPORTANT! coysT.TAX
PLEASE.READ REVERSE SIDE BEFORE C���
CALLING FOR FINAL INSPECTION. TOTAL v �'r(C0
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'•BUILDING PROJECT I DENTIFICATI ON PERMITNUMBER
BUILDING APPLICATION & PERMIT ^ ^O
ADDRESS (J G
22.348 VM4RA.XT R.D• ' BUILDING - ELECTRICAL-PLUMBING-MECHANICAL y;
OwNER'5 - PLAN CHECK VALIDATION -
NAME .•�� �L,� -
ITV. ELECTRIC PERMIT FEE
CONTRACTOR'S -- ce
N MEOUTLETS-SWITCHES-RECEP 10.00/1.00
S �i-. � •LSIS LIC.NO. 44 LIGHTING FIXTURES 10.00/1.00 f.0
coNrRA R�'S., - PPLIANCES-RESIDENTIAL" 4.00
_ ADpRE55 l( /Tipp'
k O� $ P J1V7) W?;'3 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO. '
OR - -4Qu� Apc+0ITs-TS PANELS (OVER 200 AMP) 20.00 -
ENGINEER
LIC.N.C-1-70SIGNSTRANS. 3.00
ARCH.OR ENG,? F Fn M� �p�K PERM1UT VALIDATION
+
ADDRESS ^'-1 7' • SPECIAL CIRCUIT 5.00 /V///✓/2_'_
J Ole TEMP. METER OR POLE INS. ;'20.00
IZ
ADDRESSTS N• MArM1" T MOTORS . SEE FEE SCH.
J
d}� OIF 91�6� SERVICE CHANGE 20.00
0 0 o LICIiNSCD CONTRACTORS UIiCLARA"PION - l(
a
all 1 toothy affnm That 1 am licensed under provisions of ampter'l _ ISSUANCE DATE
may (commencing with Section 7000)0(Division 3 of the Business and SLOG. ELECT. PLG. MECH.
F y z I'refessions Code,Al my license is in full to }}..��f��et� �• ❑ ❑
0 i w o Liven Cla s Lit.Numb Zb�- -
H F Dale Conl recto .•��rrlYq- -
a m s TeAo94 - BUILDING PERMIT
¢ ¢ w OWNER-BUILDER DECLARATION ' INFORMATION'
X'x : ' r I hereby affirm that I um exempt from the Contractor's License MISC.- RD
LL o a law for the following reason.(Set.7031.5,Basin ess and Professions VALUATION $/FT.
H - PERMIT ISSUANCE 10.00 1I1 0 U
Code:Any city or countywhichany structur e permit l O l construct,alter, j 3�
a ¢ a0 improve,Aemolish,nr repair any structure,Prior In cls issuance,uls0 ELEC.CONTR. LIC NO. ELEC. QV0
0¢ requires the applicant for such permit to file a signet statement that TOTAL
La
wm he is licmaed pursuant to the provisions of the Contractor's License PERMIT TO
H z a Law(Chapter 9(commencing with Section 7000)e1'Division 3 ofthe Ap
4 o I3usiness and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 ( STORIES TYPE CONSTR.
u 3`� by any.applicant for a permit subjects tire a,pllcunr tollewilpcnalty, ALTER-DRAIN of not more than five hundred dollar,(S500)J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.CROUP ,RES.UNITS
sole compensation,will do the work,and the structure is not
intended or offered-for sate(See. 7044, Business andProfersionx DRAINS-FLOORROOFAREACOND. 5.00
Code:The Contractor's License Law does not apply to an owner of , , ,
'
property who builds or improves thereon,mad who does such work F IXTUR ES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such Improvu-
BentsareGetintended or offered for one.If,however,the building GAS-EA:SYSTEM-11NC:4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA:SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of Prnv:ng that he did not build or im BUILDING USE
prove for purpose of sale.). - RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑, ❑ ,❑ ❑,
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does not apply
to an owner'ol property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 ...
contracts for such projects with a contructods)licensed pursuant to SEWER-SAN V-STORM EA.2001t/10.00
Dae Contractor's License law. - TRACT NO, PARCEL NO.
❑ I:on exempt amdm Sec. ,B.&PUC.1'arahix WATER HEATER W/VENT - 6.00
reason
Owner Date WATER SYSTEM 5.00 Ace.DATE ACC.FILE N0,
WORK Ii Rs'COMPENSn'1'ION DECLARA'T'ION WATER TREATING EQUIP. 5.00 a
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See 3800,l a ,C). •• - -
folic
Ctrlif n ¢retry 4unishcd' FIRE SPRINK ENERGY T-24
'Z Z Cey(1 ed cop lied wish the city inspection Aivisinn.
F p nnPlicm MISC. REFER TO ORD. Y ❑' N❑ 'Y ❑ N❑
� y CIiR'TIPIC({1TG OP.IiXISMI'fION PROM WORKIiRS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.0 G.
LU ,COMPFNSA1'ION INSURANCE PLG.CONTH. LIC,NO! PLG.
Z f this section need nor be completed'it'the permit is for one TOTAL - Y'❑ N❑ v ❑ N❑
hundred dollars IS MID)or less.)
..C.1 O _ 1 cerldy,thar in tire performance of the work I'nr which this per- QTY. MECHANICAL PERMIT. FEE FEE SUMMARY
LL F. mit is issued,I shall nor employ any person in any nwnner so as to
..O W become subject to the Workers'Compemation Laws of California.
a Date. Applicant ALTER OR ADD TO-MECH. 5.00 BUILDING
} rn- �,oricli 'I'O APPLICANT'. If,ai'ter making this Certificate of Ex.
H ?' option,you should revenue subject to the workers'Com unsmien APPLIANCE 5.00 'PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
-.0•, such provisions or this permit stat Ile deemed revoked: AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
,CONSTRUCTIONLENDING AGENCY AIR HANDLING UNIT(OVER IO,000GF.M.16.00 SEISMIC FEE t D
I hereby affirm that rhere'is a construction lending agency far _ EXHAUST HOOD (WITH DUCT) . - 5.00 -
rhe performance of the work for which IInS permit is issued(Sec. MICROFILM
- 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
Lender's Name HEATI NG UN IT 100,000 B.T.U.)9.50
' Lcndura Address ELECTRIC
a
I certify that l have read this upplienion and state that rhe above VENTILATION_'FAN (SINGLE) 4._00
ordinances and state laws relating to building cpmstnmlion, and a BOILER-COMP(3 H.P.Or 100;000 B.T.U.) 6.00
information is correct. I agree to comply with all city and county PLUMBING
- hereby authorise representatives of this City to enter uppmthe BOILER-COMP(Over 100,00.0 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree m Save, indemnify and keep harmless the City of MISC.- .REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - - 'CONST.TAX'
in way accrue against mid City in consequence of the PERMIT ISSUANCE - 10.00
ting of his pernI I . - MECH.CONT. LIC.NO. MECH. _
ytj e� TOTAL TOTAL J3 xb�
S nal OfA Team/Contractor - late �':
OFFICE COPY