15973 (2) f ,
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF. CUPERTINO 15973 }W
INSPECTION DIVISION .. „
JOB INSPECTION RECORD'
' 6// p� -� - xPERM IT EXPIRATION
JOB ADDRESS 10(1' / 36171} LOT#
PERMIT•EXPIRES IF'WORK E
owNeR & CONTRACTOR , . �. a IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR IN ECTION RECORD 180 DAYS OF'PERMIT ISSU
FOUNDATION _ ANCE OR'1BO DAYS,FROM
NOTE: - LASTCALL E D INSPECTION:'.
LIFER " ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE _ TO COMPLY WITH THE APPROVED'PLANS AND CIN OF PERMIT VA l.mgI ION -
CUPERTINO STANDARDS., - .M^' •,.-
GARAGE SLABS .. -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB �0
PLUMBING - en , "' •:y'• 14,E C:
ELECTRICAL - •�� p0 -.ISSUANCE OA IE
MECHANICAL - - JE e6 .ELECT. PLG.- MECH
eLl Cl ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED suaowc PERMIT '
INFORMATION -
' .WOOD F-,LOOR + .,�,rEF VALUATION - s/FT.
PLUMBING. . - fr ,yt E� 4`''`Wi: .
MECHANICAL
ELECTRICAL - PeRMIT To
FRAMING
INSULATION - STORIES) I RIPE CONSTR.
t' OCC.GROUP. RES UNITS_
PLACE'NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE,` SO r'r.FLDaN AREA roTAI.ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID- '
BUILDING USE
ROOF SHEATHING - - - e HOS --IND CON ,PB 'U14.••,
APPLY NO ROOFING UNTIL ABOVE•HAS,BEEN SIGNED •'.FINALS DATE,..,4 , INSP.,,` ❑ Q ❑ El' . ❑
ROUGH SAN.N ASSESSOHSFAHCEL No -
PLUMBING ELECT.ENERGY Y '
TRACT NO. PARCEL NO,
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - - - MECH.ENERGY -
ELECTRICAL - BUILDING ENERGY Acc.DAT Acc.FILE NO. .
FRAMING �C •s?r ELECT,FINAL TEST - -
ZONING ENG.SITE N(1++•" -
INSULATION - _ PLUMBING, - "'PS
a�
,
GAS TEST. , GAS
FIRE SPHINK 'ENERGV T 2
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y'0 "11 N "�
L ' -^
EXTERIOR.SHEAR LLL;
. _ ELECTRICAL RELEASE �b Y NO FLOOD ZONE AL N�
.INTERIOR SHEAR - FIRE DEPT. `
SHEETROCK - . GRADE - FEE SUMMARY
'EXTERIOR LATH .BUILDING — BUILDING
INTERIOR LATH TEMPORARY APPROVALS,
SCRATCH.COAT ELECTRIC: PLAN CHECK
• GAS
FEE ._.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE, 13-011
OCCUPANCYOF BUILDING IS NOT PERMITTED•UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252 4505, ELECTRIC
I-� ONE WORKING DAY BEFORE'REQUIRED INSPECTION.
'PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING..
Z V. - - MECHANICAL �I
- SEE PERMIT FOR. EXPIRATION DATE -. I
, , -r
• IMPORTANTCONST-TAX
'!. -
PLEASE'REA'D REVERSE SIDE BEFORE . T
CALLING FOR FINAL INSPECTION:. TOTAL 9eaw '
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
e
BUILDING PROJECT I DENTIFICATI ON APPLICATION $I PERMIT., PERMIT NUMBER
� 5973 -
6ulLowc J J J
.� aoDREss , / ILDING — ELECTRICAL—PLUMBING—MECHANICAL �"
OWNER'S PLAN CHECK VALIDATION
NAM aY. ELECTRIC PERMIT- FEE
PHONE ,
CONTRACTORS UTLETS-SWITCHES-RECEP ,10.00/1.00
LIC.NO. TGHTING FIXTURES 40,00/1,00 •'SO ,
CONTRA OTOR APPLIANCES-RESIDENTIAL 4.00
N° fS rn
7( ONE /+TJ PANELS 10.00 OATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER '
LIC.No. SIGNS TRANS. 3:00
ARCA"Ess ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS
ADORE 5 MOTORS SEE FEE SCH.
AAAr1 SERVICE CHANGE 20.00
0sz
F o O LICIiN ON'I'RACTOItS DECLARATION
¢ i w 1 hereby affirm that 1 am licensed under provisions of Chap of 9
ISSUANCE DATE
H ¢ (commencing with cion 7000)of Division 3 of the Busines's and BLDG ELECT. PLG. MECH.
0 w i Lick,maions Co d� 'cense is N full for n t ❑ ❑
0 2 w o License Class Lic.Number ,1
w F w Eric_ Conlmctnr fj
ac ee s 4 ^ IFILDING PERMIT
E o n U GWNIi R-NUILDER DIiCLARATI N FORMATION
wo w w 1 hereby ufBrn that lam exempt from the Contractor's License MISC.— REFER TO ORD
u O a Lxw for the following reason.(Sec.7031.5,Businessand Professions P4�R VALUATION S/FT.
I- — PERMIT ISSUANCE
N,w Code:Any city or county which structure Permit o its issuance,
,also
>' ELEC. —LIC NO /'71
rt ¢ ¢Q improve,demolish,or repair any structure,prior n its issuance,also TEL 5 d �C
i w m a- requires the applicant for such revisit to file a signed statement that TOTAL/ PERMIT TO
he is licensed pursuant In the provisions of the Contractor's License
HiQ Law(Chapter
still 9(cosions Codeng with Section 7s execit therefrom she
i o Nosiness and Professions Code)or that he is exenrpl therefrom slid OTY. PLUMBING PERMIT FEE
X I- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES CIPE CONSTR.
a3_ by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 .
of not more than five hundred dollars($500)):
❑ Las owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole 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 not apply to an owner of
property who builds or improves oleicon,and who docs such work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare.not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) .2.00 BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ I,as owner of the property,ant exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 F-1 ❑ ❑ 1:1 , ❑
licensed contractors In eonstruct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
town owner of property who builds or imp roves thereon.and who LAWN SPR IN KLERS-OVER 5(EA.) 1.00
contracts for such projects with a conlractods)licensed pursuant to SEWER-SANITARY-STORM EA.200/t/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ lam exempt under Sec.—,BAFC.for this
mason WATER HEATER W/VENT 6.00
Owner Dare WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent to self-insure,
or a certificate of�Woo�rke�rs'Cnmpmue n In mncc_or Ja cart 'led ZONING ENG.SITE NO.-
apy s�nL�tAI my Leo
,(} Policy piny
0 ❑ Certified copy is hereby furnish
❑ Certified - isle IE 1 cit FIRE SPR INK ENERGY TZ4
I—Z- 2AApplicant _ _ _ MISC.- REFER TO ORD. Y N❑ Yo N[]
N CHR'I'I PICATE 'EXEMPTION FROM Wf R ' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UG.
W > COM HNSATION INSURANCE PLG.CONTR. LIC.NO, PLO,
CL Z (This section need not he completed if the permit is for one TOTAL Y 0 N Y [:] N�
hundred dollars($100)or less.)
U O 1 certify [list in the performance of the work for which this Icor- CITY MECHANICAL PERMIT FEE FEE SUMMARY
EL U nut is issued,I shall not employ any person in any manner so as to
Oad become Subject to the Workers'Compenmtion Lawsaf California. �N
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE '1'0 APPLICANT: If,after making this Ce Hificate of ISx-
? ennption,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you nest forthwith Comply with /
3 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE ! _
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 SEISMIC FEE As�
1 hereby affirm than there is a cunst,iethm lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this Permit is issued(Sec. MICROFILM
3097,Cie C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UN IT(0 V ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify than l have read this application end Inose omi the above VENTILATION FAN ISINGLE) 4.00
I,formation is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and - BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city es enter upon the BOILER-COMP (0.,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree [ emnify and keep harmless the City of MISC.- REFER TO ORD.
uperfr, list If les,judgments, costs and exp sea which CONST.TAX
mu any wa coon against as y lice of the PERMIT ISSUANCE 10.00
IT
of er it. MECILCONT. LIC.NO. MECH.
d/VC gy1} TOTAL TOTAL �f QS—'
Signat p licant/ otruclor isle ¢�
OFFICE COPY