18572 (2) POST THIS CARD NEAR FRONT OF BUILDING, PERMIT NUMBER
CITY OF-- CU.PERTINO 18572
INSPECTION DIVISION
JOB INSPECTION RECORD
�� • PERMIT EXPIRATION
JOB A DDR ESS_�LDaf SA�.,L�PCx•2991 k UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER v g CONTRACTOR w IS NOT STARTED WITHIN:
INSPECTION DATE INSPECTOR PANSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION. ANCE"OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE,_, TO COMPLY WITH THE APPROVED P S AND CITY OF PERNI T VALIDATIONm
GARAGE SLABS - CUPERTINO STANDARDS. . ' I -^
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ! �• \
UNDERGROUND /SLAB � �
PLUMBING ON_ d �" ,9^*' ✓ •fi ..0 G� ••k.:.�
0011110
ELECTRICAL l(
ISSUANCE DATE
MECHAN ICAL - BLDG ELECr I PLCMECH.
El El ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED qua BUILDING PERMIT
„ WOOD FLOOR* INFORMATION
VALUATION $/FT,
PLUMBING
MECHANICAL '
ELECTRICAL, - - - - PERMIT 10
1
FRAMING
INSULATION - .s RIES TYPE CONSTR.
OCC GROUP .RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
` - ROOF NOTE:NO FINAL INSP.SHALL BE-MADE BEFORE SD.Pr FLDOR ARFA TOTAI.ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING RES INo�LO ON USE
Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 1'❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.q
PLUMBINGELECT.ENERGY
. TUBS&SHOWER PAN 1` PLUMBING ENERGY n1ACT NO. PARCE.1.NO
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC.FILE NO
� -
FRAMING, ELECT.FINAL TEST
INSULATION PLUMBING ZONING -ENG.SITE NO.
GAS TEST - - GAS
FIRE SPRINB ENERGY T.74
MECHANICAL "11- Y ❑ N❑ -Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD 20NE _A.L.
• EXTERIOR SHEAR ELECTRICAL RELEASE U,C, .
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK , GRADE FEESUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH - TEMPORARY APPROVALS BDILowG
• SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC
. o� ONE WORKING DAY BEFORE.REQUIRED INSPECTION.
PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING..
SEE PERMIT FOR EXPIRATION DATE - MECHANICAL -DO
IMPORTANT!' CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR'FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON .PERMIT NUMBER
BUILDING APPLICATION &"PERMIT O C e�
ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL of I
A.
JX
PLAN CHECK VALIDATION
"AME - ( OTY. ELECTRIC PERMIT FEE
` - PHONE S
°inure� Js VVy � �A-e-a' OUTLETS-SWITCHES-RECEP 10.00/1.00
} LIC. .c.No. Q LIGHTING FIXTURES 10.00/1.00
ADDRESS
ADDRESS PPLIANCES-RESIDENTIAL 4.00
`V • PHONE M y- jj/ PANELS 10.00 DATE OF APPLICATION
ARRCHITECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO.. SIGNS TRANS. - 3.00
ADDRRESS E"G' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00 -4(
ADDRESS
AvvucANrs MOTORS SEE FEE SCH.
SERVICE CHANGE 0.00
o¢ i
F D o LICENSED CONTRACTORS DECLARATION - -
a u 5 1 hereby afl'irnt that I urn licensed under provisions of Chapter 9 ISSUANCE DATE
z w (conuneneing with Section 7000)of Division 3 of the Business and
B G. ELECT. PLG. MECH.
N i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
0 0 - License Class Contractor
Number
9 =H Dale Cmrtmcmr a1u ot rjlu� e
a ,, 9�.w w�g1q BUILDING PERMIT
¢ ¢ w OWNF-R-BUILDFR DECLARATION -
w0 LL y 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
LL o j Law for the following mason(Sec.7031.5,Ilusiness and Professions VALUATION $/FT.
H - PERMIT ISSUANCE 10.00
Code:Any city or county which retlions a permit to construct,inter
al ¢ improve,demolish,or repairany structure,prioeto its issuance,also ELEC.CONTE. LIC.NO. ELEC.
iL D¢ requires the applicant for such permit to file a signed statement that TOTAL
w m w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H )
Law(Chapter with Section 7000)of'Division 3 of the
-M o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE M ec,
¢ s- $ the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES - TYPE CONSTR.
w 3 .- by any applicant for a permit subjects the applicant to it civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00
oi'not more than live hundred doll...(55001.1:
Cl I,as owner of the Properly,or my enmloyees with wages as BACK FLOW PROTECT. DEVICE 4.00 Oce.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,CON D. 5.00 . '
Code:The Contractor's License Law does no apply to an owner of
• Property who builds or int Proves thereon,and who docs such work FIXTURES-PER TRAP 5.00 j SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments arenot intended oroffered 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- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 r
_ builder will have the burden of proving than he did not build or int- 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 contractorsto construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:I lie Contractor's License Law dues not apply
.
to an owner of property who builds or improvesthereon,and who LAWN SPRINKLERS-OVER 5(EA.)' 1.00
contracts for such projects with a contractorls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
Cl I ani exempt under Sec.-,BARC.for this WATER'HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK FRS'COM PENSA"TION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have u certificate of consent no self-insure,
or a certificate of Workers'Compensation Insurance,or a cernificd ZONING ENG.SITE N0.-
copy Ihereof(See.3800,Lab.C.).
Policy No. Company -
0 •❑ Cetlil'ied copy is hareby famished. FIRE SPRINK ENERGY
-T-24
Z Lf Certified copy I filed�w�I t Npp1le ty inspection division. T-Y4
F O Applicant-��/(,LCKt>nT MISC.- REFER TO ORD. y ❑ N❑ Y ❑ N❑
CCN CERTIFICAflz OF RXF:MPr1ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.LLC.
LU COAIITNSATION INSURANCE PLG.CONTR. LIC.N0. PLG. '
d O ('Phis section need not be completed if the perm if is for one TOTAL V❑ N❑.. Y❑ N❑
7) Z hundred do11nrs(S100)or LSSJ ,
U O 1 certify That in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
0
become subject to the Workers'Compensation Laws of California.
Ul Dam Applicant BUILDING
G.>- DO NOTICE TO APPLICANT: If,after making this Certificate of Ex-
ALTER OR ADD TO MECH. 5.00
Fz emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -
provisions of the Labor Code, you mind I'.Nhwidh comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER I0,000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATI NG UN IT OV ER 100,000 B.T.U.)9,50 ,OU ELECTRIC
Lender's Address
I certify that I have read this application and sante that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
mudmicces and state laws rclming to building construction, and BOILER-CUMPI3 H.P.or 100,0008.T.U.) 6.00
hereby entiorid representatives ns inspection
this city es enter upon the BOILER-COMP(Ove.100,000 BTUI SEE FEE SCH. -MECHANICAL dD
above-mentioned properly 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 - CONST.TAX
may in any way.accrue agai t said City in consequence of the PERMIT ISSUANCE 10.00 Z,OD
ranting of this per - MECH.CONT. LIC.NO. MECH.
4of„� � �n TOTr�L 3 oD TOTAL OD
Sign ra�f Applicant/Contractor Date - .�
OFFICE COPY