15546 (2) POST THIS CARD,NEAR FRONT OF BUILDING , PERMIT NUMBER
CITY 01 CUPERTINO 15546
INSPECTION'DIVISION
• JOB INSPECTION.RECORD, r
pp /(g PERMIT EXPIRATION
JOB ADDR ESS/_60'! �J6-k.NTOG- ' _ SUTA l��i-'G�' UNIT# _LOT# '
PERMIT EXPIRES IF WORK
OWNER S ,.(_ S .y C_. CONTRACTOR. 0 w`rkrc) -EL�—C7Q T L IS NOT 'STARTED WITHIN
INS ECTION DATE INSPECTOR. INSPECTION RECORD 180 DAYS OF PERMIT ISSU- f
FOUNDATION ANCE OR 180 DAYS FROM -
NOTE: -
UFER - � - ALL.GRADING AND DRAINAGE SHALL Rif INSTALLED LASTCALLE DINSPECTION. -
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION . .
_ CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED • (,�/y. - . lwl�GG iyGy��- F '••:-' - ^--^-%'
UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL - 1.� ISSUANCE DATE
MECHANICAL - - ELECT PLG MECH.
.. QtC .. ❑ r ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED auR_DING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $IFT,
� -� - � -
MECHANICAL
ELECTRICAL - 'PERMIT TO
E FRAMING
INSULATION
STORIES TYPE CONSTR,
' - � � � - ,
OCC,GROUP RES UNITS
' _?fr
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.ET.F LOOP A R E A TOTAL ACREAGE
- ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -
BUILDING USE
ROOF SHEATHING - RES IND CON PB Oma,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALSDATE INSP. ❑ ❑ ❑ 11 ❑
ASSESSORS PARCEL NO,
ROUGH SAN.#
PLUMBING - ELECT.ENERGY
TRACT NO. y PARCEL NO
TUBS B SHOWER.PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ACC.OATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY '
FRAMING - ELECT.FINAL TEST
ZONING ENG,SITE NO. f
INSULATION PLUMBING-
, GAS TEST - - GAS
MECHANICAL FIRE SPRINK ENERGY T-14
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '' IY ❑ N❑ Y 0. NEI -
' .EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE A.L a c
.- INTERIOR SHEAR - FIRE DEPT.
❑ N❑ Y ❑ . NO
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. OCCUPANCY sElsMlc FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ARRANGE
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! covsT.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
IL BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER -
�°IhDI
OOR ES D I
c " _ � UILDING—ELECTRICAL—PLUMBING—MECHANICAL 15546
NAME
NE S , PLAN CHECK VALIDATION
D ELECTRIC PERMIT FEE
Q PHONE O D
NAVEOQNTRAcroRs p OUTLETS-SWITCHES-RECEP 10.00/1,00 S�
O P V kT1eC_LnC NO. r7y'4j LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4,00
ADDRESS
LO PHON - ' -G PANELS DATE OF APPLICATION
ARRCHITET - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE" P.C.NO.
O
ENGINEER
uc.NO SIGNS TRANS. 3.00
moo Ess ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
APPuCANT's
zIP rrEMP.METER OR POLE INS. 20.00 ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
''o 0 LICENSED CONTRACTORS DECLARATION (P III ftz KV LP L/ S t5
a v 1 hereby affirm that 1 am licensed un der•provisions of Chapter 9 ISSUANCE DATE
G w Ironvnencing with Secli n 7000)of Division 3 ol'the Business and BLDG. ELECT. PLG. MECH.
H w Professions Code d m In�Icense is in full for fl T' ❑ ❑ ❑
z O m- License lass es -(Z Lic.Number r -
ow r w UWe_ "{ Contractor
BUIL NG PERMIT
Ix w< OWNER-BUILDF-R.DECLARATION
w3: LL N 1 hereby affirm that I am exempt from tire Contractor's License MISC.— REFER T D INFORMATION
u0< Law for the followingrcasoa(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION SIFT.
� - -' Code:Any city or county which requires a permit to construct,alter,
rt ¢c o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELECD•
DLL requires the applicant for such fern t to file a signed smleuent that IOTA
u w $ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO -
H z Law(Chapter 9(commenciagwitt Section 7000)Df Division3ofthe
4 4 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
T E. S the basis for the alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR.
A , by any applicant for a permitsubjects the applicant to a civil penalty gLTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner,of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 400
their sole compensation,will do the work,and the structure is not . OCC.GROUP RES.UNITS
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 in owner of
property who builds Or Improves thereon,and who does Such Work FIXTURES-PER TRAP 5,00 SD.FT.FLOOR AREA TOTALACREAGE
himself through his own employees,provided that such improve- '
me impurere nm intended or offered for If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
w
or improvement is sold within oneeyear or of completion,the owner- GAS EASYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that h - .e did not build or ire- BUILDING USE
prove for purpose ofsate.). INDUSTRIALWASTE IN ER. 30.00 RES IND CON PB other
❑ L as owner of the property,amexclusivelyproject
See.contracting4 , u with 0 0 0
licensed contractors: construct Conmltie project La 7044,Business LAWN SPRINKLERS-1 INC5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply -
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 6 (EA.) 1.00
cnm tenets for such projects with a conlmctor(s)licensed pursuant to
the Co a,exempt under
Law. SEWER-SANITARY-STORM EA.200f[/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&1'.C.for this
fea]'On WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK E RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I 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.
"0 copy thereof(See.3800,Lab.C.
Policy No. Cnnhpmy Le c N!]C A;
O Certified ropy is hereby fun.ihed C `/70 .79 FIRE SPRINK ENERGY T-24
Z 2 CertiO npy is Ble�j q th t cty nspeetion d eaom.
O Atplicant. -lL�l-( ]"! _M/r-' MISC- REFER TO ORD. YC] NE] YC] No
ir y CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE - A.LU.C.
LU �: COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
Z hundred dollars(SI00)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL l- Init is issued, I shall not employ any person in any manner m ns In
O ) become subject hh the Workers'Compensat ion Laws of California.
y Date—Applicant ALTER OR ADD TO MECH. 500 BUILDING
>_ m NOTICE TO APPLICANT. If,after making Alis Cerlil'ic-m of lix-
.
♦— Z emotion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U Itch provisions or this permit shall be deemed revoked: AIR HANDLING UNIT(TO 10900C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10ACC.F.M.) 6.00 SEISMIC FEE'
I hereby affirm.that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) , 5;00
the perl'annance of the wohi
rk for which this permit is issued(See. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
Lender's Name HEATING UNIT 100,000 B.T.U.)9,50
Lender's Address ELECTRIC
I certify that i have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and hate lows-relating to building construe lion, and BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives for ins ec this city to .mer upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL'
above-mentioned property tativ inspection H puiposca.
(We) -gree to save, indemnify and keep:hnrmlesa the City of MISC.- REFER TO ORD. - -
nperlino against liabilities,judgments, costsand ex pens..which' CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
rant this permit MECH.CONT. LIC.NO. MECH.
D C� „/3• TOTAL TOTAL
Signatu of plean/Contractor Date
OFFICE COPY