17504 (2) o
POST THIS CAR D.NEAR FRONT OF BUILIN
DG
PERMI� UMBER
704
- CITY OF CUPERTINO ••
INSPECTION DIVISION -
JOBINSPECTION RECORD
40 • - - r••}}`` PERMIT.EXPIRAT.ION
( a� FfS SC- .ul c ��@ UNIT# LOT# (/Ci x /
JOB ADDRESS—/ T -
�j PERMIT EXPIRE$ IF WORK
OWNER. .0 t"Ow W CONTRACTOR CQ JA "IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ NOTE: ANCE OR .180 DAYS FROM
,LIFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED — (. 1505
UNDERGROUND /SLAB 1 . -
PLUMBING - yJ fi`
- ELECTRICAL - j1-?� f`� I` tA0t-C.lt
ISSUANCE DATE
MECHANICAL city Of ftato BLDG ELECT I PLG, MTCH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATIC I' SIFT..
� Q• V
MECHANICAL.
ELECTRICAL TTO'/•a /1
FRAMING - (I A( -vy o/
'INSULATION • - , STORIESTYPE CONETR.
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'ROOFSO.IT FL OR AIILA TOTALACRf AGE
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOFSHEATHING
BUILDING USE
- RES wO CON PB o.o.•,;
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.p ASSESSORS PARCEL NO
' -
PLUMBING - ELECT.ENERGY
TUBS 8 SHOWER PAN
TRACT NO PARCELING
� PLUMBING ENERGY � '
MECHANICAL MECH.ENERGY -
ELECTRICAL' ACC.DATE ACC.FILE NO•
BUILDING ENERGY
FRAMING ELECT.FINAL TEST
zo"
INSULATION PLUMBINGZONING ENG.SITE No.
GAS TEST. GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' Y❑ ^❑ ° ❑ "D
EXTERIOR SHEAR - E LECTR ICA L RELEASE '* FLrloDz.NE AL.U.C.
1NTERIOR SHEAR FIRE DEPT. YI N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APP. O ALS ILDING
SCRATCH COAT ELECTRIC PLAN CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY _ S IC EE'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUI LOING FINAL IS SIGNED BY BUI LDING 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
IMPORTANT! CONST.TAX '
PLEASE READ REVERSE SIDE BEFORE TOTAL � u
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PER qT NUMBE9
a"I1aINc.. APPLICATION & PERMIT
Aoo YEss / 4
t J- SCE /C L3LV0 BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 750
A
OWNER'5 ^ p/ PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT FEE I�
N Y+r✓,/ PHONE ZZ
CONTRACTOR'S /
NAME OUTLETSSWITCHES 10.00/1.00
'tea - 0
2 �nV`✓�,No / LIGHTING FIXTURES 10.00/1.00 I�, �v r
AD
ADDRESS RRAcroR's z e. - APPLIANCES-RESIDENTIAL 4.00
,�(
7� (544AOoli PHONE 72-Z PANELS 10.00 . DATE OF APPLICATION
OR
ARCHITECT , - PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
ENGINEERn -
//`� uc.rvD.' OC SIGNS TRANS. 3.00
ADDRESSis
ENG, q q SPECIAL CIRGl1IT 5,D0 PERMIT VALIDATION
20 S�v Cr xIP! of EMP.METER OR POLE INS. 20.00 t7,
APPLICANT'S MOTORS' SEE FEE SCH. 1 -� t
ADDRESS
f �fii-I L� SERVICE CHANGE 20.00 -
F C o. LICENSED CONTRACTORS DECLARATION 0
< U w �4 1 hereby affirm Thal I am licensed under provisions of Chapter 9 - nRR� NJ ISSUANCE.DATE
Nz (consmencin with Section 7000)of Division 3 of the Business and
a c K BLDG. ELECT. G. MECH.
H w z Professions Cndeem�d my license:is in lull force a
Z o m License Class-t/ Lic.Num C�tY pUQB
C, 2 r w Date Contractor V
P: r2 -1 BUILDING PERMIT
= m M a OWNER-BUILDER DECLA /m N
A 0 w o INFORMATION
X ;u y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
H u O J Law for the following reason.(Sec.7031.5,Ruslnessand Professions PERMIT ISSUANCE 10.00 VALUATION �Q $/FT.
mv, mit F Code:Any city or county which requires a Perto construct,alter, q 0
Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
D 0: req hires the applicant for finch permit to file a sighed statement that TOTAL P T TO
w he is licensed pursuant to the provisions of the Contractor's License
F z a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Ifusloess and Professions Code)or that he is exempt Iheref om and OTY. PLUMBING PERMIT FEE L
w $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
n3 � by any applicant far a permit subjects the applicant lou civil penally ALTER-DRAIN -WATER IEA.) 5,00
of not more than five hundred dollars($500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 oec.GROUP REB.UNITS
Rich sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law does not apply to ua owner of
,314 - property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 7;T.PLOOZAREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- /I
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner.
t builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) .2.00 BUILDING USE
' -
Prove for purpose of sale J. RES IND CON PB OmerINDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
O d as owner of the property,am exclusively contracting with
licensed contractors to ce Comct,the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
to Professions Code The Con tremors License Law docs not apply
to owner of property who builds improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
hCont WE -SANITARY-STORM EA.2
for such projects with a contractor(s)licensed pursuant to
the
Contracts
SEWER-SANITARY-STORM tContractor's LICCn$C Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B,&1'.C.for this WATER HEATER W/VENT 6.00
rea5011
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent m self-insure, ZONING or a certificate of Workers'Compmce
Compensation lnsun ,or a certified ENG.SITE NO.
copy thereof(Sec.3800.Lab.C.). pp
Policy No. CompanY_aed-l"
O ❑ Certified copy is hereby l urnished. FIRE SPRINK ENERGY T-24
Z 2 kCert�i�'+d''�L/�y�Jis F,!;#whit the city inspection division.
FO Apphcam MISC.- REFER TO ORD.
✓ ' ( Y ❑ N❑ Y ❑ N❑
h CERTIFICA'I'EOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.0U1 FLOOD ZONE - A.L.UX.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
O (Phis section need not he completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
2 hundred dollars IS 100)nr less
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I Shull not employ any person in any manner sa as to
O W bcconw subject to the Workers Compensation Lnws of Calitbr1".. M
y Dale Applicant BUILDING
�. to NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH.
r Z caption,you Should become subject to the Workers'Cmnpeasalion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE r-
U such provisions or this permit shall he deet....revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE rIP3
1-hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the ork for which this permit is issued(Sec. MICROFILM
3097,Civ.C.1. e�Q/ HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19.50
Lenders Address - ELECTRIC
I certify that I have read Misapplication tion and smte flat the above VENTILATION FAN (SINGLE) 4.00
ordinances n correct. I agree to comply with u11 city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and slate laws relating In building construction, and
f
hereby authorize representatives for ins c f this city to enterVW upon the BOILER-OOMP (Over 100.000 BTU)SEE FEE SCH.
above-Inentinncd property for irepeclmn purposes. MECHANICAL
(We) agree to save, indemnify and keep harmless rhe City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
any in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
anti this permit Of
-- J-Z9--Q`9 MECH.CONT. ' LIC.NO. MECH. /'��
TOTAL TOTAL l U C1I&SS
SS are of Ap onmtlContractor
Dan,
OFFICE COPY