14362 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF. CUPERTINO 14352
INSPECTION DIVISION .
JOB INSPECTION RECORD
• PERMIT EXPIRATION
Y10295 SCENIC BLVD.
JOB ADDRESS UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER Dorothy Pa O CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS.OF PERMIT ISS6.
FOUNDATION ANCE OR 180-DAYS FROM
LIFER ALL GRADINGAND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGESLABS
n
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING'
ELECTRICAL 4,,AUANCE DATE
MECHANICAL .:CT. PLC. MecR
ut9 . Ll O ❑ ' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR . INFORMATION
VALUATION $jFT.
• PLUMBING - � � � -
MECHANICAL _
ELECTRICALPERMIT IU u -
FRAMING
INSULATION - STORIES TYPE CONSTR.
T
OCC.GNOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - a
sO.Fi,FLOOR nR[A TOTAL ACREAfE
ROOF NOTE:NO FINALN T IS H BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILOI USE
ROOF SHEATHING Res IND CON
PR oinr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE- INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.q .111:SSORS PARCEL No
,•
PLUMBING ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS 8 SHOWER PAN - - PLUMBING ENERGY -MECHANICAL ' MECH.ENERGY
ELECTRICAL y, BUILDING ENERGY ACC oarE ACC FILE No
FRAMING ELECT.FINAL TEST iy2_ ak ZONING ENC,SITE NO.
INSULATION - 'jam PLUMBING
GAS TEST GAS
' MECHANICAL - FIRE SPRRNK ENERGY TQa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING )1 El "❑ N[]
' • EXTERIOR SHEAR ELECTRICAL'RELEASE FLOOD ZONE A.L.UC.�
. N❑
• INTERIOR SHEAR - FIRE DEPT. Y ❑ N❑ Yl❑
SHEETROCK GRADE - FEE SUMMARY
- EXTERIOR LATH — BUILDING - ,,$ , y
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUIL DING ISNOTPEfi M ITTEDUNTILBUILDI NG FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC,
Iw—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
ZMECHANICAL
—'SEE PERMIT FOR EXPIRATION DATE--
IMPORTANT! CONST.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. f
OFFICE COPY"
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.BU LDING PROJECT IDENTIFICATION ,PERMIT NUMBER-
aunolNG APPLICATION & PERMIT C j�
ADORES o G
J BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATION
I RacroRs L') TV.
ELECTRIC PERMIT FEE
PHONE rn
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
LIG.NO. LIGHTING FIXTURES 10.00/1.00 -
CNTADDRESS
CONTRACTOR - APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
Rcflrtscr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
O
Not
uc.NO SIGNS TRANS. 3.00
EOR
ENG' SPECIAL CIRCUIT $,QQ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 q
ADDRPLIESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 /��/
w02 LICENSED CONTRACTORS DECLARATION (/ d
a u (commencing
hereby affirm that I am licensedng wSection under provisions of Chapter 9ness an
JTSUANCE DATE
% ( iith Sti7000)of Division 3 of the Business rn ¢ y B GFS CT. PLG. MEDIA.
r D z Professions Code,and my license is in full farce and effect. ` El
2 O wo License Class Lia Number
o Z - � Date Contractor (G -
a y 5 =a C " ING PERMIT
re ¢ W. OWNER-BUILDER DECLARATION C
F
;a H I hereby affirm thut I am exempt from the Contractors License MISC.- REFER TO ORD INFORMATION
F u o to Law for the following reason.(Sec.7031.5,Bminessand Professions PERMIT ISSUANCE 10.00 VALUATION
Code Any city or county which requiresa permit to construct fter, Q /a ✓1
R ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. " ELEC.
Ix requires the applicant for such permit to file a signed statement that TOTAL t�
a W m LL he is licensed perm ont to the provisions of the Contractor's License j1PER-MMIIT TO
Law(Chapter 9lcommuncing with Scclinn]OOOI a(Ilivision3 nl'the ��)Y7, 's/
2 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
m
by any applicant for a permit subjects the applicant on civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars 135001.):
❑ 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 cd INred for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:1'he Contractor's License Law dues not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re But
intended
his own employers,provided that such improve-
ahents moose in is sold or within
onefor
year o((,however,the the ower- GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one your of completion the owner- GAS-EA,SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving titre he did not builA ur Ire- - BUILDING USE
prove
for purpose of the.j. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
O d as owner of the property,he exclusively contracting 044,Business with El EJ
licensed contractors : I ie Cont the project(Sec. times ofply LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code','the Contractor','s License Low docs not apply
to tr owner ouch projects
who hands t r improves thereon and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ l um'uxenhpt no,Sec. ,B.&I'.C.for this WATER HEATER W/VENT 6.00
reason
Owner_ wORKERs'C A IiN ATI DECLADate WATER SYSTEM 5,00 PCC.DATE ACO FILE NO.
RATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have u certificate of consent to self-insure,
or a certificate of Workers'Compensalion hlia rance,or a Certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y❑ IN Y ❑ N
~ w - PERMIT ISSUANCE 10.00
- CIiRTI1tlCATli OE EXEMPTION FROM WORKERS' PERMIT ZONE A.L.u.C.-
L COhIPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL.2 (This section need not be completed if the permit is for one TOTAL Y N Y N�
hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
L F mit is issued, I shall not employ any person in any n unser so as to
U become subject to the Workers'Compensation Laws of California.
0. late Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �Q
} N N TICK
TO APPLICANT: 1f,after ,taking this Certificate of Ex-
F ? emptinn,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
CJ such C
provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000 F.M.) 4.00
CONSTR UCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 70
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 N issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 �,0
LCnJcr's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct. 1 agree tog to b with all city and county, and PLUMBING
information
and stole laws relating In building construction, and BOILER-CCJMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP Over 100,000 BTU(SEE FEE SCH. MECHANICAL
(we) agree to nave, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino aganist 'abilities,judgments, costs xpenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any ccrue against said C' con quence o the
ranting of rtnIL MECH.CONT. LIC.NO. MECH.
r TOTAL TOTAL O / 2 0
Sun re of App ca Contr o Date
OFFICE COPY