11572 (2) „APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY.
BU I LDING PROJECT I DENT F ICATION - $AL
RM IT NUMBER
no l LmaG APPLICATION &,PERMIT
AD�E 11572,
CRPr[( 61 BUILDING-ELECTRICAL-PLUMBING-MECH
OWNER'S - HECK VALIDATION
lit NAME
C EnrRa[, F1 it e PR 45! Sinn p1r TV. ELECTRIC PERMIT
PHONE J
CONTNRCTOR'S
NAME SIDE C14 Z/STS 'in UTLETS-SWITCHES-RECEP 10.0011,00
R Fvo.0 eU 2161' LIc.No. Q LIGHTING FIXTURES 10.00/1.00CONTRACTOR'SADDRESS //1ryy(. Lter• �'�MA,�'LL P�V-2.. APPLIANCES-RESIDENTIAL 4.00
Q.717/0,9£, GQp Flibn 76! L') PANELS 10.00OF APPLICATIONORCHrc[cT PANELS (OVER 200 AMP) 20.00K FEE P.C.NO.
OR ENGINEER uc.No. SIGNS TRANS. 3.00ARCH.OR ENG. - SPECIAL CIRCUIT 5.00IT VALIDATION
ADORESsZIP EMP.METER OR POLE INS. 20.00
ADDRESNrs MOTORS - SEE FEE SCH.
SERVICE CHANGE 20.00
0 0 0 LICENSED CON'I'RACfOR$DECLARATION
III/emby affirm that 1 am licensed under provisions Of Cbapter 9 CE DATE
vHi< i (commencing with Section 7000)of Division 3 of the Business and B PLG. H.
H n mfessi ins Code, my license is in full fort aryryd fel. ❑
,e o m- License la Lno Number sLL`� ❑
9 y- Date Contractor_
r
¢ ¢ wa OWNER-BUILDER DECLARATION ! NG PERMIT
ca MISC.- REFER TO ORD y O INFORMATION
X ;u H I hereby affirm that I am exempt from the Comracior's License
u. 0 ¢ Law for.the following reason!(Sec.7031.5,Business and Professions VALUATION $/FT.
PERMIT ISSUANCE 10.00 ���.�
� W0+ � Codei Any city orcounty whichmElairesapermitloconstrucl,alter, '
in Q Q p Improve,demolish,or repair any structure,Frio,to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
Fu,es he is licensed pursuant to the provisions of the Contractor's License
rii
.POST THIS CARD''NEAR FRONT OF BUILDING
PFRMIT NUN19EN
''.CITY' OF CUPERTINO, 11572
--
INSPECTION DIVISION
JOB INSPECTION RECORD
•� c' .. PERMIT EXPIRATION
JOB ADDRESS �Ei U4✓ehaSCYCZK ' UNIT# LOT#-
, PERMIT EXPIRES IF WORK
OWNER �r�'q IA, I G. » -CONTRACTOR S' ST, -Is NOT STARTED WITHIN `
INSPECTION, DATE INSPECTOR INSPE .ION RECO 18oDAYS OFPERMITISSU-
FOUNDATION
ow?J(:. ih^ '�ANCE OR 180 DAYS FROM ,
- f'-IZ>� LAST CALLED INSPECTION.
.I LIFER - .+ ..
PREGUNITEPERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - Yi
r
UNDERGROUND /'SLAB
PLUMBING
LU G
•. ELECTRICAL '` � � � � � � issunrvcE DATE
MECHANICAL MECH.ELEC .
� - �' ' '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
.. WOOD FLOOR VALUATION s/FT.
'PLUMBING - '.' ,� --
MECHANICAL -
ELECTRICAL
FRAMING
INSULATION '� STORIES - TYPE CONSTR.
.. -
OCC.GROUP, RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF r SOIFT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM • - '
_ BUILDING USE
RES - INDCON PB 00,n,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ �'"
l I • ' .,ASSESSORS PARCEL NO
ROUGH
.
` GAS TEST , TRACT NO. PARCEL NO.
MECHANICAL » '
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS 'DATE INSP. ,
I FRAMING' SAN # - zomwc ENG.SITE No.
S INSULATION PLUMBING
GAS
' FIRE SPRINK .'ENERGY TQC
MECHANICAL.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ r N❑ E] N❑
I LATH—INTERIOR I i 'p, ELECTRICAL FLOOD zorvE - A.L.U,C.
I
LATH—EXTERIOR FIRE DEPT. Y N� Y 0 N� a
-' SHEETROCK GRADE.' - FEE SUMMARY
SHEARINTERI ORr - BUILDING
Ir SHEAR EXTERIOR TEMPORARY APPROVALS -86ILDING r —
,1-""°'FIREWALLS `1 „ ELECTRIC PLAN CHECK
GAS .FEE ' -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' ISEISMIC FEE
OCCUPANCY OF'BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ,MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252.4505,
ELECTRIC
H .ONE WORKINGDAY BEFORE.REQUIRED'INSPECTION, PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING..
— SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
";' - OFFICECOPV - - —