15943 (2) POST THIS CARD•NEAR FRONT OF BUILDING , ' : "PERM1,ITNUMaER'
CITY OF: 'C,UPERTINO . ,
• 15943
' .INSPECTION,DIVISION• q,r
JOB INSPECTION RECORD
PERMIT EXPIRATION
' JOB ADDRESS �vl `""'" UNI T# _LOT#.
PERMIT EXPIRES IF WORK
CONTRACTOR - ,IS NOT STARTED WITHIN r
.. INSPECTION DATE INSPECTOR' INSPECTION RECORD leo:DAYS oFPeRMlrlssu-
_ ANCE OR 180 DAYS FROM
FOUNDATION - NOTE: l-',
- LASTCALLED INSPECTION: '
' UFER . '` - ALL GRADING'AND DRAINAGE SHALL BE',INSTALLED,
4, PREGUNITE - ' • TO COMPLY WITH,THE APPROVED PLANS'AND CIN OF PI,HoIT,VA U DAT ON
CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'BAUD
, ,UNDERGROUND /SL ' I'7,. •�+- I->Ili'4'..J�'•-'� •Y
PLUMBING _ _ _. A Ll 0
ELECTRICAL - �, . ISSUANCE DATE '
:. .,� 111 3 ELIcr PLG
MECHANICAL •mecR„�
CIty;Of Cupertin) 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED euaomc PERMIT
INFORMATION
.WOOD FLOG R' - VALUATION s+F.T.
PLUMBING . �-7 }
MECHANICAL . � l
PENM1IIT TO A
• ELECTRICAL - •• q. - ;
:•1 .FRAMING ry t. •.�.f�L�i'q
'INSULATION - STORIES TYPE CONSTR.
OCC.GROUPRFS.UNITS '
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.IT.aoox AREA TorAL ACREAGE
DIAPHRAGM• THE CONSTRUCTION'TAX IS PAID
BUILDING,USE
ROOF-SHEATHING • RES' 'IND CON PB 0",” 1
APPLY-,NO ROOFING UNTIL ABOVE.HAS BEEN SIGNED FINALS DATE -INSP. ❑ 0 0 D E —
'ASSESSORS PARCPI O.
ROUGH sAN,k
' PLUMBING ELECT.ENERGY- '
TUBS B SHOWER PANPLUMBING ENERGY - TRACTNo, PARCEL NO.
MECHANICAL. MECH.ENERGY. O Acc.GATE ACC.PILe NO.
ELECTRICAL••' - BUILDING'ENER -
FRAMING `. ' „ ELECT.FINAL TEST �'
ZONING ENO.SITE NO. `
.INSULATION' - PLUMBING
GAS TEST - GAS .. '
. FIRE SP RINK ENERGY T24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v "�. _ ` NO
" EXTERIOR-SHEAR,`, ELECTRICAL RELEASE • P,.00O z0NF A.1.LC.
r INTERIOR SHEAR' - FIRE DEPT. vQ• NE v ❑ N❑
.. - SHEETROCK'�, - . GRADE FEESUMMARY
EXTERIOR LATH," BUILDING
'• INTERIOR LATH - - :TEMPORARY APPROVALS - BUILDING A
SCRATCH COAT ELECTRIC PLAN CHECK,
-
FEE
GAS "
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY
r-- ' sElsMlc FEE 'I-b
• OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC
ONE,WORKING DAY'BEFORE:REQUIRED INSPECTION:: ''PwnnB,i11
0 PLEASE GIVE JOB ADDRESS WHEN PHONING. +.•
�r Z '. .MECHANICAL .
- SEE PERMIT FOR EXPIRATION DATE
coNST.TAX
IMPORTANT! , -
x rr
PLEASE READ REVIERSE SIDE BEFbRIE31
CALLING.FOR FINAL-INSPECTION: 14 TOTAL , l
„ OFFICE COPY«
r
APPLICANT TO FILL.IN INFORMATION WITHIN RED LINES -'USE,BALL'POINT PEN ONLY
_ BUILDING PROJECT IDENTIFICATION - '� ,
'PERMIT NUMBER' "'
BUILDING APPLICATION & PERMIT , (�
ADDRESS 1
�12�SBUILDING-ELECTRICAL-PLUMBING_MECHANICAL '' 1 9
D( ZoS�d ljk E �Q
OWNER'S 43
PLAN CHECK VALIDATION
(y/ NAM , ELECTRIC ' FEE ��'ttt Y
L V/'1�� / ,✓1-D"l/�VNE OTY
�SS'rZS i -PERMIT � �y •
CONTRACTOR'S
NAME OUTLETS'-SWITCHES=RECEP :10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
ADDRESSTofls PPLIANCES-RESIDENTIAL -" 4.00 -
PHONE PANELS 10.00 DATE OF APPLICATION' r
ARCHITECT - PLAN CHECK FEE P,C.NO.
on " PANELS (OVER 200 AMP), 20.00
ENGINEER
uc.No,. ,SIGNS TRANS. - 3.00ARCH OR '
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS: 20.00
- APPLICANT'S y
Roofless MOTORS SEE FEE SC /y�. II
^, ••{ SERVICE-CHANGE 20.00 IT. ' `��"' LM- 1'
woo LICENSED CONTRACTORS DECLARATION w. - AUGB
I.,u' i 1 thereby affil , Hot( um licens•Ld under pnrvisionx lif ChuPtor9 _ - Ib6u ANCE GATE
H G H (commencing with d my l 700e i in Division 3 of the Business u0d cityDG. ELECT. PLG. MECH.
r D z ff
I'rrfessions Code,and my license is in full force and effect , Upe 1:1
❑ ❑
Z o H - License Class Lic.Num her
'O m r w [)ate Contractor
Q a, j - • `
-¢ ¢ w.a OWNER-BUILDER DECLARATION - . BUILDING PERMIT
''D a " ' MISC.- REFER TO ORD '.. INFORMATION -
x ; r I hereby affumdhal I am exempt from the ConUuclor's License -
-w M VALUATION SIFT.
LLoa Lowforthefollowingreason.(Sec.7iresa permit
tocndprofessions 10.00
r - PERMIT.ISSUANCE �•
Code:Any city or county which requitese permit tots sSlrS aaeq
orw,04 ' ELEC. LIC. '^ 4OVOr
Iia ¢ O improve,demolish;'or repair any structure,prior to its issuance,also ELEG 1
or m LL requires the applicant for such permit to file asigned statement that TOTAL
u w he is licensed pursuant to the provisions of the Contractor's License - PERMIT TO
F a a
Law(Chapter 9(commencing with Section 7000)of Division 361 the - - _ `
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
X I_o the basis for the alleged exemption.Any violation of$ection 7031.5 + } STORIES TYPE CONSTR.
ani by any applicant for a Permit subjects theuppli,ant to a civil penalty, ,u ALTER-DRAIN -WATER (EA.) 5.00
-
of not more(into file hundred dollars($500).)i
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. - 4.00 OCC.GROUP RES.
their sole compensation,will do Ilse work,and t . urvlTS the structure is no _
intended or offered for sale (Sec. 7044, Business and Profession, DRAINS-FLOOR,ROOF,AREA,COND. .5.00 -
Code:The Contractor's License Law does not apply to on owner of
properly who builds or improves,therenn,and who does such work + FIXTURES-PER TRAP .'• 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own enlployees,provided'that such improve-
mentsarenotintendedorofferedforsmo.If,however,the building � GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,.the owner- -
builder will have the burden of proving that lie not build or int- �' GAS-EA.SYSTEM-,OVER 4'(EA.) f 2.00 BUILDING USE -
proveFor purpose al'suleJ. ti ". INDUSTRIALWASTE INTER. . 130.00 RES' IND CON PR - omer
❑' I,as owner of the property,am uxelusively contracting with I - - .0 El Q ❑ Q
licensed contractors to construct the Burnett(Sec.7044:Business LAWN SPRINKLERS-1 INC 5 V.B. - 6.00 ASSESSORS PARCEL N0.
and Professions Code:'I'lie Contractor's License Low does not apply -
to an owner of properly who builds or improves thereon.and who ' LAWN SPRINKLERS-OVER 5'(EA.)' ,1.00
contracts for such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.t
[lie Contractor's License Law. - 200tt/10.00 TRACT NO. PARCEL NO.
❑ I hm exel tt undo Sec. - ,B.&P.C.for this WATER HEATER W/VENT -.6.00
reason
Owner One . WATER SYSTEM _ '5.00
s ACC.GATE. " ACC.FILE N0.
\VORKIiR$'COA1PIi NSATION DECLARATION i WATER TREATING EQUIP.. - 5.00
I hereby n0inn that I have a mlificfe'itf consent to self-insure,.
or a certificate of Workers'Compensation Insurance,or a certified 't ZONING ENG.SITE N0. -
copy thereof(Sec.3800,Lab.C.). `
Policy Nn. Company - _
-0 ❑, Certified copy is hereby Itotaled. '"N. if
z Z ❑ Codified copy it filed with the city inspeclion division. ' FIRESPRINK ENERGY T-24 '
^ F O Applicant - MISC.- - REFER TO'ORD. Y ❑ IN[] . Y [] N. I EJ �
CERTIFICATE OI°I-XEh1PTION-FROM WO RKERS' - PERMIT ISSUANCE - ` 10.00 FLOOD ZONE A.L.u.C.
LU
COMPENSATION INSURANCEPLG.CONTR.
CL 0 (This section need not he compleled,if the terror is for one SDTAL Y 0 No VE] No
O hundred Aollars 18100)or less.l ? ' , - - -
I eenify that in tum performance of the work for which This per QTY. MECHANICAL PERMIT' FEE FEE SUMMARY
IL F mit is issued, I shall not employ any person in any manner so as to
hni
ecoe subject to""the Workers'Compausntion Laws
O W of California
n Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
` } N NOTICE'10 APPLICAN r: If,after making this Certificate of . - _
-�. 2 corption,you should become subject to the Workers Contpunsal ion APPLIANCE _ 5,00 '' PLAN CHECK
provisions of the Labor Code, yet,must forthwith comply with - - FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 110=110M.) -4.00
CONSTRUCTION LENDINGAGENCY AIR HANDLING UNIT(OVER'10DWC.F.M:) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the purforrnI of the..,it fur which this permit is issued(Sec. - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.)'• 8:00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address- ,ELECTRIC ,
I certify that l rase read Clots application and Stale that the aIRwe VENTILATION FAN (SINGLE) , 4.00 -
ino nrtatlon Is correct. I agree to comp ly with.'all city and county PLUMBING' ,
ordinances and state laws relating to buildingonsrr�tion, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 '-
hereby actlomwe rtpresentatives of Hit, city to enterupon the BOILER-COMP(Over 100,000BTU)SE E FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) -ERIC to save, rude nmify and keep harmless the;Clty of ,MISC.- REFER TO ORD:
Cupertino against liabilities,judgmenls, costs:Ind expenses which PERMIT ISSUANCE 10.00" CONST.TAX •`
may in w' accrue again sat alt of true
rami d per
MECH.CONT. , LIC.N0. MECH:.
JX fII� !r ! 51 S3
TOTAL
TOTAL LP� 5a
Signature of Applicant/Conlrador Date u
OFFICE COPY