18609 (2) POST THIS CARD NEAR FRONT OF BULLDING
PERWTNUNIOER
CITY ' 0F gPE,RTI_N0' , 16609
INSPECTION.DIVISION
JOB INSPECTION RECORD '
t T ' + • kE�ITI iqXPI RATION,
.IOe ADDRESS
, �Gnr� .° - I�-'� •' UNIT# _LOT# _ �('�f,J
....v+ e•.° /{� /� i :6'_ ".• (rE RM1'�YrIRES IF WORK
OWNER,/'/��' CONTRACTOR ' Ton` 11..Gras •"�' COAs •. S• Nb ARTED WITHIN ,
INSPECTION DATE INSPECTORS - .' INSPECTION RECORD t80 DnvsoF aERMrc lssu "
Fp. , ANCE'OR 180•DAYS FROM
OUNDATION 'NOTE: '
LIFER. ' - ALL•GRADING AND DRAINAGE SHALL BE`INSTALLED
PR EGUNITE LAS �A Llr�p INSPECTION.
TO COMPLY WITHTHEAPPROVED PLANS AND CITY OF TT PERrn�IT.•••VALID n• nfIN
'T ' - ' ,
CUPERTINO STANDARDS.
. . . GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED' MW
"UNDERGROUND /SLAB �• 1 ` fI L S L .I
,}.. . PLUMBING
+
ELECTRICAL "' " - ISSUANCE DATE .
MECHANICAL"
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 4 tc-7- 'QLJJ'r '."('J/t -e + - BUILDING, MIT
• " WOOD•FLOOR - - r. ,INFO RMA ION
:
PLUMBING
' v VALUATION .SIFT.
• MECHANICAL /26r i?'{!cr-rC Pf' '
• `
ELECTRICAL AIY:eTd
FRAMING
' " .• t I f/ .• - ((v'-
1 .
TYPE CONSTR.
INSULATIONIT
OCC.:GROUP
- RES UNITS
} PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT,FLOUR AREA TOTAL ACRI:AGI''.
T
ROOF ' NOTE:'NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - - THE CONSTRUCTION.TAX IS PAID - -
` '`• BUILDING USE
ROOF SHEATHING " RE IND CON PU O"j"
—APPLY NO ROOFING UNTIL ABOVE'HAS BEEN SIGNED ,•FINALS-- - - DATE'— INSP., � El�' El ED ❑ '
'ROUGH
ASSESSORS PADCE L NO
.. SAN'.#. ,
" PLUMBING ELECT.ENERGY' -
• TUBS B SHOWER PAN PLUMBING ENERGY _ rano No. .PARCEL NO.
MECHANICAL, " • .MECH:ENERGY '
ELECTRICAL .ACC.DATE ACC,FILE NO,
• •/- BUILDING ENERGY' .
'FRAMING ' ' •ELECT:FINAL TEST ZONING ENG.SITE NO.
INSULATION d., PLUMBING , '
i.'•. .GAS TEST - GAS '
MECHANICAL FOIE SPRINK ENERGY T2
COVER NO WORK•UNTILABOVE HAS BEEN SIGNED HEATING' '' Y NE] Y F] N�
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOODmNE A.1-U,C.
' ,Y�' Nn YL, NEj
.
INTERIOR SHEAR' FIREDEPT . '
SHEETROCK GRADE _ FEE SUMMARY
EXTERIOR LATH BUILDING - 'BUILDING
INTERIOR LATH - _ ', TEMPORARY APPROVALS
.SCRATCH COAT ELECTRIC ' PLAN CHECK' 7(/.�
GAS . FEE i\ -' / f 4
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUP•ANCV SEISM�C'F
OCCUPANCY,OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING~INSPECTOR. M�Cr• .
uj ARRANGE FOR INSP_ECTION'.BY PHONING' 252`4505 ' Le TRIC, l • M1 ~
ONE WORKING DA-Y BEFORE REQUIRED INSPECTION 2 AABING .
z • f PLEASE GIVE JOB ADDRESS`WHEN PHONING
-.SEE PERMIT. FOR EXPFRAT(O,N DATE MgcHAwcA
CONST.TAX
. , .. ,
IMPORTANT!
PLEASE READ,REVERSE SIDE BEFORE, , TOTAL , 1 ,
CALLING FOR FINAL INSPECTION. q y
OFFICE COPY
AP.PLICANT'TO.FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT-PEN ONLPERM ITNUMBER -
BUILDING Y
-
BUI LDI NG PROJECT IDENTIFICATION APPLICATION & PERMIT
ADDRESS
18609
`
DRE55 -
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL � i' .
�'�4alh OWNE S • PLAN`HECK VALIDATION
NAME OTY. ELECTRIC PERMIT ' ' FEE
�� 7-•� _" G
�f CPHONE
ONTRACTOR'$
rvnmE � . UTLETS-SWITCHES-RECEP 10.00/1.00
f`�-
LIC.No LIGHTING FIXTURES 10.00/1.00
ADDRESS R's - °
APPLIANCES 4.00 I 1 �'
CONTRA
PHONE ) 'PANELS - 10.00 DATE OF APPLICATION :
ARCHITECT - - -PLAN CHECK FEE • I P.C:NO.
on PANELS (OVER 200 AMP) 20.00
ENGINEER u - /
c.uo. - SIGNS TRANS. t - .3.00 GL
AARCH.08 DDRESS ENG. SPECIALCIRCUIT 5.66 - PERMIT VALIDATION
'ZIP TEMP.METER OR POLE INS. ',20.00
APPucANTS - MOTORS SEE FEE SCH. .
.
ADDRESS
��-
AMG SERVICE CHANGE 20.00
o o LICENSED CON'T'RACTORS DECLARATION 1'
a
to 1 hereby affirm that I amlicensedunder provisions of Chapter 9 - ISSUANCE DATE
% (commencing wilh Seetion'7000),of,Division 3 of the Business and In D y LO 'ELECT. P MECH.
D z Professions Code,and my license is in full force and effect ❑
o 0 m W License Class Lic.Number SEE 21
H Data * Contractor -
a x BUILDING PERMIT.
rc o i .OWNER-ROD.DCR U-CLARATION - „ ' - INFORMATION
x 3 ac I- I hereby affirm that I am exempt from the Contractor's License. MISC.— .REFER TO ORD
ce acA VALUATION $/FT.
o at Law for the following reason (Sec 70315 Busmessand Professions Z•U
PERMIT ISSUANCE 10.00
Code Any mulish(it coo repair my structure P prior
it o its issuance,
alsoter, /J�� /{�f
Q x Q
improve,AfmDI1511,Of repair any slrllClnlfi,pr10r lO IIS ISSnllnce.aISO ELEC.CONTR. LIC.ND ELEC. ` oOV I '
G¢ requires the applicant ti+r such permit to file a Signe)statement that, k: TOTAL/`� � p MIT TO
''F z i he Is lid pursuant to it,,provlsi nus of the Contractor's License: << - - l F1 e n
Law(Chapter,9(commencing with Section 7000)of Division 3 of the s
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT, FEE '
EE
o the basis far the alleged axmin plion.Any emlethin of Section 7031.5 STORIES TYPE CONSTR.
B. byanyapplicant for a permit subjects the applicant too civil penally ALTER-DRAIN -WATER IEA.) 5.00 QN
afoot more Than five hundred dollars($5001.):
❑ 1,as owner of the property,or my employees whir wages as BACK FLOW PROTECT. DEVICE 4.00 '
Their sole compensation,will do the work,and.lhe structure is not OCC.GROUP RES.UNITS
intande'd,aroffered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
` Codc:The Contractor's Licens,Law does not apply to an owner of - -
property who builds or improves thereon.and-who Tines such work FIXTURES-PER TRAP 5.00 - SG.FT FLOOR AREA TOTAL ACREAGE
himself or through his own umployces,provided that such improve-
mentsara not intended or Infrared for sale.11,however,the building. GAS-EA.SVSTEM=11NC.40UTLETS 6.00 '
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
huller will hove the burden of proving that he did not build or im- - - _ BUILDING USE
prove for purpose of sale.). - INDUSTRIALWASTE INTER. 30.00 RE IND CON .'PIt Omar
13I,as owner of the property,am exclusively contracting with ❑ ❑ 0 ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6,00 + ASSESSORS PARCEL NO.
and Professions Code:"I'lie Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00
contracts for such projects with a emoraclor(s)licensed +ursuunt to SEWER-SANITARY-STORM EA.200ft/10.00
1 the Contractors license Law. ' TRACT NO. PARCEL NO.
r .❑ I:un exempt under Sec. ,B.&I'.C.for this WATER HEATER'W/VENT 6.00
- reason - -
Owner - Data WATER SYSTEM 5.00 ' ACC.DATE ACC.FILE NO.
- "WORK 17 RS'COMPBNSAI ION DECLARATION WATER TREATING EQUIP. 5.00
Q14 . I hereby affirm that I have a certificate of cooxunt to self-insure,
11' ora certificate of Workers'Crintpensntion Insurance,or a certdiud ZONING ENG.SITE NO.
"
fl' copy thertof(Sec.3800,Lab.C.L
�_ Policy No. Company .
,0 ❑ Certiliedeopyis hereby l u fished. v. FIRESPRINK ' ' .ENERGY T-24
-Z Z CYC tified co is fit, Inspection division. MISC.- REFER TO ORD;
Appli "�—� y E] N Y ❑ N�
s� W CERTOP EXIiA1P1lON FROM WORKERS' PERMIT ISSUANCE 10.00 ,0 FLOOD ZONE A.L.u.C.
L'> COMPFNSATION INSURANCE PLG.CONTR. LIC.NO.., PLG.
d 0 I Thii .secllon need not be completed if the permit is for one TOTAL .O U Y❑ ' N E] Y❑ N
D Z h undmd dollars IS 100)or less.) -
0 0 1 certify that in the performance of the work for which this Per- OTY MECHANICAL PERMIT FEE - FEE SUMMARY
L I- mil is issued,I shall not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws of California. . �q
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING l �I V
},N NOTICE TO APPLICANT': If,after making this Certificate of rix- -
♦— ? emption,you should become subject to the Workeri.Compensation APPLIANCE , 5.00 FERN CHE K / ^�
5 Inch
of the Labor Code, you must forthwith comply wjth �'g`t
ch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00
I hereby affirm that [here is a coustnmtion lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is Issued(Sec..
3097,Civ.C.L J.p/. Lpp(t 4 HEATING UNIT(TO 100,000 B.T.U.) 8.00 ,
Lender's Name
Lender's Adores l60h HEATING UNIT(OV ER 100,000 B.T. )9, 0 CTRIC .
1 certify that I have read this application and state that Wo above VENTILATION FAN (SINGLE) ,
inl'onnadon is emrec[. I agree to comply with all city and county. PLUMBING
oNinancer and state laws relating to building cons .) 110
truction, and BOILER-COMP H.P.or 100,000 B.T.
herchy aulhori c representatives of this city to enter upon the BAILER-COMP IOwr 100,000 BTU)SEE EE SCR. MECHANICA
. ., above-mentioned property for insPeClion purposes, - -
(We) agree to save, indemnify and keep harmless the City of MISC.- 1 REFER TO ORD. .'
Cupertino against liabilities,judgments, costa and expanses which PERMIT ISSUANCE _10.00 CONST:TAX
may in any way accrue •''nst said City in conserucnce of the
granting Of this perms MECH.CONT. LIC.NO. , MECH.
.i/ "'� _ ' TOTAL ' TOTAL
Sig mu Applicant/Contractor me
OFFICE COPY - 07