15736 (2) POST THIS CARD NEAR FRONT OF BUILDING FhRT NUMBER
CITY OF CUPERTINO 15736
INSPECTION DIVISION
�ry /JO FBI INSPECTION RECORD
F�. JOBADDRESS BOO X33 c[J YI �UNIT# _LOT# PERMIT EXPIRATION ,
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN,'
INSPECTION DATE INSPECTOR INSPECTION RECORD '.180DAYSOFPERMITISSU-
FOUNDATION ANCE!OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAuuanON, -
CUPERTINO STANDARDS.
GARAGESLABS
I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB _ "' _
PLUMBING •-
ELECTRICAL ISSUANCE DATE
MECHANICAL _ nIELECTPLC. c
❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED -BUILDING PERMIT -
WOOD FLOOR INFORMATION
VALUATION $/FT_
PLUMBING
MECHANICAL
ELECTRICAL
"i-
ELECTRICAL - `M PERMIT TO -
FRAMING
INSULATION
STORIES TYPE CONSTR.
C,ip�Ur9r'HLC�' r` S-•m-� fG�
' ✓e�`%b LOGIC.. '
OCC.GROUP NES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sn.n.FI,Darl aRl;n mraL ACR lace
• , ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM . THE CONSTRUCTION TAX IS PAID 1
BUIIUING USE
ROOFSHEATHING _ I ❑ ❑ ❑ry 1pa 3co" .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ic
ssessoRS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY t '
TRACT NO. PARCEL NO
.TUBS&SHOWER PAN PLUMBING ENERGY .
MECHANICAL MECH.ENERGY
.ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
'FRAMING ELECT.FINAL TEST
ZONING , ENG,SITE NO.
INSULATION - PLUMBING
GAS TEST GAS
IF $PRINK ENERGY T 44
MECHANICAL I—�' J'" '•.Y [D NE) Y ❑ N[]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR I ELECTRICAL RELEASE FLOOD ZONE A L U C
INTERIOR SHEARFIRE DEPT. Y❑; N❑ Y ❑, N❑
SHEETROCK - GRADE - FEE SUMMARY .
EXTERIOR LATH BUILDING ..
INTERIOR LATH TEMPORARY APPROVALS BuiLDwG
SCRATCH COAT ELECTRIC. - PLAN CHECK '
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY .SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MMICROFILM
ARRANGE FOR INSPECTION BY-PHONING 252-4505, T !�CECTR IC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION?A
0PLEASE GIVE JOWADDRESS WHEN PHONING. '
PLUMBING"'
z = SEE PERMIT FOR EXPIRATION DATE - A�U'� 98 ,. MECHANICAL aL
IMPORTANT! ! .coNST.TAX
PLEASE READ REVERSE SIDE BEFORE �=
CALLING FOR FINAL INSPECTION. TOTAL (
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES'- USE BALL POINT PEN ONLY .. _
BU I LDING PROJECT IDENTIFICATION - .PERMIT NUMBER _.
BDIeaINGAPPLICATION & PERMIT,
FO KESS -
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 15736
OWNER'S
PLAN CHECK VALIDATION
NAME -gAI,Z OTY. ELECTRIC PERMIT FEE '
W
CONTR\Nep AMACTORS OUTLETS-SWITCHES•RECEP 10,00/1.00
LIC.NO, O - LIGHTING FIXTURES - 10.00/1.00
CONTRACTOR' APPLIANCES-RESIDENTIAL 4.00
AaDR E55 '�j R
PHONE M- Iq f PANELS 10.00 DATE OF APPLICATION'
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AW 20.00
ENGINEER
LICNO. SIGNS TRANS. 3.00
A7DRCH
ENa SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
,. SERVICE CHANGE 20.00
a a i
FOO LICENSED CONTRACTORS DECLARATION
a v u I hereby affirm that I an licensed under provisions of Chapter 9 ISSUANCE DATE .
e_ (commencing with Section 7000)of Division 3 of the Business and
a y SLOG. ELECT. PLG. MECH.
H z Professions Co a license is in lull VRAI
z O`� - Licen s le i!Numbep
o w r Dme tt Contractor
t �, BUILDING PERMIT
w O CRBUILDISR DIiCLINFORMATION
x'u u H I hereby affirm that I am exempt front the Contractor's License MISC.- REFER TO'ORD
LLpor Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
'� - Code:Any city or county which requires a permit toconstrucq alter, PERMIT ISSUANCE 10.00
a,¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
O 0 requires the applicant for such permit to file a signed statement that TDI PERMIT TO
n w m a, he is licensed pursuant to tine prnvisians al'tire Conlnmlors License
Hz> Law.(Chapter 9(commencingwith Section 70000of Division 3 of the
i o Business and Professions Code)nr that he is exempt therefrom and CITY. PLUMBING PERMIT FEE Q
Ie H the basis for the alleged exen.pllon.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; by any applicant for a permit subjects the applicant loa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(55000.):
17 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS
their 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,COND. 5.00
Code:The Contractors License Law does 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 or through his own employees,Provided that such im Prove-
meatsarenot intended or offered for sale.If,howeveq the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM OVER 4(EA.) 200
builder will have the burden of proving that he did not build or im - . , BUILDING USE
prove for purpose ofsele.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively conducting . .
awith 13 El ❑ F-1 IDlicensed contractors to construct the pn.jac1(5ee. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply .
to an owner of property who huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conlmctorS)licensed Portland to SEW ER•SANITAR V-STORM EA.200ft/10.00 s -
theContractor'sLicenseLaw. TRACT NO. PARCEL NO.
❑ lam exempt under Sec,-,BAP.C.for this WATER HEATER W/VENT 6.00
reman
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 certifncate of consent to wlf-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereoffSec.3800,Wb.C.L -
Policy No. Company
O ❑ ertifled copy is hereby furnished. FIRESPRINK ENERGY T-24
Z 2 erhit,J any is FUld wish the yit '�'faclion division. MISC- REFER TO ORD.
O pp and MISC.- .- Y❑ N❑ Y ❑ .N❑
~ w ROMW'.N•r PERMIT ISSUANCE - 10.00
LU - CISRT'l l°ICCOMP ISATION INS PROM WORKERS' FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR, LIC.N0. PLG.
(L 0Z 1'1'his section need not be completed if the permit is 1'nr one TOTAL Y[:] N❑ Y❑ N❑
hundred dollars($100)or less)
U O 1 certify that,in the performance of the work for which(his per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is Issued,I shall not employ any person in any manner so as Io ,
O w become subject to the Workers'Compensation Laws of California.
Q. Daze Applicant ALTER OR ADD TO MECH. 500 BUILDING
>_ rcalNOTICE TO APPLICANT': IL after making this Certificate of Fx-
,
F-. ? em if011,you should become subject Bn the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with - FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING U p00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLI NIT OVE ) 5AC.F.M,) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency I'or EXHAUST HOO I H 0
tire perfornwTwo of the work for which this permit Is issued(Sec. MICROFILM
3097,Civ C.). - HEATING 00 OB.T.U.) 8.00
Lender's Name HEATING B.T.U.I 9:50tTRICLepkn.Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information a correct I agree ti comply with all city and canary BOILER-COMP I3 H.P.orr100,000 B.T.U.) 6.00 PLUMBING
ordinances ad state laws relating 10 building construction, and 6V
hereby authorize representatives of this city to enter upon the
�abovcmentioned property for inspection purpoces. BOILER-COMP (Oak,100,000 BTU)SEE FEE SCH. MECHANICAL Z
(We) agree m save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00
kCONST.TAX
in -
may any way accrue against said City in consequence of the
ran g of this pPn 1. MECH.CONT. LIC.NO. I MECH7
I� TOT 1 TOTAL z
Signature of lican/Con/mctor Dute
OFFICE COPY .