18100 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
A. CITY OF CUPERTINO
18100
INSPECTION DIVISION '
JOB INSPECTION RECORD�p'r"
-. PERMIT EXPIRATION
JOBADDRESS_'Q,,� INI�Lv's/ l_—UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER (v \l�'Q y�-� G�/ CONTRACTOR a V( �tV�� VA IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD leo ogvs of PERMIT Issu
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF, PERMIT VALIDATION
PR EGUNITE CUPERTINO STANDARDS. /
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _
UNDERGROUND /SLAB
PLUMBING 'q. \
ELECTRICALIssuANCE DATE
MECHANICAL - - RLDG e7F Pm MccH -
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL ��_
FRAMING '
INSULATION - - SIGH I In TYPE CONSTH.
I
x
OCC GROUP PES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF - NOTE:NO FINAL INSP.SHALL BE MADEBEFORE so Pr ;Looe nnEA TOTALACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
nun.DlrvG USE
ROOF SHEATHING HES IND CON PR
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. 11 ID
ASSESSOHSPARCEL NO. '
ROUGH SAN.I!
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH,ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACG;0.E NO,
FRAMING ELECT,FINAL TEST
ZONING 'ENG SITE NO. '
INSULATION. PLUMBING '
GAS TEST IGAS
FIRE SPRINK ENERGY L29
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .v "� v � "�
LONE A L U C.
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ NQ'
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH'COAT ELECTRIC 6.z PLAN CHECK
GAS• FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
\ ARRANGE FOR INSPECTION BY PHONING 252-4505, t:F.. ELEFTRIC
1 H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING. E`
z SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST. TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL OI
OFFICE COPY
APPLICANT 40 FIfLLL IN`iATION WITHIN RED LINES - USE BALL POINT PEN ONLY
" BUILDING PROJECT I DENTI FICATION of PERMIT NUMBER
BDIL .NG APPLICATION & PERMIT ' 18100
AopREss LAPS /�•K/.YSO A4 t
BUILDING - ELECTRICAL=PLUMBING-MECHANICAL -
.'• O
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
[ PHONE
NAME"ncroR's UTLETS-SWITCHES-RECEP 10.00/1.00
Luc.No, LIGHTING FIXTURES 10.00/1,00 '
CONTRACTORS
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
/
PHONE�.T�-S'Z'D PANELS 10.00 DATE OF APPLICATION
ARc ITECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
OR
ENGINEER
' LIC.NO. ISIGNS TRANS. 3.00 -
ADDRREss ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 �O. �6 -E1
-
ADDRESS
is
AMOTORS SEE FEE SCH.
oREss ,k
_ SERVICE CHANGE • 20.00
0 0 0 LICENSED CONTRACTORS DECLARATION
<rZ w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and n ¢ n •• BLDG. ELECT. I PLG. MECH.
H i Professions Code,and Numy license is in full force and effect ❑ EJ ❑
o z m G License Class Lie. ml'rr - city of Cupertino hfY-'ll
¢ Y f Uate Contractor BUILDING PERMIT
I[ m< OWNER-BUILDER DECLARATION INFORMATION
A 0 a MISC.- REFER TO ORD
w 3 I- 1 hereby affirm that I am exempt from Lite Contracmr's License
LL.
LLOj Law for the following reason.(Sec.703 1.5,Business and Prufessians PERMIT ISSUANCE 10.00 VALUATION E/FT.
� - Cade.An cit of count '�
Any y county rcyuiresu permit to construct,altos
¢ ¢ ¢ improve,demolish,Or repair any StRICI Lira,prior to its issuuncc,also ELEC.CONTR. LIC.NO. ELEC.
iL O ¢ requires rhe applicant for such permit to lite a signed statement that TOTAL 2�.o D PERMIT TO
al$m hr is licensed pursuant to the provisions of the Contractor's License
Lot
r La..(Cha ter 9(commencin with Section 7000)of Division 3 of the G
r ¢ Easiness and Pro&scions Code)or the he is exempt Therefrom and QTY. PLUMBING PERMIT FEE T 2
¢H e the basis for the alleged exemption.Any violation of Section 7031.5 STORETYPE CONSTR.
La 5-; by any applicant for a pernil subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees witli wages as BACK FLOW PROTECT. DEVICE 4.00 `
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
meets arc not
ough ntende own emred for sale.
if,ed however,
the
improve- GAS-EA.SYSTEM-1 6.00
month arc not intended oroffered
on for snlr.IL however,tth building
Lir Impnwrmcnt is held burden
one your hat lie did
the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
' builder will have the burden of proving that he did not build or im- BUILDING USE
RES IND CON PB Other
prove for purpose of salt.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively. 7044, ins with ❑ ❑ ❑ ❑ ❑
and No contramod to the project(Sec. does 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 inowner
foto of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts r such with u contractor(S)licensed pursuant to
the Contractor's LicvnW cunsr Low. SEWER-SANITARY-STORM EA.200ftI10.00 TRACT NO. PARCEL NO.
❑ lain exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
oras..
owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certlficalcofcnnseat to cel Nusure, - -
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Thereof(Sec.3800,Lob.C.).
Policy No. Company
Q ❑ -. rofied copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z Certifie a y is lily with rho city inspection division. MISC- REFER TO ORD.
O Applicant at; -�y�+"` Y ❑ N❑ Y ❑ IN
F w PERMIT ISSUANCE 10.00
LU CIiRTIPIC(70 1:N XA TIONMPTION NSURAFROM WORK IiRS' FLOOD ZONE A.I.U.C.
W � COMPI>NSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y[:] N❑
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of lire work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued, I shall not employ any person in any mender xo as 1.
Ow become subject to the Workers Compeoeltion Laws of California.
Q- Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>- GO NOTICE TO APPLICANT': If,after eking this Cerlificate of Ex-
F ? emption,you should become subject to 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 UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD(WITH DUCT) 5.00
The performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Z,Q�
I certify that I have read this applicatimi and state that the above VENTILATION FAN (SINGLE) 4.00
information is correcl. I agree-to comply with all city and county PLUMBING -
onllnanccs and slate laws rel'etlng to building conslruclion, and BOILER-COMP(3,H.P•or 100,000 B.T.U.) 6.00
hereby autharize'repfesental fives of This city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep handless the City of MISC.- REFER TO ORD.
upertmo against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the -
ranting of IN nni tMECH,CONT.. LIC.NO. _ MECH. - 'p
TOTAL TOTAL yZ�r pl
Si naRlmo pplicant/ ntmcoci Date
OFFICE COPY