15198 (2) POST THIS CARD NEAR FRONT PF BUILDING 15198
rEnnil NR
CITY OF CU�'ER�I . INO
INSPECTION DIVISION
JOB INSPECTION RECORD
• S PERMIT EXPIRATION
JOB ADDRESS/ 1/e UNIT#_ LO7#
. .. PERMIT EXPIRES IF WORK
OWNERc n(,a CONTRACTOR ' IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR rNSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCEfOUNDATION a - OR 180 DAYS FROM
NOTE: LAST CAL LED I NSPECTION.
LIFER 4 ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALIDATION
CUPE OTINCO STANDARD
GARAGE,SLABS , �O\. Y-•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING '
ELECTRICAL - �� ISSUANCE OXTE
MECHANICAL 1 R Q^O O ELECT ME�CR
V \ Y
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED `aV` Q 0 BUILDING PERMIT
WOOD FLOOR
GHINFORMATION
- - OE VALUATION SIFT.
PLUMBING - /�
MECHANICAL - -
ELECTRICAL
vERnuT ro
FRAMING _ Q '
INSULATION _ _Cb STORIES TYPE CONSTR
/,! 4t, _
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT FLOOD AFFA TOTAL ACREAGE
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID — 'i r ,
BUILDING USE
ROOF SHEATHING _ i RES IND CON PB O,m•,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 E E
ROUGH SAN.q I ASSESSORS PARCEL NO
gas
PLUMBING 0 —t ELECT.ENERGY 93 "ct
TUBS BSHOWER PAN PLUMBING ENERGY - -' TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY /
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION '�, PLUMBING
GAS TEST - _�, ,� GAS
MECHANICAL FIRE SPRINK ENERGY r?4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y 0 NED v o No
FL000 ZONE A.l U C.
' EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR �(� t u FIRE DEPT. - Y N❑ e❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH '� TEMPORARY�APPROVALS BUILDING
SCRATCH COAT ELECTRIC Z PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ISEISMIC FEE I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ;
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX /
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTI FICATION B�� "' /' ^PERMIT NUMBER
AP
BUILDING PLICATIDN & PERMIT 1 [� (]�
a ADDRESS 1 �of AT • I J J
IIf/O� BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
PLAN CHECK VALIDATION
1 \E aDTV. ELECTRIC PERMIT FEE
f PHONE
NAMER"crDRs OUTLETS-SWITCHES-RECEP •10.00/1.00
LIC.NO, LIGHTING FIXTURES 10.00/1.00
ADDRESS APPLIANCES DDRES5 PPLIANCES-RESIDENTIAL 4.00
OORE5
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT , PANELS (OVER 200 AMN 20,00 PLAN CHECK FEE P.C.NO.
ENRGIN
f LiC.NO. I SIGNS TRANS. 3.00
ARCH.OR ENG, I PERMIT VALIDATION
ADDRES a SPECIALCIRCUIT 5.00
Ell SVY zIP EMP.METER OR POLE INS. 20.00MMU n M —"
APPucnrvrs ; 95 S MOTORS SEE FEE SCH. ' n
AD RESS 7
Q
SERVICE CHANGE 20.00 l)
,' 02 LICENSED CON'1 ACTORS DECLARATION
M u w I hereby affirm that I am licensed under provisions of Chapter 9 CJQe ISSUANCE DATE
w (commencin with Section 7000)of Division 3 of the Business and
¢ e. g BLDG. ELECT. PLG MECH.
H w i Professions Code, d my license is in full force and effect •�
G i w,o License I Lic.Number - -
Date Contractor
a s s t S J- BUILDING PERMIT
¢ ¢4 OWNER-BUILDER DECLARATION
m w U INFORMATION
E
;' H I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
uoj ' Law for the'following reason.(Sec.7031.5,Insinessand Professions PERMIT ISSUANCE - VALUATION $/FT.
LN0 Code:Any city orcounty which requires a permit to construct,alter, C?�. (] �a
ELEC.CONTR. LIC.NO.
a Q ¢ Fo improve,demolish,or repair any structure,prior to its issuance,also ELEC. O
G LL requires the applicant for such permit to file a signed statement that TOTAL I PERMIT TO
n w m he is licensed pursuant to lite provisions of the Contractor's License
H z
Law with Sect f D on 7000)oivislon 3 o l'I lie
Q
4 sr Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
0c H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant toa civil penalty 001 5
WATER (EA
DRAIN&VENT- . .
of not more than five hundred dollars($500).): ALTER-
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCCGROUP RES.UNITS
intended
sole compensation,will do the work,and tire .e structure is not -
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ,Q
Code:The Contractor's License Law does not apply to an owner of ,` —
• property who,build,or Imp raves thereon,and wllll does f'UCII sent, FIXTURES-PER TRAP - 5,00 50,FT,FLOOR AREA TOTAL ACREAGE
himself or through his owoemploycc,,pro,dcd that such improve- GAS 8,00
ments are not intended or offered for sale.If,however,lite building Q
or improvement is sold within one year of completion,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 Pe Other
prove fly r�ornom of sale.). INDUSTRIAL WASTE INTER. 30.00 2 0 � 1
BSI,ns owner of the property,ant exclusively . 7044,contracting with (L-1�
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to ancontracts
cts for
of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00.
the Co is ctor'shcenectswithacontractnrfsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00'
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ Iu xempl under Se ,B.&P.C.for this WATER HEATER W/VENT 6.00 p
reason _ _ ,fit gp,
Owner_ a Date 9U/ WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION D17:CLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to setf-insure' ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy Ihereof(See.3800,Lah.C.l.
Policy No. Company
O ❑ rtin COPY lsbereby furnished. sJ FIRE SPRINK ENERGY T-24
Z Z Cern( I. 'filey�py7� th t t •cY n division. ❑ ❑ ❑ ❑
FO Applicant = -1.-/.. _ MISC- REFER TO ORD. y N y N
CC W CERTI FICA'TE OF EXEMPTION I°ROM WORKERS' PERMIT ISSUANCE 1 —lTow FLOOD ZONE, A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. J
d 0 (This section need not be completed if the permit is for one TOTAL O Yo N� Y 0 N[]
Z hundred dollars($100)or less.) -
U O 1 certify that in the performance ol'tire work for which Otis per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
i
Date—Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Q 9 v5z
} N NOTIC17 'f0 APPLICANT: If,after making this Certificate of E.
F Z 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 10.000C.F.M.) 4.00
CONS]'RUC'I'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for 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
Lenders Address ELECTRIC
I certify that I have read this application and store dial the above VENTILATION FAN (SINGLE) 4.00 n
. information is correct.I agree to comply with all city and county PLUMBING d
ordinances and state laws relating to building construction, and - .. BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives ec This city es enter upon the BOILER-COMP(Over 100,000 BTUI SEE FEE SCH. MECHANICAL
/ above-mentioned enlioned property for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of MISC..- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX 03
may in any way accrue again t said City in consequence of the PERMIT ISSUANCE }6v88
ra mg of this Perot't MECH.CONT. LIC.NO. MECH.
V- I TOTAL TOTAL (Q 6�a
Signature of Applicant/Contractor lc
OFFICE COPY