18161 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO, g1 �
INSPECTION DIVISION r
JOB INSPECTION RECORD
( � 7 ] Z • l PERMIT EXPIRATION
JOB ADDRESS 1NIT#
(1'�C dU( 'R _LOT#
PERMIT EXPIRES IF WORK
OWNER (tel Itv C&- Q CONTRACTOR - Vk \, IS.,NOT STARTED WITHIN,
INSPECTION DATE INSPECTOR INSPECTION ECORD(, 180 DAYS OF PERMIT ISSU-
FOUNDATION' - I
ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
'
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED D
UNDERGROUND /SLAB - '
PLUMBING
ELECTRICAL n - ISSUANCE❑AI
.MECHANICAL HLOG ELECT I PLG. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED- BUILDING PERMIT
WOOD FLOOR ' INFORMATION
SIFT.
PLUMBING
MECHANICAL '
ELECTRICAL IIL�_L^l(qq
FRAMING
INSULATION STORIES TYPE CONSTR,
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. - ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING -HES IND ILDCON ON USE
00-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L L L L L
ROUGH SAN.N
n5SE55DRS,PARCEL NO
'
PLUMBING ELECT.ENERGY
TRACI NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDINGENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG,SITE NO.
INSULATION PLUMBING
GAS TEST GAS
' MECHANICAL FIRE SPRINK ENERGY r-Pa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "o NE]
E
EXTERIOR SHEAR ELECTRICAL RELEASE 1 7 7
LOOD 2UNE A L U.C.
INTERIOR SHEAR FIRE DEPT.
YL
L NL NL
SHEETROCK - - GRADE FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - TEMPORARY PPROVALS BUILDING
SCRATCHICOAT ELECTRIC PLAN CHECK
GAS' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
w
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
` "i3:�
I_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. "`"
PLEASE GIVE JOB ADDRESS WHEN PHONING.' PLUMBING .
MECHANICAL
SEE- SEE PERMIT FOR EXPIRATION DATE
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 4�
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -,USE BALLPOINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDIN D APPLICATION & PERMIT Q 1 61.
ADDRESS 1 1 U I U
U ING-ELECTRICAL-PLUMBING-MECHANICAL
OwNER'6 PLAN CHECK VALIDATION
NAME l OTY. ELECTRIC PERMIT FEE
. \\r Is. 12 In
NOMERAcrrns OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S -
ADDRESS �// APPLIANCES-RESIDENTIAL ,- 4.00
z(� PHONE fit:+�(y PANELS 10,00 DATE OF APPLICATION -'
ARCHI E T PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) , 20.00
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
AZIP - EMP.METER OR POLE INS. 20.00 �d+fO
ADDRESS
MOTORS SEE FEE SCH. U
ORBss
SERVICE CHANG 20.00 I+ A-V� 'O y,��V cc-
.102
L
u.F+o o LICENSED CONTRACTORS DECLARATION � -
a i w I hereby affirm that I am licensed under provisions of Chapter 9 J U N1 ISSUANCE DATE
,o a (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
I- w i Professions Code,and my license is is full force and effect. .k ❑ El E:1L H
z o m - License Class Lic.Number City Of. C�flO1 lIO_O
E E Date Contractor
a m f BUILDING PERMIT
ED w a OWNER-BUILDER DECLARATION
a o d w INFORMATION
w ; w I hereby affirm Ihal I am exempt from rhe Contractor's License MISC.- REFER TO ORD
w O v, - Law for the following reason.(Sec 7031.5,Businessand Professions ,D VALUATION $/FT.
I- - PERMIT ISSUANCE 10.00
Code:Any mulish county which reqstructurees a,
p prior
toconstruct,alter,
0 improve,demolish,or repair any structure,prior no its issuance,also ELEC.CONTR. LIC.NO. ELEC.
n
O LL requires the applicant for such permit to file a signed Statement that TOTAL ��. PERMIT TO
le m he is licensed pursuant to the provisions of The Contractor's License
i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthn
io Business unit Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE -e lsak -(se G
M I- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES I TYPE CONSTR.
by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more IT.five hundred dollars(SSOKHT):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.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,AR EA,COND. 5.00 -
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves Ihereon,and who does such work FIXTURES,PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
metitsfor o intenougll ded
or offerdfors, le.If,
ed however,
improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
cents are not intended or offered for sole.If,however,the building
Or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- REB IND CON PB OrM1ar
prove for 1,as o pner of soled' INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the properly,he exclusively, 7044,ling with
licensed contractors to construct the project La 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's improv Law does not apply
to tr owner of property who builds tr improvesensethereon.
pursuant
who LAWN SPRINKLERS-OVER 6(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.2001t/10.00
' IIIc Contractor's License Law. TRACT NO. ' PARCEL NO.
❑ lam exempt snider Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO.
WORKERS'COMPENSATION DECLARATION - WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent In self-insure. ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lub.C.L
Policy No. Company -
O ❑ nilied copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z 0P Ceriffled��Wo�jy is pcledth the 'ity
i:: inspection division.
O Applicant,�L'�ZLF --- 064 MISC.= REFER TO ORD. YC .N[3 Y [3 N�
In / PERMIT ISSUANCE , 10.00
LU - CERTI FICAI'li Of SXI; TIPROM WORKERS' FLOOD ZONE - A.L.u.C.
W � COMPENSATION INSURANCE PLG.CONTR. � LIC.NO, pLG,
Z' (This section need mol be completed if the permit Is for one TOTAL Y[:] N C Y C] N
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
W 1- mit is issued,I shall not employ any person in any manner so as to
O w become subject IO the Workers'Compensation Laws of California.
Date-Applicant - BUILDING
Q. I v ALTER OR ADD TO MECH. 5.00
} to NOTICE'1'0 APPLICANT: If,after making this Cernificam of Ex-
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply will' FEE
C.1 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=11F.M.) 6.00 SEISMIC FEE
I 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 -
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Q'D
I ex,ily that I have read This application and state that the above VENTILATION FAN (SINGLE) 4,00
infornllion is correct. 1 agree to comply with all city and County BOILER-COMPI3 HA Of 100,000 B.T.U.I 6.00 PLUMBING
ordinances and Stale laws relating to building construction, anti
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL -
(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
may in any way accrue against said City in consequence of lite PERMIT ISSUANCE 10.00
ranting of this Anil. MECH.CONT. LIC.NO. MECH.
G--14-, - TOTAL TOTAL , Od
Si nature of Applicant/C ractor Date:
OFFICE COPY
FINAL' GRADE ^'
ROUTE SLIP
'File No.'
Date
Location
r, -
Sub,j ec
Notes
Approved
Da eInspector
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date .S.........1-57................... 19.ZJ.1.... Building Permit No. �SI...
The Building Located at .....
Owned by .........
Has Been Com let >��D�
(Altered) For Use As: ......
........................................................................................................................... j
................................................................................................................................
.....................................q..................................................
PD-7 ......... .W ..........................................
BUILDING INSPECTOR
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