15528 (2) POSTT'HISCARD NEAR FRONT.OF BUILDING PER iTNDmBER
CITY OF CUPERTINO 15528
INSPECTION DIVISION
JOB INSPECTION RECORD
q
a ,�/ /'/ •'•� �, S/-' l��'✓ ~� PERMIT EXPIRATION" ,
JOB ADDRESS/0/ �V• VV U�FL" /, - UNIT# _LOT# '
' + PERMIT EXPIRES IF WORK'
OWNER ii.iG.�f' ' . cZ'-!E/+-/ Li2,Z-j CONTRACTOR ." k—rlviiz Z_ �„ - - ',IS NOT STARTED WITHIN
INSPECTION" DATE I INSPECTOR 11 INSPECTION RECORD •'-180 DAYS of PERMIT1sSU" ,
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 14 PEHMIT VALIDATION -
CUPERTINO STANDARDS. 1,
GARAGE SLABS / ++'•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED AZ "rcc
'
UNDERGROUND /SLAB
.. PLUMBING
ELECTRICAL -
I ISSUANCE DATE
MECHANICAL BLDG. ELECT I PLG. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED pp BUILDING PERMIT
WOOD FLOOR - - .. 19P. INFORMATION
PLUMBINGVALUATION,- $IFT.
. - -
MECHANICAL - ..CiVQg ` • '
PERMIT TO
ELECTRICAL -
FRAMING -
INSULATION ,STORIES TYPE CONSTR. .
OCC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SQ IT,FLOOR AREA. TOTAL ACREAGE
- ROOF NOTE:NO,FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOPSHEATHING RES IND CON PB Co", "
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ' ❑
ASSESSORS FARCE L NO
ROUGH 'SAN.# .PLUMBING
ELECT.ELECT.ENERGY -
1
TUBS&SHOWER PAN PLUMBING ENERGY "ACT NO PARCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL ,� _ BUILDING'ENERGY ,?cc,DATE' ACC,FILE No
FRAMING ELECT,FINAL TEST. '
INSULATION PLUMBING ZONING ENE SITE No.
GAS TEST GAS '
MECHANICAL EIRE STRINK ENERGY T.74'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ° ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE. FLOOD ZONE, aLuc.,
INTERIOR,SHEAR FIRE DEPT. Y❑ "❑ ❑, "❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS 'FEE ,f'"• .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMI�FEE ,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ~ .
ARRANGE FOR INSPECTION BY.PHONING 252-4505, , ELECTRIC f Q:
-ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
i z '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
A ICANT TO TILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER n)
'SOLD,NG Pr /p�� APPLICATION & PERMIT 1CC'/,/gyp
AD'AEss 1 -1 J 2
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL V
w E PLAN CHECK VALIDATION
HAVE QTV. ELECTRIC PER IT FEE
DNE `v 56 30
cOMee DRs A T! E�+. 27-OUTLETS-SWITCHES-RECEP 40.00/1.00 ,
/7 uc.ND. LIGHTING FIXTUR ES�1 10.00/1.00
nooees -Hsu' /J1A- / G APPLIANCES-RESIDENTIAL 4.00
S-� PH0NEtj/6 Z PANELS - ��,� 10.00 YQ pATEOFAPPLICATION :
ARCHITECT PANELS (OVER 200 AMP( 20.00 PLAN CHECK FEE
OR P.C�NO.
ENGINEER
uc.NO. SIGNS TRANS. 1/0 V 3.00Q OL
ARCH,OR Ervc. SPECIAL CIRCUIT IISV� PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
AVPLICANTS - MOTORS N SEE FEE SCH.
ADDRESS
SERVICE CHANGE
0
Go LICENSED.CONTRACTORS DECLARATION
<U u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Nay (commencing with Section 7000)of Division 3 of the Business and ,. BLDG. ELECT. PLG. MECH.
r H ", Professions Code and my license is in frill for e e -
z o m 0 License Class Lic.Number ❑ ❑
O - ,G Date Comractor
a y f Cab. BUILDING PERMIT
OWNER-BUILDER DECLARATION INFORMATION
X O a H I hereby affirm that I am exempt from the Contractor L'' MISC.- REFER TO ORD ,
3 ¢y �-�t VALUATION
F u. og Law for the followingreason.ISec.7031.5,Businnesior Pro esoions PERMIT ISSUANCE sQttt;91T ��HJp
Code:Any city or county which requires a permit to Construct,alter, -
¢ ¢ ¢0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC N0. ELEC. q
O ¢ requires the applicmU for such permit m filC a signed Statement that r• �• TOTAL /Q /• PERMIT TO -
i
w m he is licensed pursuant to the provisions of the Contractor's License
rzi Law(Creole,9(commencingwith Section 7000)of Division 3 ofthe C
¢ Business and Professions Cade)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE' /
¢ H o" tIIC basis for the alleged exemption.Any violation of Section 7031.5 �STDR E$ TYPE CONSTR.
Aam by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500):).
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
Blair
sole compensation,will do the work,and the structure is no[
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 thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
• himself or Ovough his own employees,provided that such improve-
Centsara not intended or offered for sale,If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one yearofcompletion,the owner- GAS-EASYSTEM-OVER 4 IEA) 2.00 BUILDING USE
builder will have the burden of proving that h . .
e did not build or an- RES IND CON PB Dili.,prove for purpose of saleJ. INDUSTRIAL WASTE INTER. 30.00
❑ I,as,owner of the property,am exclusively contracting with
licensedContractors 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 Ines not apply - -
to an'ownei;.of-property who builds or improves thereon,and who LAWN-SPRINKLERS-OVER 5(EA.) 1.00
evolutions for such projects with a contrumor(s)licensed pursuant to SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the DnorraClor'S License Law.
❑ I am exempt under Sec. B.&P.C.for this WATER HEATER W/VENT 6.00
reason
.Owner Date WATER SYSTEM - 5.00ACC.DATE ACC.FILENO.
WORKERS'COMPENSATION DECLARATION , WATER TREATING EQUIP. 5.00
I hereby affirm that l have`a certificate of consent to self-Insure. ZONING ENG.SITE NO.
_ or a certificate of Workers'Compensation Insurance;or a certified
copyther (S Lab.C.).
Policy N Pany
Q ❑ Cmfit. Wer is hereby furnished. ,' FIRE SPRINK ENERGY L]4
❑ Certlfiigd�, c,,Qpp,,y to fl.y i[h tI� c it p"" n d' inion.
� p,�x Applicaot_/J_1r3 'r'.i !i . / n• � MISC.- REFER TO ORD. y� N� y ❑ '�.,N❑
~ rn/ PERMIT ISSUANCE 10.00 FL000 zoNE A.L:U;c.
Cr CERTIFICATE OF EXISMPTION FROM WORKERS'
LJ > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. VE] Ng v0 N0
CL O' (This section nAL need not be completed if the permit is far one TOT
D Z. hundred dollars IS 100)or less.)
V O 1 Certify But In the perborr ame of the work for which this per- GTV MECHANICAL PERMIT FEE FEE SUMMARY
LL H• mit is issued,1 shall not-employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. BUILDING
y Date Applicant ALTER OR ADD TO MECH. 5.00
} rn NOTICE TO APPLICANT: If,after making this Certificate of Ex-
� ? emption.you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
(.7 sor visions uch provisions her th Labor Code, you must forthwith comply with FEE
permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is o construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,CIv.C.). -
Lender's Add,
Lender's Address HEATING UNIT(OV ER100,000 B.T.U.)9.50 ELECTRIC
( certify-that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 -.
information n correct.I agree to comply Cottle all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.001PLUMBING
information
acestio and orate lows rete c m building construction, and
hereby authorize representatives 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 harmless the City of I MISC.- REFER TO ORD.
upertino
against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,001CONST.TAX
may m any way a agai d City in consequence of the
.. of this MECH.CONT. LIC.NO. MECH.
�- _ TOTAL TOTAL
I an ontractor Data
OFFICE COPY