15574 (2) POST THI RD NEAR FRONT OF BUILDING PF.RMITNU619ER
CIN o
' CUP.EFiTINO� 1 6674
INSPECTIONI DIVISION I ,
INSPECTION RECORD
• OO
r ./ PERMIT EXPIRATION s`I
'JOB ADDRESS /LiR3 /V1 'wdC-Fi= a UNIT# LOT# -
PERMIT EXPIRES IF WORK'i
OWNER,' Af Gr I',,DONTRACTOR C-0,0 IS NOT,STARTED'WITHIN : .
INSPECTION DATE INSPECTOR NSPECTION RECORD .'180 DAYS OF PERMIT ISSU-"
FOUNDATION.! - +ANCE OR '180 DAVS.FROM'1
NOTE: 'LAST CALLED INSPECTION.,-.'LIFER 'ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE• - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PET MIT VALIDATION
CUPERTINO STANDARDS
..
GARAGE SLABS' . . '-_
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND'/SLAB
PLUMBING
4
ELECTRICAL"
+ISSUANCE DATE4
. MECHANICAL: - - 'J'<. 6 BLU(: ELECT I PLG. X,MECH.
DO NOT-POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
'•'WOOD.FLOOR .4 , . INFORMATION_
PLUMBING
VALUATION - S/FT.
.�. - - � � � � ,
MECHANICAL '
ELECTRICAL
PERMIT TO
/ � � - . . . . - T '
INSULATION - STORIES TVPECONSTR. .I
.00c/GHOUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.SO.FT,FLOOR AREA TOTAL ACREAGE
• HOOFNOTE:NO FINAL INSP.-SHALL BE MADE BEFORE
F DIAPHRAGM THE CONSTRUCTION TAX IS PAID
_ BUILDING USE
ROOF SHEATHING' - RES IND- CON BE.s01e11
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 'El
ASSESSORS PARCEL NO:
ROUGH-, : SAN.N
PLUMBING - ELECT,ENERGY
TRACTNO, PARCEL NO.
TUBS&SHOWER PAN _ PLUMBING ENERGY -
MECHANICAL MECH!ENERGY
. - ELECTRICAL BUILDING ENERGY - Acc.DATE - ACC.FILE,NO,.
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING - ZONING ENG.SITE NO. 1
GAS TEST GAS -
MECHANICAL FIRE SPRINKENERGY T-24 I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y NE] ` ❑' "F
_� FL0002ONE - A'.L.U,C.
- EXTERIORSHEAR ELECTRICAL RELEASE +
3« INTERIOR.SHEARFIRE DEPT. `"❑ - "❑ v ❑ "❑
�I SHEETROCK GRADE -
- _ FEE SUMMARY
EXTERIOR LATH BUILDING
.INTERIOR 'LATH• TEMPORARY APPROVALS (BUILDING -
SCRATCH COATS - ELECTRIC PLAN CHECK ,
GAS - FEE', 'I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGN ED B YBUILDING INSPECTOR. MICROFILM FY:
ARRANGE FOR INSPECTION.BY PHONING 252.4505,
°•" ELECTRIC' . -0
F ONE-WORKING DAY BEFORE REQUIRED INSPECTION 'PLUMBING
0�r PLEASE GIVE JOB ADDRESS WHEN PHONING •
.• MECHANICAL
7-7- SEE'PERMIT FOR EXPIRATION DATE —• �.
IMPORTANT!: .' covsT.TAX
PLEASE READ REVERSE.SIDE BEFORE ,
TOTAL '
CALLING FOR FINAL INSPECTION: a
OFFICE COPY
.�.:
APPLICANT TO,FILL IN INF MATION WITHIN RED LINES - USE LL POINT PEN'IONLV
BU I LOING PROJECT I DENTIFI N -PERMIT NUMBER
" BUILDING " 999 APPLICATION & P IT
'I ADDRESS ,. ° .. :1667.4
"
�- 2--A BUILDING'= EL.ECTRICAL—PLUMBING —MECHANIC
AL (
O NEP'S - PLAN CHECK VALIDATION
NAME I r� ' '
A)"
6TY. •,ELECTRIC PERMIT FEE i
V - 1 A) ONE .
CONTRACTOR UTLETS-SWITCHES-FECEP. 10.00/1.00 9ts0 n
NAME '
- (' i .rvo, �j •�- LI GHTING,FIXTURES ^ 10.00/1.00 Q,.3 -
'
CONTRACTORS PP LI AS ^ 4.00 >!
ADOREss A�-. .. .. '. �.
7/ A) PHONE' /�,06D I ..PANELS 10.00 DATE OF APPLICATION
ARCHITECT, 'PANELS (OVER 26OAMP1. 20.00 PLAN CHECK FEE` "P.C,NO.
OR
ENGINEER '
uO rvO. SIGNS TRANS ", a': '3.00,
ARCH.OR END - ^ - SPECIAL bIRDUIT ' - 500 I - ti PERMIT VALIDATION
ADDRESS
•
ZIP _ EMP.METER OR POLE'INS. 20:0
APPLICANT s MOTORS SEE FEEPW
ADDRESS .
SERVICE CHANGE -20.00
wsz
F O 0 LICENSED CONTRACTORS DECLARATION - ��✓�'' . +'Y' 'pQ "
U 1 hereby affirm that 1 am licensed under provisions of Chapter 9 - OY ISSUANCE DATE e
vHi Q III (commencing with Section 70001 of Division 3 of the Business and - ^ - .BLDG. ELECT. PLG. MECH.
r 0 z Professions C de, d my license is in full force and effect ❑
z D= License C s Lia Number - ❑• ❑
9 z r_0 Date G Contractor_
rcw < owlvr:RBulu3eR DECLARATION "' CtC +, BUILDING,PERMIT'
0 a O - - - MISC:— F ,REFER TO ORD INFORMATION
w3 LL N' I hereby affirm 1hut 1 con exempt from Ili Contractor's L¢'nse - - vpLUATION $/FT.
+' LL04 Law for the following reason.(Sec.7031!5,Business and Professions PERMIT ISSUANCE 10.00
m Code:Any city or county which requires a permit toconstrucl,alter,
arc < improve;demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. UC.NO. LEC. HI
O¢ requires the applicant for such permit to file a signed statement that +� C v 7 OTAL zo? PERMIT TO
w $ he is licensed pursuant to the provisions of the Contractor's License -
Hii
Law(Chapter 9(commencing with Section 7000)of Division 3 of the „•
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
$ the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES - TYPE CONSTR.'
w. by any applicant for a permit subjects the applicant toacivil penalty' ALTER-DRAIN IL VENT-WATER (EA.) 5.00 +
of not more than five hundred dollars(S500L): '
O 1,as owner of the property,or my employees with wages as BACKFLOW'PROTECT.'DEVICE - , 4.00 .00C.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:'file Contractors License Law docs not apply to an owner of '”
property whe builds or improves thereon,and who does such work FIXTURES-PER TRAP, 'y 5.00 Sa FT,FLOOR AREA 'TOTAL ACREAGE -
• himself or through his own employees,provided that such improve.
memsarcnot intended orOffered for sale.If,however,the building GAS-EA.SYSTEM-1 I INC.4'OUTLETS 6.00
or impruvemela is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA.) ' 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im . - RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. -' 30.00 .
❑. I,as owner of the property,am exclusively contracting with - - .❑' ❑ -11 ❑ Ellicensed contractors to construct the project(Sce.7044,Business LAWN SPRINKLERS- 1 INQ5 V.B. 6.00 '.t. ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply', .
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-.OVER 5(EA.) 1.00 - L
contracts forsuchLicense
LwilhacomradoAs)licensed pursuant m, SEWER-SANITARY-STORM EA.2008/1.0.00 TRACT NO. PARCEL NO.
the Contractor's for s License Law.
❑ lam exempt under Scc. ,B.&P.C.for this WATER-HEATER W/VENT 6.00
reason -
' Owner, Date
WATER SYSTEM 5.00 ' I ACC.DATE ACC:FILE NO
WORK F-RS'COMPENSATION DECLARATION WATER'TREATING-EQUIP. .5.00 I " '
I hereby affirm that I have a certificate ol'comsent m self-iosufe; F 20NING ENG.SITE NOI
or a certificate of Workers'Compensation Insurance,or a certified
copy there J.�e�c�38 0,Lab.C.I. s
Policy No.�L12yf�ompany.�vLT •nom' +'
Q - .❑ Certified copy is hereby furnished a , FIRESPRINK ENERGYT24
Z Z Jg Certified'.c is tiled with a oily inspect division. j
— O Applicant •^ / ' MISC ^,'K- ^ .REFER TO ORD. y❑ _N01 y ❑ N❑
PERMIT-ISSUANCE - 10.00
lr — CIiRTI FICATb:UP EXEMPTION FROM WORK ERS' - FLOOD ZONE A.L:u.C..'
. Ql > COMPENSATION INSURANCE: - PLG.CONTR.,, L LIC.NO, PLG. '
o (This section-need not be completed if the permit is for one _ • TOTAL Y E] N.E]' ' Y❑. N❑
Z hundred dollars IS 100)or less.) 1.
_ - 1
U O - 1 certify that in the perfurmance of the work for which this per. OTY 'MECHANICAL PERMIT FEE ! FEE SUMMARY
U. H mitis issued,I shall not employ any person in any manner so as to; ,
O,w bccome subject to the Workers'Compensation Laws of C.-Ilm niu. s
Date 'Applicant 'ALTER OR ADD TO MECH. - 5.00 . BUILDING
} N NOTICE TO APPLICANT: IL after making this Certificate of rix
♦— ? emtprion,you should become subject to the Wurkeis'Compensation APPLIANCE' 5.00 I' PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(T0,10MOCF.M.) 4.00
'coNSTRucT10N1ENUINO ACI:Ncv AIR HANDLING UNIT(OVER 10=C.FiM1600 f SEISMIC FEE
'.1%hereby affirm that there Is a construction lcm mg 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 IT0,100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 'ELECTRIC
Lender's Address
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE), '4 00 - -
inlonnutinn is Correct. I agree to comply with all uty and county BOILER-CUMP(3 H.P:;or 400,000 B.T.U') 600 LP,LUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to corer upon the BOILER-COMP.IOverr100,000 BTUI BEE FEE gCH. " MECHANICAL
• above-mentioned property for inspection purposes. ,_
_Lwe) agree to szve, indemnify and keep harmless the City of MISC.-' REFER TO ORD. - ,
aper no against liabilities,judgments, cos and enses which CONST.TAX
ay i any way accrue against said Ci I co u ce of the PEO MIT ISSUANCE` - 10.00
rant g of kispermit T ME ON,CONT. LIC.NO." MECH, y -, ;
jazz,ir �; :.• - TOTAL t "',TOTAL "<
She of Applicant/Contractor - Date (,,. _
OFFICE COPY.