15639 (2) _ POST THI RD NEAR FRONT OF BUILDING
PERMIT NUMBER•
'CI OF CUPERTINO 15639
INSPECTION DIVISION
JOB INSPECTION RECORD
,�/ PERMIT EXPIRATION
JOB ADDRESS /QQ /V 1 Wd LALs T(Q UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER, CONTRACTOR E c ,27q.,L IS NOT STARTED WITHIN
INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS•FROM
NOTE: LASTCALLED INSPECTION...
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALIDATION
_ CUPERTINO STANDARDS. .
GARAGE SLABS -PO UR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,
.UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE'
MECHANICAL - BLDG ' ELECT I PLG MELH, -
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL '
PERMIT T
ELECTRICAL �'Af,�,. ie
FRAMING „'/C(L/'J'
INSULATION sroHies TYPE CONSTR.
OCC.GROUP .RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE;p p W FT FLO?.AREA TOTAL ACREAGL
,. DIAPHRAGM THE CONSTRUCTION TAX IS PAID, Q
BUILDNG use I
ROOF SHEATHING s IND CON Pe C11-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE jX4N§P ❑ ❑ ❑
ROUGH SAN.p
` A SSESSO.S PARCEL NO
-
PLUMBING ELECT.ENERGY
fNAC1 N0. PARCEL NO
TUBS 8 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.
_ GAS TEST - GAS
MECHANICAL 'eg RE SPRINK ENE RGv T.N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NE-1 [:] "❑
FLOOD ZONE AT.U.L.
EXTERIOR SHEAR ELECTRICAL,RELEASE
INTERIOR SHEAR FIRE DEPT. Y❑ No Y ❑ N❑'
SHEETROCK' - GRADE ' FEE SUMMARY
EXTERIOR LATH ' BUILDING '
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK _
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY .SEISMIC FEE
OCCUPANCY OF BUILDI NG IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LOING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC.
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE,GIVE JOB ADDRESS WHEN PHONING.
z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE. READ REVERSE SIDE BEFORE TOTAL
C.
CALLING FOR FINAL INSPECTION.
OFFICE'COPY
APPLICAN='TO FILL- IN INFORMATION WITHIN RED LINES'- USE BALL POINT PEN ONLY
BU LDING PROJE TIDENTIFI N .:PERMIT NUMBER
15.11-curs. APPLICATION & P IT 15639
AO RESi " fit '
/�0 ./006.4 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL x-.
OWNER'S PLAN CHECK VALIDATION
Na
-•� C L IF. IE ONE OTV. ELECTRIC PERMIT FEE
RA �� C
CONTRACTORS
NAME
rvgME '/ UTLETS-SWITCHES-RECEP 10.00/1:00
F No 332.` LIGHTING FIXYURES 10.00/1.00
CONTRACTOR
ADORE APPLIANCES 4.00
PHONE '� PANELS 10.00 DATE OF APPLICATION r
ARCHITECTPLAN CHECK FEE P.C.NO:
on PANELS(OVER 200 AMP) 20.00 r
ENGINEER
LIC.NO. SIGNS TRANS. 3.00 '
ADD ESS Ervc. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 20.00
APPLICANT'S - MOTORS SEE FEE SCH. LTJ
ADDRESS
SERVICE CHANGE - 20.00 -?/ /�/��
2
0
Foo LICGNSIiD CONTRACTORS DECLARATION
a u v I hereby affirm drat I am licensed under provisions of Chapter 9 ISSUANCE DATE
H w (commencing with Section 7000)of Division 3 of the Business and
¢ BLDG.- ELECT. PLG. MECH.
F y i Professions C anJ R li e e is in full fart f tZv ❑ ❑ ate'
z O w - Licens lu m.Number IL-�r
a m r
Dare
,�s -
rc a¢ ¢ - OWNER-BUILDER DECL A ON "•-� BUILDING PERMIT
- o a O - - - INFORMATION
X 1- 1 hereby affirm.that I am exempt from the Contractor's License MISC.- REFER TO ORD
FLL0m VALUATION $/FT.
4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE. .-10.00
,A to Code:Any city or county which requires a permit to construct,
s ¢¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC,CONTR. LIC.NO. ELEC.
o s requires the applicant for such permit to file a signed statement that TEL
PERMIT Tppp
A w $ he is licensed pursuant to the provisions of the Contractors License
F 2 i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the -
¢ Business and Professions Code)or that he is exempt therefrom andQTY. PLUMBING PERMIT FEE
¢F m the basis for the alleged exemption.Any violation of Section 7031.$ - STORIES TYPE CONSTH,
a ; _ by any applicant for a permit subjects tire applicant to a civil penalty
of not more than five trundled dollars($500).):
ALTER-DRAIN -WATER IEA.) 5.00
.❑ 1;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 thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his awn employees,provided that such improve.
menu are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-11NC.4 OUTLETS .6.00
or improvement 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 h .e did not build or ink- - RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WAS TE INTER. 30.00
❑ I,as owner of the property,ark exclusively contracting with ❑ ❑ ❑ ❑ ❑
icensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'The Contractor's License Law Joos not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
comr4ets for such projects with.a contractoffs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Set.-,B&P.C.for this
reason ' WATER HEATER WIVENT - 6.00
Owner Date WATER SYSTEM- 5.00 ACC.DATE ACC.FILE NO.
WORK IiRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, ZONING
or a certificate of Workers'Compensat' 1 Insurance,or a certirad ENG.SITE NO.
Copy they�grojj(Sec.3800,Lab.C.).
Policy NtS / Xpaoy L
O ❑ Cerlifiedcopyl hereby fumislued. FIRE SPRINK ENERGY T-24
Z Z � Certified copy is riled with the city inspection division. MISC- REFER TO ORD.
0 A{Z,.Cnt Y❑ IN Y [3 N❑
N C17RTIFICATE'OF EX17MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
W COMPENSATION INSURANCE PLG.CONTR. ❑c.NO. ca., PLG,
CL O (This section need nor he completed if the permit is for one TOTAL "Y 1:1 N❑ Y E] N❑
Z) Z hundred dollars(S 100)or less.) '
U O I cerlity that in the performance of the work for which this Per- QTY. MECHANICAL PERMQ�,}�' rFEE FEE SUMMARY .
LL F mit is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of Califmnia.
Date Applicant .q BUILDING
u - ALTER OR ADD MECH. .0
} w NOTICE TO APPLICANT: If,after making this Cenificam of lix-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5 0 \ PLAN CHECK
provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10 FEE
V such provisions or this permit shall be deemed revoked. .000C )
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 . . -i1 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 590
the performance of the work for which this permit is issued(Sec. MICROFILM
3097-C,v.C.). k- HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I cerlify.t Or I have read this app kation and state lha a use VENTILATION FAN (SINGLE) 4.00
• information is correct.I agree to comply with all city and county PLUMBING .
ordinances and state laws rebating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the 80 LER-COMP(Over 100.000 BTU)SEE FEE SCM. MECHANICAL S
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way accrue against said City in consequence of he' PERMIT ISSUANCE
ranting of this permit �� MECH.CONT. LIQ NO., TOTAL ./F f?� TOTAL
Si are pp Ica t/ Itraclor ate u '
OFFICE COPY