15642 (2) POST THIS CARD NEAR 'FRONT OF BUILDING
PERMIT NUMBER
'CITY OF CUPERTINO 15642
rINSPECTION DIVISION
r JOB INSPECTION RECORD
�9, /019 A-• PERMIT EXPIRATION
JOB ADDRESS /6 O7� wo LF,- Ryy / UNIT# � " LOT# -
PERMIT EXPIRES IF WORK
owNER ' , L .OZ) ' CONTRACTOR ..E><FLC.0 S �'T [_ .IS .NOT STARTED WITHIN'
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 GAYS OF PERMIT ISSU-
FOUNDATION - • ANCE OR 180,DAYS FROM'
NOTE: ' LASTCALLED INSPECTION. '
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUN ITE , TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
.CUPERTINO STANDARDS.
GARAGE SLABS f. ---•� '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - - ' ISSUANCE DATE
MECHANICAL BLDG EI.ECm, ..PLC .1 MECH ,
❑ ❑ ❑ LRI
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD,FLOOR.' VALUATION GIFT.
PLUMBING - "
MECHANICAL -
PERMIT TO
ELECTRICAL -
FRAMING Recll
STORIES' TYPE CONSTR. I
INSULATION -
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sn Er FLool?AREA TOTAL Acn encE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Hes IND CON PB om '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE ID ❑ ❑ ❑ ❑
_ � AssEssoas PARCEL NO.
ROUGH - SAN.# -
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY jD0 ,-
MECHANICAL MECH.ENERGYOil Ggn
ELECTRICAL BUILDING ENERGY ACC.DATE ACG FILE NO
FRAMING - ELECT.FINAL TEST ZONING ENG,SITE NO.,
INSULATION - wPLUMBING
GAS TEST - GAS
MECHANICAL
FIRE SPRINK, ENERGY L2<
• _ 6
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ - Y ❑ NID
EXTERIOR SHEARELECTRICAL RELEASE FLOOD ZONE A,L U.C,
. - . ' � - -
INTERIORSHEAR FIRE DEPT. Y❑ NO Y ❑ ,N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
. INTERIOR LATH '
TEMPORARY APPROVALS BUILDING j
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT•PERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR, MICROFILM
ARRANGE•FOR INSPECTION BY PHONING 252-4505; ! ELECTRIC
LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
Z
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
OKI
PLEASE READ REVERSE SIDE BEFORE , TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION -PERMIT NUMBER
T
utt-DING �Z fJ APPLICATION & PERMIT [ A
s 5 4
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATION
A�-T4 Iwo
yy[[
56AI(i L- /1 . QTY• ELECTRIC PERMIT FEE
4 � PHONE
CTOR'S
�K UTLETS-SWITCHES-RECEP 10.00/1.00
tic.No. 26332-2V LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS [ / ��IJ)�� ,APPLIANCES-RESIDENTIAL 4.00
!y/ PHONE �(//�Q/j PANELS 10.00 DATE OF APPLICATION
ARCHITECT It - PLAN CHECK FEE P,C.NO.
oR PANELS (OVER 200 AMP) 20.00
ENGINEEfl
• LIC.NO. ISIGNS TRANS. 3.00
ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlv TEMP.METER OR POLE INS. 20.00
APPLICANT rs
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
"HI O 9 LICENSED CONTRACTORS DECLARATION
a v I hereby aftir"Allat I am licensed under provisions of Chapter 9 - ISSUANCE DATE
vHi "' (commencing with Section 7000)of Division 3 of the Business and
a N _I BLDG. ELECT. PLG. MECH.
H 0 Z Professions C 7n m is se is in full for e:s If c�Y
Z O'4- Licens a NOtn T ❑ ❑ ❑ co
9 m r w Date Contractor
a m f �jr(J
¢ ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
¢ Ic u, u � INFORMATION
La ;LL N I hereby affirm that I am exempl.frour the Contractor's License MISC.- REFER TO ORD
u0¢ Lawforthe followingreason.(Sec.7031.5.Business and Professions VALUATION $/FT.
r yy_1 Code:Any city or County which requires a permit-to construct,alter, PERMIT ISSUANCE 10.00
Qa ¢ 0improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO, ELEC.
i 0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w m m he is licensed pursuant to the provisions of the Contractor's License
H i,Q Law(Chapter 9(commenciagwithSection 7000)of Division3ofthe
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
re I 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
A. by any applicant for a permitsobiccts the applicant to o civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500)J:
❑ 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,AREA,GOND. 5.00 '
Code:The Contractor's License Law does not apply to an owner of - - -
property who builds or improves(hereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered for sale,If,however,the budding GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im .- - RES IND CON Pe Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00 RE ❑ CO 11❑ 1,as owner of the property,am exclusively contracting with
- licensed Contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B:- 6.00 ASSESSORS PARCEL NO.
and Professions Code: the Contractor's License Law docs not apply
to as owner of properly who builds or improves thereonl and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with a contracloBS)licensed pursuant to SEWER-SANITARY-STORM EA.2001[/10.00
lire Contractors License Law. TRACT NO. PARCEL NO.
'❑ I in.,exempt under Sec. ,B.&P.C.I'or,this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKF-RS'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'Comptro, Insurance,or a certified ENG.SITE NO.
copy Cher f S 36Q� 3�s CJ. {JfD/q _- / -
Policy NrQb�jfd0y x'� 'T-t � �
Certified copy is
filed furnished.' _ FIRE gPRINK ENERGY T-24
Z 2 Certified copy is file) with the city inspection division.
MISC- REFER TO ORD.
Q PP i[an[ V � N� V � NO
♦cc:- CERTIFICATE PERMIT ISSUANCE , 10.00 -FLOOD ZONE A.L.U.G.
LU � CO(70 OE EXEMPTION FROM WORKERS'
W MPENSATION INSURANCE PLG.CONTR, UC.NO. 'PLG.
CL Q (This section need not he completed if the permit is for one f TOTAL Y[] NV❑ No
hundred dollars IS 100)or Its,I p
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT F 99 FEE SUMMARY
LL I. 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
LU Date Applicant ALTER OR ADD TO MECH. LDING
} N NOTICE TO APPLICANT: IL after making this Certificate of Ex.
F Z' emption,you should become subject to 0e Workers'Compensation APPLIANCE • ' .00 ,PLAN CHECK
provisions of the Labor Cade, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO t0,000GF.M.) 4,
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 ', .SEISMIC FEE
I hereby afOrm 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.). A ae HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name ALL(/�✓"
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
Infatuation is correct.1 agree(a comply with all city and county - PLUMBING
ordinances and state laws relating to building construction, and BOILER-CUMP(3 H.P,Gr 100,000 B.T.U.) 6.00
hereby authorize representatives fori ins of this city es enter opal the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH: MECHANICAL 6`S�
above-mentioned property forinsp orth i purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. '
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
Kooning Of this permit. MECH.CONT. LIC.NO. MECH.
P4 4 -'_f TOTAL �, v TOTAL
gna(ure of A
pplicant/Contraelo, Date
OFFICE COPY