15650 (2) POST THIS CARD NEAR FRONT OF BUILDING • PERMIT NUMBER
` CITY OF CUPERTINO
INSPECTION DIVISION
JOBY INSPECTION RECORD p
'SPS Ia �a PERMIT EXPIRATION
JOB ADDRESS /WOU A/. W OL o C / W UNIT# _LOT#
/YU CO IO�I PERMIT EXPIRES IF WORK
OWNER . CONTRACTOR E,�q.UM .� L8.6— IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTI ON.
UFER ALL GRADING AND E DRAINAGE PLANS INSTALLED ..I.
PR EGUNITE CU COMPLY WITH THE APPROVED PLANS AND CITY OF PERquT vALmA noN
CUPERTINO STANDARDS.
GARAGE SLABS • "' r,,:,...
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ✓ °--^^`
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL IssuANce DATE
MECHANICAL + - Bloc ELECT. PLG. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR vALuanoN SIFT. -
PLUMBING -
MECHANICAL'0 - - -
ELECTRICAL - Qw �1 PERmIT TO
FRAMING
INSULATION' STORIES - TYPE CONSTR.
i - �� OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINALINSP.SHALL BE MADE BEFORE sa.ET FLOOR AREA TOTAL ACREAGE
.
DIAPHRAGM THE CONSTRUCTION TAX IS PAID,
BUILDING USE
ROOF SHEATHING RES IND CON PB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 0 0 0
ASSESSORS PARCEL NO
ROUGH' SAN.#
PLUMBING ELECT,ENERGY
TRACT NO. PARCELNO-
TUBS&SHOWER PAN - PLUMBING ENERGY
MECHANICAL - - - MECH.ENERGY
ELECTRICAL
ACC.DAT ACC FILE NO 1
BUILDING ENERGY
FRAMING. ELECT.FINAL TEST '
ZONING ENG,SITE NO.
INSULATIONS PLUMBING:
GAS TEST - _ GAS
.
MECHANICAL - FIRE SPRINK P ENERGY T-14
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. "� ° "EI
EXTERIOR SHEAR
E ELECTRICAL RELEASE FLOOD ZONE- A,L.U,C.
INTERIOR SHEAR FIRE DEPT.,' - - Y❑ N� ~ -.0 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 BUILDING IS NOTPERM ITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252=4505, ,_; ELECTRIC
ELI ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING-
ozo• - IFI
z PLEASE GIVE JOB ADDRESS WHEN PHONING. ,I
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL-
a ''
IMPORTANT! ;. CONST.TAX
PLEASE READ REVERSE SIDE BEFORE 'O
CALLING FOR FINAL INSPECTION. . ` TOTAL
OFFICE COPY
APPLICANT,TO FILL IN INFORMATION WITHIN RED LINES ,.'USE BALL POINT PEN ONLY'
43UI LDI NG PROJECT I DENTI FIC TI IN PERMIT NUMBER )
6ADD SS �L APPLICATION & PERMIT
ADDR as.
15650Lu�/bY L1 BUILDING`—ELECTRICAL—PLUMBING'-MECHANICAL
OWNER'S -
a
NAME CITY.'- OTY. - ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
-
.
CONTRACTORS
PHONE
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1,00 ^
• 62 .'uc N6,2_5- s LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADOREss $r04JI, APPLIANCES-RESIDENTIAL .4.00 ' --
3S Ai PHONE �- Qy PANELS 10.00 DATE OFAPPLI CATION
ARCHITECT PANELS (OVER.200 AMP) 30.00 PLAN CHECK FEE F.C.INO.
ENGINEER
LIC,NO. SIGNS TRANS: 3.00
ADDRESS ENG. , SPECIALCIRCUIT 5,00 PERMIT VPCIDATION
'
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S -
ADDRESS •' MOTORS ... ' SEE FEE SCH.
SERVICE CHANGE 20.00 /
woo LICENSED CONTRACTORS DECLARATION
< u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE - ^
y c w (commencing with Section ]000)of Division 3 of the Business and BLDG- ELECT. PLO. MECH.
H z Professions Cod• and m license is in full fore; �ffgct. - ❑ ❑ ❑
z0 i m�_ LlcenS Class Lia Number ''l1
F w H J ate Contractor ' BUILDING PERMIT
rt w OWNER-BUILDER DECLARATION - - INFORMATION
w ;LL w I hereby affirm that I am exempt from Ne Contractor's License MISC.— REFER TO ORD
ov, Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 - VALUATION $/FT.
Code:Any city or cou ity which requires a permit to construct,alter,
•¢ ¢ ¢p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO, ELEC.
G¢ requires the applicant for such permit to file a signed statement that TOTAL — -
e..W m u he is licensed pursuant to the ptovisions of fire Contractor's License PERMIT,TO
H z F Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
i o ` Business and Professions Code)or that he is exempt therefrom and O PLUMBING PERMIT FEE
H m. the basis for the alleged exemption.Any violation of5eclion 7031.5 ,I STORIES TYPE CONSTR.
n 3 .- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500)J:
❑ I,as ovener-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
Code:The Contractor's License Law does not apply to an owner of - "
property who build,or Improve,thereon,and who doe,such work FIXTURES-PER TRAP O.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended Or Offered to,
mprove-mentsarenotintendedorofferedfo,Sale.If,however,the building GAS-EA:SYSTEM-11 NC.4 OUTLETS r'
or improvement is sold within one year o1'completion,the owner- GAS-EA.SYSTEM-OVER 4 ( 0
builder will have the burden of proving that he did not build or am- BUILDING USE
prove for purpose of sale.). RES IND CON PB 'Other,
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. ' 3 ❑, ❑ ❑
licensed'contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V. .00 I ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Low does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA:) 1.00
- contmcls for such projects with a conlractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. - PARCEL NO.
❑ I am exempt under Sec. ,B.&P,C.fortIH, WATER HEATER W/VENT 16.00
reason
OWnerDate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERYCOMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 - 1
1 hereby affirm that [have acertificate ofconsent to elfinsure, - - ZONING ENG SITE NO..
or a certificate of Workers'Compensation Insurance or a certified `
copy thereof(Site.3800,Lab C). -
.20 Policy No. Company - -
0 ❑ Certified copy is hereby furnished. FIRESPRINK ENERGYT24
Z Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC.-. .. REFER TO ORD. - Y❑' . N❑ Y❑ N❑
= LO PERMIT ISSUANCE ,}6:00 •' FLOODZONE A_L.uc.
W _ CERTIFICATE COM E EXEMPTION FROM WORKCRS'
W - COMPENSATION INSURANCE PLG.CONTR. , ❑C.NO. PLG. -
d O' (This section need Pat be completed if the permit is Ibr one _ -TOTAL Q Y❑ N❑ Y❑ N❑
Z hundred dollars IS 100)or less.) -
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall`not employ any person in any manner so as to
O U becor�lL su�h�c{�p,�he Workers,ComPens I sof Californ'�. -
a�s-rte IIX-- � )T.�tt.fc BUILDING
y�L Date Applican ALTER OR ADD TO MECH. 5.00
^NOTICE TO APPLICANT U!aher making this Certificate of Ex-
F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 - 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(TO 10P=MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
'I hereby affirm that there is a cons`truclion lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. - - 'MICROFILM
3097,Civ.CJ. HEATING UNIT(70100,000 B.T:U.1 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U19.50
Lender's Address ELECTRIC ,
I certify that 1 have read this application and state that the above . VENTILATION FAN (SINGLE)LEI , . 4,00 - _q
5� information is correct. I agree to comply with all city and county - , PLUMBING a2..O �-
ordinances and state laws relating to building construction, and BOILER-COMPOH.P.cr100,000B.T.U.) 6.00
hereby authorize representatives of this city,to enter upon the BOILER-COMP (Over100,000BTU)SEEFEESCH. MECHANICAL
above-mentioned property for inspection purpous.
(We) agree to save, indemnify and keep harmless the City of MISC.-, REFER TO ORD. - -
Cupertino 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
i' Ming of this per 't MECH.CONT. LIC:NO. MECH.
TOTAL TOTAL
Signature of Applican l/Contractor Dale
OFFICE COPY '` '