15651 (2) POST THIS CARD NEAR_ FRONT OF BUILDING .
+ ' PERMIT,NUMBER
' CITY OF CUPERTINO : .15651
INSPECTION DIVISION
JOB INSPECTION RECORD
s',r kPERM1T'E�IRATION J
JOB.ADDRESS Id W
OL5E 'Y�j7 UNIT# _'LOT# -
PERMIT EXPIRES IF WORK
.OWNER '),ICONTRACTOR �� U � NG � ��IS NOT STARTED WITHIN i
INSPECTION DATE INSPECTOR INSP ECTIO RECORD 150 DAYS OF PERMIT ISSU
FOUNDATION`. - ANCEOR.180 DAYS FROM
NOT.E:.
LILAST CALLED INSPECTION.
FER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
- PR EGUNZTE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
` CUPERTINO STANDARDS'.
'GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED q
UNDERGROUND /.SLAB -
PLUMBING. , . . , : F k'.r;
ELECTRICAL _ ( •
- ISSUANCE DATE.
MECHANICAL• _ • _ _ BLDG ELECT. PLG. MECH, .
a ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ``1 BUILDING PERMIT
WOOD FLOOR •r . INFORMATION
ALUAT'ON SIFT.
PLUMBING - - �i /
MECHANICAL -
ELECTRICAL - �'zrr�� PERMI To-
'FRAMING
INSULATION " STORIES TYPE CONSTR.
r
OCC.GROUP RES.UNITS i
I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.,ROOF ` • SO FT FLOOR AREA TOTALACREAGE
NOTE:NO FINAL INSP.SHALL BE MADE,BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS,PAID
ROOF SHEATHING ewLDING USE
- RES IND " CON PB •00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.— E. ❑ ❑ ❑ El-
IL
ROUGH .
SAN.N '. .
" PLUMBING ELECT.ENERGY '
_ TRACT NO. PARCEL NO
NUBS 8-SHOWERPAN PLUMBING ENERGY _
MECHANICAL MECH.ENERGY.
i •
' ELECTRICAL , . BUILDING ENERGY ACC:DATE ACC,FILE NO.� -,
FRAMING - ELECT.FINAL TEST
INSULATION. - PLUMBING - ,ZONING . ENG.SITE NO.
GAS TEST •• GAS -
• MECHANICAL _ FIRESPRINKENERGY,T 70
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - `` ❑ "❑ , ` ❑ "❑I ,
FLOOD ZONE - , A,L U C:
EXTERIOR SHEAR ELECTRICAL RELEASE - -
INTERIOR SHEAR '' FIRE DEPT. 'Y ❑ "❑ Y.❑ N❑
'SHEETROCK- GRADE- ' FEE SUMMARY
EXTERIOR•LATH' ' BUILDING - - ♦
INTERIOR 'LATH TEMPORARY.APPROVALS V BUILDING
SCRATCH COAT ' ELECTRIC . - PLAN CHECK.
GAS - .. FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ''MICROFILM
ARRANGE FOR INSPECTION:BY PHONING,-252-4505, ELECTRIC .
o� , ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
I) —.SEE PERMIT F,QR'EXPIRATION DATE — MECHANICAL'
,IMPORTANT! CCNST.;TAX
PLEASE,READ REVERSE SIDE BEFORE " 'I TOTAL`
CALLING,FOR"FINAL INSPECTION. "
OFFICE COPY
ARPLICAN.T TO FILL IN INFORMATION WITHIN RED LINES - USE BALL P61NT'PEN ONLY
BUI LDING PROJECT 1 DENTI FI ATION - - - PERMIT NUMBER
8ULTllNl1 APPLICATION_ , = L' 5+& PERMIT. 1 51
' �a AOORE55 , , OO
BUILDING-ELECTRICAL ,PLUMBINGMECHANICA ' •" 1'
OWNER'
\/ NAME VAW NS PLAN CHECK VAL ATION
r � CITY. ,ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S 1 �( // \
NAME OUTLETS'-n 521�4-Z OUTLETS"-SWITCHES-RECEP, 10.00/1.00, Y
1'f �T ue.NO. LIGHTING FIXTURES',- '10,00/1.00 .
CONTRACTOR'S -
'
ADDRESS {7VOL(/'� APPLIANCES-RESIDENTIAL - 4.00 '
Z T�/IFR p,Q. PriONE.��B�Tf� " PANELS 10.00 DATE OF APPLICATION C
]ARCHITECT 0 - PLAN CHECK FEE P.C.'NO.
PANELS (OVER 200.AMP) 20.00 -
.. ENGINEER,M ' 1oLL,•
III V Iv r�7�j1�'Piuc.'N�o'�. f SIGNS TRANS: - � 3.00 i
ARCH OR ENG. _ r4*P SPECIAL CIRCUIT 5.00
AOO PERMIT VALIDATION
ziP -1 dd TEMP.METER OR POLE INS. '20.00 -
ANT'S - -
aDDHESoREss ��,,,��,�.�,���••� " ' � � MOTORS' '.. '..SEE FEE SCR.
'iNnPG' SERVICE CHANGE 20.00
o 0 z l/l///// r� �Y
FOO LICENSED CONTRACTORS DECLARATION nn o
a U u, I hereby affirm that I am licensed under provisions of Chapter 9 t ISSUANCE GATE
y a (commencing with Section 7000)of Division 3 of the Business and _ •, _
Professions Code d I y license is in full for •ayd f@r`L�Z BLDG. ELECT, PLG. "'MECH.
z O w License Clas �� Lie.Number L {
O w r�'Date_`]_. -1 �- Contractors - I
El
a " BUILDING PERMIT
rc ¢ w OWNER-BUILDER DECLARATION
wR. LL r 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
u O Q Law for the following reason.(Sec.703 LS,Business and ProfessionsVALUATION $/FT.
� - Cade:Any city or county which regniresu permit to construct,al ter, PERMIT ISSUANCE 10.00
¢p improve,demolish,or repair any structure,prior t.ifs issuance,also ELEC.CONTR. LIC.NO. -
i E m¢ requires the applicum for such permit m file a signed stmement but _ TOTAL
w ^ ,A he is licensed pursuant to the provisions of the Contractor's License _ .PERMIT
r z a Law(Chapler9(rommencing with Sce[ion 7000)of Uivision3of the 11V7Zr440A_ d
4 c Business and Professions Code?or that he is exempt therefrom unit CITY. PLUMBING PERMIT FEE
¢ F$ the basis fur the alleged exemption.Any violation.f Section]031.5 STORIES TYPE CONSTR.
n ; � by any applicant forapermit subjects the applicanttoucivil penalty ALTER-DRAIN 5.00 '
oP not more than flue hundred dollars($500).): '
❑ I,as owner of the property,or my employees with wages as, - BACK FLOW PROTECT.DEVICE 4.00
their sole cmnpensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale,(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The CoNract.r's License Law does not apply to an owner of -'
property who builds or improves\! thereon,and who docs such work FIXTURES-PER TRAP-, 5.00 -
J1 himself or through his own employeesprovided that such improve- SO.FT.FLOOR AREA TOTAL ACREAGE,
ments are not intended or offered for sale.If,however,the building GAS_-EA.SYSTEM-1 INC.4 OUTLETS-6.00
_y or improvement is sold within one year of completion,the owner*
x builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - RES IND CON PB .other
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sea 7094,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARC EL 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
contracts for such projects with a contractoPS)licensed pursuant to '
the Contractor's License Law. . SEWER-SANITARY-STORM EA_ .200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B&P.C.for this
reason WATER HEATER W/VENT' 6.00 -
Owner Date WATER SYSTEM.'' a 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 5.00
1 hereby affirm that I,have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Asour or a certified - ZONING ENG.SITE N0.
copy Cher il,L I 6�/I_ x
Policy 11 1 V I'T
0 ❑ Certifi py is he yfur ' FIRE SPRINK ENERGY T-14
Z Z .`�C Cir'if' ropy is I d . =conn division. -
� p Apll ant_ MISC. - ^REFER TO ORD. Y N� Y ❑ 'N�
CCN 'CE RTI FI EOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 - FLOOD ZONE A.L.U.C.
LU > OMPENSATION INSURANCE PLG.CONTR. uC.NO. _ PLG.
1 (This s,ctidn need not be completed if the permit is for one TOTAL Y[:] N Y 0 N
Z hundred dollars IS 1001 or less.) -
L) O 1 certify that in the performance of the work for which this per, CITY MECHANICAL PERMIT FEE FEE SUMMARY -
IL 1- mit is Issued,1 Shall not employ any person In any moaner so as to
0 W become subject to the Workers'Compensation Laws of California.
p• Date Applicant ALTER ORADD TO MECH. 5,00 BUILDING{ <S"a
} m NOTICE TO APPLICANT. If,after making this Certificate of Ex-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 ,PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
V' such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) .4.00 FEE
-CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE s414D
1 hereby affirm that there is a construction lending agency I'or EXHAUST HOOD(WITH DUCT) ' 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 `
Lender's Address ELECTRIC
1 certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) ` 4.00
information n correct. I s nal to comply with all city and county BOILER-COMP PLUMBING
ordinances and state laws relating to building construction, and (3 H.P.or 100,000 B.T.U.) 6.00
herebyauthorize representatives of this city enter upon the
above- BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposeses.
(We) agree to save, indemnify and keep harmless the City of 'MISC. - REFER TO ORD.
uperlinodfythi
I hilities, 'udgmenls, costs unit expenses which CONST.TAX
ma 'awar g aid City in can quen a of the PERMIT ISSUANCE - 10.00
tat 1. MECH.CONT. LIC.NO. TOTAL ITOTAL.� Igo tot ant/Contract. Date �.
OFFICE COPY