17926 (2) I
POST THIS,CARD NEAR FRONT OF.'BUILDING
PERMIT NUMBEA
CITY, OF CUPERTINO
INSPECTION DIVISION � ���' '
JOB INSPECTION RECORD. "
7 ` ns SQ, PERMIT EXPIRATION
JOB.ADD,RESS /0'e- � UNIT,# LOT#{' - • `',
y� ��Y\ Ons PERMIT EXPIRES.IF WORK''
OWNER 011 I CONTRAcroRil6meNUl W - IS NOT STARTED,WITHIN
INSPECTION DATE I INSPECTOR - INSPEC ION RECORD 180 DAYS OF PERMIT ISSU.
,I•. 'FOUNDATION - - ' ANCE'OR 180 DAYS FROM
'NOTE: LAST CALLED INSPECTION.
LIFER, • - ALL GRADING AND DRAINAGE SHALL BE:INSTALLED <'^A.•
PREGUNITE " - - TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. PERMIT VALIDATION
GARAGE SLABS, � � ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED w ,• -°''�1 1�� ,,'�ilw
UNDERGROUND /SLAB - S %
PLUMBING
ELECTRICAL 9
ISSUANCE DATE
MECHANICAL - - - - BLDG'. ELECT., PL MECR..
( . ❑ ❑ ❑.,
DO NOT FOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ - •BUILDING PERMIT
WOOD FLOOR INFORMATION;
PLUMBING '" , ..
VALUATION aIT.
,
MECHANICAL', q
ELECTRICAL _ - f P€ MIT TO
FRAMING - -
�m�.�
INSULATION - .STORIES. TYPA.CONSTR,
• i ,• OCC.GROUP RES UNRS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - -
1 SO,FT FLOOR ARIA •TOTFL ACREAGE
'ROOF NOTE:NO FINAL INSP..SHALL BE MADE BEFORE .
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHE - ."REs, IND , CON PB :OI-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ - ❑ ❑
ROUGH SAN.p - nssessoas PARceL No. .
PLUMBING r - ELECT.ENERGY
TRACT NO PARCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY '
ELECTRICAL BUILDING ENERGY ACC.DATE .ACC,FILE NO
FRAMING% ELECT,FINAL TEST;
ZONING ENG,SITE NO.
. INSULATION - - PLUMBING. c
GAS TEST GAS x
MECHANICAL FIFE SPRINK ENERGY.T 24,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ E] "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE , A.L U.c.
INTERIOR:SHEAR FIRE DEPT. - v❑ °N❑ y No
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING • .
INTERIOR LATH - - 'TEMPORARY APPROVALS'
- BLiILDwG ,
SCRATCH COAT ELECTRIC PLAN CHECK
GAS .FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE *,
OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTIL BUILDING FINAL IS"SIGNED BY BUI LDING INSPECTOR; MICROFILM
ARRANGE FOR INSPECTI,ON-BY PHONING 252-4505, 'ELECTRIC
EL ONE WORKING DAY BEFORE'REQUIRED.INSPECTION: P�uMBING
z PLEASE GIVE JOB ADDRESS WHEN.PHONING.
- SEE PERMIT FOR EXPIRATION DATEMECHANICAL
.-
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE p
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
w AUI LDING PROJECT I DENTI FICA N PERMIT NUMBER -
BUILDING O 2 APPLICATION & PERMIT 1 (]
ADDRESS I J
1O a BUILDING—ELECTRICAL—PLUMBING—MECHANICAL ;•„
OWNER'5 - PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE -
O_5AJU1 f45 PHONE
NOMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.N. q34 335 LIGHTING FIXTURES. - 10.00/1.00
COTRACTORSns
ADDRESS APPLIANCES-RESIDENTIAL 4.00
`
PHONE ,7j S-7S PANELS 10.00 DATE OF APPLICATION
ARCHITECT" " .� PLAN CHECK FEE
OR PANELS (OVER 200 AMP) 20.00
ENGINEER •'
uc.NO, SIGNS TRANS. 3.00 '
ADDRESS ENG SPECIALCIRCIIIT 5.00 PERMIT VALIDATION ;
ZIP - EMP.METER OR POLE INS. , - 20.00
APPLICANTS - MOTORSEE SCH. (� '
ADDRESS - -
SERVICE CHANGE 20.00 'SI2�jICJ-1 '
o o LICENSED CONTRACTORS DECLARATION _
' <t I hereby affirm that I am licensed under provisions of Chapter 9 I ISSUANCE DATE
yQu
(commencing with,Secfion 7000)of Division 3 of the Business and BLDG. ELECT PLG. MECH-
H N z Professions Codo,a my license is in full Cor ,gnd foe' ❑
z O m — License Cle% Liu Numbe 3 bJ� -
0 w I- w Dale Contractor
¢ m E BUILDING PERMIT
¢ ¢ w - OWNER-BUILDER DECLARATION 'INFORMATION
E
;LL N 1 hereby affirm that 1 ant exempt from the Contractor's License MISC.— REFER TO ORD VALUATION $/FT.
H ¢ Oj Law for the following reason.(Sec.7031.5,Busine%%and Professions PERMIT ISSUANCE - 10.00 '
,A i Code'.Any city or county which mquircea permit to construct,alter,
re 2 ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. '
O ¢ requires the applicant for such permit to file a signed statement that - TOTAL ;T p RMIT TO
E
$ he is licensed pursuant to the provisions of the Contractor's License Umj�
H z a Law(Chapter 9(commencingwith Section 7000)of Division 3 oflhe
i O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE.
¢ H$ nQ
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TV ECONSTR.
a3�
by any applicant for a permit subjects the applicant-to a civil penalty - gL'TER-DRAIN -WATER IEA.) 5,00
of not more than five hundred dollars($500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE . 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not -
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code:The Contractor's License Law does not apply to an owner of -
property who build%or improves thereof,and who does such work FIXTURES-PER TRAP -,5.00
,5,00 O„ SO.FT.FLOOR AREA TOTAL ACREAGE
himselfornot hrough
ownemployees,for salt,
If,ho everhat the
improve- GAS-EA.SYSTEM-1 INC:40UTLETS 6.00
motifs are not Intended or Offered for sale.If,however,the building
or improvement is sob within dna year of completion,the owner- GAS,EA.SYSTEM-OVER 4 IEA.) - .2.00 BUILDING USE
prove
of will have the burden of proving that he did not buil)or im- .,RES IND DON PB Omer
prove for purpose of Safe.).property, INDUSTRIAL WASTE INTER. 30.00
❑ d as owner Of the structheexclusivelyproject
Se contracting with -❑ ❑ ❑ ❑ ❑
andPro coigns rod to construct Contra the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 8.00 gssessoRB PARCEL No.
and Professions Code:The Contractor's License Law does not apply
to anowner of property who bulbs or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
' the Contractor's License Law. < - TRACT NO. PARCELNO.
O I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
r PCC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 _
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or B certified - ,
copy lhereof(Sec.1100,Lab.C.l. '
Policy No. Company
O ❑ Cerlified 'opy shereby rami jteJ. FIRE$PRINK ENERGY T44
Z Z A Certifl co i% Eled w' ✓ I' city inspectlon division. -
O Applicant` MISC.:, REFER TO ORD. Y ' N❑ Y.E] N❑
Hy
17-M FLOOD ZONE A.L.U.C.
:OP PERMIT ISSUANCE
CERTIFICAT EXEMPTION FROM WORKERS' - Z ` C7�
LU D COMPENSATION INSURANCE I . PLG.CONTR. LIC:NO, PLG,
1 O (This sermon need not be completed if the permit is for one I TOTAL ,C"' Y❑ ' N•❑ Y ❑ N❑
::) Z hundred dollur%($100)or It..)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
IjL F mil is issued,I shall not employ any person in any insurer so as to
U become subject to the Workers'Compensation Laws of California.
n Datc Applicam _ ALTER OR ADD TO MECH. 5.00 BUILDING
} to , NOTICE TO APPLICANT: If,after making this Certificate of Lx- -
?. emotion,you should become subject to the Workeri Compensation APPLIANCE. 5.00 PLAN CHECK
provisions of the Labor Code, you,must forthwith comply with 10 FEE -
V Such provisions or this permit shallAIR HANDLING UNIT(TO be deemed revoked. { =12—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 construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance:of the work for which this permit is issued(Sec. . HEATING UNIT(TO 100,000 S.T.U.) 8.00 MICROFILM
3097,Cie.CJ. -
Lender'sNameHEATING UNIT IO VER 100,000 B.T.U.)9.50 _ ELECTRIC
Lender's Address
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING �••�/
ordinances and stale laws relating 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 BOILER-COMP IOVBr100,00DBTUISEEFEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue again said City in consequence of the L
PERMIT ISSUANCE 10.00
ran[ of Is petmi. MECH.CONT. LIC.NO. MECH. -
TOT,
512 TOTAL e
Signature of pylic Contractor Date
OFFICE COPY