18010 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO'
18010
INSPECTION DIVISION /. .
JOB INSPECTION RECORD —� - ( f
1 •FERMI EXPIRATtIIOONII 7
JOB ADDRESS•.kl„L. U IT# LOTAE PERMIT 4 R11 f FUR'WORK�
OWNER ONTFACTOR IS NOT�'S1 Al WITHIN
INSPECTION DATE INSPE&OR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS' e 1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB j A� �e7
PLUMBING
ELECTRICAL . ISSUANCE DATE -
MECHANICAL OLDELECT. PLG. MECH
IeA1L2. ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDUN I BUILDING
PERMIT( INFORMATION
WOOD FLOOR - VALUATION SIFT.
PLUMBING City of Cupe.lno,: ' '
, I
MECHANICAL -
—PERMIT TO
ELECTRICAL
FRAMING
INSULATION -
STORIES TYPE, CONSTR.
� �
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT,FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND ;0 PB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
AhSllSU?l IAHCEL NO
' ROUGH SAN.#
PLUMBING 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
GAS TEST- GAS
MECHANICAL-
FIRE SPRINK ENERGY T-24
.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ " ` ❑ N�
EXTERIOR SHEAR ELECTRICAL RELEASE FL000 ZONE ,A L LLC
INTERIOR-SHEAR
FIRE DEPT. Y[J, "� YtlL N[
• SHEETROCK GRADE _ FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVAL BUILDING I
SCRATCH COAT ELEQTRIC PLAN CHECK _
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE !
OCCUPANCY OF BUI LDING ISNOT PERMITTE D UNTI L BUI LDI NG F INALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —.
IMPORTANT! cousr.TAX
PLEASE READ REVERSE SIDE BEFORE av1 r'
O
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
~ '§U I LDING PROJECT,I DENTI FICATION ,Z<'1 .PERMITNUMBER ,-
ADOR k r izz • APPLICATION & PERMIT '- (� (�
BUILDING
pp f u J
- ' Oh� 110 4 S4•r� BUILDING — ELECTRICAL—PLUMBING—MECHANICAL ,�,
0 NEn'8 R C10 ICY F'•
NAME
/ PLAN C V
�Llq.N`reIOU _ OTY• ELECTRIC PERMIT FEE
•n W 7�eld PNON yC SSS-JrU
ANTRACTORs
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 //✓^] W I
N
' LIC,NO., LIGHTING FIXTURES 10.00/1.00 ^^ ,
ADORSsTORS APPLIANCES RESIDENTIAL 4.00
�I PHONE- PANELS 10.00 DATE OF APPLICATION
T'120c, Oni ry MADS; NOS PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER _
uc.
AENG. NG.' SIGNS TRANS. 3.00 -
ADDRESS OREss � SPECIAL CIRPERMIT VALIDATION.
5.00 '
ZIP • EMP.METER ORP
0.0
APPLICANTS
SDD MOTO0-A'AEE FEAR.
J . /
SERVICE CHAN(p , 20.00 /I_
woo LICENSED CONTRACTORS DECLARATION n ' �(f
r z w .1 mentiereby g with
that 1 am licensed tinder provisions of Chapter'[ 1}„ s Auu�^' ISSUANCE DATE
(commencing with Section 700e i of Division 3 of the effect,
ss and "l z'W W •BLDG. ELECT. PLG: MECH.
H i Professions Code,and my license is in full force and effect. - ❑ ❑ ❑
o i L O License Class conjra tm - - -
m r W Date Contractor
Q m a OWNER-BUILDER DECLARATION BUILDING PERMIT
o a o - INFORMATION
F.
g LL Le I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
u O¢ Law for the following reason(Sec.7031.5,Businessand Professions VALUATION $/FT.
t —w PERMIT ISSUANCE 10.00
Eco> E Code:Any city or county which requiresa permittoconslrud,elleq
X et O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. E LEC.
v
F. o u requires the applicant for such permit to file a signed statement that TOTAL
u w m m he is licensed pursuant to the provisions of the Contractor's License 'PERMIT TO
rz> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
q o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
F-m the basis for the alleged exemption,Any violation of Section 7031.$ - STORIES TYPE CONSTR.
a by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500)J:
❑ I,as owner of the Property,-or my employees with wages as BACK FLOW PROTECT. DEVICE .4.00
their sole Compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,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 - SQ FT.FLOOR AREA TOTAL ACREAGE
himself ments re through his own employees,provided that such improve-
orimprovemenotnntmold or within
red one or year
[completion t the o neo, GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of he dill ion,the owner-
- builder will have the burden of proving that he did not build or ins- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.), RES RES INP CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 � ,.�
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSO S
13
and Professions Code:The Contmctor's1icense Law does not apply PARCEL NO.
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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No.
❑ lam exempt under Sec.reas
on ,B.&P.C.for this WATER HEATER W/VENT 6.00 '
Owner Date WATER SYSTEM - 5.00 ACC.DATE ACG FILE NO,
WORKF.RS'COMPBNSATION UECLA RATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Workers'Compensation Insurance,or u certified ZONING ENG.SITE NO.
copy thereof fSec.3800,Lab C.).
Policy No. Company -
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY TY4
Z Z ❑ Certified copy is tiled with the city inspection division.
FO Applicant MISC.- REFER TO ORD. YQ N❑ v ❑ N[_ '
CC CERTI FICATE OF 17XEMPTION FROM WORKS RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O.
CL , (This section need not beTcompTION llel ed INSURANCE
theEpermit is for one, PLG.CONTR. LIC'NO. TOTAL Y❑ N Y ED N
CL Q
D Z hundred dollars IS 100)or leas.) -
0 O ['certify that in the performance of the work for which this per. QTY- MECHANICAL PERMIT FEE FEE SUMMARY
.LL U mil is issued,I shall not employ any person in any manner so as to I
become subject to the Workers'Compensation Laws of California. •�
i . Date - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 500 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with . "
f..) such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10000C.F.M,) 4,00 FEE.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.EM.) 6.00 SEISMIC FEE,
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH D 00
the performance of the work for which this permit is issued(Sec.* MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100;000 B .00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,006IB:T7U.)V.AR ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE -
In is correct. I agree to comply with all city and county BOILER-001%
13 H.P,or 100,0 .0 PLUMBING
�`. ordinances and state laws relating to building construction, and
hereby authorize representativesoertyf is of this city to enter upon the BOILER-COMP (Over 100,000 BTU[SEE FEE SCH. MECHANICAL
above-mentioned property finspection party to
(We) agree to save, Indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANC_E 10.00 CONST.TAX
ay in any way accrue against said City in consequence of the
ranvI gof/ylls PVNMECH.CONT. LIG NO. MECH. �j
L/r.J +yy TOTAL- `;I •�y�
Srgeture of Applicant/contractor Ua[e/ u r TOTAL 7U( V
OFFICE COPY