18434 (2) 'POST THIS NEAR FRONT OF BUILDING" PERMIT NUMBER
1 CITY" OF- CUPERTINO 18434
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS:.( Q ' 2""�' �••-'d 1INIT# _LOT#
�S CONTRACTOR
PERMIT EXPIRES IF THIN
ORK
OWNER . J coNTRAc*oaf-'A-_[_TI '(T•V, � OL IS NOT STARTED WITHIN
INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION. •- - ' • + • -ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
UFER. ALL-GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION,
CUPERPNO STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _
UNDERGROUND /SLAB 11 Y a
PLUMBING
ELECTRICALISSUANCE DATE
. -cww� FLOG. ELECT. PLG. MECt.
C IC
ME HAN AL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
• - INFORMATION
WOOD FLOOR
VALUATION ". $LFT.
PLUMBING,
.. MECHANICAL
ELECTRICAL
_ PERMIT TO
'. - � ..,
'L FRAMING
INSULATION . -^ a sroRlEs TVPE co"sTR.
' OCC,GROUP' ..REs.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT.FLOOR AREA TOTAL ACREAGE
ROOF.* NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
' .' DIAPHRAGM. THE CONSTRUCTION-TAX IS PAID
BUILDING USE
ROOF SHEATHING T., RES IND CON PB of"�,
El 0 El
APPLY NO,ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ` SE " ❑
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING _ ELECT.ENERGY" -
' TRACT NO. PARCEL NO!
TUBS&SHOWER PAN' . PLUMBING ENERGY. , -
MECHANICAL MECH.ENERGY - - '
ELECTRICAL':: ' - BUILDING ENERGY : ACC.DATE - ACG.FILE`NO.
FRAMING-..!,,. - ELECT.FINAL TEST -
. ' INSULATION "-- -' PLUMBING
ZONING ENG'SITE No.
GAS TEST ., GAS
MECHANICAL - " FIRE SPBIN rc ENERGY T.24•
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y El N� ,L IN[]
EXTERIOR SHEAR - '' - ELECTRICAL RELEASE aooD zoNE A,L u.c. '
INTERIOR:SHEAR - FI RE DEPT:'• YE] N,❑ ` ❑ N❑
SHEETROCKGRADE L FEE SUMMARY
EXTERIOR LATH BUILDING - -
INTERIOR LATH TEMPORARY APPROVALS BUIL�INc ��;. .
SCRATCH COAT ELECTRIC PLANCHECK -
„f. GAS'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEEQ`
OCCUPANCYOF BUILDING ISNOTPERMITTE DUNTILBUILDING FINA LISSIGNED BY BUILDING INSPECTOR. MICROFILM•
ARRANGE FOR INSPECTION BY NON ING'252-4505, ELECTRIC. +
0ONE WORKING DAY BEFORE REQUIRED INSPECTION. PwnnBlnc
Z0__
`PLEASE GIVE JOB ADDRESS'WHEN PHONING:-
SEE.PERMIT FOR EXPIRATION DATE — MECHANICAL•,
IMPORTANT! . CONST TAX'
PLEASE READ REVERSE SIDE BEFORE TOTAL-.. 3` J'•v'�
CALLING FOR,FINAL INSPECTION.
OFFICE COPY r' .
i \ a'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT-PEN ONLY
BUI LDI NG PROJECT 1 DENTI FICATION PERMIT NUMBER
Yr wcJG . APPLICATION & PERMIT.
DdRESE D7 - 18434
.. /� �]3 a.1 4 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,I,
OWNER'$ O� �`-' PLAN CHECK VALIDATION
NArnE �{/ DTV. � ELECTRIC PERMIT FEE
Es: .., �%PI,GNCAf07Yg6
NAME ncT Rs UTLETS-SWITCHES-RECEP 10.00/1.00
'.4I LE.No. LIGHTING FIXTURES10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS (f
,1 PMON ,2^2 7Qo PANELS 10.06 DATE OF APPLICATION ^
A C ITECT PLAN CHECK FEE- - P.O.NO.
Opey�� PANELS (OVER 200 AMP) 20.00
E T uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
AODREss SPECIALCIRCUIT 5.00
CT 'v'• Za, i�; EMP.METER 0R POLE INS. 20.00
g"/ L_,&-
y
APPLICANTS
ADDRESS MOTORS SEE-FEE SCH.
SERVICE CHANGE 20.00
'�1JGc� �
.9 LICENSED CONTRACTORS DECLARATION -
a i w I hereby affirm that I am licensed under provisions of Chapter 9 THEISSUANCE DATE
n (commencing with Section 7000)of Division 3 of the Business and a y g BLDG. ELECT. I PLG. MECH.
0 o z Professions Code,and my license is in full force and effect. j .,_a ❑ ❑ ❑
0 o - License Class - Lia Number-
0 Q ILVPI✓
4 v,r Date Convadar �V.
ams c BUILDING PERMIT
ce a OWNER-BUILDER DECLARATION
a o i v INFORMATION
X ; A_ 1 hereby affirm that I am exempt from the Contractor's Licwsre MISC.- REFER TO ORD
.. oa Law for the following reason, 7031.5,Business and Professions VALUATION E/FT.
_ PERMIT ISSUANCE 10.00
Code:Any city or county which reyuires a permit m construct,alter, O
QQ ¢ p Improve,demoliall,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. -
A C,rc reyuires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A w m he is licensed pursuant to the provisions of the Contractor's License
Law,(Chapter 9(commencing with Section 7000)of Division 3ofthe
4 o Business and Professions Code)or that he is exempt therefrom and OTTPLUMBING PERMIT FEE
IS I- g she basis for the alleged exemption.Any violation of Section 703 L5 STORIES TYPE CONSTR.
a 3 - by any applicant for a permit subjects she applicant to a civil penally
of not more than five bundred dollars(5500).1: ALTER-DRAIN&VENT-WATER (EA.)' 5.00 -
❑ I,as owner of the property,or my employees with•wages as BACK FLOW PROTECT.DEVICE 4.00 OOC,GROUP RES.UNITE
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 builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 EO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered(or sale.ll',however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or ire- BUILDING USE
REE IND CON PO Other
prove for purpose oftexclusivelyeJ. INDUSTRIAL WASTE INTER. - '30.00 ❑ El ❑ 1:1 1:1❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL 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 contractors)licensedpursuant 10 SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec..,B.&P,C.for this WATER HEATER W/VENT 6.00
reason
Owner Dutc WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP.' 5.00
I hereby affirm that I have a certificate ofconsem to self-insure. - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sj; $$$0000,Lab.C.l.
Policy No. ompany -
O ❑ er ied co ereb• rniah d. ` FIRE SPR INK ENERGY T-24
Z 2e of I with nspeetion division. MISC. REFER TO ORD.
O Applican v❑ N❑ V ❑ N❑
CC CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00FLOOD ZONE A.L.U.G.
` W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Z (This section need not be completed if Ilse permit is for one TOTAL Y❑ N❑ Y [3 PIC]
hundred dollars(5100)mile.
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL mil is issued,I shall not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws d(Calilbntia.
a Date Applicant ALTER OR ADD TOWECH. 5.00 BUILDING C(�
} m NOTICE TO APPLICANT: 11,after making this Certificate of Fs- -
? 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 10M)CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOODC.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. MICROFILM
3097,Cie.C.). H EATI NG UN IT(TO,100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.0.50 ELECTRIC
I certify that I hove .it this application and stale that it,,above VENTILATION FAN,(SINGLE) ' 4.00
• information is correct.I agree to comply with all city and County BOILER H.P.or 100,000 B.T.U.) 6.00 PLUMBING -
ordinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter Upon the BOILER-COMP(Over t00,0008TU15EE FEE SCM. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.: REFER TO ORD.
aper' ainst liabilities,judgments, costs and expenses which PERMIT ISSUANCE. 10.00 CONST.TAX
m m any way against said City in consequence of the
aNingof p lit. MECH.CONT. LIC.NO. - MECH.
8-
TOTAL TOTAL 3 r S�
Signature of Applicant/Contractor Date
OFFICE COPY