18562 (2) -POST THIS CARD.NEAR FRONT O•F BUILDING
PERMIT NUMBER
CITY ,OF CUPERTINO 18` 6
INSPECTION DIVISION'O
JOB INSPECTION RECORD 5�' 2072
p PERMIT.EXPIRATION
JOBADDRESS` 1_ IZ3, C.CJQLY— UNIT# _LOT# -
'PERMIT EXPIRES IF WORK.
owNER-, �- +� - CONTRACTOR '� �. j IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. .
FOUNDATION NOTE: - - ANCE OR 180 DAYS FROM
LIFER ALL GRADING AND DRAINAGE SHALL LED LAST CALLED INSPECTION.
PREGUNITE - TO COMPLY-WITH THE APPROVED PLANS AND jC'ry'ye,,jp��E . PERMIT VAL CATION
CUPERTINO STANDARDS." itiv -
"GARAGE SLABS,. a ....��
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
'UNDERGROUND /SLAB
PLUMBING �7
I ELECTRICAL a ISSUANCE CAFE
'MECHANICAL - BLDG rLECT I PLG. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING vALuanoN SICT.
MECHANICAL' ;
Dod )
ELECTRICAL - PERMIT TO
FRAMING -
INSULATION - - sroRlEsrvPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. - ROOF' - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE. 'so.Er:FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
" ROOF SHEATHING BUILDING USE
RES IND CON PB omr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED" FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH • - . ASSESSORS PARCEL NO
SAN.#
PLUMBING ELECT.ENERGY
TUBS&SHOWER,PAN PLUM B ING ENERGY raacr No. - PARCEL NO,
MECHANICAL MECH'ENERGY -
ELECTRICAL- ' - BUILDING ENERGY Acc.DATE. C,FILE No.
FRAMING ELECT,FINAL TEST
• INSULATION - • PLUMBING' - ZONING ENG,SITE-No.
GAS TEST. GAS
MECHANICAL FIRE SPRINK ENERGY T-Zp'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ 1 i °'❑ N,❑ Y ❑ . N❑
EXTERIOR SHEAR ELECTRICAL RELEASEFLOOOZONE A.L C. ,
INTERIOR SHEAR FIRE DEPT. ' -v❑ N❑. Y L NQ:
SHEETROCK GRADE a - FEESUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LgrHTEMPORARY APPROVALS - RDILDINc -
SCRATCH-COAT ELEPLAN CHECK
- GCTRICAS FEE
NO.TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ' sol
OCCUPANCY.OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR:
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505
LU , ELECTRIC
� ONE-WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING -
Z PLEASE GIVE,JOB ADDRESS''WHEN'PHONING. '
- SEE PERMIT FOR EXPIRATION DATE -: MEGHAwcALO 7
'IMPORTANT!.
,CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING'FOR FINAL INSPECTION. - TOTAL' '
OFFICE COPY'. .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTI FICA ION PERMITNUMBER
Aos ?� APPLICATION & PERMIT
ILDING —ELECTRICAL—PLUMBING—MECHANICAL . :2,., S 6 Z'
- OWNER'S
NAMEib PLAN CHECK VALIDATION
� CITY, ELECTRIC PERMIT 'FEE
C RgCTOR'a / _
N�mE•.-�N /� 7A S5 OUTLETS-SWITCHES-RECEP 10.00/1.00
r ul LNa. `t LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S '
go/p�R�Ess AMTRANS.
-RESIDENTIAL .'
�. `T IS/"'A 1 1POl'YI�N V� PHONE QTI�w I� PDATE OF APPLICATION - '
ARCHITECT - PANELS 200 AMP) 2 "
OR PLAN CHECK FEE P.C.NO.
ENGINEER �..
uc.NO. SS. 3. 0 -
ARCH.OR ENG.
ADDRESS SCUITPERMIT VALIDATION
_ ZIP OR POLEINS.neo ass Ts M - /�}w� VGC.
SEE FEE SCH. Otis
SERVICE CHANGE 20.00 `
2 F
0
aoo LICENSED CONTRACTORS DECLARATION „
< u 1 herehy affirm.that I am licensed under provisions a]Chapter 9
y¢n
(commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
H L 2 Professions Code,y se Is In full tome u d c�e�_t, RLOG. 'ELECT. PLG. MECH-
z o m - , License Cle C. Lia Number
Z, re H°, Date '4 Contractor" N ❑ ❑ ❑ YJ
it w a 'OWNER-BUILDER DECLARATION BUILDING PERMIT
D INFORMATION
w H i hereby affirm that 1 mn exempt from the Contractor's License MISC.— REFER TO ORD
' Ha 00< Law for the following mason.(Sec.7031.5,Business and Professions VALUATION $/FT.
PERMIT ISSUANCE 10.00
w i 0 Coda:Any City or county which requirese permit toconsua c alter, M OO
IE rt o O improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /W0
i we rc requires[he applicant for such permit to lite a signed statement that TOTAL PERMIT TO
m m he is licensed Pursuant to the provisions of the Contractor's License
FZ Law(CKapter,9(commencing with Section 7000)of Division 3 of lire
4 O Business and Professions-Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE,
Ie '-$ the basis for the alleged exemption.Any violation of Section 7031.5 I - STORIES TYPE CONSTR.
e, 3 by any applicant fora Permit subjects $500).licum tOacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
t
of not ,as ownan er
o e hundred dollars(my :
❑'I,as owner at the property,or my,andt employees with re is Got BACK FLOW PROTECT. DEVICE 4.00
their sole compensation;will(S the work,and the and Pr re is ons OCG.GROUP RES.UNITS
intended or offered for sale (Sea 7044,does
nosiness and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work -PER TRAP 5.0D 50.F,T,FLOOfl AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
FIXTURES ments are Fri intended or offered for sale,If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not h -mictor im- BUILDING USE
prove for purpose of sale.). IN DUST RIA L WASTE INTER. - 30.00 RES IND CON PB orne,l'
❑ I,as owner Of the properly,am exclusively contracting with O ❑
licensed contractors m construct the project(Sec.7044,Business LAWNS PRIN KLERS-1 INC 5 V.B. 6.00gSSEs50R5 PARCEL No.
and Professions Code:The Contractor's License Law does not apply
t0 an owner of property who builds or,improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmctods)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 ' TRACT NO, PARCEL NO.
❑ I am exempt under Sec.' ,B.&P.C.for this
reason WATER HEATER W/VENT
Owner - Date WATER SYSTEM 5.00 -
ACC.DATE ACC.FILE NO,
WORKERS'COhiPGNSATION DECLARATION 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 a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. - - -
Policy No. Company
O ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T 24
z.Z ❑ Certified copy is filed with the city inspection division.
HO Applicant MISC.- REFER TO ORD. V.[—] rv[:] v ❑ N
= y CERTI FICA TE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UG.
LU 1L 0 This section need not beTcompleted ION if ANte INSURANCE,
is for one PLG.CONTR. LIC.NO. TOTAL Y E] NF V 0 N
U O hundred dollar IS 100)or less.) -
I certify that in the performance of the work for which this per- FEE SUMMARY
LL F mit is issued,I shall not employ any person in any..tanner s0 as to per- CITY, MECHANICAL PERMIT FEE
O become subject to the Workers Compensation Laws of California. '
y Date - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} ED NOTICE 1'0 APPLICANT: If,after making this Certificate of Bx-
2 emptier,you should become subject to the Workers'Compensation APPLIANCE5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
C..1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=1C.F.M,) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 r�-
the performance Of the work for which this permit is issued Sec. MICROFILM
3097,Civ.C.). HEATING'UNIT(TO 100,000 B.T.U.) -8.00
Lender's Name
. Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC -
I certify that I have read this applicaton and state that the above VENTILATION FAN (SINGLE)
• information is correct. I agree to compi4.00y with all city and county PLUMBING '
ordinances and state 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 (Oval 100,000 BTU)SEE FEE SCH. 00
above-mentioned property for inspection purposes. MECHANICAL
(We) agree t save, indemnif and keep harmless the City of MISC.- REFER TO ORD.
uper ag sf ililies j g cons, costs and expenses which - r CONST:?AX
in a y way rue g t said C in consequence Of the PERMIT ISSUANCE 10.00 �:z
anti.. f is I MECH.CONT. LIC.NO. TOTAL - SQ
Signature of SNS 9 /7 .p m TOTAL
pplicenl/ Pair Date
OFFICE COPY