18583 (2) P05T THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 18583
INSPECTIOWDIVISION
JOB INSPECTION RECORD
4� S �'p
'p / � b.
PERMIT EXPIRATION
- JOB ADDRESS /df�-% N W"O (�F �.� UNIT# LOT# ,
- PERMIT EXPIRES IF WORK.
OWNER D, eS -CONTRACTOR IV �- E, 6 IS NOT STARTED WITHIN
'INSPECTION DATE 1 INSPECTORNSPECTION RECORD 180,DAYS OF PERMIT ISSU:l
FOUNDATION, - +. . .ANCE OR .180 DAYS FROM:
NOTE: ' 'h1" � f " LASTCALLED INSPECTION.
UFER - - ALL GRADING AND DRAINAGE SHALL'BE INSTALLED
-•h' PREGUNITE. - _ TO COMPLY WITH THE APPROVED;PLANS AND CITY OF PERnIIT VALIDATION, -
GARAGE SLABS CUPERTINO STANDARDS. ®A� _ ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
PAM. .
�', +' • -?
UNDERGROUND /SLABsee AL3 g�9�
PLUMBING ' ' E` "•�.' >n�L .IR E"'C- l I
` ELECTRICAL - _
,
ISSUANCE UAT
-' MECHANICAL BLOC.-. ELf.Ecrr PLL'. MECH.
a ❑, ;4 ;❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
,( ,j ,. INFORMATION
WOOD FLOOR: vALunINFOsIFT.
PLUMBING ,. - ,
MECHANICAL -
ELECTRICAL - PERFBT To
D�lf
FRAMING
INSULATION - sroRles -Tv ECONSTR.
OCC GROUP R - 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
- BUILDING USE
ROOF SHEATHING " ,_ 1,•�'.. A,a RES,!,IND CON PB •Oma,',
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED' FINALS DATE INSP. ❑ 0 , ❑ - E •❑
ASSESSORS PARCEL NO.
ROUGH SAN.p
<., PLUMBING ELECT.ENERGY �• r. '"
(TRACT NO. , PARCEL NO `•
1
TUBS&-SHOWER PAN PLUMBING,ENERGY,
MECHANICAL MECH.ENERGY, '
ELECTRICAL BUILDING ENERGY - ACC.DATE ACC.FILE NO.
'
'FRAMING - - ELECT.FINAL TEST
,
INSULATION � PLUMBING ZONING ENCSITE NO,
GAS TEST GAS
MEGHAN I CGAL FIRE SERINK ENERGY T2<
COVER NO WORK UNTIL. HE
ABOVE HAS BEEN SIGNED ATING - " 10 c N❑ ° NF] '
EXTERIOR-SHEAR' - �- - ELECTRICAL RELEASE FLOOD zorvEA,Luc. p
. INTERIOR SHEAR FI RE DE PT` } vEl rv❑ Y NEI
. SHEETROCK'' GRADE - - FEE SUMMARY
` EXTERIOR LATH - BUILDING T .BUILDING
.INTERIOR CATH `.TEMPORARY APPROVALS '
SCRATCH COAT ELECTRIC PLAN CHECK .
GAS . FEE
NO TAPE-OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE;
. OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM .
ARRANGE,FOR INSPECTION BY PHONING 252-4505 ELECTRIC
. ' Iw—�y ONE�WORKINGDA'Y BEFORE REQUIRED`INSPECTION. R
O PLUMBING O � V
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE —. MECHANICAL .
IMPORTANT! coNST'TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL Q; DO
CALLING FOR FINAL INSPECTION'
OFFICE`COPV
APPLICANT TO FILL' IN 'INFORMATION WIT.HIN'RED;LINES'= USE:BALL POINT PEN ONLY
PERMITNUMBER �'
- BUILDING.PROJECT I DENTI FICA TIO -gppLICATION & PERMIT - '
BUIZDING 1 R R
ADDRESS /-� - �I
- BUILDING -ELECTRICAL-PLUMBING-MECHANICAL '
f
oWNERs -
r� NAd r - QTY. ELECTRIC PERMIT '. FEE PLAN CHECK VALIDATION s
CONTRACTOR'S
-
NAME � OUTLETS-'SWITCHES-RECEP. 10.00/1.00 .1 ,
LIC.N1 0. (.I(Z , LIGHTING FIXTURES '10.00/1.00
CO`TRAIFTOH'S
ADDRESS -/' ,�f G APPLIANCES-RESIDENTIAL - 4.00 -
.7 b✓N NE / 72S/SI: PANELS . '510.00
• DATE OF APPLICATION a
` ARCHITEci PLAN CHECK FEE . P.C.NO.
OR - ' PANELS (OVER 200 AMP) ,' � � 20.00
f ENGINEER - _ z
UC,NO, SIGNS TRANS. 3.00
ARCH.OR ENG. - PERMIT VALIpATION
ADDRESS - +. SPECIAL CIRCUIT , 5.00
-1
ZIP EMP.METER OR POLE INS! 20.00
- ADDRas rs 'o MOTORS SEE FEE SCH.
t
SERVICE CHANGE r 20.00 �IICL
09 ) LICFNSEU CONTRACTORS DECLARATION
La
,Q .I hereby affirmltlm[I,am licensed under provisions of Chapter 9
Z w h .' ,ISSUANCE DATE' `
n e (commencing with Section 7000)of Division 3 of the Business and -
7Professions Code,,/CItril t`icense is in full for yQ f W�- .BLDG. ELECTi 'PLG. `MECH.
zz z,_ p' License Cl s' k+ y Lic:Number' `j�r `
0 m j Date dj Contractor � �'
M M IE a: OWNER-BUILDER DECLARATION' - " BUILDING PERMIT '
- o A ° - • - " INFORMATION
w ; e- I hereby.effimn that I ari,exemptfrom the Contractor's License MISC.- REFER TO ORD ,
VALUATION $/FT. ,
u O J, ; Law for the following reason. Sec.7031.5,Business and Professions 10.00
H.- g ( PERMIT ISSUANCE "
•', Code:Any city or county which regmiresa permit to construct,alteq I
R ¢4 p improve;demolish,or repair any tincture prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC. •" "
e. D¢ ' requires the applicant for such permit to file a signed statement that " - TOTAL - r
X m u PERMIT TO,
he is licensed 9( opursuant to(commencing
withS Section
of 000)ontracmr's License _ ,.x / s
r r Law(Chapter 9(wmmencing witlt Section 7000)of Dlvision3 of the x {V v. `.• IIS `'�
Business and Professions Code)or that he is exempt therefrom and QTY. . PLUMBING PERMIT FEE ' GGG `�-1 JJ 90
¢.r o` the basis for the alleged exemption.Any,violation of Section.7031.5 _ + STORIES TYPE ONSTR:',
n 3'm by any applicantfor a permit subjects the applicant to a civil penally 1
• of not more than fivehundred dollars(S500L) . ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,'as owner oPlhe property,of my employees with wages as OCC.GROUP -RES.UNITS BACKF LOW'PROTECT:DEVICE . X4.00 -
$ their sole compensation,will do the work,and the structure is not
- intended or offered for sale-(See. 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 buildsor improves thereon,and who does such work FIXTURES-PER TRAP 5.00 T4.11 SD.FL FLOOR AREA 'iTOTAL ACREAGE'`
himself or through his own employees,provided that such Improve- , -
_ mems are not intended or offered for sale.If,however,the building , GAS-EA.SVSTEM-1 OUTLETS 6.00 OD
or improvement Is sold.wilhin one'year of completion,the owner- "'
builder wilPhave the burden of proving that he did not build or int- GAS-EA.SYSTEM-OVER 4(EA:) 2.00 BUILDING- RES ]NO CON , PB • Other
prove for purpose of sale.). ' .. INDUSTRIAL WASTE INTER.. , 30.00 F-1
❑, .❑ ❑, ❑ .
❑ 1,as owner of nae propeily,am exclusively contracting with -
licensed contractors to construct,the'project(Sec.7044,Business LAWN SPRINKLERS-1 INO5 V.B. 6.00 ' n ASSESSORS PARCEL NO.
'I
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'-OVER15(EA.) 1.00
contracts for such projects with a contractors)hcerised pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
0 ,1 am exempt under Sec. ',B.&P.C.for this , D -
?- reason WATER HEATER W/VENT 6.00 -
' owner '- Date WATER SYSTEM: 5.00 - -
- •' ACCDATE - ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATIONWgTER TREATING EQUIP. 5.00 5
.- 1 hereby affirm that I have a ertificate of consent to self-insu're, _
t or a certificate of Workers'Compensation insurance,or a certified w v ZONING, -•„ENG.SITE NO."•
copy thereof(Sec.3800,Lah.C.).
_ r Policy No. Company' -
'Q ❑ Certified copy is hereby furnished * - FIRE SHRINK ENERGY T24
Z Z ❑ Certified copy is,filed with the'city mspeetion'division. -
t O Appucam - MISC. REFER TO ORD. 4i❑' IN v.❑• IN
~ ?� PERMIT ISSUANCE' 10.00 `
a CERTIFICATE OF EXF-MPTION FROM WORKERS'r .G.0 FLOOD ZONE A.L u C. '
'W -, COMPENSATION INSURANCE PL ONTR. LIC.NO/ s.- PLG." _
D- O - (This'section need not be 'completed if thepermtI for one 4NP - [ TOTAL 30.00 =YIN
'/❑ N❑'
D'Z hundred dollars(S 100)or Tess.) . e P • 1 -
U O - I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL•I- ,• mit is issued,I shall not employ any "on
in any manner su as to `
O W, hero uhf t Workers'Co en Ron Laws /Cul'(o 'o. -.
Dale jLj licam m BUILDING
a =-� , ALTER OR ADD TO MECH.' - 5.00 -
} N NOTICE TO APPLICANT: If,a cr making this Certificate of-Ex-
(.-.'Z emption,you should become subject to the'Wotkers'Compensation APPLIANCE S 5.00
I provisions of the Labor Code, you must;forthwith comply with PLAN CHECK" ' - FEE
.V such provisions or this permit shall be deemed revoked._ AIR HANDLING UNIT(T0'10000C.F.M.) '4.00
- CONSTRUCTION.LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 ._ SEISMIC FEE
I•hereby offer, that there Is a construction lending agency for EXHAUST'HOOD.(WITH DUCT), :. 5.00 0
the performance of the work for which this permit is issued(Sec. - - MICROFILM -
3097,CIvC). HEATING UNIT(TO 100,000BT.U.) ' 8.00
Lender's Nome HEATING UN ER 100,000 B.T.U.)9.50 ` I'' O,.,
Lender's Address ELECTRIC n,
l certify that l have-read this application and state that the above VENTILATION FAN4SINGLE) r 400 '
'l Information is correct. 1 agree R comply with all city and county - - PLUMBING �- ��D
ordinances and slate laws relating to building:construction, and BOILER-'BOILERH.P.Or 100,000 B.T.U.). 600 -
hereby authorize representatives of this city to.enter upon the BOILER-COMP (Over 100,000 HTUI BEE FEE SCH MECHANICAL
above-mentioned property for inspection purposes. a
(We) agtee to save Indemnify and keep harmless the City of MISC.- REFER TO ORD. -
Caper Into against liabilities,judgments costs and expenses which - PERMIT ISSUANCE - ,10 00 x' CONST-"TAX '9.
may to ah waccrue against said City in of the '�
tanhng [h' e ermit 1 MECH.CONT LIC.NO. ' - "E"Lt
TOTATOTAL30OD ^+
I.., atura oica);t/Contractor Date - '
ti
0FFICE COPY '