18625 (2) POST THIS CARD NEAR FRONT OF BUILDING.. •
' PERMIT NUMBER ,
CITY OF CUPERTINO 18625
INSPECTION DIVISION- -
JOB INSPECTION�d RECORD
CO D
II . . / - 12 •� '. - • PERMIT EXPIRATION '
JOB ADVR)E SS ��G, � J Sri /5 01I "
UNLTlk C_ LOT# /p�E/RMLT EXPI ES IF WORK
OWNER - •CONTRACTOR .� / ��.2�, J� /i�-f �� A?!N(fT STATED WITHIN_
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION • - - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION:
UFER - 'r ALL GRADING AND DRAINAGE SHALL BE INSTALLED:
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF: 'PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDDf
'UNDERGROUND /SLAB '' - ,!f•"" 1, /e,
PLUMBING
ELECTRICAL, ' ISSUANCE DATE
MECHANICAL. BLDG. ELECT; PLG .MECH._
❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION SIFT.
PLUMBING
. MECHANICAL
ELECTRICAL - +,I PE
FRAMING
OHI TYPE CONSTH. '
INSULATION —
. .
^.T. Se,SUB(UDjf oee.cuouP RES uNlrs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE^ so.FT.FLOOR AREA TOTAL ACREAGE
•�' - DIAPHRAGM THE CONSTRUCTION TAX IS PAID -
�T•?/ - -
N V ROOF SHEATHING BUILDING USE
RRE ❑ ❑N El11PH DILt-r
APPLY'NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. AssessoasPARCEL NO
ROUGH SANA
PLUMBING,' - ELECT.ENERGY "
TRACT NO. PARCEL NO
TUBS&SHOWER PAN - - � PLUMBING ENERGY
MECHANICAL` MECH.ENERGY - - -
ACC DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY -
�; 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 ❑ "0 Y [:] "❑
EXTERIOR SHEAR
ELECTRICAL:RELEASE FLOOP ZONE A.L.u.c.
INTERIOR SHEAR - FIRE DEPT. - T °❑ "❑ Y ❑ V, N❑
SHEETROCK GRADE FEE SUMMARY ,
EXTERIOR LATH - BUILDING J l
INTERIOR LATH TEMPORARY APPROVALS BUILDING .
SCRATCH COAT- ELECTRIC PLAN CHECK
GAS - FEE J
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICFOFI LM
ARRANGE FOR INSPECTION BY PHONING 252-4505,' ELEcrdlc
Y �� ONE WORKING DAY BEFORE"REQUIRED INSPECTION. PLUMBING .
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
— SEE PERM FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE*READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY,
BUILDING PROJECT IDENTFICATION - �PERMITNUMBER -
BUILoIN ` APPLICATION & PERMIT
AOOn ESl 1 ^(
BUILDING-ELECTRICAL-PLUMBING /6 ^/
=MECHANICAL - - F' , 1 V V L.I5
OW EH'is PLAN CHECK VALIDATION
. NAME r-CHarv, y - 'OTY. ELECTRIC PERMIT FEE -
CONTRACTOR'
NAME . , p _ i JOUTLETS-SWITCHES-RECEP 10.00/1.00 n.
uc.No. LIGHTING FIXTURES 10.00/1.00 c-
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
' AO RE55
PRorvE01. Q iLPPANELS 10.001 -DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) - 20.00 .. .
ENGINEER uq
LIC.NO. SIGNS TRANS. - 3.00
ARCH.ORENG. - PERMIT VALIDATION
ADDRESS - SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00 6
APPLICANT'S
MOTORS SEE FEE SCH. r
ADDRESS
SERVICE CHANGE '20.00
0 0 0 LICENSED CONTRACTORS DECLARATION
a i I hereby affirm that I am licensed tinder provisions of Chapter 9 - W - f 'ISSUANCE DATE I.
rt m (commencing with Section 7000)of Division 3 of the Basin s and ., BLDG. ELECT." ' PLG. MECH.
R w z Professions Co e, d wense is in full tor([ _
o v, - License C Lic.Number V
9 z r ra Date Contractor . ie��` . .❑ ❑ ❑ ❑
a.y f , BUILDING PERMIT -
P: tc w st OWNER-BUILDER DECLARATION ,� INFORMATION
F
o I- I hereby affirm that 1 am exempt from the Contractor's License MISC.- REF 'IIOTORD
3 VALUATION $/FT.
LL o¢ Law for lire following reason(Sec.7031.5,Business untl Professions
- PERMIT ISSUANCE - 1BeB0 A° D�
IS Zi Code: e,dem y demolish,
county whiny structure,
requires une permit o its issuan e,also
,
M e o improve,demolish,or repair any structure,prior to its issuance,also ECEC.CONTR. _ LIC.N0. ELEC. P�- D
O
.¢ re uires the titan[for such d statement that q pp C permit to file a,Con t s - TOTAL
o u' p _ � PERMIT TO 't
u w ro y he is licensed pursuant to the provisions of the )of
License ',
H z > Business
and
9(commencing Professions
Code)or Section is exempt
t Division of nd .
lie
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 'yam
it F p basis for the alleged exemption.Any violation of Section ST HIES, TYPE CONSTR.
i ;m by by any applicant fora permit subjects the applicant toacivilpmalty penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(my em): r
❑ Las owner at the property,or my employees with re is nos BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work and the structure is not r
intended or offered for sale sect. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Cade:The h o build of s License Law does not apply to an owner of
property who buildsorimproves thereon,and who does such work FIXTURES-PER,TRAP , '", 5.00 se.ET.FLOOR AREA TOTAL ACREAGE
� '- meatslare not hrough
ownemployees,for sale.
If,ed however,the
improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
AS' menu are not intended or offered y sale.IL mpleveq the building '
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) . '2.00 BUILDING USE
builder will have the burden of proving that he did not guild or im- RES IND ' CON Re O he,
th
prove for purpose of e J. INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ . 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 (EA.) 1.00
contracts for such projects with a contractor(,)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner Date 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 of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3 00,Lab.C.). ,Tf - - - '
Policy No. Company
,0 erlil'ied cop is hereby furnished, FIRE SPRINK ENERGY T 24
,[plaaoerG'f�ed �p BI i t the in r,do rvisioG. MISC_ -REFERTOORD.
Z Q AVPiicunt \ / Y❑' N❑ Y ❑ N❑
~ rn PERMIT ISSUANCE 10.06 , A.L.U.L.
LU CERTIFICATE OF EXEMPTION FROM WORKERS'
FLOOD ZONE
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Z (This section need not be completed if the permit is for one _ - TOTAL Y[:J NE] Y [:] NO
hundred dollars($100)or IessJ
U O 1 certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY
W H mit is issued,1 shall not employ any person in any manner so as to
U become subject to lire Workers Compensation Laws of California.
y Dote Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE, TO APPLICANT: It,after making this Certificate of Ex- -,
emption,you should become subject to the Workers,'Compensation APPLIANCE - 5.00 PLAN'CHECKr
provisions of the Labor Code, you must forthwith comply with . FEE �(
V' such provisions or this permit shall be deemed revoked'. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIRHANDLING UNITIOVER 10=C.F.M.) 6.00 - SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 4 -�
the performance of the work for which this permit is Issued(Sec. HEATINGUNIT(TO 100,000 B.T.U.) 5.00 MICROFILM
3097,Ci,C.).
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC M "�
Lender's Address
1 certify that I have mad this application and state that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct. I agree to comply 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 (Over 100,000 BTU)SEE FEE SCH. .MECHANICAL
abuve-mentioned property for inspection purposes.
(We) ago: to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino age sl IiuhililieS,judgments, costs and expenses which CONST.TAX
may in any ay accrue agai s said C' in,, nsequence f the PERMIT ISSUANCE --10.00 -
lingo t s ennit ECH.CONT. LIC.NO. TOTAL
tj TOTAL y^
ignature of Applicant/Con rector Date I
OFFICE COPY
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