18681 (2) POST THIS CARD NEAR FRONT OF BUILDINGPERMIT NUMBER
A`1' , CITY OF CUPERTINO
.18681
INSPECTION DIVISION
. JOB INSPECTION RECORD
r, '/ :a PERM IT EXPIRATION
-d:•'� JOB ADDRESS' zo UNIT# _LOT#
, PERMIT EXPIRES IF WORK.
OWNER' T��-i S 6,h` (�c..c._ CONTRACTOR tLTe IS:NOT STARTED WITHIN
INSPECTION DATEINSPECTOR INSPECTION RECORD X180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: - - .LASTCALLED INSPECTION. I
UFER .. ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROYED�Qb4Bl5 AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. E"A -
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - 5 E p 6 1989
..
UNDERGROUND /SLAB •.' ""'-
PLUMBING - roily
ELECTRICAL , - D �
- - ISSUANCE DATE
MECHANICAL' BLDG; ELECT PLG. - MECH,
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING - VALUAT,IQRN SIFT. Fv
' MECHANICAL
ELECTRICAL
PERMIT TO
� - � � ' l - � � r
FRAMING
INSULATION
STORIES TYPECONSTR.-
' � .� ^�
.00C.GROUP,. RES.UNITS
',P+ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - • $o FT FLDORA REA TOTAL ACREAGE
?, ROOF - NOTE:NO FINAL INSP.SHALL BEVADE BEFORE I,
DIAPHRAGM - THE CONSTRUCTIONTAXIS PAID :•
•
M� BUILDING USE
ROOF SHEATHING _ RES IND CON 'PB ou„”
APPLY NO ROOFING UNTIL•ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ �n"":0' El
ROUGH _ SAN.# ASSESSORS PARCE L NO.
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN- PLUMBING ENERGY TRACT No - PARCEL No.
MECHANICAL - - MECH:ENERGY
ELECTRICAL . BUILDING ENERGY Acc..oaTE • ACC.FaE,No.
FRAMING ELECT.FINAL TEST
INSULATIONPLUMBING ,' - ZONING ENG.SITE NO,
GAS TEST GAS',
FIRE SPRINK ENERGY T 24'
MECHANICAL. , .I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ N❑ Y ❑ ' N❑
FLOOD ZONE A',L.0 C.
EXTERIOR SHEAR ELECTRICALRELEASE
INTERIOR SHEAR FIRE DEPT.: Y❑ NE) v ❑.'• rv❑
,• SHEETROCK ' GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR-LATH - •.TEMPORARY APPROVALS BUILDING : 72, RP,
SCRATCH COAT ELECTRIC PLAN CHECK'
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY` SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRIC' `
LU
�' ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING
o PLEASE GIVE,JOB ADDRESS WHEN-PHONING. ,
— SEE PERMIT FOR EXPIRATION•DATE.— .'' MECHANICAL,'
IMPORTANT! coNST.Tnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION., .
OFFICE COPY,
APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES - USE BALL POINT PEN ONLY
'i- BUILDING PROJECT IDENTIFICATION' PERMIT NUMBER -
BUILOIINN; APPLICATION & PERMIT p 1 O6Q1
.O I s O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 0 0
OWNER'S - -
` NAME �p ,l�y/..1yQ�/ fI 0/��(� QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
DS` A4 1 ke PHONE .b`
cONTRAcrORs
OUTLETS 10.00/1.00
NA E �'t f pT CC� Cq _
UF.f+ o.0 ro 5S LICNO. aa26� LIGHTING FIXTURES 10.00/1.00
A CONTRACTOR APPLIANCES-RESIDENTIAL 4.00
dl s /eE 6tt�
- PHONE PANELS - 10.00 DATE OF APPLICATION
•
OR
C PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .' P,C.N0.
R
ENGINEE - -�
- - LIC NO. SIGNS TRANS. 3.00
ARC H.SS ENG.: - PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 t
ZIP EMP. METER OR POLE INS. 2000.
AOODRESS?s. - MOTORS. - SEE FEE SCH. r
0 0 SERVICE CHANGE O 20.00
-00
LICENSED CONTRACTORS DECLARATION
a o.' I Hereby affirm•that I am licensed under'provisions of Chapter 9
2 W ISSUANCE DATE
¢, , (commenting with Section 700e)i of Division 3 of the ef Business and BLDG. ELECT. PLG.. MECH.
r o z Professions Code,and my license is in full force and effect ❑ ❑
zo iw o License Class Lic.Number �� � �
m H W Date 'Contractor of
¢_ 2 w.at OWNER-BUILDER DECLARATION BUILDING PERMIT
UISC.- REFER TO ORD INFORMATION -
w ;u m Dhereby affirm that I am exempt from the ContContractor's License
LL O j Law for the following reason(Sec.7031.5,Business and ProfessionsPERMIT ISSUANCE VALUATION $/FT.
L - 10 00 Code:Any city or county whichrequiresa permit to construct,alter, D 0
M 4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. r 0 O
ELEC.
O ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A w m LL he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE V`�� •-41= �0
is the basis'fotlheitbeged exemption.Any violation ofSection 7031.5 STORIES - TYPE CONSTR.
a3 � by any applicant fora permit dollar,cts($50m.)icam toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars the applicant
.7
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
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
Cade:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 $0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
ments are not intended or offered for sale.if,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or,improvement is sold within one year.of completion,the owner-
builder will have the burden of proving that he did not build or,im- BUILDING USE
prove for purpose of sale.). GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 RES IND CO PB Other
'a ❑ -1,'as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 El El ❑ E]licensed contractors to construct.the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS
and Professions Code:The Contractor's License Law does not apply - PA•ECEL No.
to an owner of propertywhobuilds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmclons)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SAN ITARY-STORM'EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tom'exempt under reason Sec, ,B.&P.C.for this . WATER HEATER W/VENT „6.00
'
Owner Date WATER SYSTEM 5.00 ACC.DATE ACD.FILE NO.
WORKE;RS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have o certificate of consent to self-insure,
or a certificate of Workers'Compensation Insumuce,or a certified ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.CJ.
Policy No.• - Company _ `
-0 ❑ entified copy is herehy furnished. - FIRE SPRINK ENERGY T 24
" Z Z �er[ifled,c i d w' I the city ins •etimt divisi r. '
H 0 Applicant; - _ MISC.- 'REFER TO ORD. - Y❑ N❑ Y ❑ .N❑
CC CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE: PLG'.CONTR. LIC.NO.
LU O PLG.
Z (This section need no[ be completed if the fiction is for one TOTAL Y[:] N❑ Y❑ N❑
hundred dollors(S 100)or less. -
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
} y , Date - Applicant '- - ALTER OR ADD TO MECH. 5,00 BUILDING 72, p 0
W NOTICE TO APPLICANT If,Site,taking this Certificate of Ex-
-,i.: Z emption,you should become subject io Ole Workers'Compensation APPLIANCE 5.00 PLAN CHECK
• provisions.of the Labor Code, you must forthwith comply with IU FEE such provisions or this permit shall deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10.000C.F.M.) 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,,CiYCp. HEATING UNIT(TO 100,000,8.T.U.) 8.00
Lender's Name -Lender's Address - HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Itcertil that'I have read thisapplication a ad state that the above VENTILATION FAN ISING,LE) 4.00
information is correct.I agree to comply with all city and county gO1LER•COMP.(3 H.P:or 100,000 B.T.U.) 6.001PLUMBING
ordinances and sfete.iaws relating to building construction, and
hereby authorize roperty fariins-ofec this city es enter upon the BOILER-COMP'(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
• above-mentioned property for inspection purposes.
(Wei agree to save, Indemnify.und keep harmless the City of MISC.- REFER TO ORD.
upertinoagainst liabilities,judgments, costs and expenses which' PERMIT ISSUANCE '10.001CONST.TAX -
ay In any way accrue against raid City in consequence of the
noting of lhl5 -rmit MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 7401
S' re Ap icant/Contractor, ~ Date , ' - - ' ,
- OFFICE COPY