14311 POST THIS CARD NEAR FRONT OF BUILDING L1IT NUMtlEN
CITY OF CUPERTINO 14311
INSPECTION DIVISION
JOB INSPECTION RECORD
' C(7 at-v GL��`s'—[�
• PERMIT EXPIRATION
JOB ADDRESS D% 0 ei
� UNIT N LOT ft PERMIT EXPIRES If WORK
OMNER CJ�t l V CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
LAST CALLEDiNSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF «I IyMI(�E.ya'I1N
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB To
PLUMBING
ELECTRICAL Issuwmrl ua TE
. IIII:I VLI: Mll.r
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR —L-IIUN III
PLUMBING
MECHANICAL
vuuu( u
ELECTRICAL
FRAMING
.nl.uus Iti rl um.il
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
`. nun uu.r.uv
ROOF SHEATHING "' N
P.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑
AS`.iS1111S V.1{ICII NII
ROUGH SAN.#
PLUMBING ELECT.ENERGY v
u.ncl Nu weeeT r.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ALL ualE wcc nu..
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST t `
fUNINU EN6 SITE 1I,
INSULATION PLUMBING
GAS TEST GAS T 9CT IU
fInE SVIONN ENI RUr i,
MECHANICAL r NEI r NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE {Luau TUNE +L ul
INTERIOR SHEAR FIRE DEPT. •❑ NEl r L No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, g}x}' ELECTRIC SIJD
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING. `
Zf MECHANICAL
-SEE PERMIT FOR EXPIRATION DATE-
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BCFORE t' c
TOTAL
CALL IN(, FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN IINFORMAI'ION WITHIN RED LINES USi I:ALL POINT PLN 141-Y.
BUILDING PROJECT 1 DENTI FICATION PEN++IT NUMBER
e-runic APPLICATION&PERMIT 14 311
wopRlu 3 _ ('
O 1 SS ��V�1V i `Y. tj BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OHw•IMIMf D�, IV
PLAN CNECK VALIDATION
- J CITY. ELECTRICPERMIT FEE
OUTLETS.SWITCHES-RECEP 10.00/1.00
W r fY� S uc.No. �y Ds'1 LIGHTING FIXTURES 10.00/1.00 1,570
CON .2 1')14J 0 PPLIANCES-RESIDENTIAL 4.00
w�j rLz,r�4�,.t, PHONE'e2S PANELS 10.00 DATEOFAPPLICA TION
wonRc.nacr S.y N PANELS(OVER 200 AMP) 20.00 PLAN H K FEE ..H0.
1-vistER r0 vO LIC NO SIGNSTRANS. 3.00
Z.-Z. t- O SPECIAL CIRCUIT 5.00 PERMIT VALIDA rioN
Un Z., EMP.METER OR POLE INS. 20.00
ADD.,
ATi . O MOTORS SEE FEE SCH.
omu
y� SERVICE CHANGE20.00 R
W o LICENSLU CONTRACTORS DECLARATION
u u I hereby affirm that I am l,crnseJ under pruvisiom of Chapter 9 ISSUAvvcf DATE
=u' (commencing with Section 70001 of Un-.d.f fur Business and tlLUG. ELECT. PLG. MECH.
Professions Cnse is in full Iu, yJ EH t J(-/
=o Ljcena �- Lw'.Nuns E r; -LT30-r 1J� I ❑ L�1 ❑ ❑
O=f m UVIe. 1 fnnbacluK! 1Plmer ff
s A E �' BUILDING RM PERMIT
¢¢:�
OWN[It-BUILDER DECLARATION INFORMATION
11-br affirm IIIA I am eeempt from she Comia tm%License MISC.- REFER TO ORD VALUATSOH SjFr.
W o7 Law for thef.R.,ena rcawa lSec.toil LS.Rusutnsanp Profrsrmns PERMIT ISSUANCE 10.00 c
Cope.Any 11.ur cuunly whish requiter a Iwm,l lir cuner,m'I.alter,
Cw�O improve,JcnwlMh.urrcWhr any+IrlA'lurc.rrwrlu ilr bwanar,slut ELEC.CONIN. LIC.NO. FLEC.
a O w 4uircs the appf'anl fur R,ch pem,tl lir lik a oaneJ slalrnhent Ih+l TOTAL 51 So PERMIT TO
K m he is Ikenwj pursuant to the prurtuon or the Contractor,License
Law lChapferYI-no-mmt will,Section 7000).f Uiruiun J oflha
a i o Timis- nil FY fewonsC kIYj or that he",will,'therefrom and OTY. PLUMBING PERMIT FEE
TYPE CON5r11
Ih,bffw the Vlc,a•J earmplwn.Any r uJ,evuuut Sea'Itun7011.5 STORIES
:;S au
br enr+pDlI. furaprmw wbleeu Om arrlla+m luacndl•'nally ALTER-DRAIN&VENT-WATER IEA.15.00
of not more Then file Imadrcd Jolla"I ssoo))
❑ 1,.s owner of it.,prs.pe t'.or my cnhplu,c with ossa.as BACK FLOW PROTECT.DEVICE 4.00 occ.GRouP RES.UNIT5
their wk cmulvenutu n.will Ju the work.and the EIru,I,a n not
imm.ded or offered(,r sale IS.,.7041,Buun"s and Pwlewonr DRAINS.FLOOR,ROOF,AREA,COND. 5.00
Cod,:The Conlracror's Ls.rnse law Jun nut apply to an owner of
P=ITY who builds m jmp-es,thereon,and who Jon-1,work FIXTURES•PER TRAP 5.00 W rt.FLOOR w.eA TOTAL ACREAGE
himself or Ihrough h....emploYen,provided that-h inhprore-
menls a¢nog f-le,IL however,the hwklmg GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
'�. or impruvemenl is sol wuhm one year of complclion,the"wisp GAS-EA.SYSTEM.OVER 4(EA.) 2.00 BUILDING USE
budder will have the burden of proving that he JW out build or is. RES IND CON PB Olsen
re for INDUSTRIAL WASTE INTER. 30.00 r--t
❑ I,aMmer ut the I N y ontracbn,.,it, ❑ ❑ ❑ ❑
property.he eLclwirrl
andPro contraction, mmrrwltee profrct I L,.7074,mIlunaw.,ply LAWN SPRINKLERS•1INC 5 V.B. 8.00 A ESSORS PARCEL NO.
end Protection'
pe.p The who
bwkI,r i rmp, Law Joos nut apply
to an owner of proprny woo builds or impmrr+thereon...it who LAWN SPRINKLERS•OVER 5 IEA.) 1.00
wril-ts for soon projects with a conlra,wrisl licensed pu"nam to
the CmIl-lo;s Llccnse Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NU.
13 I imeeempt under See .R.&P.C.for this WATER HEATER W/VENT 6.00
Ownr Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO
WORK F RS'COMPF NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby alt that l have a ce.ifw'alr of a'onsent to self-inwre. all L.1 ZONING ENG.SITE NO.
or 1111.6-c of Worken'CompenMtiu Llnwranec,or a certtfed
copy IlKrrol ISIN-31100,Lab.C�rZ�E�
Poker No. CmnpanyL AL
O ❑ Cellhlwd a py n herchy(.nuvh d JAN 31 r m4 FIRE SPRINK ENERGY T-24
Z z ,[ Ce Irw e r n n wit br nspra on clivi on. MISC.• REFER TO ORD.
O Apph an
Y❑ NO Y❑ N❑
F"a PERMIT ISSUAN .E� 10.00 FLOODZDNE A.L.U.C.
6' CERTIFICATE OF EXEMPTION FROM WORKERS' +u
Lu> C'OMPENSATION INSURANCE PLG.CGNTR. ❑c.NO. PLG. r❑ N❑ 'A
❑ N❑
6 O _ TOTAL
(This secllon d not be completed if the permit is for one
Z hundred dollen 4$1001 of k )
U o I certify that ut the performance of the w.,k for which this per• CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL H our is i,-d.I shall not empk,y any pawn m a ry nNnnn w as lir
U bu wm
ewnb„al lir she Wwke Cophu
enutn lawrnl'CA(mma.
O w Date Aprlicanl ALTER OR ADD TO MECH. 5AO BUILDING
}
Di NOTICE TO APPLICANT.If,after making this Crrlir.,Ic of Ea-
L..? emplion,you asmuld become wb)ect to the Worken'Compensatwn APPLIANCE 5.00 PLAN CHECK
V wEao tr comply with FEEnprm othisprrmibor Mall be JeemeJ ,.kvd AIR HANDLING UNIT(TO IOADOGF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQ=G F.NU 6.00 SEISMIC FEE
1 hereby affhnn that there is a consurown knding ayeney for EXHAUST HOOD(WITH DUCT) 5.00
the
ci c.in«of the wort for which mu prnnil h iuurd IS HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM
L,nderi Name HEATI NO U15',�a[N IT R 100,000 B.T.U.)9.50 ELEC
Lrndrr`+AJJrcM TRIC
�
1"Try that i have r,.d Ihn+pplkaliin and"etc Thal the above VENTILATION FAN(SINGLE) 4.00
PLUMBING
Id, ton n mrrcel.I+gen m comply with all eilY and county gpILER•0aW 13 H.P.or 100,000 B.T.U.) 6.00
ar I-ncel and stale law rclaim,to budding smict a'Imn,and
hereby authorize repreuntAl-of this city m enter upon the BOILER-COMP h3wn 10GAM BTUI SEE FEE SCH. MECHANICAL
v above-memionN Property for Inspection pulp..,.
IWei wee to care.indemnify and keep harmless the City of MISC.• REFER TO ORD.
upenjno aVmal liabilities,judgments,cost,and capenur which PERMIT ISSUANCE 10.00 CONST.TAX
aY N any way accrue a finer Dip City in-nseywnce of the
"lingo this,,,. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL SSO
ipMlureof Applicanl/Contraclor Date /16 FI