15270 POST THIS-CARD NEAR FRONT OF BUILDING, "
`'.. PERMIT NUMBER"
CITY OF CUPERTINO . 15270 . 1
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB'ADDR ESS 2I � L-�r 1 .✓"T7/°ry C'r UNIT# '_LOT#
" .x, �,I PERMIT EXPIRESIF WORK
owNER.��` L '�\�.,� L!I'l!'�� CONTRACTOR- - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT Issu;'
- - ANCE OR 180 DAYS FROM"
FOUNDATION NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PR EGUNITE _ ._ •TO COMPLY WITH THE APPROVED PLANS AND CITY OF _ PERMIT VALIDATION
CUPERTINO.STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL
• � ABOVE'HAS BEEN SIGNED - ' ' -' ", - -. •. '�� .+,.., ! •_ „i� r� ' '
- -. -UNDERGROUND /SLAB
PLUMBING - -
ELECTRICAL - - ISSUANCE DATE
MECHANICAL - - BLDG. ELECT I PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION SIFT.
PLUMBINGTV
-
• MECHANICAL A 112%
PERMII TO
ELECTRICAL - �gg
FRAMING -. - .. QY— �o �'�IE.V'.•G -
- sroAlEs tvPEcoNSTR
INSULATION .
OCC GROUP RES.UNITS
PLACE NO'SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.LT.RooR ARBA TOTALAVRPAGE vI .
- - ROOF '" NOTE NO FINAL'INSP.SHALL BE MADE BEFORE ( •"?
i DIAPHRAGM THE CONSTRUCTION TAX IS PAID i1
. BUILDING USL YYEIP
ROOF SHEATHING - HES IND CON VB 1"'GO—
11
APPLY NO ROOFING UNTIL ABOVE HAS BEENSIGNEDFINALS DATE INSP. '� '`�
' - nSSE550H$VGNCtI ND.
1 . ROUGH - - SAN.# -
PLUMBING- ELECT.ENERGY'
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN - PLUMBING ENERGY 3 • •r "
MECHANICAL MECH.ENERGY - .ACC.DATE ACC FILE rvo.'
ELECTRICAL BUILDING ENERGY - -
' FRAMING - ELECT.FINAL TEST /'. ZONING ENG SITE NO
INSULATION PLUMBING "�.3 ,*
GAS TEST GAS, 6 3_ `
FIRE BPRINA ENERGY Taa
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. v ❑ .N❑,
FLOOD ZONE A.L.U
EXTERIOR SHEAR ELECTRICAL RELEASE "
INTERIOR SHEAR - FIRE DEPT. r ❑. rv� r L1 _ N�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING• S_
INTERIOR LATH - TEMPORARY APPROVALS BUILDING.' "
SCRATCH COAT ELECTRIC PLAN CHECK
. . GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED. OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTEO UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC •
F�`• ONE,WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING HSg
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE'PERMIT FOR EXPIRATION'DATE = MECHANICAL
"'IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL*INSPECTION. • ,
r; OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER -
BUILDING APPLICATION & PERMIT [270
ADD s,,, 3 G J .
I
BUILDING — ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S r - PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
• U PHON ryC
NAME OR's " OUTLETS-SWITCHES-RECEP 10.00/1.00
_ IC.No LIGHTING FIXTURES 10.00/1.00 'I '
CONTRA TORS _ APPLIANCES-RESIDENTIAL 4.00
ADDRESS C� -
Jo: III PHDN , (S PANELS 10.00 DATEOF APPLICATION" -
RCHITECTPLAN CHECK FEE P.C.N0.
OR _ PANELS (OVER 200 AM
PI 20.00
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. - SPECIAL CIRCUIT - 5.00 - PERMIT VALIDATION
ADDRESS -
'ZIP TEMP.METER OR POLE INS. 20.00
^�
ASMOTORS SEE FEE SCH.
'
ADDREDORESS '
SERVICE CHANGE 20.00
wo o LICENSED CONI TRACTORS DECLARATION
u I hereby affirm that I am IicenscJ under provisions of Chapter 9 ISSUANCE DATE
w a A. (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F D z PH,11,sions Co `a mz license is in full to p e v
Z, O= License Class Lic.Number ❑ ❑ 1/Y ❑
_.. o H w Uale Contructor._d!•a
y
'U' BUILDING PERMIT
wA - OWNER-BUILDER DECLARATION INFORMATION
aaa "
wy 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
.. 0 ¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
LN Code Any city oreounlY which requiresupennilloconstmet,niteq '
R ¢ Q improve,demolish,or repair why structure,prior to it,issuance,also ELEC.CONTR. 'LIC.NO. - ELEC. `
D w nquireS the applicant for such permit to file a signed statement that TOTAL, ' PERMIT TO -
whe is licensed pursuant to the provisions of the Contncmr's License -
HiQ
Law(Chapter 9(commencing with Section 7000)olLivision 3 ofthe
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE -
r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S5000)
❑. I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their Side 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
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
- himself or through his own employees, provided that such improve-. .
merits are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-I1NC.4OUTL T .00
or improvement is sold within inn year of completion,the owner GASEA.SYSTEM-OVER 4 IE 2.0 BUILDINGUSE
builder will have the burden of proving that he did not build or int- - RES IND CON PB Omar
prove for purpose of sole.).' INDUSTRIAL WASTE INTER. 0 ❑ ElEl 11 11❑ 1,as owner-of the property',an exclusively contracting with _
licensed contmetirs to c n§Nuet the project(Sec. 7044,Business LAWN.SPRINKLERS- 1 INC 5 6.00 0 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's Liccnse Law does not apply
to an o
owner of property who builds r improves thereon,and who LAWN SPRINKLERS-OVER EA.)
contracts for such projects with a contraclotls)licensed pursuant to SEWER-SANITARY-STORM EA. 110 00
the Co ntmcloi s Liern,Law. TRACT NO." PARCEL NO.
0 lam exempt under Sec.—,K&P.C.for this WATER HEATER W/VENT •�
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
_ wORKERs'COMPISNSATION DECLARATION - WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
ha ceRificate of W 3k 'Ch p s 1'm Ivurance or a certWed
I Y U ❑ Ccif, by ft rill I' FIRE$PRINK ENERGYT24
Z Z C rCf- copy whh thu 'it inspeU nn division.
�...v—�=)—� - MISC.- REFER TO ORD. - ❑' ❑ ❑ ❑
Q 1 pbaanl Y N V N
i N CERT VICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE +9000 /)O FLOOD ZONE A.L.U.C.
L COMPENSATION INSURANCE. PLG,CONTE. LIC.NO. PLG. ,,11.^. Y N Y N
CL 0 1'This section need not•be completed if the permit is for one TOTAL
'00 ❑ ❑ ❑ ❑
Z) Z hundred dollars IS 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 1— mil is issued,I shall not employ any person in Bay rihanner so as to
U become subject to the Workers'Compensation Laws of California.
W Date Applwant ALTER OR ADD TO MECH. 5.00 _. BUILDING
} N NOTICE*TO APPLICANT: If,after making this Certificate of Ex-
(_ Z enhption,-you should become subject to the WorkersCompensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will; FEE -
U soul;provisions or this permit shall be divined revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00 '
CONSTRUCTION _F'NDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
f hereby affirm that mere 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,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Address Name HEATI NG UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC
Lender's
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 ,1�
information is correct:1 agree m comply with all city and county PLUMBING �y
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.-T.U.) 6.00 o
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned property forinspection purposes.
(We) agree to save, indenu.by and keep harmless the Cil,oh MISC,- REFER TO ORD. ,
uPerano again, Itabi lilies,judbmean costs and expenses which CONST.TAX
inI n any way ccrue against said Ciry in wn,cyuvnce of the PERMIT ISSUANCE 10.00
•r' lin ofili,pert it. MECH.CONT. ' LIC.NO, MECH. '
DTAL TOTAL 1y�0
- Shgnatu of Applicant/Contractor - Dale P`
OFFICE COPY