15781 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
-` CITY OF CUPERTINO
'INSPECTION DIVISION 5781 '
✓ JOB INSPECTION RECORD
1i. PERMIT EXPIRATIO N. •
_ JOB ADDRESS/o' ,y 4d O Vn+-S w,'4C-1 UNIT# _LOT# _
/�F - - PERMIT EXPIRES IF WORK
OWNER _111 lc?'77c CONTRACTOR 'ts'"�r�RC o� F��-V C IS NOT STARTED WITHIN
INSPECTION - DATE INSPECTOR NSPECTION RECORD 180 DAYS OF PERMIT ISSU-;
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
LASTCALLED INSPECTION:
' UFER � � � 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 SIGNED w'^
' UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ' - ISSUANCE(3AIF.
MECHANICAL: r
ELECT. PLG. ;MECH.
d ❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED IU3MLDING PERMIT
_ ,- INFORMATION
WOOD FLOOR
• 'PLUMBING I ION s/Fr.
'•
MECHANICAL 737,6 '
ELECTRICAL PERMIT- `
FRAMING - -f 7v WEA. J.Z
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RFS UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' 'SU,IT.'LOOP AD" ' TOTAL ACREP(E
'ROOF . .NOTE:NO FINAL INSP.SHALL BE MADE BEFORE"
DIAPHRAGM THE CONSTRUCTION TAXIS PAID .
BUILDING USE
ROOF SHEATHING HES IND • CON Pa o
T APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - DATE INSP. - L 0' 0. 0
ASSESSORS PARCEL NOT
ROUGH BAN.# '
PLUMBING - ELECT.ENERGY
IHACT NO. - PARCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY ,
MECHANICAL : MECH.ENERGY -
ACE DATE ACC.FILE NO.
ELECTRICAL - BUILDING ENERGY
FRAMING. ELECT..FINAL TEST
ZONING
PLUMBING ENG,SITE NO
GAS TEST GAS `
FIRE SPRINK ENE RGY T 2a
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N0 r ❑ N❑.
EXTERIOR SHEAR ELECTRICAL RELEASE ,FLOOD zonE• n,L.0 C.
L
INTERIOR SHEAR '_ FIRE DEPT. NL L NL.
SHEETROCK . GRADE FEE SUMMARY
EXTERIOR LATH, BUILDING
INTERIOR, LATH TEMPORARY APPROVAL BUILDING .
SCRATCH COAT ELECTRIC PLAN CHECK
.'�� GAS FEE _
NO TAPE R PL TER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE '
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR: MICROFILM
ELI ARRANGE FOR INSPECTION ;BY PHONING 252-4505ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.'
I ? y MECHANICAL -
- SEE PERMIT FOR,EXPIRATION DATE -
M IMPORTANT!` CONST.rnx
PLEASE READ REVERSE SIDE.BEFORE " TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
Pri ADDITIONAL PERMIT FEES
BUILDING PROJECT I DENTIFICATION VALUATION
RG
APO SS
/ LAs 0-vJZX6 WA
NANEfl S
a/IV3"S FEE SUMMARY
uEyr� 4RONE yrs
CONTRACT..s BUILDING
4ME t ..//��EEQQ��
/�" JF Ffict uc.No. Y/W/ PLAN CHECK
r, NTRACTORS AA • FEE
AooflEst Z&O'R.41 ,4y A,% T
L ENONE 57,1_S
7 -5zz SEISMIC FEE J •+
PTY. ELECTRIC PERMIT FEE .
UTLETS-SWITCHES-
RECEP ELECTRIC
LIGHTING FIXTURES
PLUMBING
APPLIANCES-RESIDENTIAL
PANELS MECHANICAL
SIGNS {(�
SIGNS TRANS. TC��
SPECIAL CIRCUIT C
EMP.METER OR POLE INS. PER\M``\T VA D .0. -
\V~
MOTORS SEE FEE SCK JG� `w0
Q SERVICE CHANGE
F- o TOTAL
ISSUANCE DATE
W DTV. PLUMBING PERMIT CL B FEE BLDG. ELECT. PLG. MEAN.
2 ALTER DRAIN&VENT WATER(EA.1
V O BACK FLOW PROTECT.DEVICE
Qw DRAINS-FLOOR,ROOF,AREA,COND.
} 0. FIXTURES-PER TRAP
N
�— GAS-EA.SYSTEM-11NC.40UTLETS
(„) GAS-EA.SYSTEM-OVER 4(EA.)
INDUSTRIAL WASTE INTER.
LAWN SPRINKLERS-I INCSV.B. /
LAWN SPRINKLERS-OVER 5(EA.)
SEWER-SANITARY-STORM EA.200f4
WATER HEATER W/VENT
WATER SYSTEM
WATER TREATING EQUIP.
TOTAL
OTY. MECHANICAL PERMIT FEE
ALTER OR ADD TO MECH.
APPLIANCE
AIR HANDLING UNIT ITO 10,000C.F.M)
AIR HANDLING UNIT(OVER 10=C.F.M.)
EXHAUST HOOD(WITH DUCT)
HEATING UNIT(TO 100,000 B.T.U.)
HEATING UNIT(OVER 100,000B.T.U.)
VENTILATION FAN(SINGLE)
BOILER-CONT 13 H.P.or 100,000 B.T.U.)
BOILER COMP 10.11 100.000 BTUI SEE FEE SCH.
TOTAL
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
r ; .;MI LDI NG PROJECT I DENTI FICATIONAPPLICATION & PERMIT ;PERMIT NUMBER
BUILDING . 5 1 U�
ADDRESS _ 5 r Q
/0We/ SAS �d.4 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL f"
OWNER'S w PLAN CHECK VALIDATION
/J/J
rvamE- I' QTY. ELECTRIC PERMIT FEE V
1PHONE I
cANTRacrogs - OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
SLAC 4r_415611C No. „5 LIGHTING FIXTURES 10.00/1.00
coNTRAcioR's CArH�eE�•L PPLIANCES-RESIDENTIAL 4.00
40DRESS, 0 r
Alp R411.&).4 .4 �J PANELS 10.00 DATE OF APPLICATION :
P.C.No.
ENGINEER
ARCHITECT PANELS (OVER 200 AMP), 20.00 PLAN CHECK FEE
OR
uc.No. SIGNS TRANS. 3,00
ADDRESS G.ENCIRCUIT 5.00 PERMIT VALIDATION
_
ZIP EMP. METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH. �fy�h`-"'-'
ADDRESS
, - SERVICE CHANGE 20.00 /
wo O LICENSED CONTRACTORS DECLARATION - i /
< u I hereby affirm that I am licensed under provisi.uS of Chapter 9 ISSUANCE DATE
in 3 m Icominencing with Section 7000)Of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F m z Professions Code,and my license is in full fort• f ❑ ❑ ❑ ❑
Z o w - License Clan_ Li, Number
o H w )ac!2/a$ Contractor
y s BUILDING PERMIT
0 w u OWNER-BUILDER DIiCLARATION
MISC.- REFER TO OR
INFORMATION
X ac LL w 1 hereby uffinn that I um exempt from the Contractor's License VALUATION
F LL o a Law for the following reason.(Sec.7031.5,Business and l'mlessions PERMIT ISSUANCE 10.00 SIFT.
Code:Any city or county which reyuiresa permit tuconstruc4 alter, �6T
G 2O improve,demolish,or repair any structure,prior to Its Issuance,ako ELEC.CONTR. LIC.NO. ELEC.
0..0 requires the applicant for such permit to file a signed statement that TOTAL -S a PERMIT
X m y he is licensed pursuant to Thr provisions of the Contractor's License - _ �
arz < Law(Chapter9(colnmencing with section 7000)of Division 3 of the _
P 4 O Business and Professions Code)of that he is exempt therefrom and QTY. PLUMBING PERMIT �{V
or o the basis for the alleged exemption.Any violation of Section 703 L5 �•' STORIES' TYPE CONSTR.
T E m by any applicant for a permit subjects the applicant for civil penally
of not more than five hundred dollars($500).)
ALTER-DRAIN -WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE - 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044..Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
• Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SO,FT,FLOOR AREA TOTAL ACREAGE
himselforof throughhisownemployees,for safe.
If,ed that however,
the
improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
omenta are not intended or n employee sine.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- - RES IND CON PB Other
prove for.purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
r ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project IS, 7044,Business LAWN SPRINKLERS-'1 INC 5 V.B. 6.00 ASSEssons PARCEL NO.,
and Professions Code:The Cowrucf ors License Law does not apply
to an owner of property who builds or Tropanes thercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contomr.ctsuch Licenecr,awithacuntmctortsl liccnxJ pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor i License Law.
❑.I"m exempt under Sec. .B:&P_C.for this WATER HEATER W/VENT 6.00
R'a50n
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORKER$'COMPI-.NSATION.DECL\RATION WATER TREATING EQUIP. 5.00
1 hereby affifm that I have a cerlil'icate 6040nsem 10 sel procure, ZONING ENG.SITE NO.
or a cert it cute of Workers'Com pen sat ion Insurance;or a cc U it icd
copy thereof(Set.3800.Lab.C.). -
Policy No: Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
C
Z
OT ❑lIIce ertified .copy ix tiled with the city inspection Aivision' MISC. V N- REFER TO ORD. ❑ ❑ E] N❑
. MAw CER1'IFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLooDzorvE A.L.U.c.
Uj 1 Q COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ V C] N❑
(This section need nor, be completed if the peons is for one TOTAL
Z'Z Modred dollars IS 100)nr lcc.) ,
L) O 1 certify that in the performance of the work fur which.lh'net- GTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H - mil is issued.I shall not employ airy person in any manner so as to
U.:. become suyt ct}o�the Workers'C mpnr .Uahlor 'a ^
-mow - Dated(�/p�Applicant s BUILDING
a 4 eAPFL - ALTER OR ADD TO MECH. 5.00
} r NOTICE O ICAN'1''. If,atter nwking th. it f tate of Ex-
Z cnmption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with { FEE
m -
U such provisions or this permit shall be declared revoked. AIR HANDLING UNIT(TO 10DMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ,lSa
I hereby uffinn 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.Civ.C.). HEATING UNIT(TO 100,0008.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and stall that the"hove VENTILATION FAN (SINGLE) 4.00 -
information is correct I agree to comply with all city and county $OILER-COMP13 H.P.or 100,0008.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction. and
hereby authorize representatives of this city I. enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(we) agree to save; indemnify and keep lonnless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments. Costs and expenses which PERMIT ISSUANCE - 10.00 •CONST.TAX
may any way accrue against said City in consequence of the
rbA Da It Of tl.is •rat' / MECH:CONT. LIC.NO. TECH. /
TOTAL TOTAL
Signature o f Applwapll o f cto� -fie J .
OFFICE COPY