18354 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT rvDh,6LR
CITY OF :CUPERTINO8354
INSPECTION DIVISION
JOB INSPECTION RECORD "
I PERMIT EXPIRATION
/ JOB ADDRESS `/ UNIT# - `OT#
PERMIT EXPIRES IF WORK
-CONTRACTOR S co vA g IS NOT STA RTED.WITHIN
IN PECTION_ ' DATE INSPECTOR INSPECTION RECOR 180.DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
WEER' ALL GRADING AND CR 46E-SMACK INSTALLED - - -
PREGUNITE - TO COMPLY IN PPROVEO_PlXNS-AND-CITY'OF PERMIT VALIDATION
CUP TANDARDS. ' r
GARAGESLABS _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGN _ l
UNDERGROUND /SLAB' - 57W-
PLUMBING '
ELECTRICAL ISSUANCE DATE
MECHANICAL uLDG ELECT. PL, MscR.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR. - - " VALUATION SIFT.
PLUMBING -
MECHANICAL
ELECTRICAL - _PERMIT TO
'
FRAMING. 2 ,Lf'
ST HIES TYPE CONSR.
INSULATION _
OCC.GROUP RES.UNITS,,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO EL FLOOR AREA TOTAL ACREAGE
ROOF ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID 4
.JBUILDING USE
ROOF SHEATHING RES IND CON Pa 011111
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. Cl - El El 1-1 ED
_ ASSLSSORSPARCELNO,
ROUGH SAN.4 -
PLUMBING -' ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS B SHOWER,PAN - PLUMBING ENERGY, r
MECHANICAL. A'dMECH.ENERGY
ACC,DATE ACC FILE No.
ELECTRICAL' ' - p BUILDING ENERGY
FRAMING - ELECT.FINAL TEST zorvlNc eNc.sere No.
'INSULATION-. PLUMBING
GAS TEST _ - GAS.
MECHANICAL FILE SPRINK ENERGY T.74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . ❑ NO
EXTERIOR SHEAR ELECTRICAL RELEASE FL000 mrvE A.uc.
INTERIOR SHEAR FIRE DEPT. v El NE Y ❑ N❑
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC "PLAN CHECK .
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FLE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY,BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC / D
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION., PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z -MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL-
CALLING FOR FINAL INSPECTION. J_G!• D
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Ji -•-� PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION
'
OWNING APPLICATION & PERMIT
ADDRESS10 18354S T,� , L) BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWN R5 - PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
PHONE
NAMERaCTOR UTLETS-SWITCHES-RECEP 10.00/1.00 A.$0
LIC.Net LIGHTING FIXTURES 10.00/1.00 p
EIRF'SCONT8ACTOR's PPLIANCES-RESIDENTIAL 4.00
AOORE^sscR �(
d�O PI10NE w �j PANELS 10.00 DATE OF APPLICATION'
ARCHITECT ` PANELS (OVER 200 AMP) 20.00 e0# PLAN CHECK FEE .C.NO.
ENGINEEfl
S SM ua ND. SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS I SPECIALCIRCUIT 5.00 r
XV W/A 21P EMP.METER OR POLE INS. 20.00
APPuc ANT'S MOTORS SEE FEE SCH. [
ADDRESS ,,11
SERVICE CHANGE 20.00 �_ AV�lulnv „
o o LIC17NSED CONTRACTORS DECLARATION �I YY YY II ,y,�l,/`/,
cca I hereby affrsn that I am licensed under proUsions of Chapter 9 ISSUANCE DA
y a a (commencing with Section 7000)of Division 3 of the But" sx and BLDG. 'ELECT. PL MECH. .j
D'v' Professions Copy, Intense is in full to, I
i Ho 4'/, Licen LIC.Numb 1 _ ❑ ❑ ❑�
o N F w Date Commctor 1
s BUILDING PERMIT/
w ¢ OW'NER-BUILDIiR DECLARATION INFORMATION
aoA ° MISC.- REFER TO ORD
w LL y I hereby affirm that I so exempt front the Contractor's fs License vgLUATION
H u_ oa Law for the following rcason.(Stt.7031.5,Business and Professions PERMIT ISSUANCE 10.00 ,Z p /6/FT.
Cade:Any city or county which squires u pantile to conslmcL alter.
2 rt ¢ o improve,demolish,or repair any structure,prior to its issuance,also LEC.CON H LIC.rv0. ELEC. �I
O u requires the applicant for such permit to file a signed Statement that �a,1 TOTAL �� V PERMIT TO/
d w m he is licensed pursuant m the provisions of the Contractor's License r
r m a
Law.(Chapter!) Section 7000)af Division 3 of0m
Business and Profossions Code)or that he Is esculpl thcsimin and OTY. PLUMBING PERMIT FEE
r the basis for the alleged exemption.An
g p yviOlation of Section 703 L5 STORIES
TYPE CONS R.
by any appliarit for a permit subjects the applicant to a civil Penalty ALTER-DR -WATER (EA.) b.00
of mol more than five hundsd dollars(5500).1:
❑ I,as owner 0f the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCG 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 docs not apply to an owner of
property who.builds or improves'thereon,and who does such work FIXTURES-PER TRAP 5.00 S2FT.FLOORAREA TOTALACREAGE
• .,His are Hot hrough
ownemployees,fors,provi,ed that however,the
implore- GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
mems are not imm�ded or offered for sok.If,mpleveq the building
or improvement has is sold within one year of completion,ion,Lill owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not buil)or int- BUILDING USE
prove for purpose of sok.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Otn.r
❑ Las owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensad contractors to ronmuct the project(Sec. 7044.Business LAWN SPRINKLERS- 1 INC,5 V.B. 6.00 ASSESSORS PARCEL NO.
Code.and Professions CodThe Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA,200ff/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ;B.&ItC.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKBRS'COMPENSCI ION DFCLARA'HON WATER TREATING EQUIP. 5.00
I hereby alfirm that I have a certificate of consent to salf-insure. ZONING
or a CertiGate of Workers'Compensation Insurance,or a ecrlilled ENG.SITE NO.
copy thereof(Sec,3800,[.all CA - -
Policy No. Company
ZZ Certile Co 'ishWeby(uphey5 ,d FIRE SPRINK ENERGY'-YO
.Certif• til he y ns if. division.
MISC.- REFER TO ORD.
O APPlicant Y❑ N❑ Y ❑ ) N❑
CC T CER7'1171CATE OF Ii Ts ESIVfION PROM WORK FIRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W 7 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. P,LG. V E] N❑ V ❑ N❑
CL O (fills section need nut be'conlph:ied if the Pennit is fur one TOTAL
Z) 2 hundred dollars IS 100)or less-1
U O 1 cerlity that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I shall not en,loyany relmm in any nmmcr so us to
U become subject to the Workers'Cumpensatiun Laws of California.
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of I's
-
F Z emption,you should become subject to the Workers'Compensalion APPLIANCE q 5.00 PLAN CHECK
provisions of the Libor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1OS1000F.NL) 4.00
CONSTRUCT ION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE'
I hereby atfnm that [here is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the perfurmanac of the work for•which this Permit is issued(Sec MICROFILM
3097.C1v.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nada HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC O
I certify that I have read 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 tate laws dinas . releting m building moa,octim. and cBOILER-C(1MP 13 H.P.or 100,000 B.T.U.) 6.00
hereby autllnrix representatives of this city to enter upon the BOILER-COMP (Oster 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentuned property for inspection purposes.
(We) agree to one, indemnify and keep hxnulle,, the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses whichCONST.TAX
ay in any way accrue against said City in'ronsequenee of the PERMIT ISSUANCE 10.00 '
�a lin of this permit MECH.CONT. LIC.NO. MECH.
obX 'hicin TOTAL TOTAL �4 (/
Ignalure of Applicant/Contractor Date �0
OFFICE COPY.,
i