17325 POST THIS CARD NEAR FRONT OF BUILDING PETART NUMBER
" CITY OF CUPERTINO 1p17325
"INSPECTION DIVISION
JOB INSPECTION RECORD,
/ PERMIT EXPIRATION
JOB ADDRESS_l 0 60� 1 ��-LS.�I�UNIT# L'OT# '
�^ I PERMIT EXPIRES IF WORK
OWNER CONTE AC TOR ) I IF IA_ G x.15 L S" IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR .INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIO_N - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
r PREGUNITE .. CUPERTINO STANDARDS.. J-
GARAGE SLABS _ ` •� '-^ ' '-
POUR NOXONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUNDPSLAB MAR 01 IARQ
PLUMBING' - 14"
ELECTRICAL of ISSUANCE DATE'
MECHANICAL BLuc, aecr. PLG. mecD,
❑ ❑ ❑ `,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 3 4 IC -5 Nm tail BUILDING PERMIT
INFORMATION
WOOD FLOOR - oZ. VALUATION S/IT.
PLUMBING � _ �
MECHANICAL -
ELECTRICAL - - EERnIT ro
FRAMING - - �
:INSU CATION -
SIOR ES TYPE CONST,
' � - � -
• _ OCC,GROUP RES,UNITS
t
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO11.FL(H1R AREA IUTALACREAC.E
ROOF' ' 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING - RES IND CON PB O, .-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED' FINALS DATE , INSP. ❑ ❑ ❑ ❑ ❑
ASSESSOHS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO. PARCELNO
SUBS&SHOWER PAN PLUMBING-ENERGY
MECHANICAL - MECH.ENERGY
ACC DnTE ACC-F•ILE NO,
ELECTRICAL BUILDING ENERGY
FRAMING ELECT,FINAL TEST
ZONING ENG,SITE NO.
.INSULATION PLUMBING
GAS TEST. GAS
FIDE SPHINKENERGY T 24
MECHANICAL v N�' Y ❑ N[]
COVER NO WORK UNTIL ABOVE HAS BEEN,SIGNED HEATING
FLOOD ZONE A.L.U.C.
EXTERIOR SHEAR ` ELECTRICALRELE
INTERIOR SHEAR FIRE DEPT. •
❑ N❑ ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH - TEMPORARY APPROVALS . BUILDING-
SCRATCH COAT ELECTRIC PLAN CHECK / Q
GAS FEE C :bIr
NO,TAPE.OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE y,
OCCUPANCY OF BUILDING IS NOT PERMITTED,UNT.IL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ED ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT!
CONST.rax
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
BUILDING PROJECT I DENTI FICATION
'PERMIT NUMBER
�S'oAEss APPLICATION & PERMIT �, 1 T325
�/� e2A) 't@� BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
ONNER'S 'v PLAN CHECK VALIDATION
NAME
JJ �e5-.�7j DTV. ELECTRIC PERMIT FEE
N C3-
8sP n vnanE
L.
E CONTRACTORS
NA.
NAME t /r/ 'C. OUTLETS-SWITCHES-RECEP 10.00/1.00 _
S/ N G� s�1 CSs,,1'FLIGHTING FIXTURES 10.00/1.00
r,ONTRAc Rs - PPLIANCES-RESIDENTIAL 4.00
ADDRESS T. Q
{7tie PRDNE�I 66PANELS 10.00 DATE OF APPLICATION -`
ARCHITECT PLAN CHECK FEE I',.C.NO.
OR PANELS (OVER 200 AMP) - 20.00
ENGINEER
" sec.No ISIGNS TRANS. 3.00
�OD
RReu ENc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
''
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
-
SERVICE CHANGE 20.00 W
wOH+o or LICENSED CONTRACTORS DECLARATION
Q u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
w (commencing with Section 7000)of Division 3 of the Business and'
a n MAR �/ BLDG. ELECT. PLG. MECH.
r o i Rumessicns Code,and in,license is in full force and effect. ❑ ❑ ❑
z o`v{' - Licenm Cluis Li,.Nwnhe,
o 4 H as 0 Date Contractor �,,� �E�
¢ Y city Of Q Wi BUILDING PERMIT
as OWNER-BUILDER DECLARATION
a o w'o INFORMATION
Rows,
O u y I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
3 u VALUATION 5/FT.
Huoa Law for the following reason.(Sec.7031.5,Nosinessani Professions PERMIT ISSUANCE. 10.00 ;�
Coda Any city or county which requires d perm❑to const mct,alter, ^p�
Q p improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
u w0 u requires the applicant for such permit to file a signed statement that TOTAL PERMITTO
93 be is licensed pursuant to the provisions of the Contnetor's License - S- 0
I Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a' Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
r$ the basis fur the alleged exmnption.Any violation of Section 7031.$ STORIES. TYPE CONSTR.
by any applicant for a permit subjects the xpplicvnt toucivil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 -
of not more than Ove hundred dollms(5500).):
❑ 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 Comnctur s License Law docs not apply to an owner of
a property who builds or improves thereon,and who does such work - FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or Uvaugh,his own employees,provided that such improve-
meNs are hot intended or ffc,cdfor svle.If,however,.ihc building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,0¢owner-
builder will have the GAS-EA.SYSTEM-OVER 4 (EA.), 2.00 BUILDING USE
bis Nen of proving cost he did not build or ire- RES IND DON PB Omer
prove for purpose of sale.).' - INDUSTRIAL WASTE INTER. 30.00 ❑ El ❑ ❑ ❑
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License-Law doesnot apply
to an owner of property who builds or improves thercun,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with a contractons)licensed pursuant to
1Iu.C�w wr's License Ww. - SEWER-SANITARY-STORM EA.200ft/10.00 - TRACT No, PARCEL NO,
l amexempt under Sec.-.B.&P.C.f )l" WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0,
WORKERS'COMPENSATION DECLARA'r1ON WATER TREATING EQUIP. 5.00
I.hereby affirm that I have a certificate of consent to"kinslrc;
or a certificate of Workers'Compensation In surarice,
I6,a"Hified ZONING ENG.SITE NO.
Copy thereof(See.3800,Lab.c).(�u%y eZ rQ.
Policy No. Company -
O ❑ lificd copy is hereby fur.ished. FIRE SPRINK ENERGY T 24
Z 2 Certife py 11 filed w. h me city inspection division. MISC. REFER TO OR D.
O Applicant �'- {I� v N v N
-�, e1ep :y ❑ ❑ ❑ ❑
~ rn PERMIT ISSUANCE 10.00
-. CERTIFICATE Oh 1 XEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LU 5; CO..41iNSATION INSURANCE PLG.CONTR. `LIC.NO. PLG. v❑ NE] v� N❑
CL0 (This section need nm be completed if the permit is for one TOTAL
U O hundred dollars(5100)or I..) '
I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
U. H mit is issued,I shall not employ any perste in hny manner m us to
Ow become subject to the Wmkcrs'Compcnwtion Laws of Cali&imia. BUILDING
CL Dxtc Applicant -
>_ r0 NOTICE TO APPLICANT: If,after making this Certificate of ISx-
ALTER OR ADD TO MECH. 5.00
H ? coalition,you should become subject to the Warkerz'Compensation - APPLIANCE - " 5.00 PLAN CHECK C
provisions of the Labor Code, you must forthwith comply with - FEE 31
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.)' 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 6.00 SEISMIC FEE i
I hereby affirm that there is a constrmhum lending agency for EXHAUST HOOD(WITH DUCT) _ 5100
the performance of the work for which this permit is issued(Sec. MICROFILM.
3097.CicC). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's
Lender's Address
ss HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
-
-. IceHily that l have r,ad His applicvfign and xlate that the above VENTILATION FAN (SINGLE) 4.00 '
information is Correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOIL.ER-COkV(3H.P.6e100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP Ilse,160,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
OVO agree to save, indemnify and keep hannlesr the City of misc.- .REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which' PERMIT ISSUANCE 10,00 CONST.TAX
ay in any way scenic against said City in ConSe(sence of the
f th pcmn //_f �DMECH.CONT. LIC.NO. MECH.
C'
LI ./Jv. x Q��✓lOf� /N, TOTAL TOTAL y�E�
SigiatEurree of Applicant/Contractor at
OFFICE COPY