15851 POST THIS CARD NEAR FRONT OF BUILDING PERMITNUNIBEq
CITY OF' CUPERTINO 15851
INSPECTION DIVISION
_ JOB INSPECTION RECORD
•- - '� - I PERMIT EXPIRATION
JOB ADDRESS 1�• U`` , NIT# .LOT# v :�
rPERMIT EXPIRES IF WORK
R !
OWNE ( G�j�� CONTRACT R �LLQ(��\ G,w IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:' LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF .PERMIT VALIDATION
CUPERTINO STANDA S.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB D
PLUMBING 2 ' e - Q
ELECTRICAL - ' •� O U � O ISSUANCE DA TE
MECHANICAL BLDG ELECT PLG.+ MECH.
CIO
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Ru1LDI NG PERMIT
WOOD FLOOR - - INFORMATION
vn LUATioN SIFT
PLUMBING .
MECHANICAL
EHMIT TO
ELECTRICAL
FRAMING
INSULATION Y. STUDIES TYPE CONSTR.
- DCC. ,HGuP ITE S
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' - R-3 S
ROOF NOTE:NO FINALINSP.SHALL BE MADE BEFORE so.FT.1 UDII AIIEA TOTAL.AumAGL
.I DIAPHRAGM THE CONSTRUCTION TAX IS PAID '+
t HULLUI NG USE
ROOF SHEATHING — Rcs IND CON PB.
APPLYNO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. R Q ❑ ❑ 11
ROUGH
,ASSESSOHSPAHCEL NO
SAN.a
Q�'C EC
PLUMBING ELT.E ERGY' 111 114
TRACT No
PARCEL NO,
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY 8098
ELECTRICAL - ACC.DATE. ACC.FILENO,
BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
' INSULATION - .l PLUMBING
.GAS TEST Ibto IM. OU, GAS
- FIRE SVRINK ENERGY i.Ze
MECHANICAL r N� ❑ N[:]-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -
.
EXTERIOR SHEAR •�..� ELECTRICAL''RELEASE .• FLOOD ZONE A.LU C.
0 N� v ❑ . N❑,
.INTERIOR SHEAR FIRE DEPT.
SHEETROCK ��' ' GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH Q TEMPORARY APPROVALS
BUILDING
SCRATCH COAT Y 611, ELECTRIC PLAN CHECK .�
GAS - FEEEhqp
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY.BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, Y ELECTRIC
ONE WORKING DAY BEFORE'REQUIRED INSPECTION: PLUMBING' rte'
Oz PLEASE GIVE JOB ADDRESS WHEN PHONING. r
- SEE PERMIT FOR EXPIRATION DATE -4 ` MECHANICAL
IMPORTANT!
CONST.TAX 03
r: PLEASE READ REVERSE SIDE BEFORE TOTAL
'„CALLING FORTINAL INSPECTION.
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - li
1
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BDILDING APPLICATION 15 8 51ION &'PERMIT
ADOREss ]1
�-��tY �xJ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ..
DWUER
nN PLAN CHECK VALIDATIONNAMEd-b�-'yCr1DLj�r I71C. IS ELECTRIC PERMIT FEE
veoUTLETS-SWITCHES-RECEP 10.00/1.00
NAMEuc, LIGHTING FIXTURES 10.00/1.00
roNT Acr Rs�'� ^ PPLIANCES-RESIDENTIAL 4.00
ADOREss L.LI/"L y n a-dpi'fyFIC 9M9 PPHO- PANELS 10.00 DATE OF APPLICATION
ARCHITECT � PLAN LMECK FEE .GNDR PANELS (OVER 200 AMP) 20.00
ENGINEER
Lm. SIGNS TRANS. 3.00
ARCCHOR ENG. SPECIALCIRCUIT 5,00PERMIT VALIDATION
2031 Cni�d Dr..:c-rd-a Ana 111- EMP.METER OR POLE INS.' - 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS,
SERVICE CHANGE 20.00 ��,J
O O 2 LICENSED CONTRACTORS DECLARATION \ /(�� (00
r
a v I hereby affirm that I am licensed under provisions of Ch.,(cr 9 Q\`1QISSUANCE DATE
a (cote n...in,with Section 7000)of Division 3 of the Business and Q • G. ELECT. PLG. MECH.
F O z Professions Code,a force my licenw is in full up
.1 L, •®
z O - License 's Lice Number Y /
o r w Date �. GonlydCLOr -
a y f BUILDING PERMIT
o: or < OWNER-BUILDER DECLARATION .INFORMATION
REFER TO ORD
K
3 I hereby affirm (hot I am exempt from the Contractor's License MISC.- VALUATION SIFT.
F .. O a Law for the following reason.(Sec.7031.5.Nosiness and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requims a permit to construct,alter,
o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ETEC.
- O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A-is m he is licensed pursuant to the provisions of the Conlmctor's License
ri > Law w(Chapter 9(commencii,w ith Section 7")u f Division 3 of the
Q Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
Or I $ the basis for the alleged cscnsp t ion.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR.
d � by any applicant fora permit subjects the appplicant loa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not mom than five hundred dollars(f 500).):
❑ 1,as owner of the property,or my employers with wales as BACK FLOW PROTECT. DEVICE 4.00 OCC. ROUP RErMTS
their sole compenscrum,will do the work,and the stmeture is nal
intended or offend for sale-(Set. 7144, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 R-3 1
Code:The Contractor's Licrew Law docs not apply to an owner of
properly who builds or,improves thereon,and who docs such work FIXTURES-PER TRAP 5,00 60.FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC-40UTLETS 6.00 9161
or improvement is sold within enc year of completion, the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving that he did not build or im- . . .
RES IND CON PB - Omer
prove for purpose of sale.l. I N DUSTR I A L W ASTE INTER. 30,00
❑ I,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 Low does not apply
to an owner of property who builds or improve%thereon.andwho LAWN SPRINKLERS-OVER,5(EA.) 1.00 366-09-31,32,33
contracts for such projects with a contractors)licensed pursuant to -
• the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am esempl under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 8098
reason
Owner - Date WATER SYSTEM - 5.00 ACC.DATE ACG FILE NO,
WORK I7RS'COMPI7NSAT1❑N DIiCLARATiON WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to wlf-insu¢. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,mLab C. llu I T�,...p
Policy No. CopanY _Fbmflc_ -
O ❑ Cenilied copy is hereby famished. FIRE SPRINK ENERGY T-24
Z O Ar.�nrtif �(I')k�with the ciiy inspection division. MISC.- REF ER.TO OR D. Y ❑ N❑ Y ❑ N❑
CC rn CERTIFICATE:OI'I CI'.MPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. pv N YI.G.
CL o (This wctioa need not be completed if the permit is ler one TOTAL ❑ ❑ ❑ N❑
::) Z hundred dollars(S 100)or less.l
U 01 certify that in the performance of the work for which this Iter- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LkL 1- mit n issued,I shell not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
Ut i Dula Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE. TO APPLICANT'. It,after making this Certificate of Ex-
F Z entption,you should bemnte subject to the Workers'C'ompensalion APPLIANCE 5.00 PLAN CHECK
C) s�hprovsof the isins or thiLabor
permit shullou must be devoted rehwokedcomply with AIR HANDLING UNIT(TO IOPMGF,A4) 4.00 FEE $�'�
CONST'6UCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.NL) 6.00 SEISMIC FEE
I hereby affirm 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.). IL7ty 1p�f, HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC'
ml.rsAddre.T }> �-4th F]r:SF"94
I cenily that I have read this applicration and stale that the above VENTILATION FAN (SINGLE) 4,00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-DOW Q H.P.or 100,000 B.T.U.) 6.00 $55.50
hereby authorize representatives of this city to enter upon the BOI LER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned property for inspection purpose,
(We) agree to save,rindamnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may In any way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00 7,03
gpaarja�ih omit. MECH,CONT, LIC.NO. MECH.
WINx/JzTOTAL ' TOTAL
sign arca Applic t/Conlractor ate a $1326.76
'' OFFICE COPY