15852 POST THIS CARD NEAR FRONT OF BUILDING
PER h11TNUMBER
CITY- OF CUPERTINO 15852
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION'
JOB ADDRESS ` `� ./ •�' - ` �YS�1�._�•/UNI,T�#�y��'�� 'LOpT`# PERMIT EXPIRES IF WORK
OWNER �( ""� CONTRACTOR LpoelaoF� �r.(J IS NOT STARTED WITHIN
INSPECTION -DATE INSPECTOR INSPECTION RECORDI 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM .
FOUNDATION 7YfZ7� NOTE LASTCALLED INSPECTION. .
LIFERALL 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
UNDERGROUND /SLAB
PLUMBING IZ •� Pp,, E- r; -�
ELECTRICAL C Q ISS ANCEUATE I
MECHANICAL AVG'. ELECT. PLG. MECN. ;
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - vas' BUILDING PERMIT
WOOD FLOOR . C� INFORMATION
VALUATION SIFT.
PLUMBING -
MECHANICAL -
ELECTRICAL ' � ' PERMIT TO
FRAMING
INSULATION sroRlEs WLIPE coNSTR.
r
OCC.GROUP Nlrs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO,FT L R APER IOTA ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING S� ' ouILO N use
P
R[5 IND COON BOm_ 1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. N ❑ El El ❑
.ASSESSORS PARCEL NO,
ROUGH SAN.H
PLUMBING e ELECT.ENERGY I
o,
' TUBS IS SHOWER PAN - �-�, PLUMBING ENERGY
MECHANICAL MECH.ENERGY Rnoo
TE ACC,FILE No
ELECTRICAL BUILDING ENERGY
FRAMING ELECT. FINAL TEST ZONING ENG.SI TE NO.
INSULATION 1 PLUMBING
GAS TEST GAS
' - MECHANICAL FIRE SPHINK ENERGY r.]e
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y " El N❑'
FLOOD LONE A.L.U.C-
EXTERIOR SHEAR 6-10 C,- ELECTRICAL RELEASE ' v C] N� ' ❑ N❑.
INTERIOR SHEAR ' _II_ FIRE DEPT.
SHEETROCK GRADE _ FEE SUMMARY
EXTERIOR LATH BUILDING _
,INTERIOR LATH TEMPORARY PPROVALS' BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK �� ;
- - • GAS .. FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FE
OCCUPA NCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC .
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
S IMPORTANT!
CONST.TAX
PLEASE'READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
„APPLICANT TO FILL IN INFORMATION WIT"I -RED LINES - USE BALL POINT PEN ONLY ;
•
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APOLICATION & PERMIT 15852
euaolNG
AOOREM 11793 T-kty EjxuAay C----I- BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
T(} ?q7 2A
OyaelEmS PLAN CHECK VALIDATION
NAME Y -1'Pr & QTY. ELECTRIC PERMIT FEE _
• QQTETt vHONK]15
NAMERAcroR's UTLETS-SWITCHES-RECEP 10.00/1.00
anocry Gear, 1m. LIC,NO, B? 430097 LIGHTING FIXTURES 10.00/1.00
ADNrnScrons '�'y\ (� rr��,� Tom. 1� PPLIANCES-RESIDENTIAL 4.00
CONTRACTORS
22o-lam a,,in L omen ld.
FAC
94065 PHONE PANELS 10.00 DATE OF APPLICATION I
ARCHITECT PLAN CHECK FEE P.C.'NO.
OR Aran Rxmiia-1, AIA,& PANELS (OVER 200 AMP) 20.00
ENGINEER
PC;SCClateS/yy,�p r�,,m.NO, C-8395 SIGNS TRANS. 3.00
AARCH OR ODREM ENG 2031 Circhand l6. T1100 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
s3nta p0a Ms. CA ztv EMP.METER OR POLE INS. 20.00 ,y -
APPLICAN MOTORS SEE FEE SCQ.
220--C Twin palam Lt. W 940ffi SERVICE CHANGE 20.00
o il LICENSED CONTRACTORS DECLARATION T e\'L\�^'r[v,•%Jd�/j/
a o U I hereby affirm that I am licensed under provisions of Charter 9 NiISSUANCE DATE
"' (commencing with Seclion 7000)of Division 3 of the Business and
W BLDG. ELECT. PLG. MECH,
y i Professions Code,an 1�py licmtse is in full fore• J e I�cL •\�) ,�..a, •� ®.
z O m - Limnx �y{y Lia Nwn / bi N(
H Date_�j)_�_O�_Crnl meter- _ (-�f�'-�---
a m BUILDING PERMIT
It u OWNER-BUILDER DV.CLARA'I'[ON INFORMATION
a o a MISC.- REFER YO ORD
w ; u H 1 herby,atm irm that I um oxen,pt from the Contractor's License VALUATION S/FT.
Hu0< Law for the following mason.IScc.70315,Business:mAl'roftxsions PERMIT ISSUANCE 10.00
Calc',Any city or county wh ich rcquires a permit to const nett.b@r, ��O
Q Q Improve,dtnmlish,or rcpuiruny Structure Prior Io its icU,Hlcc,also CLEC.CONTE. LIC.NO. ELEC. D8 306
w
O¢ requires the applicant for shelf permit to file u signed statement that TOTAL PERMIT TO
w-m he is licensed Pursuant to the provisions of the Contractor's License
H z Q
Law(Chapter 9(aommencing with Section 7000)orDivi,sion 3 oldie
Business and Prufcmions Code)or that he is exonhpt therefrom and GTY. PLUMBING PERMIT FEE
F 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e. 3 by any applicant for a pertit subjects the applicant to a civil Penalty
ofnot more than five hundred dollars(5500)): ALTER-DRAIN&VENT-WATER (EA.) 5.00 2
❑ I,asowner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for Rale (Sec. 7014, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law don not apply'to an owner of R-3 I who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTALACHEAGE
meats are not
hde own employees, If,ed ever,hat th improve- GAS-EA.SYSTEM-11 6.00
mems are nut intended oroff on for sale,If, mpleveq the building
or Hipbuilder
will
is sob within one year of t'he did completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
2161
builder will hove the burden of Proving ihufhe did not build or ire- RE IND CON PB - Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the progeny,am exclusively contracting with
licensed camracton to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 AMEMORSPARCELNO.
and Professions Code:'I'he Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who ' LAWN SPRINKLERS-OVER 5 (EA.) 1.00 : 366-09-31,32,33
contracts for such projects with a aonlractnns)licensed Furstunt to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I run exempt under Sec ,B.&P.C.for this WATER HEATER W/VENT 6.00 8098 .
reason
Owner Dale - WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORK ERS'COMPIiNSA'IION DECLARATION, WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent on self-insert, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
Policy No.thereof(Sec.3800,p y ,U.'ated P,ifio
O ❑ Certified copy is hereby'furnished. FIRE SPRINK ENERGY T 24
Z Z � t CeniT i. �cJ with the city inspection division. -
O Avphcam - DISC.- REFER TO ORD, v N v N[]
CC N . CER'1'IPICA'I'I:Ol:EXFMVI'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.0 C.
UJB C04IiNSA1ION INSURANCE PLG.CONTR. LIC.NO. PLG. Y� N� V� NEIZ (Phis ruction need Hill be completed if rm
the peil is for one TOTAL
hundred dollars IS 1001 or lewd
U O 1 certify that in the Performance of the work for which this Per- GTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is ucd,I shall Hill em,loy any pernm in any manncrso us to
U become suhjccd to the Workers'Qnlhlmnaul inn Laws of California.
U a Dmc Applica"t ALTER OR ADD TO MECH. 5.00 BUILDING $776.00
} W NOTICE TO APPLICANT: II',after IRaking this Certificate of E.-
F ? enhption,you should become subject to the Workers Cnmpensntion APPLIANCE 5.00 PLAN CHECK $15.50
provisions of the Labor Cods, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000GF.M,) 4.00 $69 00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE .73
1 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.). 'yji f� HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name-•f�� HEATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's AJdressi4'4u-aLl5jE=,-4tF1-Fir.-.�- ELECTRIC
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 state laws relating to building construction, and BOILER-C(Xd�13 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOvm IDD,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
aper ino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
nay in any way accrue against Raid City in consequence of the
this rmil. MECH.CONT. LIC.NO. MECH.
PA till rLIW TOTAL TOTAL
Sign tare of Applicarl iContoeturaU tc
OFFICE COPY