18492 POST THIS CARD. NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY, OF CUPERTINOg4g2I
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS,_\{ AV UNIT, LOT# '/ N,
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR �. IS .NOT STARTED„WITHIN
INSPECTION - DATE INSPECTOR - INSPECTtON RECORD 180 DAYS OF PERMITIISSU-
ANCE OR.180 DAYS FROM
FOUNDATION': - NOTE: - LAST CALLED INSPECTION.
LIFER ,1 ALL GRADING AND DRAINAGE SHALL BEINSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
� •. � n �A
'POUR.NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ;.(' I 'o III, i)
UNDERGROUND /SLAB
PLUMBING
'-
ELECTRICAL-
ISSUANCE DATE
MECHANICAL , . , BL , ELECT, PLG. MECR
. . i ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �j Z_ BUILDING PERMIT
INFORMATION
WOOD FLOORVA LION5/F T.
PLUMBING - - - ,
MECHANICAL'”
ELECTRICAL '
FRAMING ' (�1 /L. v
sTo IEs TYPE corvsTR.
INSULATION.
OSC.GROUP .RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.IT FLOGR AREA TOTAL ACRFAGF
DIAPHRAGM.,;• THE CONSTRUCTION TAX ISRAID
NUILOING USE
ROOF SHEATHING •, - RES IND CON PB 0,1 �
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ �
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING . .ELECT.ENERGY
TRACT NO. PARCEL NO.
_ .
TUBS&SHOWER PAN - PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ACC,DATE ACC,FILE No
FRAMING 'ELECT.FINAL TEST ZONING elvc.SITE No.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T-]4
MECHANICAL Y N❑ Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .
EXTERIOR SHEAR ELECTRICAL RELEASE ELooD zoNe A uc.
INTERIOR SHEAR _ FIRE DEPT. Y❑ N❑ i ❑ NO
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - BUILDING 11 0
INTERIOR'LATH - TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC
�! ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE,—
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL ' J
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION - .PERMIT NUMBER
BUILD14G�z W 11 7 f_rr APPLICATION & PERMIT " 18 4 9 2
ADDRESS I (�
SlaT/N O BUILDING —ELECTRICAL—PLUMBING—MECHANICAL j,
ONrvERS PLAN CHECK VALIDATION
NAME a�rjH/a¢2,� C, �� C—� '` TY. ELECTRIC PERMIT FEE `
PHONE �7•r
CONTRACTORS
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00CONT _
ADDRESS �I
EACTORs - APPLIANCES-RESIDENTIAL 4.00 �•�,`\ f�
ADD
PHONE PANELS 10.00 DATE OF APPLICATIO
ARCHITECTPANELS (OVER 200 AMP) 20,00 r PLAN CHECK FEE P.C.NO.
OR
ENGINEER
sec.no' SIGNS TRANS. 3.00
ADDREOR SS ENG. - SPECIALCIRCUIT 5.00 PERMIT VALIDATION
11P EMP.METER OR POLE INS. 20.f10 1
APPLICANT MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHAN 20.00
Woo LICENSCU CONTRACTORS DECLARATION -
< C, u I hereby affirm that Iran licensed under pu;,kicns of Chapter 9 ISSUANCE DATE
yz w (commencingwith Section 71X10)of Division.3 of the Businev and L
¢ m g BLD ELECT. PLG. MECH.
r• w z Professions Code and my license is in full force and cffed. A ❑ ❑ ❑
z o - License Class Lie Number ! .
Z
C, Dale Contractor
BUILDING PERMIT
¢ ¢ w u OWNER-BUILDER DECLARATION INFORMATION
A o a MISC.— REFER TO ORD
C, . P, I hereby affirm that I am exempt from the Contractor's License VALII IO f/FT.
FU0< Law ferny city owing r countmason.wch(See perm tocone Professions PERMIT ISSUANCE 10.00a
m i Calc',Any city or county which structure,
pennil o tsnsuanc .aeq
R S ¢
improve,demolish,or repair any Mrudun.,prior to its issuance also ELEC.CONTR. LIC.NO. ELEC.
- O le requires the applicant for such permit to Cite a ugned statement that TOTAL PCs
T T
w $ he is licensed pursuant to the provisions of the Contractor's License _
I-
z i
Law(Cltapter9(commencing with Section 7000)of Division 3 oftlm
¢ Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE
¢ r$ the basis for the alleged exemption.Any violation of Section 7031.5 STO ES TYPE CONSTR.
d ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of npt mora than tivel unded dollarst$5001J:
1't I,as owner of the property.-or my employees with wages as BACKFLOW PROTECT. DEV ICE 4.00 ' OCG GROUP RES.UNITS
tfiBmr_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,CONED: 5.00
Code', The Contractor's License Law docs not apply to an owner of '
properly who builds or improves thereon.and who Cott such wort( FIXTURES-PER TRAP 5.00 SO-FT.FLOOR AREA TOTALACREAGE
himself or through his own employm,provided that such improve-
ments SYSTEM are not intended or offered for sale.If,however,the building
or impro,menI is told.within one year of completion, the owner. GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving that he did not build or inn . . .
RES NO CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑-
licensed contractors to construct the project IS,,7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improve,thereon.and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00
contracts for such projects with a conlracmKg)licensed pursuant to -
theContractor'sLicense Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lar rapt under S ,B.&I'.C.Ibr this WATER HEATER W/VENT 6.00
reason
Owner - / / WATER SYSTEM 5.00 ' ACC.DATE ACC.FILE NO.
WORK Ii RS'COM PENSATION DEC1ARATION / WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certilitate of consent to sah�insure' ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a Certified
copy thereof(Sec.3800.Lab C.).
Policy Na Company
O ❑ Ccrtilied copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. REFER TO ORD.
O Applicant MISC.-• Y❑ N❑ Y ❑ N❑
~ sayPERMIT ISSUANCE 10.00 FLOOD ZONE. dL.uc.
Q CIiRTIPICA'1'E OP[i%I!MY,]'ION FROM WORKERS' '
IL COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. -
CL 0 CL Z (This section need not be completed if the permit is for one TOTAL ❑ NE] Y E] NE]
hundred dollars IS 1001 or Icss.)
U O 1 certify that in the perfunnunce of(Le work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mitis issued,I shall not employ any person in any manner so as to
become subject to the Workers'Comln
peation Laws of Califorrmc
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
- W NOTICE '10 APPLICANI: if,after making this Certificate of Ex-
N ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you most forthwith comply with FEE
U such provisions or this pennil shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M,) 4.00
CONSTRUCf1ON LENDING AGENCY AIR HANDLING UNIT(OVER 10SMC.F.M.) 6.00 SEISMIC FEE
m
I hereby affirthat there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit n issued(Sec. MICROFILM
3097,Civ,C,) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lerdur's Na mc HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC.
_ Lender's Address
I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply win all City,mul enmity PLUMBING
ordinances and state laws relating to building construction, and BOILER-CC1MP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree Ip save, indemnify and keep blond. the City of MISC.- REFER TO ORD. -
6,. upertinu again,( liabilities,judgments, costs and «penis which - CONST.TAX
ay N any way accrue against sal City in consequence of the PERMIT ISSUANCE 10.00
ntj�ypf is pertniL ECH.CONT. LIG NO. MECH.
L ` rtiw2015 TOTAL TOTAL 1
ignaWre of ApplicmtlContractor Uate `
OFFICE COPY