18862 POST THIS CARD NEAR FRONT OF BUILDING FFRMIT NUMBER
CITY OF• CUPERTINO 1.8862
INSPECTION DIVISION
JOB INSPECTION RECORD
/� PERMIT EXPIRATION'
JOB'ADDRESS. �.0 6s� UCS.-l�f_�O_ (7- `[EY7 /�T- ' UNIT# LOT#
C PERMIT EXPIRES IF WORK
OWNER .. CONTRACTOR CU IS, NOT STARTED WITHIN
INS TION DATE INSPECTOR ANSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION' ANCE OR 180 DAYS FROM.
NOTE: ' - - LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE.INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF •' PERMIT VAI.TDATTON
CUPERTINO STANDARD
GARAGE SLABS. S. . '� qA', t+l— _ y •.�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - Nov QH ILc7� ' �A.�r.T'f ,YVc<
r PLUMBING -
ELECTRICAL ISSUANCE DATE
MECHANICAL 'BLDG. ELECT.I PLO. wECR.
- DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED1 BUILDING PERMIT.
WOOD FLOOR. VALUATION S/F:r
INFORMATION
PLUMBING
MECHANICAL• 1„ vF A a
ELECTRICAL
FRAMINGfit
i g ,.sroRles rvvc CONS R.
INSULATION
Ob
clwur Res.umrts
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF . NOTE:NO FINAL INSP.SHALL BE MADE BEFORE - SD.IT FLooRAREA TOTALACREAGE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
- aw LDI use
RODE SHEATHING Res IND CDNON PB ow.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - DATE ^ INSP. '0 ❑ - ❑ ❑ 0
ROUGH SAN.H n ESSOR ARr LNO.
' PLUMBING ELECT,ENERGY ' - �Y •, —Y /7
• TUBS B SHOWER PAN , PLUMBING ENERGY rnncT No. PARCEL NO
MECHANICAL , MECH.ENERGY
ELECTRICAL ACC DATE ACC.PILE No
BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONINGENc.srtE No.
INSULATION PLUMBING - -
GAS TEST GAS'
. . MECHANICAL- FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 1'0 NE] ❑ N❑
FLOOD ZONE _AL U C.
EXTERIOR-',SHEAR ELECTRICAL RELEASE
-+
INTERIOR.SHEAR FIRE DEPT. YD N❑ - V ❑ N❑
SHEETROCK GRADE T FEE SUMMARY
EXTERIOR LATH' BUILDING - -
INTERIOR LATH TEMPORARY APPROVALS
BUILDING
SCRATCH COAT ELECTRIC PLAN'CHECK
- GAS FEE
NO TAPE OR-PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ,. SEISMIC FEE
r` OCCUPANCYOF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
_ ARRANGE FOR,INSPECTION BY PHONING 252-4505, ELECTRIC _
LU,� ONE;WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
17Mz MECHANICAL '
— SEE PERMIT FOR EXPIRATION DATE_
! IMPORTANT! coNsr.rnx
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 IDENTIFICATION PERMIT NUMBER -
ILDING - APPLICATION & PERMIT a }n }^( //�
Oo s S ��Ir BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .>, 1 .8862
, - PLAN CHECK VALIDATION
OWNER'S
ONA
WNE QTY. ELECTRIC PERMIT FEE
-� PHONE /
- � CONTE T s y/ ,.ly 3 UTLETS-SWITCHES-RECEP 10.00/1.00 5 -
N EIIIPAr ! C'(�c[Id.NO, �j LIGHTING FIXTURES 10.00/1.00
G
ADDIRE OR'$ S�„^F:V-ct Q PPLIANCES-RESIDENTIAL 4.00 '
NTR
4 y/ NE 9 - PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE .C.NO.
OR - I PANELS (OVER 200 AMP) 20.00 --
ENGINEER
'LIC.NO. SIGNS TRANS. - 3.00
ADDRESS ENG. CIRCUIT 5,00 PERMIT VALIDATION
iiP EMP.METER OR POLE INS. 20.00
APPLICANT '1 2
ADDRESS -a 9
SMOTORS SEE FEE SCH. a
M
SERVICE CHANGE ,, ,,,20.00
o¢ i • rev l�U
r o O LICENSED CONTRACTORS DECLARATION
aU u I hereby affirm Thal I ant licensed under provisions of Chapter 9 NI n�/ n[) 5� ISSUANCE DATE
w i (commencin with Section 7000)of Division 3 of the Business and „._ ,,,
¢ g 1n v . BLDG. ELECT. PLG. MECH.
F rise is in full for,,'rofessiunCode ml lice
z o mLicense C aCLic. m
o a eff
rr r of (xrr..nr°fin r
¢ m s BUILDING PERMIT
¢ o n U. OWNER-BUILDER DECLARATION i - - INFORMATION
wg N 1 hereby affirm that I am exempt from the Contractorfe's License MISC.- REFER TO ORD
wLL og Lw for Om following«uson.(Sec.7031.5,Businessund Prossio as , PERMIT ISSUANCE 10.00 VALUATION
- Code:Any city or county which requites a permit to construct.alter,
G ¢ <0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC. (70 D
- O LL requires the applicant for such permit to file u signed statement that TOTAL�a (C pE MITTO
' w he is licensed pursuant to the provisions of the Conirnctor's Licere. .�
F z i law(Chapter9(commencing with Section 7000)of Division3ofthe
¢ Business and Pro&ssions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
Cr
the basis for the alleged exemption.Any violaliutl of Section 7031.5 f STORIES TYPEICONSTR.
a � by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than Ove hundred dollars(5500).1:
❑ I,as owne,of Hisproperty,or my employees with cadges as BACK F LOW 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 71)44, Business and Profession. - DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: The CO ntmctor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 - SIT FT.FLOOR AREA TOTALACREAGE
himself Or through his own employees,provided that such improve-
mentsarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of cmnpleiion.the owner- GAS EASYSTEM OVER 4 IEA) 200
builder will have the burden of proving that he did out build car im- - . - . .
BUILDING USE
prove for purpose ofsale.). RES IND CAN PB One,
❑ 1,as owner of the property,am excursively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ 0 ❑ 0 ❑
licensed contractors to mrstruel the project(See 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. ' 6.00 ^A ESSORS ARC
and Professions Code:The Contractor's License law does not apply A/l 0,j
to an 9.111,of property who builds car improves thereon.and who LAWN SPRINKLERS=OVER 5(EA.) 1,00
contracts for such projects with a contructots),licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec.-,B&P,C.for this WATER HEATER W/VENT 6.00 -
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of,mmci t to self-insure. ZONING
or a certificate of Workers'Compensation Inscr nce.or a certifc. ENG.SITE NO.
co Py�,y'ry�J,J$ 3500,Lh.C.). E
Poli(ypbfJO(vCompany
0 �� Certi((i'edcopy Isbereby furnishe FIRESPRINK ENERGYT-24
- Z Z Certified copy OI-I with they insy�mon division.
F- O ApplicantC-y��r .FLL..e� " TK1=C-' MISC.- " REFER TO ORD. YE] NE] Y F] NE]
ir M CFR'f0'ICA9'E OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C,
LU 7 COMPENSATION INSURANCE, PLG.CONTE.- LIC.NO. PLO. V El N� Y [:] IN E)
a.Z (This section need not be completed if the permit is for one TOTAL
bundrad dollars($100)of less.)
U O 1 certify that in the perform tanre of the work for which this psi- OTY. :MECHANICAL PERMIT FEE FEE SUMMARY
IL 1- mit is issued, I shall not employ any person in any manner so a to
U become subject to the Worked Compensation Laws of California.
Q d Date-Applicant ALTER OR ADD TO MECH. 5,00 BUILDING
} N NOTICE TO APPLICANT: If,after making furs Certificate of Ex-
.F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN
provisions of the Labor Code, you Inuit forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LI'NDING AGENCY AIR HANDLINGUNIT(OVER 10000C.F.M.) 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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN
Lender's AddIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC q, 1Press
I ecrtity that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 -
information is cornet. I'agree to comply with all city and county - PLUMBING
ordinances and state laws relating to building construction, and BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00
A herchy authorize representatives of this city to voter upon the .BOILER-COMP 10xer 100,000 BTUI SEE FEE BCH. MECHANICAL
abovcmentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmiss the City of MISC.- REFER TO ORD.
uperlinO against habilitie,Judgroms, cost, and ox,Oi,s which CONST.TAX
may in any way accrue against said t n consequence of the PERMIT ISSUANCE 10.00
tannin this permit. MECH.CONT. LIC.N0. MECH.
�� l e. y TorAL TOTAL
S' ure o p 'rant/Co r nor Dale -
OFFICE COPY