18440 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO t/18440
INSPECTION DIVISION
JOB INSPECTION RECORD
�( PERMIT EXPIRATION
1 = JOB ADDRESS 1-1 � I���� "•'�`E UNIT# _LOT#
T)
# PERMIT EXPIRES IF WORK
OWNER CONTRACTOR AF-L� SGs IS NOT STARTED WITHIN
INSPE TION DATE INSPECTOR INSPECTION RECORD 1BO DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED ECTION.
LASTCALLED INSP
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERLUT vALIDATION
CUPERTINO STANDARDS. (�
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT I PLG. NIECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
PLUMBING WOOD FLOOR vALUATIO sTFT.
MECHANICAL It
E
ELECTRICAL lbE Ui TO
FRAMING r >� use-�
INSULATION STORIES TYPE CO NST
fIT
-r oQC_ O UCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEDFj--�—
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD.Er.E�ooB AREA ,TOTAL AcaencE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
00 ROOF SHEATHING BUILDING USE-
APPLY
coN PB
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E ❑ a Q
ASSESSORS PARCEL NO
ROUGH. SAN.#
PLUMBING – ELECT.ENERGY -
TRACT N0. PARCEL NO
' TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
• ELECTRICALBUILDING ENERGY, ACC DATE ACC FILE NO
FRAMING Ij ELECT.FINAL TEST
_� - ZONING ENG.SITE NO.
INSULATION PLUMBING -
GAS TEST GAS
FIRE SPRINE ENERGY L2E
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ° ❑ "El
ROOD 20NE AL U L.
EXTERIOR SHEAR I ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT.
SHEETROCK ' GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK •C
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
I
ELECTRIC
ARRANGE FOR INSPECTION BY PHONING 252-4505,
LID � ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ( tic�j
O. PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT! t
PLEASE READ REVERSE SIDE BEFORE TOTAL It
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT
ADE
BUILDING /'� �/
A°DREss//C • 3 ril R£7lyonP 0Q c: 18440
+ - BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'9 PLAN CHECK VALIDATION
NAME //1././/� 'j PTY- ELECTRIC PERMIT FEE
�c� PHONE ��J -�/�
NO M>ERAcaoRs �'7y/017 UTLETS-SWITCHES-RECEP 10.00/1.00
,5QFG1',t1 $ /7LCT LC.No. y0� LIGHTING FIXTURES 10.00/1.00 [d
oNTRACTORsORES1 PPLIANCES-RESIDENTIAL 4.00
/l/.22 SRd7'OG- Q �
aSoE37B6700 PANELS 10.00
DATE-K APPLICATION
OR
PLAN CHECK fEE P.C.NO.
oR PANELS (OVER 200 AMP) 20.00 _
NGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS enc. SPECIALCIRCUIT 5.00 PERMIT VA LI MCAATTI'ION
ZIP EMP.METER OR POLE INS. 20.00 v -4 13 J
ADDRESS - MOTORS SEE FEE SCH. -Jry. `C
ADDRESS N^+J
SERVICE CHANGE 20,00 3j�' • p,
0 ¢ i
F o a
LICENSED CONTRACTORS DECLARATION -
< u U I henehy affirm that I am licensed under provisions of Chapter 9
N z w ISSUANCE DATE
(commencing with Section 7000)of Division 3.f the Business and
r o 2 Professions Code, my license is in full for�k•,and eflecy S�LJOCIG. ELECT. PLG. MECH.
i 0 H License Class Lie..N'umber=j.Q�/_�kd
o w r U HP Contractor IL-1 rJ
ar or w a O 'NCR-BUILDFR DECLARATION BUILDING PERMIT
- o e. " INFORMATION
F
; w I hereby uflino that I am exempt from the Contractor's License MISC.- REFER TO ORD
FLLAOJ Law for the following reason,(Sec,7031.5.BusinesSend Professions PERMIT ISSUANCE �,� 11 VALUATIO& t/FT.
Cade:Any city Ormunny which requiresa Permit n construct,alter, l s ly[•yK„x 4J
e, ¢ p improve,demolish,or repair any structure,prior to its issuance,also $LEC.CONTE. LIC.NO. $LEC, II L��yy �a.�Es.•(t �1 �OILJl-��
O u mluires the applicant for such Pcrntil to lite a signed statement that TOTAL l-l-w PERMIT TO
d w m he is licensed pursuant to the provisions of life Contractors License
Fii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �(T'1+}{. Oea_n�L
i o Business and Professions Cadet.r that he is exempt thcrcGoif'and PTV. PLUMBING PERMIT FEE GPI"t+
w- the basis for the alleged exemption.Any violation.,section 703 LS 1 STORIES TYPE CONSTR.
a by any applicant for a permit subjects the applicant toe civil penally ALTER-DRAIN (EA.) 5.00
of not more than Disc hundred dollars 1$5(101.), _
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 Oce.GROUP REI.UNITS
their sole compenmtion,will du 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 Contractor's License Law docs not apply o to m owner of S
pmpurly who buih h or improves thereon,and who does foci work FIXTURES-PER TRAP 5.00 fJQ sa FT FLUOR AREA TOTAL ACREAGE
ountsl re through his awn employers,pmvidhJ that such improve-
orimprovemenotntis �ld oroffered
on forsxk,I however'
the holding GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
improvement will have
is e b rife ria pr your.f lienplct iot tic owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving That he Aid not build on int- BUILDING USE
prove IND CON PS Ober,
vc for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ElEl El F-1❑ I,as owner u(this pmpurlm y,uexclusively contracting with
licensed contractors to ecostn¢t the project(Sec 7044,Rosiness LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO,
and Professions Codc: I In,Contractor's License Law dos not apply
to an owner.f properly who huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts I'or such projects with a conlractoos)Ii eased pursuant to
the Contract.,',License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. .B.&P,C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
ss'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affi.that I have a certificate.(consent t.set Finsure.
.r a certificate of Workers'Compensation Insurance,or a certified ZONING' ENG.SITE NO.
roPY thereof(Src,3 any 1. y-Q�f dca�p
Policy No, pany�
O ❑ Cctlitic .py iso by fumshcd. RE SPRINK ENERGYT�4
Z Z ❑ Certified c y filed wtoh if I inspcclion division.
� O Applicant (,�...,.ts�-/d• E 1+- MISCI REFER TO ORD, Y � N� Y � N�
X N CERTu'IC/J,\-T6OP I BMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 l'Z OQ FLOOD ZONE A.L.U.0
W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL O fl'his welion need not be completed if the Permit is for one TOTAL L�{.!W Y[] NY [] IN
::) Z hundred dollars(S 100)or loss,)
L) O 1 certlty that in the performance of the work for which this Per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
EE I- mit is issued, I shall not employ any person in any manner so as to
Ow become subject m the Workers'Compensation Laws.(Culil in,.
e- Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>- N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become urbjcct to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with C7 FEE sucnl mi
provisions Or this pert shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
lie pert inn...0 .f the work for which this permit is issued(Sec. MICROFILM
3097,CN.C.). HEATING UNIT IT0 100,000 B.T.U.) 8.00
Lender's Name
Lender's AJJre.vsHEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
�
I certify thin l have read ifik.,plicuti.n and slate that the above VENTILATION FAN (SINGLE) 4.00
ordinances
n estate l I ague n comply with all city and county PLUMBING t `�
ordinances and slam lax, malting to building construction.upon
and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 6.00 {,
above-Hereby entioned representatives of this city es enter upon the BOI LER-COMP Over 100,000 BTU)SEE FEE SCH, MECHANICAL
above-mentioned property for inspeuion Purposes.
(We) agree In save, indemnify and keep hamlcn the City of MISC.- REFER TO ORD.
upertirm against Inabilities,judgments,costs and expenses which PERMIT ISSUANCE 1000 CONST.TAX
Lling
any way ace against raid City in coseqence of the.f this perms MECH.CONT. 'LIC.NO. MECH.
TOTAL awr..r AppBc tartar-ss Dam? TOTAL NJD
OFFICE COPY LT to