17583 FF
NT'TO FILL IN INFORMATION WITHIN RED LINES'- USE BALL POINT PEN ONLY
ING PROJECT IDENTIFICATION - PERMIT NUMBER
Aar 17583
APPLICATION & PERMIT -
-
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OwNER'B
y! ,f PLAN CHECK VALIDATION
NAME
4' QTY. ELECTRIC PERMIT FEE
I � � HOrvE
NArvieflA0 OP5 UTLETS-SWITCHES-RECEP 10.00/1.00
SGA/ ropc.No. /$/ LIGHTING FIXTURES 10.00/1.00 -
Aoo/a'EssroRs APPLIANCES-RESIDENTIAL 4.00
H� T
�C.PHIDNE2 37 PANELS 10.00 DATE OF APPLICATION -
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 -
ENGINEER
LC.NO. SIGNS TRANS. 3.00
ADDRESS ErvG. _ SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 C'
APPLICANT
D RESSTE MOTORS - SEE FEE SCH.
SERVICE CHANGE 20.00
FOO LICENSED CONTRACTORS DECLARATION - j ( \ ' I `�cc/,I
Qin v 1 hereby infirm that 1 all,licensed under provisions of Chapter 9 -
o,G i (commencing with Section 7000)of Division 3 of the Business and APR ` U ISSUANCE GATE
BLDG. ELECL PLG. MECH.
F y i Professions Coad a license is C full for y4Lrffed. ❑ ❑ ❑ ❑
z o u,- License less Lic.Numbe 7 /
w _Contmcto f .{'y. ' city ,5F f4Fnee4"a
Q y f V V V, WI!wfuNe
ce a, w¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
o A "
w ; m 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
a_o¢ Low for the following reason.(Sec 7031.5,Business unJ Professions VALUATION SIFT.
- PERMIT ISSUANCE -10.00
Code:Any city or county which requirese permit Inconstruct,,also ��OOO-O
¢ ¢ improve,demolish,or repair any shucture,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
¢ requires the applicant for such permit In file a signed statement that TOTAL - PERMIT TO
a w m,� he is licensed pursuant to the provisions of the Contractor's License
r z a Law(ChaPter 9lrolnmmming with Section 7000)of Division 3 of the L9 L4
4 se Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ I o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; m by any applicant for a permit subjects the applicant macivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500)):
❑ I,as owner of the property,or any employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will do the work,and the structure is not . .
OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
:
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 17583
.- INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS-;LD UNIT# - _LOT# '
' q� PERMIT EXPIRES IF WORK
OWNER 'V CONTRACTOR ca. co azT r� �J IS NOT STARTED WITHIN
INSPECTION DATE - INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM.
NOTE: LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE. TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS. "
GARAGE SLABS C
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED \ •�'
UNDERGROUND /SLAB
PLUMBING OJ �D L� Fi"N �L � � �'Lr
ELECTRICAL ISSUANCE DATE
MECHANICAL aloe. ELEC*. PLc. MecR
❑ ❑ ❑ ❑
OO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING' VALUATION
MECHANICAL ~—
ELECTRICAL - PERMIT TD
I
FRAMING - - 'll
INSULATION STORIES TYPE CONSTR
OCC.GROUP. RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
I ROOF NOTENO FINAL INSP.SHALL BE MADE BEFORE SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID-
ROOF SHEATHING - BUILDING USE
HITS IND CON PB 0,1n
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.N
ASSESSORS PARCEL NO.
�
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN .PLUMBING ENERGY- "'ACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION - PLUMBING , z°N'NG ENc.sIrE No.
GAS TEST GAS -
MECHANICAL - FIRE STRINK EN E RGYT.pc
COVER NO WORK UNTIL ABOVE HAS-BEEN SIGNED HEATING Y ❑ N'❑ ° ❑ . IN
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODIONE n,L D-C,
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR.LATH BUILDING
INTERIOR LATH TEMP RARY APPROVAL 71?-'
SCRATCH COAT ELECTRIC -
PLAN CHECK
GAS FEE F
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
w ^---
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I— ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
�� PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE - ' MECHANICAL
' ' . IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
' OFFICE COPY
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