18746r
POST THIS CARD NEAR FRONT.OF BUILDING
PERMIT NUMBER
?' CITY OF CUPERTINO18746
JOB INSPECTION DIVISION
JOB INSPECTION RECORD .
_ L 1 PERMIT EXPIRATION
JOB ADDRESS ao-�7_tZ v�.ea?� LlQ UNIT#k __LOT###
PERMIT EXPIRES IF WORK IT
OWNER '1. 1�dcr�e CONTRACTOR OT-5eV1 S �/ IS NOT STARTED WITHIN
INSPECTI N DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
'FOUNDATION NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE' TO COMPLY WITH THE APPROVED PLANS AND CITY OF -PERMIT VALIDATION
CUPERTINO STANDARDS. _ j- - , /
- GARAGE SLABS � / (i ` I - /
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -AI®
UNDERGROUND /SLAB -
PLUMBING
NDERGROUND /SLAB •PLUMBING
ELECTRICAL
'A ISSUANCE DATE
MECHANICAL city at cupitc!) IDG ELECT I PEG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING
VALUATIONr SIFT.
' � !` a
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING �1 'I-�<-• '�
INSULATION STORIES . TYPE CONSTR.
OCC GROUv RES UNITS
-PLACE NO SUBF.LOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF111.11.FLOOR AREA TOTALnLFEAGE
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
F DIAPHRAGM THE CONSTRUCTION TAX IS PAID
` ROOF SHEATHING' eua USE
RES IND CCON ON PO Olnw
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGHSAN.N .. ASSESSORS FARCE L NO.
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN ' ' PLUMBING ENERGY rRncT No PARCEL No.
MECHANICAL MECH.ENERGY -
ELECTRICAL _ BUILDING ENERGY ACC.DATE ACC.FILE No
FRAMING ELECT.FINAL TEST
INSULATION - PLUMBING. I ZONING ENG.SITE NO.
GAS TEST GAS "
MECHANICAL FIRE SPRINK ENERGY L?O
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ -❑ ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L U.C.
INTERIOR SHEAR FIRE DEPT. Y❑ -E] YL N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDINGSCRATCH COAT ELECTRIC PLAN CHECK ��f'p'V
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC'FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. '
> MICROFILM
_ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z 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
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
RIJI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS Q
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL (V7
OWNER'S PLAN CHECK VALIDATION
NAME l/ le OTV. ELECTRIC PERMIT FEE
T D PHONE
NAIVE TRACTORS
NAME . r7 -SWITCHES-RECEP 10.00/1.000 TSS Si 6 JOCTIC LIGHTING
FIXTURES 10.00/1.00
ADDRESS TORS APPLIANCES-RESIDENTIAL 4.00
PHONE _PANELS 10.00 DATE OF APPLICATION '
ARCHITECT - - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00 -
APPLICANT'S
OREss' MOTORS SEE FEE SCH.
AO /'1�, aN✓��`
�Zt,, SERVICE CHANGE 20.00
o¢ z
Foo LICENSED CONTRACTORS DECLARA'f N
Ea I he¢b affirm that I am licensed under
¢ y' provisions of Chapter9
H 2 w ISSUANCE DATE
¢ a (oommimn,Ccing with dtryl ]00eIof fird for Softhe Business unJ BL G. ELECT.- PLG. MECH.
H m i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
zm License Class Lic.Number
„ Date CmRmcl., City of CupertiP.o
¢ ce a OWNER-BUILDER DECLARATION BUILDING PERMIT
w- o a" - INFORMATION
I hereby affirm that I am exempt from 0m Contractor's License MISC.- REFER TO ORD
u 0 4 Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
. - PERMIT ISSUANCE 10.00
Cope:Any city or county which requires a permit reconstruct, also
p �
� � ¢ � improve,demolish,nr repair any sln¢Iare,prior to its issuance,Blso ELEC.CONTR, LIC,NO.
O
O u requires the applicant for such Tomtit ID file a signed actor s Li that TOTAL PERMIT TO
1-$m he is(Chapter
pursuant to the provisions of the Contractor's License
G5 Laww(Chand Professions
Cde)ng or Section is 00)exempt therefrom the
9/ It 4 o Business for lie alleged xempt or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE J ez("thLl I
It 1- the basis for the alleged ears subjects
Any violation otoocl ion 703 LS
a 3 by any applicant fora permit subjects tlm applicant top civil penalty STORIES TYPE CONSTR.
- of not more than five hundred dollars lS500).1' ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00
their sole compensation,will do lire work,and lite slnw(Une is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law docs not apply 1D an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedoroffered for sale.If.however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
{� or improvement is Sold within one year of completion,the owner-
1� builder will have the burden of proving that he did not build or I'll- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove 1,aso neeose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON , PR Omer
❑ L m owner of the properly,am exclusively. 7044,tBu with ❑ ❑ ❑ E3 ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law Aoes not apply
to as owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts I'or such projects with a coneactor(s)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00TRACT NO. PARCEL NO.
❑ lam exempt under Sec...B&p,C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure,
or a��cIeejr.tiifpficate of Workers'Compensation Insurance,or a certified - ZONING ENG.SITE N0.
oolli()1A/r�l� .imlta9nY1. ti�3f�-tv mvr
Q �e IYCer]i11eJ copy is hereby fumishtJ. -
z Z ferlili• 'op Be w I the cit in tion Division. FIRE SPRINK ENERGY T-24
� O Ap icam �j..14/'-G�_f_-4_N CfU MISC.- REFERTO ORD. rLANHE
� Y0 N�
T CE R'I'IFICATE OF E1XEMPMON FROM WORKERS' PERMIT ISSUANCE 10.00 E A.L.U.C.
W > COMPHNSA1'ION INSURANCE PLG CONTR. LIC.NO. PLG.
CL C1 (This section need not be completed if the pennil is for one TOTAL El y❑ NEl
� Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE
H mit is issued,I shall not employ n SUMMARY
LL V p Y a Y Person in any manner so as to
become subject to the Workers'Compensation Laws of California.
i Uetc APPlicant `
} rn NOl'ICIi TO APPLICANT: If,alter making this Cunifica0.•of Ex- ALTER OR ADD TO MECH. 5.00 /+ 0�emption,you should become subject to the WorkersCompensation APPLIANCE 5.0 CKprovisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.0 CONSTRUCTION uiNUfNG AGfNcy AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 EE1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUC 1 5.0the Pcrlannane, of the work for which this permit is issued(Sec.3097.Cie.C.). HEATING UNIT(TO 10 00 00 MLender's NameLender'shddress HEA TING UN IT(OVE 100, B.T.U.)9.
I certify that I have read this application and slate that the above VENTILATION FAN (SING LEI 4.00
information n correct I agree to comply with all oily and county PLUMBING
hereby to and state laws -tilting to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby entionide tem-col-tiles for ins of this city to enter upon the BOI LER-COMP(Over 10,000 BTU)SEE FEE SCH
above-mentioned property for inspection purposes. MECHANICAL
(We) agree to save, indemnify mad keep Iwrndess the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which LCONST.TAX
may in any way accrue ata sI said City in consequence of the PERMIT ISSUANCE 10.00
t i pe-miL ` MECH.CONT. LIC-NO. MECH.
/ D 6 OTAL OTAL
5 a[ure of Applicant/ nv r Date - /
OFFICE COPY
m _