17957 .+r POST THIS CARD NEAR FRONT OF BUILDING PENN„TNHM9ER
CITY OF CUPERTINO 17957
INSPECTION DIVISION
JOB INSPECTION RECORD
-�n1 /, PERMIT EXPIRATION
JOB ADDRESS /y/`' V / UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
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 PLHN+n VALIDATION
CUPERTINO STANDARDS. _
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL, pitV of CI nPl11110 ISSUANCE Un I F.
SLUG ELECT PLG. b1ECR.
MECHANICAL ❑ 1:1121/ El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOORvnLun nory SIFT.
PLUMBING N
F,
MECHANICAL
PEHMIT TO
ELECTRICAL
FRAMING O
STORIES ES TYPE CONSTH
INSULATION '
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SU FT (LOOM ANE.A TOTAL ACH(.nGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
R W LDI ON USL
Hes IND
ROOF SHEATHING - El 11 0 PH O LL 1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
nS5E550R5 PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS y'
• FIRE SPH INK ENERGY T.]<
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ! ° ❑. N'❑ 1:1 N�
EXTERIOR SHEAR - ELECTRICAL RELEASE
FLOOD ZONE A.Luc
INTERIOR SHEAR FIRE DEPT. `'❑ NE) NL N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
F
- GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' I' SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT I61
7957
BUILDING-ELECTRICAL-PLUMBING -MECHANICAL 1,
OWNER'S PLAN CHECK VALIDATION
NAME TY. ELECTRIC PERMIT FEE
P0PHON
co FACTOR s UTLETS-SWITCHES-RECEP 10.00/1.00
NA z4o
LIC.N LIGHTING FIXTURES 10.00/1.00
CONTRACTORS ! APPLIANCES-RESIDENTIAL 4.00
ADDRESS
7T PHONE D PANELS 10.00 DATE OF APPLICATION
ORCHITET PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
- cl, EMP. METER OR POLE INS. 20.00
ADDRESS {/^�1
AMOTORS SEE FEE SCH.
DRESS E55
SERVICE CHANGE 20.00
w o o LICENSED CON'T'RACTORS DF.CLARA'fION C
Q v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N Q w( commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
o P'.fesslona Clicense is in full for n t.
Nu ❑
z 41 a
o w License Clout 'X/J Lic. mbei��� 0 11 ❑
9 z r Dale Coractor CDPEp[1N
a Y� 3 nt1SY 04 DEPS' BUILDING PERMIT
OWNI:R-BUILDER DECLARATION INFORMATION
Ce
o a O MISC.-r REFER TO ORD
w 3 u m I hcrehy affirm That 1 am exempt from lbe Contractor's License VALUATION S/FT.
FU04 Law for Dte following reason.(Sec.70JL5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requiresa permit to construct,alter,
tt Q 0 re Improve,demoi h,nr¢pair any st octon,,prior to its issuance,ala. ELEC.CONTR. LIG N0. ELEC.
C u requires the applicant for such pemtit to file a signed statement that TOTAL PERMIT TO
u w m he is licensed pursuant to the provisions of the Contractor's License
r z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Fb IKk
NC
- a Business and Professions Code)or that he is exempt therefrom unA CITY. PLUMBING PERMIT FEE , Nl
M F o the basis]or the alleged exemption.Any violation of Secliun 7031.5 STORIES TYPE CONSTR.
cL by any applicant lot a permit subjects the applicant boa civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars{$500).):
"❑ 1,as owner of the property.or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Oce GROUP RES.UNITS
their sole compenmtion,will do 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 does not apply to 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-
mentsare not intendedoroffered lot sale,If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND eOry PB Omn
❑ I,as owner of the property,am exclusively contracting with El
El 13 11IiccnscJ contranors to construct the project ISec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 Ass ESSORS PARCEL NO.
and 1'rofcssions Code:The Contractor's License law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a c.ntractons)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft110.00 TRACT No. PARCEL NO.
❑ l mn exempt under Sec.-.B&P.C.for this WATER HEATER W/VENT rr�0
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSA1'ION D[CLARA'f ION WATER TREATING EQUIP. '5.00
1 hereby affirm that I have a certificate ofconsent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurane• a certified
�,pyB • p fi, '. . s yyllIC.).qq
[)Oil Ginnany
O ❑ Certifmdc.py is here yfurnished. FIRE SPRINK ENERGY T.24
_Z Z ertifi cop h h• c' MISC.- REFER TO ORD. y ❑ IN C] y ❑ N❑
p A li ;ud n
Fw11§CATI501
([ IiXF h1 P1'10 KI?RS' PERMIT ISSUANCE 10.00 N FLOOD ZONE A.L.U.G.
, R
Lid COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLO.
d ❑ ('flus sectilin need nut be completed if the permit is for one TOTAL /1 Y❑ NNE] Y ❑ No
Z hundred dollar,($100)or Icss.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
IL I- mit is issued,I shall not employ any person in any manner so as to
0U become subject to the Workers''Compenset ion Laws of Carfornw. BUILDING
Date ApplicantALTER OR ADD TO MECH. 5.00
} rail NOTICE TO APPLICANT': 11,after making This Certificate of lA
F ? emption,you should th"muesubjcet to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AG17NCy AIR HANDLING UNIT(OVER 10=C.F.M.16.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the pertormance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). IHEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
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 to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upetlino against liabilities,judgments, costs and expenses which CONST.TAX
in any way accrue against said City in consequence f the PERMIT ISSUANCE 10.00
ling Of this pe nit. MECH. LIC.NO. MECH. `
TOTAL TOTAL
b re Applicant/Contramor Date
OFFICE COPY ..