17927 (2) s' POST THIS,CARD NEARTRONT'OF BUIL'DING. '
'� •'." a ' PERMITNUMBER
CITY:
OF.,CUFERTINO 17927
INSPECTION DIVISION
// JOBB��INSPECTION
/1REECCORD' {�
JOB`A DDR ESS "'� "`� ' / - UNIT# LOTS# _ Y�PE TEXPIR TION
• _PER"PlIk ES"IF WORK
oWIN Ea �✓, �, CONTRACTOR - IS,NOT. STARTED WITHIN—=
INSPECTION DATE INSPECTOR INSPECTION RECORD - i80 DAYS ORPERMIT,ISSU-
FOUNDATIONr • ' , x - ANCE OR'180'DAYS FROM
NOTE:- LAST CALLED INSPECTION.!
LIFER ' AL-GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE v. TO.COMPLY WITH THE APPROVEDFLANS AND CITY OF - PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLAB
POUR'NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /.SLAB -6-'N
PLUMBING \ .. -. . . .. Y
- ELECTRICAL � ISSUANCE:DATL
MECHANICAL t '\ .BLOC. ELECT. PLG, MECH. o
❑• ❑.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED "j kjll 1Buaowc PERMIT
.�, L INFORMATION
-1 - WOOD FLOOR -
PLUMBING VALUATION $/FT:
' -
,
MECHANICAL ' J ��I•�tD`I�.!
ELECT,R ICAL ' ' -f PERMIT To
FRAMING
INSULATION' STORIF.Sj PECONSTR,
OCC,GROUP RES.UNITS
/y PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED'
' 1 , 1- •`, SO.FT FLOOR AREA TOTAL ACREAGE
ROOF. NOTE'i NO FINAL INSP.SHALL'BE MADE BEFORE
�.
DIAPHRAGM,— THE CONSTRUCTION•TAX IS:PAID -
BUILDING USE '.
ROOF SHEATHING • a'., '.'Res IND CON PB 00",
APPLY NTROOFINGUNTIL ABOVE HAS BEEN'SIGNED ? "FINALS ,`;DATE" INSP. ❑ '. ❑ " ❑ 'C] E]
ASSESSORSPARCEL NO
ROUGH SAN.N"
PLUMBING ': - ELECT.ENERGY
TUBS 8 SHOWER PAN TRACT '
'PLUMBING ENERGY NO. PARCEL NNO.
-
MECHANICAL _ MECK ENERGY
ELECTRICAL ACC.DATE ACC.FILE N0.
BUILDING ENERGY
FRAMING - , ELECT.FINAL TEST -
,ZONING ENG.SITE NO.
INSULATION _ � PLUMBING �. '
• GAS TEST,, • - ..7 GAS -
MECHANICAL ' .FIRE SPRINK .t ENERGY T pa•'
�� ❑ . 11 ❑ N❑
' COVER NO,WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING'
' EXTERIOR SHEAR'
ELECTRICAL RELEASE • FLnoDZONE A.LD.C..
ANTERIOR SHEAR - - FIRE DEPT. Y❑ '"❑ Y L] N❑
SHEETROCK • - - - GRADE FEE SUMMARY
EXTERIOR LATH _ - _ BUILDING T
INTERIOR_LATH - r TEMPORARY APPROVALS BUILDIN'SCRATCHCOATELECTRIC PLAN C.FEENO'fAPE OR PLASTEfl UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMICOCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL-IS SIGNED BY BUI LDINGINSP ECT OR. '-
+ MICROFARRANGE FOR INSPECTION BY PHONING 252-4505; eLECTRH� ONE WORKING DAY BEFORE REQUIRED INSPECTION_ PLUMBIO PLEASE GIVE JOB ADDRESS WHEN PHONING.. MECHASEEYERMITFOR EXP,IRATION'DATEIMPORTANT!.. cousT
PLEASE rREAD REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL / 034b-' .
OFFICE COPY
T
APPLICANT TO FELL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY,41
BUILDING PROJECT IDENTIFICATION-- PER
- � MIT NUMBER
APPLICATION & PERMIT
BUILDING 1, {, J 179,27 7 y�
- ' A BEs,• '
BUILDING:- ELECTRICA L=PLUMBING-MECHANICAL' „�R - :.1 9,27 '
^,PLAN CHECKVALIDATION
VESS
TY. .:.ELECTRIC PERMIT + F,EE y 4
DNE ., w S 1 Pd
y - .e UTLETSrSWITCH ES-RECEP 10.00/100
LIGHTING FIXTURES 10:00/1.00 ( Y;
e N -
s . f�N„„y;d"' -:APPL•IANCES:RESIDENTIAL - 4.00 1 y
PRONE t PANEL$ p O.00 PATE OF APPLICATION gym" ii PLANCHECKfEE PC ND PANELS'(OVER200AMP) 20.00(y f4
No. d SIGNS TRANS. 3.00 ?
>-..a ARCRoR G. SPECIALCIRCUIT _ a % - % PERMIT VALIDATION, .
ADDR SS.. 1
9'kxll
- -
TEMP. METER OR POLE INS. 20.00 '
w
APPLIcART's s'. .t D ' . MOTORS, SEE,FEE SCH..
U .'IAvro.vuCC�..
- 1 ADDRESS.
' ;., SERVICE CHANGE +. ,20.00
o o' ^ LICENSED CONTRACTORS DECLARATION s 1
1
G v MD
U c 1 hereby affirm that Lain licensed tinder provisions of Chapter 9. ISSUANCE GATE
H 3 I., (commencing with Section 7000)of Division 3 of the Bramessand - BLOGh .'ELECT. PI-9.
H o% Prolesslo s Code :Ind.my license s In ft Iilforce a I f ep .i: _
fo OO
o f o,i L¢ense as L Number n e.-"
H Date -C nt[ator Q
Y s - t a 'i'--BUILDING PERMIT:
-¢ w 61 :,.OWNER BUILDER DECLARATION, INFORMATION'_
V
w 3 u 'l hereby atom,that I am exantpl from the Contractor's Licen e MI$D VALUATION $/FT- ,
Hlcoa Law for the follow mg reason.(See 70315,Btsnessand Prnfe ions' PERMIT ISSUANCE , 1000
Code Any city rc count;which requires a permit t 'onstruct,alter ' w t
Q0• improve;demolish or repair any structure,prix to its Issuance also ELEC.CONTE.- LIC.NO. ELEC - - "'�
a u requires the applicn t for such permit to filo a signed statement that .. - TOTAL
6wm he is licensed pursuant tothe provisions of the Contractor's Liense i PERMITTO,
zi Lave(Chsatti-9 comivencing with Section 7000)of Division3ol the _ C ''..^^ ,
a: Business and Pmlessions Code)or that he is exempt therefrom and DTV. ,n .''PLUMBING PERMIT- FEE `�^W�� �gD• 4 �
E. m the basis for the alleged exemption.Any violation of Section 7031.5 -. t STORIES ! V E CONSTR., •`'I
'd ; _ by any applicantfonapermits bj ds the epplicanuoacivil penalty ALTER-DRAIN'&'VENT-WATER (EA.).5.00
of not more then fee hundred dollars($500) lic n -
0 L.as owner of the property,or my employees with wages as BACK FLOW PROTECT:DEV ICE 4.00 x' - OCC.GROUP RE5 UNITS;
their sole compensation,-will do the work:and the structure is not, 1,
intended or offered.fur,.In(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 - - - ''i �1'L n
' property who builds or improves thereon,and who does such work FIXTURES-PER TRAP' /'' 5_.00 y ' S0.FT.FLOOR AREA TOTACACREAGE
himself or through his ow n.employees,provided that such improve
ments are not intended'or of feted for sale.I L however,the budding GAS:EAI SYSTEM=1 INC.40UTLETS 600
or improvementys sold within one year of completion,the owner- GAS-EA.SYSTEM'-OVER 4 (EA.1-- . 2:00 - BUILDING USE
builder will have the burden of proving that he did not build or cm-+ - RE9•.IND COR US PB � Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER.' 30.00
O I,as owner of the property,am oxclusively'coniG ctiog with - '❑ ❑ ❑ , "D : ❑
licensed,contractors to,construct the pioicet'(Sec.7044,Business LAWN SPRINKLERS=:T,INC 5:V.B. 6.00 ' gssEssoRS PARCEL No.
and Professions Code:Tlie Contractor's License Law does not applyi
to an o wner,ofrpropen,who hulld. it improves thercoi and.whi, ", LAWN SPR IN KL'ERS-OV ER 5�(EA.)" 1.00
contracts for such projects with e'contme[o N s)licensed pursuant In - '
the Contractors License Law: I I SEWER-SANITARY-STORMEA.200ft/10.00 . TRACT NO. .. PARCEL NO.
,❑ 'lamexemptunder Sec. ,B.&P.C.for this •
reason WATER HEATER W/VENT-' '" i(' 6:00
e Owner ,WATER SYSTEM ' 5.00 ACC.DATE 'ACC:FILE NO.
-
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sell msum,.
ora certificate of lWorkers;Compelisetion'I nsurance,or a certified- - ZONING ENG SITE NO.
_
copy Chemo (S BOO,LabC -
Ito cY N� y -
-0:CertiRo w �funish�� d. ��-� i FIRE RPRINK -ENERGY T 24 •K
Z2 ❑ Ce tily� yyB iQ t mspe tion division: -
p Applicunl�e •�'l fllfci - MISC REFER.TOORD. y'❑ N� ;, y ❑ ' N❑ '
PT ' - PERMIT ISSUANCE 10.00 ,FL000 ZONE - , 'AL.U,C:
cc CERTIFICATE OL EXEMPTION PROM WOKKFRS'
LU D " ' COMPENSATION INSURANCE - PLG.CONTR. .. LIC.NO. .PLG,
O_ O (This`wction need nob.be-completed if the permit i,rfoi ohu TOTAL a V❑. N❑ � ' Y ❑ N❑
Z hundred,dollars($100)orless) . ^ ' - -
L) O 1 certify that in the perforinan a of the work for wlfch th s per. OTV.'- .MECHANICAL PERMIT FEE, FEE SUMMARY,
LL F mit is issued,I shall not employ any,p D.11 in any,nmmmr so este
U become subject to the Workers Com�cnsation L ws of Califontia.- ie
' �.a Date Applicant -' " ALTER OR ADD TOM ECH., _ 5.00 BUILDING - /4Y, OO
'} m NOTICE TO ALPI'LICANT,. If after makfng'tUv Certificate i t Ex- ^ - - _
- F ? emption,you should become subject to the Workers'Compensation. APPLIANCE 5.00 PLAN'CHECK' _
provisions of the Labor Code, you must forthwith coin Ply:wilh
U such provisions or this permit shall be deemed revoked. ,_ AIR HANDLING UNIT(TO 10,000 C.F.M.) %4.00 FEE
_ CONSTRUCTION LENDING AGENCY, 1 AIR HANDLING UNIT(OVER 10,000C.RM.),6:00 SEISMIC FEE ":' -/. QrJ" '
1 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.)r- - HEATING UNIT�(TO 100,000 B.T.U.) 800 ;
Lender's Name " HEATING UNIT(OVER 100,000 B.T.U.)9.50
L ndera Address _� _ ', '- •- ELECTRIC -
I certify that 1 ha c read the application and state that the above - 'VENTILATION FAN (SINGLE):,," 4.00
information is correct. I agree to comply with all city and county - - PLUMBING
ordinances and state laws Dilating to building construction, and BOILER--COMP(3 H.P.or 100,000 B.T.U)'6.00
hereby 'au[ho[ee representatives of ibis city to cuter upon the _ BOILER-COMP (Over 100,000BTU15EE FEESCH. MECHANICAL
above mentioned property for inspection purposes. ,
-(We) agree to save, indemmfy'and keep.harnihns the City of t MISC.'- _ REFER TO ORD. "
upertino against liabilities,judgments; costs and expenseswhmh CONST.TAX, '
ay,m any way accrue against said City"imeonsequence'of,the "PERMIT ISSUANCE- 10.00,
ttiinn of thhiis oliit. lg .yf, MECH.CONC LIF NO.a• TOMECH T J _
J-� / - - TAL
TOTAL- s'
igralure f Applicant/Contractor -Date l/
irc, ,;y^OFFICE COPY