18608 POST THIS,•PARD NEAR FRONT OF BUILDING f t PlE.11NLIMEER
- CJTY OF- CUPERTINO' .-
INSPECTION DIVISION 18808
JOB INSPECTION RECORD
J) /
PERMIT EXPIRATION'
JOBADDRESS_(_C L.�_ ! �U.�" ', 1!� UNIT#' _LOT# "•'ter'
N " ' 1-•� PERMIT EXPIRES IF WORK
GwmER V Pr. pl �d, a CONTRACTOR `—� IS NOT STARTED WITHIN
INSPECTION DAlrE I INSPECTOR -INSPECTION RECORD .180 DAYS of PERMIT ISSU-
ANCE OR 180 DAYS,FROM
FOUNDATION'. - NOTE: '
LIFER - - - - ALL GRADING SAND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
_ CUPERTI -STANDAR S.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .. - CT 11 1389
UNDERGROUND /SLAB- - -
PLUMBING ClLp Of CUp01'ftRO �\ u'• � ''.�1 y �Ai'I
ELECTRICAL ISSUANCE DATE ff
MECHANICAL BLDG ELECT. PLG. - MECR. .
m ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- INFORMATION
WOOD FLOOR - ✓VALUATION S/FT.
PLUMBING - y-��I�j>;/
MECHANICAL ' F/'vU..,• -
ELECTRICAL - �'. {,CI f rtV .l•.
FRAMING - lA
INSULATION _ sTOHIES TYPE CONSTR..
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR.UNTIL ABOVE HAS BEEN SIGNED - '
' • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.Er FLUOR AREA rm Al.Ac+eneE
DIAPHRAGM THE.CONSTRUCTION TAX IS PAID
_ BUILDING USE
ROOF SHEATHING I ' RCs' ND CON PB Om••,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. '❑ ❑ ❑ El ❑.
ASSESSORS PARCEL NO.
ROUGH - SAN* ,
PLUMBING - ELECT.ENERGY
TRACT NO. PARCIELNG
TUBS 8 SHOWER PAN PLUMBING ENERGY -
MECHANICAL - MECH.ENERGY
ACC,DATE ACC.FILE NO
ELECTRICAL , — BUILDING ENERGY
FRAMING ELECT.FINAL TEST TONING , ENG.SITE NO.
INSULATION PLUMBING -
GAS TEST GAS
FIRE SPLINE. (ENERGY T 2
MECHANICAL '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ n❑ . ❑ N❑
FLOOD ZONE A.L.U.C.
EXTERIOR SHEARELECTRICAL RELEASE
y � NO Y
INTERIOR SHEAR . FIRE DEPT. -
❑ NNEISHEETROCK GRADE .. - FEE SUMMARY
EXTERIOR LATH BUILDING -' B
UILDING
INTERIOR LATH • TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC ' - N CHECK
- - GAS '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY MIC FEE 1� {i
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGN ED BY BUILDING INSPECTOR. ROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, CTaic
ONE WORKING DAY BEFORE REQUIRED INSPECTIUJ
ON: PLUMBING
0 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
•. ,APBLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
,BUI LDING PROJECT I DENTI FICATION - PERMIT NUMBER
AooDIN APPLICATION & PERMIT'EESivFI^� R
4 �� BUILDING -ELECTRICAL-PLUMB)k-MECHANICAL 1 8 6 0B'
N R' PLAN CHECK VALIDATION
NAMEn J'�flLt D• � U�G�/T
IF/I ual NMA7U blto E P37 075 QTY. ELECTRIC PERMIT FEE
'
CONTRACTORS rYE M
NAME _ UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00 '
ADDRESS
•- PHO PANELS 10.00 DATE OF APPLICATION `.
ARCHITECT 'PLAN CHECK FEE "P.C,-NO.
OR PANELS (OVER 200 AMP) 20.00
E NGINEE
u
• - c.No. � SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS.. 20.00
APPLICANTS MOTORS - SEE FEE SCH.
'., ADDRESS n
AI /* ��7 GU eo e SERVICE CHANGE 20.00
,- oo• LICENSED CONTRACTORS DECLARATION '
IS U LHi I hereby affirm that I am licensed under provisions of Chapter 9 _ 19nf% ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Rosiness and C 1 BLDG. ELECT. PLG. MECH.
FD i Professions Code,and my license is in full force and effect El El- License Class Lic.Number
z -
o mo m r Dale Contractor
City Of Caperhno BUILDINGPERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION
¢w v INFORMATION
we, ;LL H 1 hereby affirm that I am exempt from lire Contractor's License MISC.- REFER TO ORD yq LUATION $/FT.
Law for the following reason. 703 I.S.Dia,me,,,ed Professions PERMIT ISSUANCE 10.00 -
Code:Any city or county which requires a permit to construct,alter,
¢ ¢ ¢ o improve,demolish,or repair any structure.prior to its issuance,also ELEC.CONTR. LIC.NO. , ELEC.
n w m u requires the npPlican[for such permit[o Nle a signed stulemenl that TOTAL pE MIT TO
he is licensed pursuant to the provisions of Ihu Contractor's License a7d�� P� �-y.
HiQLaw w(Chapter9(Cummeneing with Section 70000nf Division 3 of life ( 1 QF-r0
i D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H p the basis for the alleged exemption.Any siolation of$eetion 7031.$ STORIES TYPE CONSTR. -
d � _ by any applicant for a pemfit subjects the applicant Loa civil penalty ALTER-DRAIN& V ENT-WATER (EA.) 5.00
of pqI more than five hundred dollar,($Soot):
t�I,as owner of tire property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
t mu sole compensation,will do life 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-
memsarenotintendedorofferedforsale.If,however.the building GAS-EA.SYSTEM-I INC-4 OUT L ETS.6.00
Ilkor improvement is sold within one year of completion, thw
e owner- GAS-EASYSTEM-OVER 4(EA.) 200 BUILDING USE
builder will have the burden of proving that he did not build or int . . .
RES IND CON PB Other
Prove for purpose of sealed. INDUSTRIACWASTE INTER. 30.00 0 0 0 0 0
0 1, is owner of the Properly,am exclusively contracting wilh
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:1'he Contractor'%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
License Law.is for such projects with a contractor(s)licensed pursuant to
the CSEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Co
❑ feel exempt under Sec. ,B.&FC.ler this WATER HEATER W/VENT 6.00
reason
Owner Date`/ WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WURKER OMPIiNSA'FIoN DECLARATION WATER TREATING EQUIP. 5.00 "
1 hereby affirm that I have a certificate of consent Lo self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified -
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby tarnished: FIRE SPRINK' ENERGYT24
Z Z ❑ Certified copy is filed with"the city inspection division. MISC.- REFER TO ORD.
0 Applicant Y O N❑- Y [D N[]
CC y CERTIFICATE OF EXEMPTION FROM WORKERS- PERMIT ISSUANCE - 10.00 FLOODZONE A.L.U.C.
LL > COMPENSATION INSURANCE PLG:CONTE, LIC.NO. PLG: - v N V N�
O' O ' (This section need nut he completed if elle permit is for one TOTAL
0 Z hlmdreddoIIJ,s(S100)crlCa.) ' - _
V O 1 artily thut in the pedrunnncc of the work tun which GIl per- QTY. .MECHANICAL PERMIT FEE 'FEE SUMMARY
LL F nlil Is issued,1 shall not employ any Pcaun in any manner so ma to _
U become subject to the Workers'Compensation Laws of Calil'omia.
V a Date ApplicantALTER OR ADD TO MECH., 5.00 BUILDING' g�. Q
} rA NOTIC17"f0 APPLICANT: If,after making this Certificate of fix- -
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK �,�.•�
provisions of the Labor Code, you must forthwith Comply with FEE
V, such provisions or lhis'pennit slmll be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 -
CONSTRUCTIONLENDINCACENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 .SEISMIC FEE �J�
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.). .
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that l have Lead this application and state that the above VENTILATION FAN ISINGLE) 4.00
Information is correct. I agree to comply with 411 city and county - PLUMBING
ordinances and :tate laws relmi g to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
her by amhuriz rep ental iv s of l .ir- city to f t r upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
aboven nlloned property for inspection Purposes
.(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way acen against said City in consequence of the PERMIT ISSUANCE 10.00
ran I go]11 cnull. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL:
gna ure of (cant Contractor e
OFFICECOPY