17087POST THISD NEAR FRONT OF BUILDING
CITfOF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
Q �� NL/ I
JOBADORESSSS l�` J� NL( L( � DA- UNITtk LOT tJ
OWNER L-JIT CONTRAc*0;T_t%3A K� '�.
PFIINIIT NUMNER-V 1.
�!
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK.;
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU,
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
LIFER
PR EGUNITE
PLHMIT VAI.mATION
ISSUANCE UAIL
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
IILUG
LLt CI.
El
PLG. MLCH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION
j/(/��('� Off_
1� 03
SIFT.
PLUMBING
MECHANICAL
ELECTRICAL
PEHA111 TO
! rr\a e_
FRAMING
INSULATION
SIOHIES
TYI'E CONSLH.
uce. GHOUP
Hes. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
s°.I T.I Loult AncA
roTAL nc HLncL
DIAPHRAGM
ROOF SHEATHING
IIUILU USL
HE INcONury Po om., .
D
El ❑ ❑_
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SANM
ASSLSSOH PAHCELNU.
PLUMBING 'S-
ELECT. ENERGY
TUBS R SHOWER PAN
PLUMBING ENERGY
Illnf-1 NO
Ln11CLL NO
MECHANICAL _Z
MECH.ENERGY
ELECTRICAL � 3_
BUILDING ENERGY
ACC DATE
ACC PILE NO.
FRAMING
ELECT. FINAL TEST
INSULATION �2
PLUMBING —
ZONING
ENG, SITE NO.
GAS TEST
GAS
MECHANICAL —/ (
TIRE Sr1uNA
ElN�
ENERGY i-24
v � N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING _/'}–
EXTERIOR SHEAR
ELECTRICAL RELEASE
LL000ZONE
A.L UC.
INTERIOR SHEAR
FIRE DEPT. i
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING 3 / I t`
BUILDING
z
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
--')^7
L
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
1 ,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR.
;
t
�
`I
MICROFILM
-
ARRANGE FOR INSPECTION BY PHONING 252-4505,
0 ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
—SEE PERMIT FOR EXPIRATION DATE —
Fk
°s
IR�
ELECTRIC
PLUMBING
tf2?
MECHANICAL
CONST. TAX
IMPORTANT! A'
PLEASE READ REVERSE SIDE BEFORE .;� S�d`t.
CALLING FOR FINAL INSPECTION.
TOTAL
cJ�l li
APPLICANTS POSTING COPY
O¢z
FOo
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a 'w
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ayH�
IS
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r og
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at ¢
LIS 40
C O
u ca
H I a
s ¢ O
re
a 3 m
A u
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`APPLICANT TO FILL IN INFVIATION WITHIN RED LINES - USE LL POINT PEN ONLY
OFFICE COPY
PERMIT NUMBER
AUI LDI NG PROJECT I DENTI FIC ON
APPLICATION & PERMIT
BUILDING- ELECTRICAL- PLUMBING - MECHANICAL
- �• 1 1] o o
I I o
BUILDING
ADDRESS Y i-
T -
OWnE 'a
NAME
L ' � PXDNE, �
•
TY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
'
DATE OF APPLICATION
CONTRACTOR'S
NAME
aRRUR�.No. �7�
UTLETS-SWITCHES-RECEP 10.00/1.00 Qp
LIGHTING FIXTURES 10.00/1.00
ADNTRAcroR's
ADORES
E -
PPLIANCES- RESIDENTIAL 4.00 10 ,00
PANELS 10.00
ANCHITECi \{VL
OR
ENGINEER
uc. No
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ENG.PERMIT
ADDRESS
SPECIALCIRCUIT 5.00
VALIDATION
EMP. METER OR POLE INS. 20.00
ZIP
l 3-GYJ�
APPLICANTS
ADDRESS
SLtW
MOTORS SEE FEE SCH.
SERVICECHANGE 20.00
LICENSED CONTRACTORS DECLARATION
I hereby al firm that I am licensed under provisions of,Chapter 9
ISSUANCE DATE
(commencing with Section 7000) of Division 9 of the Business and
ProfeLicense Gla Co tt my license is in full fore fi
License Class lI Lic Number_
BLDG.
ELECT,
PLG. MECH.
Date I. QContracmr'�'�.
'
BUILDING PERMIT
CC!!
OWNER -BUILDER DECLARATION
I hereby elfvm that 'I,am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5, Busin x and Professions
Code. Any city or county which requires a Permit to mnstmcl, alter.
improve, demolish, or repair any structure, prior no its issuance, also
requires the applicant for .ouch pemmil to file a signed natcmcnt that
he u lin used pursuant to the provisions of the Comms tar's License
Law (Ch apter9rmant(,ohnnumeirgthe withSent sionsion the COfDivision License
Business and Profcssiom Code) or that he is exempt therefrom and
INFORMATION
MISC. - REFER TO ORD
VALUATION
I� �Y ,, ,,00
O(X J
1
S/FT.
PERMIT ISSUANCE 10.00 L�
ELEC. CONTR. LIC. NO.
ELEC. pT
TOTAL��IL]O
PERMIT TO
I, ` -
N
QTY. PLUMBING PERMIT FEE
STORIES I
TYPE CONSTR.
the basis for the alleged exemption. Any violation of5eaion 7031.5
by tiny applicant for a permit subjects the applicant tuacivil penalty
of not more than five hundred dollars (5500).):
ALTER -DRAIN -WATER IEA.) 5.00
❑ h as owner of the property, of my employees with wages as
their sole compensation. will do the work, and the structure is not
BACK F LOW PROTECT. DEVICE ' 4.00
OCG. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA, COND. 5.00
intended or offered for sale (Sec. 7044. Business and Professions
Code, The Contractors 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
sa RT. PLCDR AREA
TOTAL ACREAGE
himself or through his own employces, provided thus such improve-
mints are not intended or offered for sale. If. however, the building
'
GAS- EA. SYSTEM- I INC. 4 OUTLETS 6.00
of improvement is sold within one year of completion, the owner -EA.
builder will have the burden of proving that he did not build or ice-
Five for purpose of the.).
1, as owner of lou property, contracting with
SYSTEM -OVER 4 IEA.1 2.00
-
BUILDING USE
RE IND CON PB Omer
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS- 1 INC 5 V.8. 6.00
LAWN SPRINKLERS -OVER 5 IEA.) 1.00
ASSESSORS PARCEL NO.
he project
andto contractors m construct the project La 7044, of Rp,a
and Professions Calc: The Con builds c License Low does not apply
to owner of property who builds or improvesrasedthereon. and who
tr
contracts for such projects with a contmnod sl licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 2006/10.00
TRACT NO.
PARCEL NO.
❑ l am exempt under Ser.-, B,&P,C. for this
rea,m
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO,
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate ofcnmem to self-instue,
or a certificate of Workeri Corimmsrtion Insurance, or a certil icd
ZONING
ENG. SITE NO.
copy thereof(See. 3800, LabCy.�
Policy No. Colnponyla NG._T�4.3F-[��
❑ C•tilied copy is hereby furnished
C niOed cam '. fie. jb1�kLiity ins •t'4k�1�`ii
Appliian _ Y ?47- `R�E�A-
FIRE SPRINK
V N
ENERGYT24
Y N
MISC.- REFER TO ORD.
CERT WICA'1'1: 01' EXEMPT ION FROM WORKERS'
M
PERMIT ISSUANCE 10.00 LIAJ
FLOODZONE
A.L.U.G.
PLG.CONTR. 1' L�I�[yy
K1 �+!
PLG
TOTAL 1(J.J
CO\IPENSATION INSURANCE
('Phis section need not be emnpleted if the permit is fur one
V O N❑
Y ❑ 'N❑
-
QTY MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars (5100) or kss.)
I certify than in the pcDormance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
BUILDING
//''
Lgr2 L0
become subject to the Workers' Cumpcnsst ion laws of California.
naw Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICAN 1': If, after making this Certificate of Cx-
APPLIANCES, 5.00
PLAN CHECK
FEE
��s O
emption, you should bcconie subject to the Workers' Compensation
provisions of the Labor Cale, you must forthwith comply with
such ponvisims or this permit shall be deemed revoked.'
AIR HANDLING UNIT (TO 10=C.F.NL) 4.00
AIR HANDLINGUNIT(OVER 10MOC.F.M,16.00
SEISMIC FEE
t
CONSTRUCTION LENDING ACENCY
I hereby u0irm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00 O0
the performance of the work for which this Firmin is issued (Sec.
30'17, Civ C.). s
MICROFILM
` HEATING UNIT'(TO 100,000 B.T.U.) 8.00
HEATING UN IT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
so
Lender's Name
Lender's Address
I certify that l have read this application and stale that the above
int memalion is correct. I agree to comply with all city and county
ordinancesand state laws relaxing to building construction, and
VENTILATION FAN (SINGLE) 4.00 '
PLUMBING
lW
-
BOILER -CObP(3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP IOPu, 100,000BTUISEE FEESCH.
MECHANICAL
I too
` lWov�-
hereby an hurice representatives of this city to enter upon the
aboeu-mentioned property lot inspection purposes.
misc.- REFER TO ORD.
_ --(We) agree to save, indemnify and keep hardess the City of
uperUno against liabilities, judgments, costs and expenses whichxw..l
may in any way accrue against aid City in conscquuma, of the
CONST. TAX
E
PERMIT ISSUANCE 10.00 CID
ranting of this p til.
-11�F I-13- 9
Signdturc of Applic r /Contractor Datc
MECH. CONT. LIC. NO.
=►1T�K�r 39Sµ7
MECH.
TDT1 �O
TOTAL
�7
Cf / 1
OFFICE COPY