14343POST THIS CARD NEAR FRONT
CITY OF CUPERTINO
INSPECTION DIVISION:
JOB INSPECTION
JOB ADDRESS f ' a % "'��^'�Lf
`
OWNER �,.p 42Z 'C-o �>•"'+ '�7f� EONTRACTOR
OF BUILD-ING
'
RECORD
�j
"e�.UNIT# _LOT# -
'/ -
�0.,.,G/�C �orL�iZ
' .PERMIT NUMBER
x14343
PERMIT EXPIRATION '
PERMIT EXPIRES, IF WORK.,
IS NOT STARTEDWITHIN
180 DAYS OF PERM1715SU-'
-ANCE OR 180 DAYS FROM `
I
LAST CL LED I P&PECTION. '
I i
INtPECTION DATE INSPECTOR
INSPECTION RECORD-
FOUNDATION -
-
NOTE:
ALL GRADING AND DRAINAGE SHALL•BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
-
U FER
PREGUNITE '.
PERMIT VALID TION
.; '!mAf .'�;;,�' `'
- -y '.`��✓'(}
fSSUANCE DATE -
BLDG, ELECT, . PLG .I MECH.
GARAGE SLABS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
�z,.9, ''•W„Q• [iD, ej .�.,flr<o
UNDERGROUND/SLAB
PLUMBING�}
O • 1 1YOLW!�' .I-3`
r'�?--T8'E�t o(�«(. I
ELECTRICALNu10
MECHANICAL - -
[f_lU S f
5*.-7 I
r�" S jr.F- C i� /
00 NOT POUR:FLOOR UNTIL ABOVE HAS BEEN SIGNED
.BUILDING PERMIT
1Q(IJFORMATION
WOOD FLOOR
VALUATION
S/FT.
PLUMBING
.MECHANICAL
ELECTRICAL" " I " r
L
PERMIT,TU-
FRAMING
INSULATION
-
STORIES
TYPECONSTR.
--
OCC, GHCUP,.
-
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP, SHALL BE MADE BEFORE
THE CONSTRUCTION'TAX IS PAID
..
so, Fr rLoov AREA
TOTAL AcvEAce+
DIAPHRAGM
ROOF SHEATHING -
BUILDING USE
HES IND CON PB 00—
' ❑ ❑ �� ❑
APPLY NO ROOFING UNTIL ABOVE HA&B'EENSIGNED
`,FINALS � � DATES" ' INSP. =I
ROUGH
SAN.p,
nssessovs PARCEL No
,
'
PLUMBING -
ELECT. ENERGY
TUBS 8 SHOWER PAN
PLUMBING ENERGY
TRACT NO,
PARCEL NO
MECHANICAL
MECH.ENERGY
ELECTRICAL''-
BUILDING ENERGY
ACC, DATE
ACC. FILE NO
FRAMING -' -
ELECT. FINAL TEST
INSULATION
PLUMBING
'ZUNING
EN G. SITE NO.
GAS TEST
GAS '
MECHANICAL
FIRE SPRINK.ENERGY
•Y ❑ "'
424
'° NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING'Egg
EXTERIOR SHEAR -
ELECTRICAL RELEASE
FL000 ZONE ,
Y ❑' •N❑
A C.
L. u,
v ❑ N❑�
INTERIOR SHEAR
SHEETROCK•
FIRE DEPT.
GRADE-
FEE SUMMARY
EXTERIOR LATH'
BUILDING'.
BUILDING
4 `-::
INTERIOR-LATH' _,
.TEMPORARY. APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK'
FEE
-
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUI LDI NG ISNOT PERM ITTED UNTI L BU I LDING F INAL IS SI GNED BY BU I LDI NG I NSPECTOR'
MICROFILM.-, ,
ARRANGE FOR INSPECTION,BY PHONING 252-4505,
LU
.:ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION`DATE'—
ELECTRIC'
PLUMBING..
I
MECHANICAL . .
CONST. TAX
IMPORTANT!,-
PLEASE READ•REVERSESIDEBEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY
Am irzNT TO FILL IN INFORMATION WITHIN REDLINES, USE BALL POINT, PEN ONLY
BU}LDI NG'PROJECT I DENT FICATION
APPLICATION &PERMIT ,
BUILDING -ELECTRICAL -"PLUMBING - MECHANICAL
PERMIT NUMBER
A rj /I
. 4 `7 4{
TING
goDRESs!
'/1./, t
/$
(ff
OwN 'S -p
NA D / Q
• PHONE h
QTY. ` ELECTRIC PERMIT' ` FEE
"' PLAN CHECK VALIDATION
�j
/ 3 ;k, `�-'•
crrvr s
OUTLETS=SWITCHES-RECEP 10,00/1.00
/
/I fI uc. rvo. (s' �'.FGH
.DATE OF APPLICATIONRcurtscr
FIXTURES 10.00/1.00r•
TRacrOR
7 g PHONE �( ..0�,:
CES -'RESIDENTIAL 4.00AS
,, 10-00
ENGINEER '/ uc. Nol.'/
AMPI ' 20.00 '�
PLAN CHECK FEE PC. NO.off,..•OVER200
ANS. 300
ARCH.0 rr}}GG /// o
AD ss '��,TER
CIR CUIT 5.00PERMIT
VALIDATION
OR POLE INS.`', .' 20.00
•7
,
COP
APPLICANT S',
ADDRESS,; , _
MOTORS -' ;SEE FEE BCH.
'
SERVICE CHANGE :, 20.00
LICENSED CONTRACTORS DECLARATION
4, '
1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code nd my license s n full for �I. .
License Class Lm Numbc
Date Co tractor
(:
.-. OWNER -BUILDER DECLARATION'
ISSUANCE. DATE
_
BLDG. ELECT. PLG. _ MECH.
_
'� ❑ ❑ ❑-`
�11LDING PERMIT
; t TT '., .
+. R��--
MISC. - - ''. - REFER TO ORD
1 hereby affirm that 1 am exempt from the Contractor's License
Lawforthe' following reason. (Sec. 7031.5, Business and Professions=
Code', Any city or county which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed. statement that
he is licensed pursuant t0 the provisions of the Contmcto(i License
- Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or'that ho is exempt therefrom and
e(�\ NFORMATION
PERMIT ISSUANCE - 10.00
- VALUATION
S
� 0 '
$/FT.
ELEC. CONTR... LIC. N0:
ELEC. •
TOTAL
PERMIT T
'
�ij/��R/.0,� x5ovII
QTY. PLUMBING PERMIT FEE- �
STORIES
TYPE CONSTR.
the basis for.the alleged exemption. Any violation of Section 7031.5,
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (S5000.) " -.
❑' 1, as owner of the properly, or my employees with wages as
their sole compensation,.will do the work, and the, structure Is not
intended or offered for sale (Sec: 7044, Business and'Professions
Code: The Contractor's License Law does not apply.to, an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such an prove.
ments are not intended or offered for sale. If, however, thelauilding
•-
ALTER-DRAIN&'VENT-WATER (EA.) 5.00
BACK FLOW PROTECT. DEVICE 4.00
-
OCG GROUP
-
RES. UNITS
DRAINS-FLOOR„ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00
SO. FT FLOOR AREA
TOTAL ACREAGE,
GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
or improvemen Pis sold within one year of completion, the owner.
builder will have the burden of proving that lie did not build or int -
prove for purpose ofsale.). ,'. ' '. ..
• -0 1, as owner .1 the properly, um exclusively -contracting with
.
-GAS - EASYSTEM -OVER 4 (EA.) 2.00
' -
,'BUILDING USE
RES IND ,CON. PB 1 Omer,
E]'❑ -, ❑ ❑ ❑
INDUSTRIAL WASTE INTER. '30,00
licensed, contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Lew does not apply
to an owner of pperty who builds or improves thereon, and who
ro
LAWN SPRINKLERS - 1 INC 5 V.B. - 6.06 ,
-
LAWN.SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
contracts for such projects with a contractor(s) licensed pursuant to
the Contractor's License Law.
❑ I am exempt mhdceSee; ,B.&P.C. for this
reason
SEWER -SANITARY -STORM EA.;200ft/10.00
TRACT NO.
m
PARCEL N0:
'
- _
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'
Ihereby'affmmthat 'Ihave acrtificuteofwnsenttoself-insure,
ora certificate of Workers',Com atiou I u ria, or, a COtitied
copy thereof (See 3800; Lab C)Q%P�y�
_
ZONING"
Y
ENO SITE NO.
, ,
Policy No Company
❑ ea itified copy is he by furnish d-
Rf Certified 'c `is filed wi he ,cit 'nspec division,
Applicant � -
(, (�/
'CERTI FICATE OF' EXEMPTION I' R WO KGR'
-
FIRE SPRINK
YQ' NO
^' ENERGY T 24
Y'❑ ,NQ'
MISC.- REFER TO ORD. -
PERMIT ISSUANCE - 10.00 .
FLOOD ZONE
a. L'. u.C.
- ' COMPENSATION INSURANCE .,'
l'Fhia section need not be -completed if the permit is for one
PLG.CONTR._ LIC. NO.
_
PLG.
TOTAL
'
Y ❑; N[_
Y ❑ N ❑,
hundred dollars IS 100) or lesa)
-' I certify that in the performance of the work for which this per-
miC Is Issued; I shall not employ any person, in any manner so as to
QTY. MECHANICAL PERMIT FEE
,
FEE SUMMARY
BUILDING
become subject to the Workers' Compensation Laws of Califon ia.
Date Applicant
- -
'' ALTER OR ADD TO MECH: 5.00
NOTICE TO APPLICANT: If, after, making. this Certificate of E.-
-
App LIANCE - -5.00
PLAN CH ECK
emptiom,:you should become'subject m the Workers' Compensation,
provisions of'thc,Labor Code, you must forthwith comply with
such.provisions or this permit shall be deemed revoked.
FEE
AIR HANDLING UNIT (TO 10=C.F.M.) , 4.00
AIR HANDLING UNIT (OVER.10=C.F,M.) 6.00,
SEISMIC FEE
/
J7 /' ¢I�
U
CONSTRUCTION LENDING AGENCY.' ,
I hereby affirm that there is a constnmtion,lending agency for
EXHAUST HOOD (WITH DUCT) ` 5.00
the performance of the work I'or which this permit is Issued (Sec.
3097,Civ,C.) "' • '.
Lender's Name'-'-
MICROFILM
-
-
HEATING UNIT (TO 100,000 B.T.U.) 8.00
_ HEATI NO UN IT ER 100,000 B.T.U.) 9.50
ELECTRIC,
' -
Lender's Address -
Icertify that l have read this application and state that the above
VENTI_LATION.FAN(SINGLE) 4.00_
information is correct. I agree to comply with all city and county
ordinances and state laws Eelating to.budding construction, and
PLUMBING
BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE 6CH,
MECHANICAL
hereby, authorize rcprescnurtives of this city to enter upon the
above-mentioned property J'or inspection purposes.
MISC. -� REFER TO ORD.
.',(We) agree o, save, indemr' y and kcep'harmless the City of,
upertino g at liabilitie inerts, costs, and expenses'whicB
' may in' y a -me • n t said Clty-In consequence of the
CONST. TAX-
PERMIT ISSUANCE 10.00 '
Iantin
/ ' `
MECH. CONT. - LIC. NO, MECH.
TOTAL ' 1
5 'I
-e- -'
'1 OTAL
- q G
J�„[ 9 Y
Vv
i rata a ofA
g Pic nt/Cont otor Date
. OFFICE COPY
.11"r