18770 POST THIS CARD NEAR FRONT•OF.BUILDING
` - PERMIT NUMBER
= ' CITY OF . CUPERTINO 18770
INSPECTION DIVISION
JOB INSPECTION RECORD-
p - - PERMIT EXPIRATION
JO B A D DR ESS_ C ' C�-1Cf �Ld. Br~ UNIT# LOT#
PERMIT. EXPIRES IF•WORK
OWNER I )ccA S •' - CONTRACTOR . IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR - INSPECTION RECORD. - 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
No
TE: r LAST CALLED INSPECTION.
UFER• ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE. TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAIJDATION'•
CUPERTINO STANDARDS. p�
.' GARAGE SLABS -- .. . : PAI®
POURAO CONCRETE UNTIL ABOVE HAS BEEN SIGNED—
UNDERGROUND /SLAB
IGNED
-? -G UNDERGROUND /SLAB - �- . . .� 2, �gS9 ;J y� "14 0
PLUMBING
. . .-.4'/
ELECTRICAL s " " 'citw Df. ' i- . ISSUANCE DATE
MECHANICAL - BLLUU-E. ELECT. :PLG. MECR.
DO NOTPOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED -' • • BUILDING PERMIT
WOOD FLOOR - - INFORMATION '
PLUMBING -� - V9LUATION ., S/FT.
-
MECHANICAL
ELECTRICAL
PERMIT TO
- � � .. � � �----
FRAMING .
;INSULATION - STORIES , TYPE CONSTR.
- • . .t ,
p .. UCG GROUP RES.UNI T5
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ' • • ,;� `
• ' SO.FT.fLOOR AREA TOTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID' -
BUILDING USE
ROOF SHEATHING - - nes IND coN, Pe -om"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS . -DATE INSP. - ❑ [- El -❑ '',.❑
ASSESSORSPAHCELNq,
.. ,. . - ROUGH. � - . : �. SAN.H �: � - ' . -' ; .,�... •.. .
PLUMBING ' ELECT.ENERGY '
TRACT N0. PARCEL NO.
TUBS&SHOWER PAN ;` .. PLUMBING ENERGY
MECHANICAL MECR.ENERGY - -
.ELECTRICAL - _ ACC,DATE ACC FILE NO.
BUILDING ENERGY -
FRAMING: '. ELECT:FINAL TEST_
ZONING •ENG.SITE NO.
INSULATION � PLUMBING
GAS TEST , - - , GAS
MECHANICAL , - ' EIRE SPRINK ENERGY r:24
COVER,NOWORK UNTIL ABOVEHAS BEEN SIGNED HEATING _ v ❑. "-❑ ° ❑ "❑
EXTERIOR SHEAR - ELECTRICAL RELEASE - FLOOD ZONE A UC.
INTERIOR SHEARFIRE DEPT., Y❑ N❑ ° ❑ "❑'
SHEETROCK* - GRADE. _ y . .FEE SUMMARY
EXTE RIORLATH BUILDING , -.
INTERIOR' LATH - TEMPORARY APPROVALS. BUILDwc 3 D
SCRATCH COAT ELECTRIC PLAN CHECK
GAS _FEE rib .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY • SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BV-BUILDING INSPECTOR. WiICROFILM .
ARRANGE FOR INSPECTION BY PHONING 252-4505,' EL'ecrRlc '+
LU ' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMewG ' .
'• O PLEASE,GIVE•JOB ADDRESS WHEN.PHONING - -
z ' — SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! (CONST'.TAX
PLEASE READ REVERSE SIDE.BEFORE_ TOTAL
CALLING FOR FINAL INSPECTION. u
;OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN' RED LINES.- USE BALL POINT P,EN,ONLY h
�yBUI LDI NG PROJECT IDENTIFICATION � -PERMIr,NUMRER
APPLICATION & PERMIT .q r� O
•I1.• 4wLmNG
ADDRESS
7� pAn��,,'-�^k M• err-�• II 1
AooaEss F>ARJ2 `rvCA DeW9 . BUILDING — ELECTRICAL-PLUMBING —'MECHANICAL }.
OWNER'$r ( (� ,I .. ' ";� PLANCHECK VALIDATION.,
NAME ' ' + y.,�.4I.1 �V1�1`� QTY. 1
IJ1r r ELECTRIC PERMIT FEE
croRs
NAME OUTLETS-SWITCHES-RECEP. 90.00/100,
NAME '
ucrNo. - _LIGHTING FIXTURES ,: 10.00/100 '
CONTRACTOR'S. ���� -5,
ADDRESS APPLIANCES-RESIDENTIAL 400
PH E PANELS �^+ .r DATE OF APPLICATION
ARCHITECT 8R14�1a; = 9 PANELS (OVER ZOO AMPI'. ; '20,00 PLAN CHECK FEE P.o.NO.
OR
ENGINEER -
' uu No. SIGNS TRANS. 3.00
ARCH,OR ENG. ''•S.00 2,Tjo: t -PERMIT VALIDATION
ADDRESS. Of perfino SPECIALCIRCUIT -
ZIP TEMP.METER OR POLE INS.' 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS � — 1 ..._
SERVICE CHANGE 20.00'
J ��—rayt�cc %
0 0 0 ,LICENSED CONTRACTORS DECLARATION
G v v I Iteaby affirm that 1 am licensed under provisions of Chapter 9 Q ISSUANCE DATE
"' (commencing with Section 7000)of Division 3 of the Business and
SLOG. ELECT. PLG. MECH.
yz Professions Code,and my license is in full force and effect
-0 0 m o License Cluss Liu Number �' ❑
Date Cmdriun., City of Capertinp
}
¢ s _ BUILDING PERMIT
¢ ¢w c¢i - OWNER-RUILDLR DeCLARA'PION -"INFORMATION
x 3 a- H 1 hereby affirm that I am exempt from theCmtractor s LI ensu MISC.— >£ REFER TO ORD "
u y VALUATION D $/FT.
ea ao¢ Law for the following ausna(S�c.7031.S;B Business, Professions' PERMIT ISSUANCE 1000 0
�'y m Code Any city or county which requiresa permit to construct,alter,
ar 2Q 0 improve,demolish or repair any structure,prior to Its issuance,also ELEC.CONTH" LIC.NO, ELEC. - y ++ r
O u - requires the applicant for Such permit to file a signed statement that TOTAL PERM TO -
F:
he is licensed pursuant to the provisions of the Contractor's License s. r r
H Z Q Law(Chapter9(commencing with Section 7000)Of Division 3 of the ' '
Business and Professions Code)or that he is exempt therefrom and DTV. {PLUMBING PERMIT; , FEE
LM . the basis for the alleged exemption.Any violation of Section 7031.5 _ 1 STORIES TYPE CONSTR.
_63m u by any applicant for a permit subjects the app lmana'ivil penalty gLTER
-DRAIN&VENT-WATER (EA.) 5.00 `
o n t more than five hundred dollars($50011 -
1,as owner of the property,or my employees with wage.as BACK FLOW PROTECT. DEVICE 4.00 „ OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not _
intende&or offered for sale (Sec- 7044, Business and Professions DRAINS-FLOOR;ROOF,AREA,COND. 5.00 ,
Code:The Contractor's License Law does not apply to an owner of
Property who builds or.intproves thereon,and who does such work FIXTURES-PER TRAP 5.00 4SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his ownemployees provided that such improve-
ments.are not intendedoroffered forsxle.If,hr wegthebmldmg GAS-EA.SVS7EM-71NC.40UTLET5.6.00 • ,
or improvement is sold within one year of completion.the owner- GAS-EA.SYSTEM-OVER 4 IEA.) ' ''2.00 - - BUILDING USE
builder will tm e.the burden f proving that he did not build or Ina FES „IND CON" PB Otbar
prove for purpose of sale.).. , - INDUSTRIAL WASTE INTER. y�r30.00 '
❑ 1,as owner oI the property,am exclusively contracting with ❑ _ ❑ " El- ❑ • .❑ ,�y
licensed contractors to construct the project(See,7044,Business LAWN SPRINKLERS-1 INC 5 V:B.'= ''6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who buildsorimproves thereon,and who LAWN SPR IN KL"'ERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractors)licensed pursuhntto —the Cc tar's Licens Law. - ' SEWER-SAN FEAR V-STO RM EA.200ft/10.00 "". 'TRACT NO: PARCEL'NO. '
❑ Iant xcmptun •r Sec. ,B.&P.C.for th is -" WATER HEATER'W/VENT -6.00 "
reason 91 A
OwnerDate I .� WATER SYSTEM" ° 5.00 ,ACC.DATE ACC.FILE NO.
- WORKERS'COMPENSA'r1ON DECLARATION WATER TREATING EQUIP. `5.00
Thereby affirm that
have acrRificaie of consent toself-insure, - ,
or a certificate of Workers'Compensation Insurance,or-acertifieA - ZONING ENGc$ITE NO.
copy thereof(Sec.3800:Lab.CJ.
Policy No. " Company-
0
ompany O _ ❑ Certified copy islivreby furnished. FIRESPRINK ENERGY T24
Z:z ❑ Certified copy is Bled will, the city inspection division,- - -.x Y El ,�� a 'Y ❑ N❑•'e .
0 . Applicant - MISC.-; .. REFER TO ORD.
y - PERMIT ISSUANCE - `:10.00 FLOOD ZONE , - . A.L.UG:
CERTIF'ICA'TEOF EXIiMPT[ON FROM WORKERS'
LU _ COMPENSATION INSURANCE PLO.CONTR. LIC,ND., PLG. '
CL 0 - (This,section need not he completed it the pemdt is for one - TOTAL - Y N❑ Y;Q N❑
t Z) Z hundred dollars IS 100)or less:) _ - -
U O- 1 certify that in the performance of firework for which this per- QTY. - ' MECHANICAL PERMIT -FEE• - F FEE.SUMMARV;„
LL F.,, mit is issued,I shall not employ any p arson any Wanner so as to '
L) ' become subject to the Worker Compensation Laws s 1 California.
O-w Dar As locant BUILDING- 63_
y , Ip ALTER OR ADD TO MECH.. 500
} r7 NOTICE TO'APPLICANT If,after making this Certificate of E. - '-
Z e' emption,you should ec-me subject to thew rk rs Compen ation -APPLIANCE - 5.00
" PLAN CHECK'
provisions at the Labor Code, you must forthwith comply with "FEE
U such provisions or this'pennit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
•CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 . SEISMIC FEE S7b
I hereby'affirm that there is a construction lending agency'for EXHAUST HOOD(WITH DUCT) 5.00
v the performance of the work for which this permit is issued(Sec MICROFILM,•..
3097,Civ.C.). .,' - HEATING UNIT(70.100,000 B'.T.U.) 8.00
Lender's Name - HEATING UNIT(OVER 100,000 B.T.U:)9.50 i ELECTRIC
Lenders Nam Address
[,certify th tf1 have read this application and state that the above._ VENTILATION FAN (SINGLE) 4.00
information.Isco Correct, I agree to comply will ell city and county - PLUMBING _
. ordinances and state laws relating to building construction and BOILER-COMP(3 H.P.or100,000B.T.U.) 6'00
hereby authorize representatives of this city to nter upon the :R COW lover 100,000 BTU)SEE FEE SCH ,MECHANICAL,•
se-mentioned property for inspection purposes.
( e)agree to save, indemnify:and keep harmless the City of MISC.- ,REFER TO ORD. _ -
Cupar ono against liabilities,judgmeiite, cents and expenses which-, PERMIT ISSUANCE LL' 10.00 [t ,CONST.TAX t J
To
m anN,wa accrue against said,City 'n cons Vuence of the '
rat his p m it MECH.CONT. LIC NO. MECH Y �a !
TOTAL
L� L L , � TOTAL' � 9
Signature of Ap locant/Con[ ori -"Date r
OFFICE COPY