17473 POST THIS CARD NEAR FRONT OF BUILDING PERN,rTNUMBEA
.CITY OF" CUPERTINO: ,. = 17473
•y INSPECTION DIVISION
I' JOB INSPECTION•RECORD
`w
' ' PERMIT EXPIRATION
JOB ADDRESS �I 7dGD�(N\/.ps'^yf UNIT# ILOT# PERMIT EXPIRES IF WORK
- c l
OWNER, 'CONTRACTOR Cj® ��To„ ' ISNOT STARTED.WITHIN '
INSPECTION DATE INSPECTOR I I INSPECTION RECORD—, ' IOU DAvs OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - .TO COMPLY WITH THE-APPROVED PLANS AND CIN OF PERMIT VALIDATION
.CUPERTINO STANDARDS.,
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ” ~ /
I" - •UNDERGROUND /SLAB
PLUMBING • It ul,
_ S(M.�Cx•(f., },.t�
ELECTRICAL
CAL ^� -
ISSUANCE DATE.•
MECHANIBLLc ELECT. PLc ECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
' - INFORMATION
' WOOD FLOOR sf VALUATION $/FT.
PLUMBING Iq
MECHANICAL -
ELECTRICAL - - _ 1� BE' LTTO
• FRAMING • '".`�
INSULATION - ,- -STORIES. , TVIE CONSTH.
' - OCC GROUP RES UNITS
EIPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50,FT FLOOR AREA iOi PL ACREAGE
! ! ROOF NOTE:NO FINAL INSP:SHALL BE MADE BEFORE
DIAPHRAGM' THE CONSTRUCTION,TAXIS PAID
BUILDING USE
ROOF SHEATHING - RES IND , CON PB OR—
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. • El ❑ 11 - El El
A SSESSORS PARCEL NO
' ROUGH � SAN.p� -
PLUMBING ELECT.ENERGY'
TRACT ND PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY ..
MECHANICAL MECH.ENERGY '
ELECTRICAL r 'ACC DATE Acc.FILE No.
y'/ BUILDING ENERGY
FRAMING ELECT,FINAL TEST
ZONING - ENG SITE NO.
. INSULATION PLUMBING ,
' GAS TEST GAS
- FIRE SPRINK ENERGY T.24
MECHANICAL
"COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y. El Y ❑ No
' .L.U,C.EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A
INTERIOR SHEAR FIRE DEPT. Y❑ N[] Y ❑ No
SHEETROCK GRADE . FEE SUMMARY
EXTERIOR,LATH.— BUILDING
INTERIOR LATH ' TEMPORARY APPROVALS eulLDwc (j D.
SCRATCH COAT- -.d{ qIvU55 ELECTRIC PLAN CHECK '
- GAS FEE.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY, SEISMIC FEET"
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ""^"'"RAp
ARRANGE FOR INSPECTION BY PHONING.252-4505A ELECTRIC �OY
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Ql�
wo E - z PLEASE GIVE JOB ADDRESS WHEN PHONING.'.
- SEE PERMITrFOR EXPIRATION DATE77
- MECHANICAL ' '
IMPORTANT!, ~ conlsr.Tnx:
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
4MI LOING PROJECT IDENTIFICATION PERMIT NUMBER
.UR.m G APPLICATION & PERMIT . ''
ADDRESS
1Z e, VI BUILDING-ELECTRICAL-PLUMBING-MECHANICAL . 17473
OWNEH's PLAN CHECK VALIDATION
NPME
"�. PRONE2'5�-1166 DTV. ELECTRIC PERMIT FEE
V% LPIIn NAAtMTERACTOH's UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00K 147'
CONTRACTOR'S �Sr,J1 r,ye9, PPLIANCES-RESIDENTIAL 4.00 •V
ADDRESS
r PHONE I PANELS - 10.00 DATE OF APPLICATION'
ARCHITECT - PLAN CHECK FEE" P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER •,�
w/ uc No. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 •T_��1��
APPLICANTSDDRSMOTORS SEE FEE SCH.ADDRESS 1 I
ll SERVICE CHANGE 20.00
D o S LICENSED CONTRACTORS DECLARATION
Q U w I hereby affirm that I am licensed under provisions of Chapter 9 hrSSUANCEDATE '•
en <w (commencing with Section 7000)of Division 3 of the Business and - LOG. . ELECT. PLG. MECH:
M i Professions Code it ply license is in full force n e t.
S 0 in o License Class 11 Lic.Number_ -
F m H J • Contractor
a r iJA
Cft BUILDING PERMIT
c a OWNER-BUILDER DECLARATION
e- U INFORMATION
X ;LL N I hereby al tion that I am exempt from the Convector's License MISC.- REFER TO ORD
F u o a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION 'i $/FT.
� W0J`C Cade:Any city or county whictinquiresa permit toconstrucLalter, Z� Q�
Q d.¢ 0 improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC. pp / �O • '
i 0 u requires the applicant for such permit to file a signed statement that TOTA 1 V D IT TO
w $ he is licensed pursuant to the provisions of the Contractor's License PER
r Law(Chapter 9(commencing with Section 7000)oesf Division 3 ofthe In' r
io Busins and Professions Code)or that he is exen.pl therefrom and L OTV. PLUMBING PERMIT FEE `1 V �1
Ir: $ the basis for the alleged exemption.Any violation of Section 7031.5 _ - STORIE TYPE CONSTR.
u; � by any applicant fora permit Subjects $5000.liwnttoacivil penalty ALTER-DRAIN -WATER (EA.15.00
of not more than flue hundred dollars(my employees
❑ I,as owner at theon,property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 F IXTUR ES-PER TRAP - 5.00 2l 0t) -sO.FT.FLDOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- It
GAS-EA.SVSTEM-1 6.00
mems are not intended or offered for sale.If,however,the building
of improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose Of sale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with . ❑' ❑ ❑ ❑ ❑
licensed contractors tG construct the project(See. 7044,Business LAWN SPRINKLERS-i INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
em,tmcls for such projects with a contractor(sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date 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 ofconsent to self-insure' ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy ther00,Lab.0
e a .l..
Policy No. Company�T-�Zt�1�-�F�+-
0 ❑ Certified copy is hereby forms ad. ' FIRE SPRINK ENERGY T-24
Z Z CerbUcp copy, is [h will yic ail inspcc ion division.
O AppliCCnt�i„ tII�M117�11i"IQVtr(A` MISC.- REFER TO ORD. Y ❑ N❑ y ❑ N❑
~ _m PERMIT ISSUANCE 10.00 Z,VV FLOOD ZONE A.L.U.C.
LU CF:RTIFI'COMPE EXEMPTION FROM WORKERS'
W need not ION
INSURANCE PLG.corvrR. - LIC.No. PLO. / 00 Y❑ N❑ Y❑ N❑
Z) Z (This section need not be completed if the permit is for one TOTAL /
hundred fy that in the pe fort
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws Of California.
U y Datc Applicant ALTER OR ADD TO MECH. 5.00 •BUILDING e Q O
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
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
U such provisions Or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=12-F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00the _
3097 Civ C.jnee of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name H EATI NG U N IT(OVER 100,000 B.T.U.)9.50
- -" Lender's Address ELECTRIC
. certify that l have read this application and state that theabove VENTILATION FAN (SINGLE) 4.00 rS
infor nation is correct.1 agree m comply with all city and county PLUMBING V
ordinances and slate laws relating to building construction, and BOILER-C f(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon .he BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL • SD
above mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
-. --- may
in
iee, 'udg nts, costs and expenses whihPERMIT ISSUANCE 10.00 IOltCONST.TAXay itiaiitd City i" consequence of the Lre. MECH.CONT. LIC.NO. MECH.TOTALTOTALna aontractor Date
OFFICE COPY