18361l
POST THIS CARD NEAR FRONT OF BUILDING' '
PERMIT NUMBER
CITY OF" CUPERTINO
18361
INSPECTION DIVISION.
JOB -INSPECTION RECORD
�j
JOB ADDRESS, -i _� D GJ RIi"kAD UN IT# _LOT#
PERMIT EXPIATION _
- ZJ �/
'PER
a '�• � - / //
'44OWNER
I X�IRES IF WORK
V1- L. �� - CONTRACTOR 1J QDIj
IS NOTI STA. .ED WITHIN
180 DAYS OF PERMIT ISSU�
ANCE OR 180 DAYS, FROM
LAST CALLED INSPECTION.
)NSPtiCTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION-
•-NOTE:
-
_
ALL GRADING AND.DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE'APPROVGCfiLQyGAND CITY OF
UFER
PREGUNITE
PERMIT VALIDATION
CUPERTINO STANDARDS. !�/INY
•
�-
p n,
..I, All
ISSUANCE DATE
GARA E SLABS. •' `
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED-
IGNED
UNDERGROUND/SLAB
UNDERGROUND/SLAB
PLUMBING
-
ELECTRICAL-
MECHANICAL
�'-�U N1'1'� P,l4
BLDG. \SECT 1P�LG,. PEECCCH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
'
BUILDING PERMIT
INFORMATION
' WOOD FLOOR
VALUATION SIFT.
fMECHANICALELECTRICAL
PLUMBING
-
-
\"^
IT TO
FRAMING
INSULATIONRES
E CO TR.
UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEDROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID -
-
TOTAL ACREAGE
DIAPHRAGM, '
ROOF SHEATHING !
BUILDING USE
.RES IND " CON PB Olen,
El 0 0 0 1:1 '
APPLY. NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ASSESSORS PARCEL NO.,
" '
ROUGH
• ''
SAN.# �— `
PLUMBING -
ELECT. ENERGY
TUBS & SHOWER PAN -
PLUMBING ENERGY
TRACT NO.
PARCEL NO
MECHANICAL . ' -
MECH: ENERGY
ELECTRICAL -
BUILDING ENERGY
Acc. PATE
ACC. FILE NO.
FRAMING -
ELECT. FINAL TEST
INSULATION
PLUMBING " '
ZONING
ENG. SITE N0.
'
GAS TEST
GAS
'
_
MECHANICAL - -
'FIRE SPRINK
ENEHGYT24
v N
v Np
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
-.
EXTERIOR SHEARELECTRICAL
RELEASE
FLOOD ZONE
Y❑ N�
ALUCr
v� Try
-SHEAR
INTERIOR
FIREDEP.T.
SHEETROCK _
GRADE
FEE SUMMARY
EXTERIOR LATH -
BUILDING,
BDILDwG
6,2,G6
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 BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM..
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
8 UL>
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
:Od
Z '-
-SEE PERMIT FOR EXPIRATION DATE —
CONST. TAX
_
IMPORTANT!
TOTALD
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
IOFFICE COPY
4PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
1 /S� /j�11
8361'
BUILDING
ADORES s n� lM
lh�.nS//n1l
OWNER'SO[
NAME G
v11oN1�� a
_
DTV. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
'
NFm ER cTORT
OUTLETS - SWITCHES -RECEP 10.00/1.00 tED
LIGHTING FIXTURES 10,00/1.00
l 7.2 ..?0
f-41f=1
AUNT ESS TO hey/
PPLIANCES-RESIDENTIAL 4.00
PANELS 10.00
•Y•TFHONE
DATE OF APPLICATION. "
ARCHITECT
OR
ENGINEER
uc. No.
PANELS (OVER 200 AMPI 20.00
PLAN CHECK FEE '- P.C. NO. "
.. _
SIGNS TRANS. 3.00
AARCH. OR DDRESS ENG
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
TEMP. METER OR POLE INS. 20.00
ZIP
APPLICANTS -
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
'
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisiousof Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Cod an_ y, _def�hcense is in full fore V c(f c . - /
License Class ( 4 Lia Number wf Y' 1
Date _.7e1�-_ sA Contractor �%jJ�y�_ _�y(�
-
ISSUANCE DATE
DG.
ELECT.
PLG. MECH.
�.-zs
I'sPl l'
CAV J UP"
BUILDING PERMIT
INFORMATION
OWNER -BUILDER DECLA ATK ION
I hereby collo that Iso exempt from the Contractor's License
Law for the city or countng aron.(ft regoes0 frondIt sand Professions
Code: Anymolish coontywhiny structures prior
oconsrn¢L, also
improve, demolish, or repair any structure, prior to its issuance, also
requires IIIc applicantlrom f0r the permit ID fill' a signed statement Lit that
Of 00ire ) ofD cisi n License
pllrallallt to lite with
La is Il (Chapter 9 (commencing) or Section is exc of Division 3 of Inc
Law less and
Business Professions Code) or that he is exempt therefrom and
{IIv 1R �`T��-
MISC. - REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION $/FT.
Al�Od.
�i
ELEC. CONTR. .LIC. N0.
TOTAL., J(('
TOTAL . I'v ��
PERMIT TO/
DTV. PLUMBING PERMIT FEE
STORIES
T ECO TR.
for
the basis for the alleged exemption. Any of Sect ion 1.5
applicant en
by nny applicant for hundred dollars the 0).): and tOaCMIpl'llalty
of not more than five hundred doelars(8500).):
ALTER -DRAIN& VENT -WATER (EA.) 5.00
❑1, as owner of the property, or my employees with wages as
their sole Compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, GOND. 5.00
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 improve-
dents arc not intended or offered for sale. If, however, the building
FIXTURES - PER TRAP 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
GAS - EA. SYSTEM -1 I NC.4 OUTLETS 6.00 U. l�
or improvement is sold within one year of -completion, the owner-
builder will have the burden, of proving that Ile did not build or im-
prove fors owns, of tireJ.
❑ as owner of rhe property, exclusively contracting with
.
GAS - EA. SYSTEM -OVER 4 (EA.) 200
BUILDING USE
RES IND CON PB Omer
❑ 0 ❑ 1
INDUSTRIAL WASTE INTER. 30.00
d contractors to construct the project (See. 7044, Business
he
and Professions
and Protorsions Code: The who builds o License Law does not apply
to owner of property who builds improves [hereon, and who
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS -OVER 6 (EA.) 1.00
ASSESSORS PARCEL NO.
tr
the CoctsforsudtcenecLwlthu contractions) licensed Pursuant to
the CanUnclor's License Law.
SEWER-SANITARY-STORMEA.200ft/10.00
'TRACT NO.
PARCEL NO.
4 Ido ozcmpr under Sea ,B.&P, C. fns Ibis
reason
WATER HEATER W/VENT 6.00
Owner Duce
WATER SYSTEM - 5.00pp
.0 y
ACC. DATE
ACC. FILE NO,
_
WATER TREATING EQUIP, 5.00 3 (il
WORK ERS'COMPENSATION DECLARATION
'I hereby affirm that I have a certificate ofecnsent to self -insure,
or a certificate of Workers Compensation Insuran c or a cert r it
co��yy�arrJJ�1est f (Sec. 3 0, Lab.0 )
P°MCyq{o��(r�any_ _
ZONING
ENG. SITE NO.
❑ Certified Copy is hereby furnished
1R (7vified c p is til w t the city inspection division.
Appllcant_��
'ROM
FIRE SPRINK
Y ❑ No
ENERGY T-24
YE] No
MISC- REFER TO ORD.
Icily
CERTIFICATE- EXEMPTION W/ ORKF:BS'
PERMIT ISSUANCE 10.00 Z.VD
FLOOD ZONE
A.L.U.C.
PLG. CONTR. - ❑c. NO.
PLG,
TOTAL t o o
COMPENSATION INSURANCE
(This section peed not be completed if the permit Is for one
Y [:] N
Y F] NEI
hundred dollars IS 100) or less.)
I certify that in the performance of the work for which this ser-
mit is issued, 1 Shall not employ any person in any manner so as to
DTV. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
become subject to rhe Workers' Compensation Laws of Cablornia.
Date ' ApplicantALTER
OR ADD TO MECH. - 5.00
.
NOTICE TO APPLICANT: If, after making this Certificate of IN-
APPLIANCE 5.00
PLAN CHECK
emption, you should become subject to the Workers' Compmisarion
provisions of'tire' Labor Code, you most forthwith comply with
such provisions or this permit shall be deemed revoked.
FEE
'
- +
AIR HANDLING UNIT (TO 10=C.F.NL) 4.00.
AIR HANDLING UNIT (OVER 10p00GEM.)6.00
SEISMICFEE
..�
-CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a
is agency for
EXHAUST HOOD (WITH DUCT) 5.00
hick [his permit
the 3097 performance of the work for which this permit is issued (Sec.
MICROFILM
EATING UNIT (TO 100,000 B.T.U.) 8.00
JE
HINN
HEATING UNIT (OVER 100,000 B.T.U.)9.50 O
ELECTRIC
Lender's Name
Lenders Address _
1 certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
ordinances and stale laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
. I%0
BOILER-COMP13 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000BTU)SEE FEE SCH.
MECHANICAL
(�D.
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
MISC. -. REFER TO ORD.
" (We).agree to Save, indemnify and keep harmless the City of
Caper fine against liabilities, judgments, costs and expenses which
may i n any way accrue agginst said City in consequence of the
CONST. TAX
PERMIT ISSUANCE 10.00 LPD
W. ting t is Permi
_10 _
MECH. CONT. LIC. NO. MECH:
TOTALS p' D
-.
TOTAL
�,oC
Signatu a of Apphwnf ntraetor to
OFFICE COPY