15904 POST THIS CARD NEAR FRONT OF BUILDINGPERMT NUMBER
CITY OF CUPERTINO 1 �j
INSPECTION DIVISION "'���
JOB INSPECTION RECORD l\
- - ". �- PERMIT EXPIRATION'
JOB ADDRESS /Or7 �� �d/0� ./X UNIT# LOT# PERMIT EXPIRES IF WORK'
OWNER R.(,� n - CONTRACTOR IS NOT. STARTED WITHIN I
INSPECTION DATE I INSPECTOR INSPECTION RECORD .180 DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
' UFER �(/ � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION :.
GARAGE SLABS
CUPERTINO STANDARDS.
-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -_�_gq_ ��14µ�-' _ / t. i- L ! •;�/•
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL 1 _
ISSUANCE DATE
1 MECHANICAL '�•\v c_-51 �.;� \y per. 77 ELECT PLG. 'MECH
El
5. a
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED rr,�,�� DD BUILDING PERMIT
WOOD FLOOR - r . INFORMATION
PLUMBING
VALUATION SIFT.
' _ � � -
MECHANICAL
ELECTRICAL r C� �{ '` P'e1Ham TO ;
FRAMING - j'i-`LJ'Ull 71UN
INSULATION ""W" TYPE CONSTH,
OCG GROUPRF.S UNITS
�✓JI-�'�J" /moi/ /L(]d//J
PLACE NO SUBF11LOOR UNTIL ABOVE HAS BEEN SIGNED �'E '�9 oY -g -
so.1 L ILOOR aFIA TOTAL ACTI
ROOF NOTE:NO FINAL INSP..SHALL BE MADE BEFORE
�- DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING ppBUILDING USE
HE$ IND CON PB .Om.'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE - INSP. ❑ ❑ ❑ ❑ ❑
• �
ROUGH SAN.q A55E 550HS PA-
HCEL NO.
' - ' � �
PLUMBING _ _gu - ELECT.ENERGY
.
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACI NOPARCELNO
MECHANICAL - _Z -_ y MECH.ENERGY
ACC,DATE- ACC.FILE NO
ELECTRICAL BUILDING ENERGY -
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE,NO.
INSULATION _3_ PLUMBING -�'('y-
GAS'TEST GAS
MECHANICAL �' .aL/ _ ,T � FIRE$PRIN I< ENERGY Taa .
' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - - v E] "❑ v ❑ -"�
i.
.
EXTERIOR'SHEAR - 2 a$ cE k FLOOD ZONE A.L UC.ELECTRICAL RELEASE _
INTERIOR SHEAR 2_Z.Z� FIRE DEPT. v❑ "❑ ` ❑ - "❑
SHEETROCK GRADE S' �,� FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATHTEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE 3 a42
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION ELECTRIC BY PHONING 252-4505,' 7„Q ;
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST,TAX
PLEASE READ REVEOSE SIDE BEFORE - TOTAL S`.Gr
' CALLING FOR FINAL INSPECTION. -
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
'BUI LDING PROJECT IDENTIFICATION PERMIT,NUMBEIR k,
BUILDING APPLICATION & PERMIT 04
A
ADDRESS A 1 I
�- _FA PP I-LD BUILDING — ELECTRICAL—PLUMBING —MECHANICAL
q
OWNER' - PLAN CHECK VALIDATION
•
—117`r DTV. ELECTRIC PERMIT FEE A-0 1�Iv VMONE
coNTRAcroas 21 OUTLETS-SWITCHES-RECEP 10.00/1.00
� NY
\r. �S UC.NO. S 2'2- LIGHTING FIXTURES 10.00/1.00 O
CONTRACTORS / 12� -
C
ADDRESS
!` APPLIANCES-RESIDENTIAL 4.00
1•' q'2) C M'Z>F.,k_ PHONE PANELS 10.00 DATE OF APPLICATION .
ARCHITECT PLAN CHECK FEE .NO..
OR PANELS (OVER 200 AMP( 20.00
ENGINEER /_ _LIC.No. O-�Ilz,l SIGNS TRANS. 3.00 'ARCH OR M1
ADDRESS ENG �!1 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
f Ir)e. I zIPEMP.METER OR POLE INS. 20.00
ADDRESS Ts MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 G
0
0
Foo LICGNSIiU CONTRACTORS UECLA RA'T'ION
a c U I herchy affnn Incl I am licensed under provisions of ChaBter 9 ISSUANCE DATE
w< m (commencing with Section 7000)of Division 3 ofthe businessanJ BLDG. ELECT. PLG. MECH.
F m z Professions Code,and my license is in full for"and effect. El 1:1 ❑
x O - License Class Lic.Number
o �"ra Date Contractor pI
a Y M ` BUILDING PERMIT
¢ ¢ d ¢ OWNER-BUILDER DECLARATION INFORMATION
X
I hereby affirm Thal 1 am exempt from the Contrador s License
MISC.— REFER TOO
t_ LL o J Law for the following reason.(Sec.7031.5.Bubinessand Professions PERMIT ISSUANCE Pki'VALUATION - S/FT.
Coda Any city or county which requircau Pcnnil toconslrucl,alter,
IS Q Q MO Improve,demolish,or repair any structure,prior to Its issuance.alba ELEQ CONTR. LIC.NO. ELEC.
wO u requires the applicant for such permit to file a signed statement that TOTALa. 7-a'
$ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
HiQ
Law(Chapter 9(commencing with Section 7000)cf Division 3 ofthe 1 .l� �U
4 st BubincV,and 1'rofusslons Coce)or that hu is exammpt thercfrom'rnd DTV. PLUMBING PERMIT FEE ✓(C.l
¢ F Q the buffs for the alleged exemption.Any violation ofSection 703 1.5 STORIES TYPE CONSTR.
ate _ by troy applicant fora permit d jlmsthe applicam toacivil penally ALTER-DRAIN& VENT.WATER (EA.) 5.00
of not more Than five hundred dollars(my employees
❑ I,az owner or me property,or my,andt Wim reeisnere BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
Their sole nnnpenvliun,will du the work,and the structure is not
intended or offered for sale (Sec. 7144. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner o1'
properly who builds or improves thereon,and who docs such work '� FIXTURES-PER TRAP .690 so Fr.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ncn¢arc not intmWcd ser offered for sales 11,however,tire building GAS-EA.SYSTEM-1INC.40UTLETS 6.00 3(C7
or improvement is sold within ane year of completion, the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did nal build or ice- BUILDING USE
Prove for purpose of rale./. m
INDUSTRIAL WASTE INTER30.00 RES IND CON PB Oer
.
❑ I,as owner of the property,am exclusively contracting with 0
licensed contractors to comat,uct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ABSESSORBPARCEL 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
contracts for such projects with a contractor,)licensed pummnl to
the Contractor's License Ltw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
IO Tum exempt Under Sec. ,B.&BC.for this
reaon WATER HEATER W/VENT/' 6.00
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPF_NSA'1'DON DIFCI.ARA'I'ION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified .ZONING ENG.SITE NO.
copy thereof(Sec,3800,Lab.C.)..
1 Policy No. Company
O ❑ CcRifcd copy khercby furnished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is fled with the city inspection division.
F_9, Applicant MISC.- REFER TO ORD. Yo ' No Y ❑ NF]
PERMIT-ISSUANCE FLOOD ZONE A.L.u.c.
LU ran CIiRTIhICATIiPE SARIO 1'INS DRUM WO RKIiRS' ls�
W > COM PIiNSA1'ION'INSURANCE PLG.CONTE. LIC,NO. PLG. q
0 (Thu section need not be completed if the permit for one TOTAL O V❑ N� V ❑ IN
hundred dollars 15100)or IcssJ
U O 1 certify that the performance of the war for wl ch t is per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F ntit is issued, 1 hall nal empI any persun' a incr. as to
U becolIrq��is��nIsla�c a Workers' n e La of ia.
Q C_ Dot Applicant BUILDING s�
} to NOTICE Tl0 PPLICANI': If,aDer making this Certificale of lie- I ALTER OR ADD TO MECH. 5ree
F Z cmplion,you should heealllc Subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such mit provisions or this pershall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LIiNDING AGENCY AIR HANDLING UNff(OVER I0)000C.F.M.) 6.00 SEISMIC FEE 3
I hereby affnn that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Gv.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nam
Address
HEATING UNIT 100,000 B.T.U.)9.50 oC 76
Lender's AAJress ELECTRIC
Icertify thus l have read this application andslate that the above VENTILATION,FAN (SINGLE) 4.00
ft information is correct.I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 Q
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU(SEE FEE SCH.
chole-mentioned properly for inspection purpuras, MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE +0-W — CONST.TAX
may in any way accrue against slid City in consequence of the
anling of This Permit. MECH.CONT. LIC.N0. MECH. C�/ 61V
TOTAL TOTAL
Signature of Applicant/Contractor Date �
OFFICE COPY
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