1652040.
POST THIS CARD NEAR FRONT OF BUILDING
f �• CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
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JOBADDRESS 121L 2T LICLr—'L �# � UNIT# LOT
OWNER CONTRACTOR V 11 42—C,
r
PFRMIT16520 6 2 0 1
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
IOU UAYsoEPERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
IN ION DATE INSPECTOR
INSPECT40N RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITU OF
CUPERTINO STANDARDS.
LIFER
PREGUNITE
rtHnvi vnI.IDA noN
,• —. �,., c
ISSUANCE DATt ''iY
GARAGE SLABSASD,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
AUIJ 031989
UNDERGROUND/SLAB
PLUMBING
//-�A/- �-L. SLI -(O- J
of
ELECTRICAL
MECHANICAL
BLDG
El
ELECT
K
PLG. MECH
El L
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
BUILDING PERMIT
WOOD FLOOR
V ALINFORMATION
Uf, 110N
_
$IFT,
PLUMBING
MECHANICAL
PERMIT ro
ELECTRICAL
FRAMING/
5 ]HI[S
TYPC6ONSTR
INSULATION
'
OCC GROUP
HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
50 IT FLOOX AREA
TOTAL nCRLAGf
'DIAPHRAGM
BUILDING USE
HES TND CON PR Om..
El
ROOF SHEATHING
-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS - DATE INSP.
ASSESSOR SPARCEL NO
ROUGH
SAN.H
PLUMBING
ELECT, ENERGY
TRACT NO.
PARCEL NO
_
• I
TUBS& SHOWER PAN '.
PLUMBING ENERGY
MECHANICAL
MECH.ENERGY
ACC unTF
Acc. PILE No
ELECTRICAL -
BUILDING ENERGY
FRAMING
ELECT.FINALTEST
ZONING
ENG SIT ENO,
INSULATION
PLUMBING
GAS TEST
GAS -
FIHE$vR1NK
Y ❑ N
ENERGY T.74
Y E] IN
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
HtooD ZONE
Y NEI
n.1. u c
YO NO
EXTERIOR SHEAR
ELECTRICAL RELEASE
INTERIOR SHEAR
FIRE DEPT.
FEE SUMMARY
SHEETROCK
GRADE
EXTERIOR LATH
BUILDING
BUILDING
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
GAS
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
JOCCUPANCY ISEISMIC
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
1Z
—SEE PERMIT FOR EXPIRATION DATE —
ELECTRIC
-
PLUMBING
MECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL?�6D
OFFICE COPY
l�
u
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r/
BUILDING PROJECT I DENTIFICATION
APPLICATION &PERMIT
PERMIT NUMBER -
q [ O
R ,Lo,NG
ADOREss
O Lki
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
I J
OWNER '$
PLAN CHECK VALIDATION
NAME
QTY. ELECTRIC PERMIT FEE
/^^
1...-O PHONE
,
NAME croRs
NAME
Vf i C. NO
X'; LI
UTLETS- SWITCHES -RECEP 10.00/1.00
IGHTING FIXTURES 10.00/1.00
oQoRQEss
PPLIANCES- RESIDENTIAL 4.00 3
PANELS 10.00
i 1 E PHONE nI
DATE OF APPLICA TION -.
ARCHITECT
OR
IN
pn, ('' LIC. NO,
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE PC..NO.
SIGNS TRANS. 3,00
ARCH. OR ENG.
ADOREss
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
METER OR POLE INS. 20.00
ZF75 A S 1 • F zivEMP.
APPLICANT
ADDRESS
MOTORS S F E SCH.
SERVICECHANGE - 20.00
(,fj. �y u ULLI
LICENSED CON'T'RACTORS DECLARATION
f
1 hereby affirm that I Wn licensed under provisions of Chapter 9
ISSUANCE DATE
N U
(commencing with Section 7000) of Division 3 of the Business and
BLDG.
ELECT.
PLG. MECH.
Professions Code, and my license is in full force and effect.
License Class Lie Number
❑
- rvr•
❑ ❑
Dale Contractor
fV'l�'I
BUILDING PERMIT
OWNER -BUILDER DECLARATION
I hereby affirm /hal I am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5. Rusinessand Professions
Code: Any City or Coll n ty which requires a permit to construct, alter,
improve, demolish, or repairany structure, prior to its issuance, also
INFORMATION
MISC.- REFER TO ORD
VALUATION
S/FT.
PERMIT ISSUANCE 10.00 ��-
ELEC. CONTE. LIC. NO.1
ELEC.
o,gmres the applicant far such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
'
TOTA
PERMIT TO
QTY. PLUMBING PERMIT FEE
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that be is exempt therefrom and
file basis for the alleged cscmptlon. Any violation of S,clion 7031.5
e1. l
STORIES
TYPE CONSTR.
ALTER-DRAIN&VENT-WATER (EA.) 5.00
by any applicant for a permit subjects the applicant toa civil penalty
of not more than five hundred dollars (8500).):
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
intended or offered for sok (See '7044, Rashness and Professions
BACK F LOW PROTECT. DEV ICE 4.00
OCC. GROUP
RES. UNITS
DRAINS-FLOOR, ROOF,.AREA,COND. 5.00
Code: The Contractor's License Law docs 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.
mems are 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 INC.4 OUTLETS 6.00
or impnrvcment is sold within one year of completion, the owner-
builder will have the burden of proving than hu did not build or int-
Pravcforpurposeofwnsalr.L
❑ 1, as oer of the properly, am exclusively contracting with
licensed contractors to construct fire project JSec. 7144, business
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PR Omar
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
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 properly who builds or improves thereon, and who
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
Contracts for such projects with a contractor(s) licensed pursuant to
the C.Inlm,to, I S License La..
SEWER -SANITARY -STORM EA. 2001t110.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
❑ Hun exempt under Sec.-. B &P.C. for this
oon
wner Dale
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WORK ERS'COMPRNSATION DECLARATION
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 (See 3800, Lah.C.).
Policy No. Company
❑ Certified, pylslt •re by furnished.
Cert1 d y I led with It • ty ins t m- division.
Applicw,t_ _-" I
FIRE SPRINK
y ❑ rv❑
ENERGY T-24
v E] rv❑
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
CIiRTIFICATIS 01' EXEMPTION PROM WORKERS'
PLG. CONTE. LIC. N0.
PLG.
TOTAL
COMPENSATION INSURANCE
(Phis ,section n ed not be conlpletud if the permit is for one
Y ❑ N ❑
Y ❑ N ❑
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars I$ 100) (11 less.)
I certify that in the perl'unnance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
become subject to the Workers' Compensation Laws of California.
Date Applicant
ALTER OR ADD TO MECH. 5.00
N01'ICI: 1'0 AI'I'LICAN'O IL after making this Certificate of Fs-
empli il, you should become subject rn the Workers' Compensation
provisions of the Labor Code, you must forthwith comply who' suchprovisions or this permit shall he dcerrled rvoked.
APPLIANCE 5.00
K
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
FFEE
E
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
performance of the work for which this permit is issued (Sec.
CN.C.).Name
EXHAUST HOOD (WITH DUCT) 5.00the
HEATING UNIT (TO 100,000 B.T.U.) 8.003097.
HEATING UNIT(OVER 100,000 B.T.U.) 9.50
i
Lender's Address
I certify that l have read this applicalion and stale that the above
mfonnallon is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
gOILEA-COMP(3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP /Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize repmsenUtives of this city to enter upon the
above-mentioned property I'or inspection purposes.
MISC. - REFER TO ORD.
CONST. TAX
(We) agree to save, indenmify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
ay in any ay accrue against said City in consequence of the
anti ng o his Fe mit. '' nnMECH.
��. �C'g'�
PERMIT ISSUANCE 10.00
CONT. LIC. NO.
MECH.
TOTAL
TOTAL
Si ore of Applicant/Contractor Date
OFFICE COPY