18024 POST THIS CARD'-NEAR FRONT OF BUILDING
'PERMIT NUMBER
CITY OF CUPERTINO 18024
INSPECTION DIVISION
JOB INSPECTION RECORD
PERM ILEXPI RATION
/ r /] F
JOB ADDRESS_(Ol N 1 S�-e'�LC.. 'U `�� UNIT# _LOT# !_j �f r
J PERMIT EXPIRES IF WORK
OWNER Q V. U - be\Lj CONTRACTOR S' IS NOT STARTED WITHIN
INSPECTION DATE INSP TOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION NOTE:
ANCE OR 180 DAYS FROM a!
O� -
UFER. ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.;
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERNII I vAuunn ON
PREGUNITE CUPERTINO STANDARDS; I '
GARAGE SLABS 113PT, luuLV
pAmp �y �*
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - GG l
UNDERGROUND /SLAB fj 19p9
N
PLUMBING M -�
ELECTRICAL cuoulll1� ISSUANCE DATE
MECHANICALeLOc. ELen PLG. MECH
a ;® 10
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED // BUILDING PERMIT
/� { INFORMATION
- WOOD FLOOR mSIFT.
VALUATION
PLUMBING // nn
MECHANICAL
ELECTRICAL - PEHI ro/I
FRAMING - IF
O' -Y
INSULATION � .• � � s RIE rn•r.co"srR.
(�
OCG Group RES.UNITS
O
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO IT rluoriA +
® ROOF NOTE:NO FINAL INSP.S LL BE MAD E� RE
DIAPHRAGM N
,THE CONSTRUCTION TAX IS PAID, Fr,rp
y/) + ///
ROOFSHEATHING -`� �' Firs INuuILOCON USE
FB . 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS —"BATE INSP.
ROUGH SAN.N ASSESSORS PARCEL NO
PLUMBING 'Qo ELECT.ENERGY
TUBS B SHOWER PAN ._z PLUMBING ENERGY TI+Aci No PARCEL NO.
MECHANICAL MECH.ENERGY. '
ELECTRICAL BUILDING ENERGY ACC DATEncc FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE:NO,
INSULATION PLUMBING -
GAS TEST - - GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �� ° E] "�
PLoou zoNl - n.I.u.c.
EXTERIOR SHEAR ELECTRICAL RELEASE '
INTERIOR SHEAR 'Z FIRE DEPT. - v❑ Yo N❑
' SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING -J'-�
INTERIORLATH -�,-y TEMPORARY APPROVALS BUILDING .7,
SCRATCH COAT (, ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGN ED BY BUILDING INSPECTOR, • MICROFILM "•'•"
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 5
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
zo PLEASE GIVE JOB ADDRESS WHEN'PHONING. r
-
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL bl.1T—,
IMPORTANT! CONST.TAX 3'a l rte?
PLEASE READ REVERSE SIDE'BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY 3?2.27
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION .PERMIT NUMBER
o`A ss APPLICATION & PERMIT _ 18024
,S Sic-EN\C� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
NAME 11p PLA CHECK VALIDATION
SONE XEL7AQ�F+Jt a5S-��1 OTY. ELECTRIC PERMIT FEE ^'
J BRorvE �S
CONTRACTOR'S
NAME CC,.�����"/I�\ OUTLETS-SWITCHES-PIECED 10,00/1.00 „
tt
S&AkE- _ LIC.NO, .5sjO�J LIGHTING FIXTURES 10.00/1.00 v -
CONTRACTOR'$
AiD_,Es;O Tw�Q£J�.LRL CN�rtIL'Ar10 PPLIANCES-RESIDENTIAL 4.00
Vt't PR NE PANELS 10,00 DATE OF APPLICATION
OARCHITECT PANELS (OVER 200 AMP) - 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
_IC.NO SIGNS TRANS. 3.00
ARCAiOR ENG. SPECIAL CIRCUIT. 5.00 PERMIT VALIDATION
SS
. cup EMP:METER OR POLE INS. 20.00
ADDRESS
ASMOTORS SEE FEE SCH.
- '
SERVICE CHANGEPAI20.00
0 LICENSED CONT RACTORS DECLARATION
a u U I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE _ 1
y<N (commencing with Section 7000)of Division 3 of the Business and SEP - BLDG. ELECT: PLG. MECH.
r m z Professions Civil.and my license is bi full f0se�ii
z o m - License CP s Lic.Number y 1
g m r Uule Contrmh _, ��'.LI�'L�- _ pity wi OuDe to Ires
a y E W W Y uaN 4UlV BUILDING PERMIT
¢ ¢ w a OWNF-R-BUILDER DECLARATION
o a INFORMATION
w ; LL I hereby a firm that I am exempt frovi the Contractor's Licence MISC.- REFER TO ORD
u. o¢ Law for the following reason.(Sec.7031.5,Business and Pro fessionsVALUATION $/FT.
I-.- PERMIT ISSUANCE 10.00 )2-.OP /�� O p/A
w 0 Cade:Any city or roomy which requires a permit to constru ession' l/V/
¢ ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. 1
D¢ requires the applicant for such permit to file a signed Statement that TOTAL d J
w m isTTO
is licensed pursuant l0 the provisions of tl,c Contractor's License
�RMIx"r�
Law(Chapter 9(commencing with Section 7000)ofDivision3orthe
i o Business and Professions Code)or diet he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ H m the basis for the alleged exemption.Any violation of Section 703 L$ STORIES TYPE CONSTR,
a ; - by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN IEA.) 5.00
of not more than five hundred dollars(SSOOM: -
0 1,as owner of the 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,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to all owner of
properly who builds or improves thereon,and who does such work' FIXTURES-PER TRAP 5,00 SO.FT.FLOOR�AREA TOTALACREAGE
himself re of rote his own employers,provided tb:v such improve- T
menti are not intended or offered for sale,IL ed that s the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00 I/ a 10
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not fund or all- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale). INDUSTRIAL WASTE INTER3000 RES IND CON PB - Other
CI . .
1,as owner of the property,am exclusively communing with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5_V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I lie Contractor's License Law docs 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 punuant to SEWER-SANITARY-STORM EA,200ft/10.00
The Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM - 5.00 ACC.OATE ACC.FILE NO,
WORKERS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure,
ora certificate of Workers'Compensation Insurance,or it certified i J ZONING ENG.SITE NO.
copy thereof(Set.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY TZ4
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
F- O Applicant Y❑ N❑ V ❑ N❑
W Cl:RTI FICATI:OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 I;t.0 FLOOD ZONE A.L.U.C.
LU > COJ fIPENSATION INSURANCE PLG.CONTR. LIC.N0, PLG. S
CL o •1'I'his section need not be,completed if the permit is for'One TOTAL ` V❑ N❑ Y C] N❑
::) re
2 handled dollars IS 100)or lrssJ
U O I certif that in the perfo ane oftliwor far whirl his per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is is mil, shall nal cm Ir at pe n In'n man cr o os lo,
LU become' V Rte Wm 'C pens i of 'Orn'
Uy Datr 1� IApplican - ALTER OR ADD TO MECH. 5.00 BUILDING 19 7-7.
} to NOTIC 'I' APPLICANTAI after making this Ceftifica`w Fs-
♦- ? emption,y u should became subject to The Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor COdc, you nmsl forthwith comply with - FEE
U such provisions or this permit shell be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANCLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the perfonnne, f.the work for w h this en vis issued(Sec. MICROFILM ^�
3097,Cis C.). L-/l (� ��� HEATING UNIT TO 100,000B.T.U.) 8.00
Lender's Name
Lender's Addre psr-J tNLI HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC SI It '
I certify that I have read this application and slate that The above VENTILATION FAN (SINGLE) 4.00 1
Ordinances n correct I agree to comply with all city and county PLUMBING [ `
ordinances send state hews relating m building l city ando0. and BOILER-COMP(3 H.P.Of 100,000 B.T.U.) 6.00 6 ,--
hereby authorize representatives of this city to enter upon vie BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify,and keep harmless the City of MISC.- REFER TO ORD. r,�
ino ago bililies,judgments, costs and expenses which CONST.TAX .
ay in any y a roc again said City in nse urns of Ihr PERMIT ISSUANCE 10.00 �•y 4
91
ra 'ng f11, m MECRCONT. LIC.NO. MECH.
(' TOTAL r TOTAL
SigWz
nature of Applicant/Con[ruc 1 n[e O I
OFFICE COPY