15281 POST THIS CARD NEIR FRONT OF BUILDING PERMITNUMBER
CITY OFUPERTINO 15281
INSPECTION DIVISION
JOB INSPECTION-RECORD
/'' r({ �o/J PERMIT EXPIRATION
JOB ADDRESS I) N, W04r- GI �/ UNIT# _LOT#. '
• /.'• - '.PERMIT EXPIRES IF WORK
OWNER E[.� RDNf r- u f oa: CONTRACTOR E, ,� Ve IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: `; LASTCALLEDINSPECTION.
UFER - ALL GRADING AND,DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLR%RT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - - - '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED :
UNDERGROUND /SLAB
. PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL - -767TELECT, PLG" MECH
- . . ❑: ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �U` - BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING' city 01 UuvorIR/D' VALUATION $IFT.
to C90 t�
MECHANICAL /
ELECTRICAL PERMIT TO
FRAMING "
/v c5<1 1,0C
INSULATION STORIES Tv ECONSTR.
„ - UCC,GROUP RES:UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.IT,FLOOR AREA TOTAL ACREAGE
. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID �F
ROOF SHEATHING RES INBDwIOWNusp8 ,--Gm..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED' FINALS DATE INSP. El ED ❑
ROUGH SAN.N -
,ASSESS ORSPARCEL NO
PLUMBING - ELECT.ENERGY "
TUBS&SHOWER PAN PLUMBING ENERGY- - ' TRACT NO PARCELNO.
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ACC.DATE ACC,RILE No
FRAMING �a0'ffg6ld ELECT.FINAL TEST '
- ' ZONING ENG.SITE NO,
INSULATION - �' PLUMBING
GAS TEST GAS xv
MECHANICALFIRE SPRINK ENERGY 12 .
y [:] N❑ y
1:1 No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUC/
INTERIOR SHEAR FIRE DEPT. . -ILI-� IL v❑ "❑ Y ❑ N❑.
SHEETROCK" GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING -/f,'_
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK
' GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
w ARRANGE FOR INSPECTION BY PHONING 252-4505, �', ELECTRIC
H-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. '- PLUMBING,
z
l PLEASE GIVE JOB ADDRESS WHEN PHONING. "`
•' R ."s
— SEE PERMIT FOR EXPIRATION DATE —. s �a' MECHANICAL
IMPORTANT!- , . ;;' ;;; CONST.TAX '
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATIQN WITHIN RED LINES - USE BALL POINT PEN ONLY
.. ieUILOING PROJECT IDENTIFICATION - PERMITNUMBER
°'`DING2020 AOCO Al APPLICATION & PERMIT 1 C 0 .
• ADDRESS I J 0
IIZ BUILDING = ELECTRICAL-,PLUMBING-MECHANICAL
OWNER'Sj_� / I L.�TR�LC6�`�,^ PLAN CHECK VALIDATION
NAME I Q�Lr'f SWI C.AXATLIYVV0l OTY. . ELECTRIC PERMIT FEE
. 'TM MA 00kA) PHON I
NTA
NA.L S .�I�f�� UTLETS-SWITCHES-RECEP 10.00/1.00
(,
UC.NZ431 LIGHTING FIXTURES 10.00/1.00 .
nooREsW as TORE/sx?. N� W�sy APPLIANCES-RESIDENTIAL• 4.00 +
Iv.'!&w PHONE PANELS 10.00 DATE OF APPLICATIOF
ARCHITE�,i.,rPLAN CHECK FEE P.C.NO.
ORAlzk PANELS (OVER 200 AMP) 20.00
ENGINEER -�c�---
LIC.N 1. SIGNS TRANS. 3.00
ARCH.OR ENG' GA aY1 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS( e<�16�A� � �L,
A�1./NR W3 S�TAN�OJI L* FEMP.METER OR POLE INS. 20.00
APPucaNr' - MOTORS SEE FEE SCH. l/AUL,\
ADDRE55 1s ale
SliMf_ 4F� w�w�ry�CS) SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION �`��
Hz W I hereby affirm that 1 am licensed under provisions of Chapter I) ! ISSUANCE DATE
w aly (commencing with Section 7000)of Division 3 of the Businessand BLp�,p ELECT. -PLG. MECH.
H D 2 Professions Code, my license is in full for c BL ❑ PL
i= G License la. L1u: Numb w�liC1 1ID�
,A H j Datc�C R To
DE `\
a x �e LDIN G PERMIT
¢ a a OWNER-BUILDER DECLARATION
¢ w u NFORMATION
ce;' N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
F u o J Law for the following reason.(See.7031.5,Business and Professions VALUATION 5/FT.
w Cade:Any city or county which requiresu permit to construct,alter, 'PERMIT ISSUANCE 10.00
¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. Qe
aa 0iL D LL requires theapplicant for such permit to file a signed statement that - - TOTAL
w he is licensed pursuant to the provisions of the Con Dactor's License PERMIT TO
wii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
7i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE r
ac H $ the basis for tire alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit Subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sale 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 an owner of
. property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
meats are not intended oroffered for Side.If,however,the building GAS-EA.SVSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4(EA.) 200
builder will have the burden of proving that he did not build or im- - . . BUILDING USE
RES IND CON PB Osho'
prove 1,aso nee of sale.)' INDUSTRIAL WASTE INTER." 30.00
❑ d as owner of the property,he exclusively contracting 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:The Contractors License s thereon,
docs not apply
to contracts
owner of property who builds tr improves rased p,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 the
Co is for such projects with a contracmr(s)licensed pursuant m 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.DATE ACC.FILE NO.
WORK ERTCOMPFNSATION DECLARATION I ,WATER TREATING EOUt 5.00
1 hereby affirm that 1 have a certificate of consent«+self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah.CJ.
Policy No. Company -
❑ Certified copy is h •by fur 'shed. FIRE SPRINK ENERGY T-20
Z ❑ Cerlif o t led w 1 he city
inspection division.
���� MISC.- REFER TO ORD.
OVA pplic:ut• G(c '� c Y"❑ N❑ V ❑ N❑'
~ w PERMIT ISSUANCE 10.00 PLOOD20NE A.L.U.C.
CIiRTIFI E OF C%IiMP1'ION PROM WORKIiRS' -
W COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. v❑ N❑ v ❑ N❑
C O (This section need not he completed if the permit is for one TOTAL
Z hundred dollars IS IOD)or less.) -
U O 1 certify that in the performance of the work for which this per- OTY. Il lNICAL PERMIT FEE FEE SUMMARY
W F mit is issued,1 slhall not employ any person in any manner so as to I
O W became subject to the Workers'Compensation Laws of California.
CL Ualc APPlmanl ALTER OR ADD 1`6L MECH. 5.00 BUILDING rb
} W NOTICE 1'O APPLICANT: II',after making this Certificate or Ex-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE r. 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,O QF.M.) 4.00
CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE 474-t-_O
1 hereby affirm 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,CivC.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name_--�� t� HEATING UN IT(OV ER.l 00,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have read this application and state That theabove VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COIvtP(3 H.P.or 100,000 B.T.U.1 6.00
hereby authorize representatives of this city Id enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
obovmmcntioned property for inspection purposes. p
(We) agree t indemnif ep huntress the City of MISC.- REFER TO ORD.
upertino ns abiliti`c !ftnts, sts and expenses which CONST.TAX
may
any against sai yin consequence of the PERMIT ISSUANCE 10.00
mg el MECH.CONT. LIG NO. MECH. , !'
TOTAL TOTAL 3 .
Signs re o ant Ommcln a
OFFICE COPY '