14718 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 14718
INSPECTION DIVISION
.JOB INSPECTION RECORD
EXPIRATION
JOB ADDRESS 116—V-6 I MNCI�� R7) UNPERMIT IT# . LOT '
PERMIT-EXPIRESIF WORK
OWNER L _R,Y 4l�� CONTRACTOR �d woad .IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECO D 180 DAYS OF PERMIT ISSU-
ANCE;OR 180 DAYS FROM
FOUNDATION NOTE: LAST CALLED INSPECTI ON.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRMO VAUDATTON
CUPERTINO STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _
UNDERGROUND /SLAB
PLUMBING 0 /
ELECTRICAL ISSUANCE DATE .
MECHANICAL BLDG ELECT I PLG. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION sIFT.
PLUMBING
MECHANICAL
1y�PERMIT 10
ELECTRICAL
FRAMING t _V
STORIES TYPE CONSTR
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INS°.SHALL REMADE BEFORE .SO R ELOORARCA U)TALACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 1 .
N USE
ROOF SHEATHING � Res ING CON PB o.I,..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ .❑ ❑ ❑ "
ASSESSORS PARCEL NO
ROUGH SAN.4
PLUMBING ELECT,ENERGY
TRAGI NO. PARCEL NO
TUBS 6 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC PILE NO
ELECTRICAL BUILDING ENERGY
FRAMING - ELECT.FINAL TEST ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPHINK ENERGY i.29
MECHANICAL •
/O Y ❑ N❑ .I N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
`I.000<oNL aLuc.
EXTERIOR SHEAR ELECTRICAL RELEASE
❑ N❑ L N
INTERIOR SHEAR FIRE DEPT. ❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVA
SCRATCH COAT ELECTRIC LAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY '"SMIC FEE ..
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SI GNED BY BUILDING IN\PEk4� .,.MICROFILM :
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 3/f�
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
_.APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
F. BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT `
BUILDINGADDRESS ,a0o wo 1471 8
. ADDRESS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OwNEg5 _ i_ t1. �Op - PLAN CHECK VALIDATION
/p�1.��7 / O OTV. ELECTRIC PERMIT FEE
14e
6� Clem
Nrfl c, _ems P OUTLETS-SWITCHES-RECEP 10.00/1.00
pre-c �( sec.No. LIGHTING FIXTURES 10.00/1.00
p f°��f5VX Ia,�5 �7 APPLIANCES-RESIDENTIAL 4.00
RLOC, O E / PANELS 10.00 DATE OF APPLICATION
ORCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS ENc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlv TEMP.METER OR POLE INS. 20.00
APPLIANTS
MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 y
woo LICENSED CONT RACTORS DECLARATION
IY u I hcrch}'aflinn Ihul 1 ran iccnscJ Imdcr provisions of Chaplcr 9 ISSUANCE DATE'
yaw (ttnmocneulg with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F 0 z Pro a ions Code,and my tic• se is in full 10 - d ( t
Z, 0 H - Li WPK �p YAILA ILn Nmnb• _ ❑ ❑
9 y Dutu$ Cnnlmno �L
Q a, W a -1 OWNER-BUILDER DECLARA TON V \ BUILDING PERMIT
oTU MISC.- REFER TO INFORMATION
w3 LL 1 hereby aRinn that I un exempt from Ilm CwlImetor's License - IWALUATION
LL04 law for the following reason.(Sec.7031.5,Ilusinasand Professions PERMIT ISSUANCE 10. 0 c 0 S/FT.
� - 0 Code:Any city or county which requires a permit to construct,alter,
R ¢ improve,demolish,or repair any structure•prior to its ismanec,also ELEC.CONTR. LIC.NO. ELEC. �N
O ¢ requires the applicant For such permit to file n signed st Contractor's
L t that TOTAL EHMIT TO
E
m�` he is licensed pursuant to the provisions 0f the Contractor's Limnse
H z r Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a :laciness
and liml'cssiuns Code)or that he is exempt thcnm fraadd QTY. PLUMBING PERMIT FEE
H 0the hasis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
aim by any applicant for a permit subjects the applicant oa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of nut more than five hundred dollars.(5500).1'.
❑ 1,as than
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 an owner of
property who builds or improves thereon,and who docs such work - FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
improhimself or through his own employees,provided that such
ve-meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
,owe1brPurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 BEs IND CON PB Omer
❑ I,os owner of the property,am exclusively contracting with El ❑ 1:1 ❑ 1-1
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 does not apply
t0 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(O licensed pursuant to SEWER-SANITARY-STORM EA.2001t/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ tun exempt under Sc,._,B&P.C.far thio WATER HEATER W/VENT 6.00
reason
owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORK ISRS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of-consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a ecifitied
co a he,-.115x� DI
Q O Certified copy is hen y umuheJ_.�5.//L.(� FIRE SPRINK ENERGY T24
Z Z yy�( C 1'ic o, ll d-w 11 clic cit ampe' n d1V\Ind.
Q Ajlplican E'rp.-{ILtO�]Iv REFER TO ORD. J�IGOD-ZONNE❑ ❑ Y ❑ N❑
�' CIiRTu' ' '1':a 'kziMP-iT7(N PRO !C PERMIT ISSUANCE 10.00_ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.0 (This %ection need not be completed if the permit is for one TOTAL Y N❑ Y❑ IN
Z hundred dollars IS 100)or Ic.I
U O 1 certify that in the performance of the work I'or which this per- CITY. MECHANICAL PERA'VAFEE FEE SUMMARY
LL H mit is issued.1 shall not employ any person in any manner ,,as to 1r I�
Owbecome subject to the Workers Compensation Laws of California.
W Date Applicant ALTER OR ADD TO MECH. .e BUILDING
} GONOT'ICE'10 APPLICANT: If,after making this Certificate of ISx-
F Z emption,you should become subject to the Workers Compensation APPLIANCE a 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with ( FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10 C.F.M.)
CONSTRUCTION LENDING AGENCY '--. AIR HANDLING UNIT(OVER IO . I{.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency 1'or EXHAUST HOOD(WITH DUCT) 5.00
the performance or1 the work for which this permit is issued(Site. MICROFILM
3097,Civ,C.l1 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders A
Lender's Adddressdress �f fllA-� HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I eerlily that I have read this upplicution and stale That the above VENTILATION FAN (SINGLE) 4.00
infonnulion n estate. I agree to comply with all oily and county BOILER-COMP(3H.P.or100,0008.T.U.) 6.00 PLUMBING
ordinances and scute laws relating to building construction, and q
hereby au0mrlre representatives of this city to enter upon ou° gO1LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL ✓
above Mentioned property for inspection purposes.
(We) agree to save, indemnify and keep h:Irm ICSS the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which i CONST.TAX
na in any way accrue against said City in consequence of the PERMIT ISSUANCE 1Q00 �Z
ant g of Ibis'permit. TLOCjLIC.NO. MECH. l
�'✓3L"13 TOTAL
TOTAL
stare oC Applicant/Contractor Date � � ec �jJ��(C
OFFICE COPY