18212 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 18212
INSPECTION DIVISION
JOB INSPECTION RECORD (i L)
CPE RMIT�PXPIRATION
--77 � �•
JOB ADDRESS- �c_[_tn/_g-PLL�/_'d�I—,UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 160DAYS OFPERMIT ISSU-
FOUNDATION ANCE OR 160 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED—
UNDERGROUND /SLAB
IGNEDUNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL 6LDG ELECT,I PLG. MECR .
0' ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION.I $TFT.
PLUMBING - R e/
G.?.
MECHANICAL
ELECTRICAL �wL'Rp1ITTo-
FRAMING '
INSULATION STOwIE:S IYPE CONST+
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT.PLrwR Ab:A TOTAL.ACRLACE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
/ RUI.DING USE
ROOFSHEATHING RES/ IND CON Pu oTn„
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP, 2 L L El L
ROUGH SAN.a
ASSESSORS PARCEL NO
,
PLUMBING ELECT, ENERGY
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE No
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
IZONING ENG SITE NO.
INSULATION
PLUMBING
GAS TEST GAS
FIFE SPFINK ENERGY T 24
MECHANICAL Y [] IN Y L NL.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC
INTERIOR SHEAR FIRE DEPT.
L No Y L NL
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH IBUILOING BUILDING . 61
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRICP LAN CHECK
GAS FEE �.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE � Q
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED By BUI LDING INSPECTOR. .MICROFILM ^^”"
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONEMORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADD RESSWHEN PHONING.
z'
— SEE PERMIT, FOR EXPIRATION DATE —. MECHANICAL - --
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL . re-1n".oV
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY•
BUILDING PROJECT I DENTI FICATION ,PERMIT NUMBER
B LDING APPLICATION & PERMIT O r� q e�
ADDRESS7371 0(J I (,
Q BUILDING —ELECTRICAL—.PLUMBING—MECHANICAL
O NER'6 PLAN CHECK VALIDATION
NAME.
PRONE �7 OTY. ELECTRIC PERMIT FEE
L.r1 UT �$
NAMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
LIC,NO. LIGHTING FIXTURES 10.00/1.00
ADDTRALTORs ' r
ADDRESS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER ,
uc.NO, SIGNS TRANS. � 3.00
ADDR OR ENG, PERMIT VALIDATION
ADDRESS _ SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00'
ESS `
APPLICANTS MOTORS 7rl 1
ABER Ess SEE FEE SCH.
r
SERVICE CHANGE
woo LICENSED CONTRACTORS DECLARATION
¢ I herebyaffirm that I am licensed under provisions of Chapter N 2 w p s ISSUANCE DATE
¢ a
(commencing with Section 700e)is
Division Sof t he Business and BLDG. ELECT. PLG. MECH.
H w i Professions Code,and my license is in full force and effect ❑ [:J0o Z,m o License Class Cone.Number flYyl
Date Contractor
P: E2 L
BUILDING PERMIT
rc ¢ono OWNER-BUILDER DECLARATION , INFORMATION
wu 3 1 hereby affirm Om[1 am exempt from the Contractor's License MISC.— . RE TO ORD
a. O¢ Law for the following reason.(Sec.7031.5,Business and Professions O VALUATION $/FT.
N ; PERMIT ISSUANCE 10.00 L/ 2� ,
Code'.Any city or county which requiresa permit t o Conslmcq.11",
¢ or ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
a
o ¢ requires the applicant for Such permit to file a signed statement that TOTAL 1�r`� '� PERMIT TO
w es Ire is licensed pursuant to the provisions of lire Contractor's License -
riaLaw(Chapter 9(commencing with Section 7000)of Division 3 oftlte �•) -
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ Ho the basis for the alleged exemption.Any violation ofSeolion 7031.5 STORIES TVPF�r^
by any applicant fora permit subjects the applicant too civil penalty ALTER-DRAIN -WATER IEA.) 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 sole compensation,will d0 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 does such work FIXTURES,PER TRAP 5.00 SO.FT,FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-� RE IND CON PB Omer
prove for purpose of sale.).[) ❑ 1,as owner ot'the properly,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑
2 licensed contractors to construct the project(Sec. 7044,Bustncss LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Coda:The Contractor's License Law does Tint apply
wO to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
z contracts for such projects with s eontractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
0 the Contractor's License Law. - TRACTi NO. PARCEL NO.
/. .YL tum exempt under Sea- -,B.&P.C.for this WATER HEATER W/VENT 6.00
OwnerDale t f WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WOR KIiRS'COA} IiNSn'1'ION DEChA RATION 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 u certified
0 Copy thereof(Sec.3800,Lab.C.). -
Policy No. Company -
Q 0 Certified copy is hereby furnished. - FIRE SPRINK ENERGY T 24
Z Z El Certified copy is fled with the city inspection division
A . MISC.- - - REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
1 N CF.RTI FICATE 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. •I-C.NO. - PLG,
Z (This section Reed not be completed if lire permit Is for One TOTAL Y❑ NE] Y E] N❑
hundred dollars($100)or less.)
U O 1 certify that in the performance of the work nor which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
V, U_ I— mit is issued,I shall not employ any person in Tiny manncrroas to OQ
O w become suhicef to the Worker Compensation'Lucas of Cnl...... .
QQ a Datc Applicant BUILDING �•�-.
} w NOTICE TO APPLICANT: If,after making this Certificate of lis- ALTER OR ADD TO MECH. .5.00
F Z eruption,you should become subject to the Workers'Compensation APPLIANCE _ 5.00 PLAN CHEC �
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.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER t0,000C.FM.) 6.00 SEISMIC FEEx5o
I hereby affirm that there is o construction lending agency our EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit Is Issued(Sec. MICROFILM
3097,Cie C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 / $`D
Lender's Address ELECTRIC
.1 certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 -
,� information-is correct. I agree to comply with all city and county BOILER-GUMP IO H.P.Or 100,000 B.T.U.) B.00 PLUMBING
oNinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter upon the 801LER-COMP(Cover100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for Inspection purposes.
(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 10.00 CONST.'I AX
nay in any way accrue'against said City in consequence of the
`ranlingoflhisrmiL MECH.CONT. LIC.NO.. MECH. ..
-;Uutc TOTAL TOTAL% ��•DD
ignature o pp ant noaclor '
OFFICE COPY