18166 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY. OF •CUPERTINO 18166
INSPECTION DIVISION
JOB INSPECTION RECORD
• 9�j (,� �D r Q PE RMIT EXPIRATION
JOB ADDRESS—I–Q�`l—LLQr( T #NIT# _LOT
II PERMIT EXPIRES IF WORK
d
OWNER V( -e CONTRACTOR A It lQ A, a(/+ IS NOT STARTED WITHIN
INSPECTION IDATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF ,y,I.PERMIT VALIDATION
GARAGE SLABS CUPERTINO STANDARDS. PAqdDG
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED t V UNDERGROUND /SLAB r� 1989
PLUMBING {,, 4
ELECTRICAL City of Cupertino ISSUANCE DATE
BLDG 'ELECT I PLG. I MECH
MECHANICAL Ei
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- INFORMATION
WOOD FLOOR
VALUATION SIFT,
PLUMBING
MECHANICAL
ELECTRICAL - PERMIT TO
FRAMING
STORIES TYPE CONSTR
INSULATION
Occ GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE sa.IT FrooR AREA TOTAL ACReACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING E
US
ROOF SHEATHING Res Irvo CON PR Go—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ E] ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
f ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE No
FRAMING ELECT.FINAL TEST ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE$PRINK ENERGY TQ•
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y o N zoNR_ ❑ rv�
FLo
EXTERIOR SHEAR ELECTRICAL RELEASE ALuc.
]
Y
INTERIOR SHEAR FIRE DEPT. N� v ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVAL
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC kf�
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL dr7
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT I DENTI FIC1ATIj;�A AM PERMIT NUMBER
au-M. , APPLICATION & PERMIT 1 0 6 v C C
ADDRESS UI DING - ELECTRICAL-PLUMBING-MECHANICAL 1 o
tov
'
OWNERS PLAN CHECK VALIDATION
NAME �a/• OTY. ELECTRIC PERMIT FEE MON O
NAME croRs OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
•e d LIGHTING FIXTURES 10.00/1.00
CONTRACTOR R's
APPLIANCES-RESIDENTIAL 4.00
ADDRESS
JV� rPHONE �(6.. EiL,4 PANELS - 10.00 DATE OF APPLICATION .
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
On
ENGINEER
LOC.No. SIGNS TRANS. - 3.00
ARCH.oRENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ADDRESS
/
ZIP EMP.METER OR POLE INS. 20.00 4-O `TZ 6-�
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE p 20.00
4, y�v�Hv �c j
o o LICI7NS1iU CONTRACTORS DECLARATION p - -
¢o u I hereby affirm that I am licensed under provisions ol'Chapter 9 sj t)IV f �7 O ISSUANCE DATE
y Gn Icommrncing with Section 7000)of Division 3 of the BusiOess and BLDG. ELECT. PLG. MECH.
H z Professions Code,and my license is in full force and of feel. EJ
z ❑ ❑
z o - Liceme Class Lic.Number
0 -CI`) Of C:ip6(lino
a xr w Dale C..nto,ior
s " BUILDING PERMIT
¢ ¢ w rt OWNER-BUILDER DECLARATION INFORMATION
o a ° MISC.- REFER TO ORD
I hereby nffurn that I um exenlo
l pl t}om the Contrucr's License
LLo¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
� - Code:Any ci ty or county which reytliresa permit to,cma"mt,allco �"0�
¢ it ¢ o improve,demolish,or repair any structure.prior to its issuance,also ELEC.CONTR. LIC.NO. ,
0 u requires the applicant for such permit to file a signed statement that TOTAL , It./ PERMIT TO
a w m he is licensed pursuant to the provisions DO the Contractor's License
HZQ
Law(Chapter 9(commencing with Section 7000)of Division 3 or tire
4 o Business and Professions Code)ITT that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES I TYPE CONSTR.
a by any applicamfor a permit subjects the applicant o a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars 1$5001.1:
❑ I,as owner of tire property,or try 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 does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
re
ments anot intended or offered for sale.If.however,lbC building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year.of completion,file owner- GASEA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or ire- - RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 F-1 ❑ El El El
1,as owner of the property,an exclusively contracting with
licensed contractors to construct the project(See. 7044.Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Profcsi(ins Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projectswirh a contractors)licensed pursuant 10 SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
O lam exempt under Sec.-.B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner DaW WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby alfirm That I have a coificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lub.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z liI it ry is- Cd ith the city inspect..... division. MISC.- REFER TO ORD.
O Applicant y V ❑ N❑ V ❑ IN C]
F- y PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
CIiRI'IPIG'I'I'.O p I?%EM PION IrROM WORKI IIS'
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. vLGTOTAL. N[_ Y ❑ N❑
d O 11'his section need not be completed it
the permit is for one
2 hundred dollars IS 100)or less)
U O 1 certify that in the performance of the work for which this per, QTYMECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any mnn
aer so as to
U become subject to the Workers'Compensation Laws of California.
0 W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificate of E.
? caption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
pmvisions of the Labor Code, you must forthwith comply Wdh FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10DWC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of lire work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Co.C.l.
Lender's Nae HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC O�
Lender's AddressOR'
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and unnty PLUMBING
ordinances and slate laws relating to building construction. and BOILER 6.00
H.P.or 100,000 B.T.U.) 6.00
hereby uuthorire m,mVertalivcs of this city to anter upon the BOILER-COMP (Over100,000BTU)SEEFEESCH. MECHANICAL
above-...entioned p,.Perry for inspection purpous.
(We) agree to save, indenmify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
tenting cfthi,permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL ,OP
Signature of App¢nalJC.y+l for Ualc �
OFFICE COPY