18847 POST THIS CARD'NEAR FRONT OF BUILDING
PER mIT NUMBER
CITY OF CUPERTINO 18847 .
INSPECTION DIVISION ,
/ '^^ MJOB INSPECTION RECORD
{ O V ` r �vz - UNIT# LOT jt ' PERMIT EXPIRATION
JOB ADDRESS - q PERMIT EXPIRES IF WORK
OWNER �. �•E Co tl CONTRACTOR d(I • , /� PL -/' IS NOT STARTED WITHIN
INSPECTION DATEV I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
_ ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF Pr RMIT.VAUDATION
CUPERTINO STANDARDS. PAID
I I
GARAGE SLABS - � S + 9/
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 091,06 , _ `'�ppcn.
UNDERGROUND /SLAB 0* 0A,,4_7 NOV 0"
PLUMBING, ,B</�6 '9 vnbG;c. ,,ir+zwr+o Oe j
ELECTRICAL OaGy,. �� �hV CIV "1 r���TPsIR� _ ISSUANCE DATE `I
MECHANICAL v4'a G�-o.ia..� on�t stat ELEcr.
p Ptc, r.+F�cR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SiPT.
PLUMBING '•+
MECHANICAL
PENF111 10
ELECTRICAL
FRAMING - ,' w X11
INSULATION
- sI Rles rvPEl NSTR.
-Occ
. OF
RES urvi rs:.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .
SO Fr.FLOOR wncA wrAI Ace Eact
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -'
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND - CON PB 0'F •
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE ' INS?. :❑ El El ❑ El
ASSESSORS PARCEL NO
ROUGH SAN.N
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 ZONING ENG,SITE NO.
- INSULATION PLUMBING .
GAS TEST - GAS
MECHANICAL
FIRE SPHINK ENERGY T24
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y ❑ [ ❑ ND
EXTERIOR SHEAR ELECTRI CAL RELEASE '. FLOOD ZONE A U,C,
INTERIOR SHEARFIRE DEPT _ ` ❑ NEJ r L' 'N�
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING '
.INTERIOR LATH . TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC - PLANCHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Zoa
O PLEASE GIVE JOB ADDRESS WHEN'PHONING.
Zf •
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
E
L
t'' CONST.TAX
IMPORTANT! ;T p
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE OOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
5U LDI NG PROJECT'IDENTIFICATION
PERMIT NUMBER
GILDING APPLICATION & PERMIT 18 8 4 7
IDDRE55
BUILDING - ELECTRICAL—PLUMBING—MECHANICAL .
OWNER'S T PLAN CHECK VALIDATION
NAME ��..�s�.�� OTY. ELECTRIC PERMIT FEE
CA S01 &7"
NAME cTOBs fi 3� UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Ic.NO: p LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESSPPLIANCES-RESIDENTIAL 4.00
CONTREAA
PANELS 10,00 DATE OF APPLICATION
Rc rrecr PANELS (OVER 200 AMP) 20.00 PLAIN CHECK FEE .G NO.
O
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS ENc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
r ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS
ADDRESSSEE FEE SCH, lSJ
SERVICE CHANGE 20.00
0 0 o LIC17NSED CONTRACTORS DECI.ARA'I'ION
4 is w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
N c to (commencing with Section 7000)of Division 3 of the Busin a add BLDG. ELECT. PLG. MECH.
H z Pool..inns Code and my license is in full I,rce a •(feel NI n\/ l �'1 ❑ ❑ zi ❑
Io "r3 — License Class�: Li,Number. ,-cam
9 H w Date��=8_�Contraclo
.� _ -s- BUILDING PERMIT
w u OWNER-BUILDER DGCL RATION .I,,,. INFORMATION
w ; LL y I hereby affirm that 1 am exempt from the Contractor's License MISC.— RE ER TO ORD - VALUATION=
F LL o a Law for the following reason.(Sec.703 1.5,Busineuomd Professions PERMIT ISSUANCE 10_.00
3w> S Code:Any city or county which reiliins a lwmit to construct.alter,
ty ¢ O improve,demolish,orrcpuir any stnmWre,prior to its issuance,also ELEC.CONTR. LIC,NO. ELEC.
va
—O u requires the applicant for such permit to filo a signed statement that TOTAL PERMIT TO
w$n he is licensed purocant to the provisions o1'(he Contractor's License
F z ¢
"w(Chapter 9(commencing with Section 7000)of Division 3 oflhe V
Business and P,oressions Code)or Omt he is exempt Ihcrefmln old QTY, PLUMBING PERMIT FEE
re F- $ the basis for the alleged exemption.Any violation of Section 7031.5 ST IES TYPE rNSTR.
u3 � by any applicant for a permit subjecls the applicant toa civil penalty Z ALTER-DRAIN -WATER IEA.) b-66 �y
of not more than five hu/eniployce
d dollars 155 ].I: -
❑ I,as owner of theperty,or my employ...with wages as BACK FLOW PROTECT.,DEVICE 440 OCC.GROUP RES.UNITS
their sole compensation, l do the war- unit the stricture u not
intended or offered for (Sec. 7174 . Business and Professions DRAINSL ROOF,'AREA,COND. 6.08
Code:'rhe Conlracmr's nse Law d not apply to an owner of
properly who builds or ove,Ihur n,aP1 who does such work FIXTURES-PER TRAP &00 p•� SE-FT FLOOR AREA rorAL ACREAGE
Ili •
himself aror not
ough ntende omred to le.If.cd ever,hat th improveGAS-EA.SYSTEM-11NC.40UTLETS 4,9&
mems are not intundeJ ofered fa sale.If,however,the buildingor improvement is Sold in one ear of completion,the owner- GAS-EA.SYSTEM-OVER 4IEA.) 9rB0builder will hove the buof prt ing that he did not build or ie, BUILDING USE
prove for purpose of saleINDUSTRIAL WASTE INTER. o9foo RES IND CON PB Omer
1,as owner of thepert ,am exclusively contracting with ❑ ❑ ❑ ❑ ❑licensed contractors to t t the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. .GBG ABB SSORS PARCEL NO.
and 14oressioas Code.Tho ramor's Licensse law doe,.not apply
to an owner ofproperty builds or improves thclton.and who LAWN SPRINKLERS-OVER 5 IEA.) 7.00rontrac isforsuchprojecth a contractodsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.88
the ConUaclor's LicenSr TRACT NO. PARCEL NO.
am exempt undec. ,B.drP.C.I'or Ibis WATER HEATER W/VENT 6= py
reaum
Owner Date WATER SYSTEM 3[" ep7 ACC.DATE ACC.FILE NO.
WORK F-RS•COMPENSAI'IoN DI!CLARA'IION WATER TREATING EQUIP. 5.99
1 hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workeri Compomation Insurance,or a certified
copy thereof 1 3800,LAC.). �
�$$c�c
Policy Noge(opy Is piny
❑ Certified copy is cby is a FIRE SPRINK ENERGY TiC
Z 2 CVifie 'op tiled wit the city inspection division.
p A plicate c MISC.- REFER TO ORD. y❑ N❑ y ❑ N❑
~ vy / IC PERMIT ISSUANCE i8,B0 -
= Cli II°ICATI;( 1iXEMPI'ION FROM WORKERS' .Zed7 FLOOD ZONE A.L.U.C.
IL > COMPENSATION INSURANCE PG.CONTR. . LIC.NO. A- PLG.
0- 0 ('Phis section need not he completed if the pennil is for one ��� TOTAL a p7 Y❑ N❑ Y ❑ N❑
hundred dollars IS 100)or Ic.S'.)
U O 1 ceniiy that in the pert ......I of the y{rk for which this per- FEE SUMMARY
LL I— mit is issued.I shall not employ any pe pl any manner so as to QTY. MECHANICAL PERMIT FEE
U become subject m the Workers'Compens ran Laws of California.
U-1 Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NO]ICE 'I'O AI'I'L'CANI: If,after .king this Certificate of 1 -
♦— ? emption,you should become wbjea o the Workeri Compenution APPLIANCE 5.00 PLAN CHECK
Provisions or the labor Code, yo must,forthwith comply with FEE
U such provisions or this permit.hal ledeemed rcvood. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION ENUINGAGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE
I herehy .(tura that there o construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the perform ane. nl the war for which this ry;nnit is isxad(Sec: MICROFILM
3097,Civ.C.). HEATING UNIT(TO 700,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
LalJer's Address
1 Lacy thtlh ca m's pplL rot and si to that lhcaWve VENTILATION FAN (SINGLE) 4.00 _
information is correct, I agree to comply with all city and county PLUMBING
ordinances a d state laws relating to buildIf construction. and BOILER-DOW(3 H.P.or 100,000 B.T.U.) 6.00
h nby aut1non, representative, of m is city In ynny, upon the BOILER-COMP (Over 11X),000 BTU(SEE FEE SCH. MECHANICAL
bo a mentioned properly I' purposes,inspection n urn se.
(We) agree to sive, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and cxpensce which CONST.TAX
may in any wa accrue against slid City in consclmcuc, of the PERMIT ISSUANCE 10.00
rantingofthi omit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Si or o A ant/Contractor.
OFFICE COPY