15414 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
` ` a CITY OF CUPERTINO54
INSPECTION DIVISION -"
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS aa`z ZcP�J�SLLCI/tib A UNIT# '_LOT# -
PERMIT EXPIRES IF WORK
OWNER ,-j &e- CONTRACTOR IS NOT STARTED WITHIN
INSPECTION -DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. ,
ANCE OR 180 DAYS FROM
FOUNDATION � - t- NOTE:
UFER ALL GRADING AND DRAINAGE SHLASTCALLED INSPECTION.
ALL BE�INSTALLED '.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS,AND CITY OF PERNnT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS /
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Cove •-
UNDERGROUND /SLAB
' PLUMBING _ d-
ELECTRICAL ciISSUANCE DATE
MECHANICAL BLDG EI.ECi PLG. MECR
El ❑ D /b
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $IFT.
PLUMBING
MECHANICAL - Am rk
TC7 .
PERMIT TO '
ELECTRICAL _/1_Ll/ /���, d
FRAMING d. V 4
STORIES TYPE CONSTR.
INSULATION
DCC GROUP RES UNITS
_r PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NO E: SP.S L B FO so.Fr,FLOOD AREA +ornL ACREAGE
DIAPHRAGM. . THE CTION TA IS'
L, ROOF SHEATHING, \ BEs- INDCON
USE
OT"L. ❑ ❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BE SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.EN
TUBS 8 SHOWER PAN -21 - _ PLUMBING ERG TI+Acr No. PARCEL No
MECHANICAL = MECH.EN GY
ELECTRICAL / L/'�- � B U ILD ING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING .
GAS TEST - GAS
FIRE SPRINR E14ERGY
MECHANICAL T.N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ` ❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE AL I C.
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ v ❑ N❑
SHEETROCK GRADE- FEE SUMMARY
L EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING > _
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE �--
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICU
_ -- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMewG i; V
O� PLEASE GIVE JOB ADDRESS WHEN PHONING. -
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE.—
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. .
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - .PERMIT NUMBER
BUILDING APPLICATIQN•&PERMIT 1
AD.2 -1$ $EL,LEVUt At/. I J I
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S 0 PLAN CHECK VALIDATION
"AME QT-Y. ELECTRIC PERMIT FEE
-rETlNDE�I� GILL PHDNEass-�g7o
ANTRACTOR,
NAME - OUTLETS-SWITCHES-RECEP 10.00/1.00 Q
N
LIC.No. LIGHTING FIXTURES 10.00/1.00 &V
ADOREss TOra APPLIANCES-RESIDENTIAL 4.00 -
PHONE PANELS 10.00 O"'- DATE OF APPLICATION
ARLw TECT PLAN CHECK FEE P.C.N0.
X 0 I1 ,1 PANELS (OVER 200 AMP) 20.00
" ENGINEER,/JG/1/ SMI��f
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
\/ ADDRESS SPECIALCIRCUIT 5.00
J� ZIP EMP.METER OR POLE INS. 20,00
ADDRESS
APPLICANT S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 �f k/
w o o LICENSED CONTRACTORS DECLARATION (/ E
a i w 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
y A$ (commencing with Section 7000)of Division 3 of the Business and DG. ELECT. PLG. fgECH.
r w a Professions Code,and my license is in full force and effect. � � ��jl
o i w W License Class Lic.Number
Date Contractor
Q y E
rt o n U OWNER-BUILDER DECLARATION BUILDINGORMATIONT
w ; y I hereby affirm that I on exempt from the Contractor's License MISC.- REFER TO ORD
FaoJ Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 1BA0 AnON S/FT.
wj Code:Any city or county which requires a permit to construct,alter,
a ¢ ¢ p improve,demolish,or repair any sl recture,prior to its issuance,also ELEC.CONTR. LIC NO. ELEC. fes/ 30,
i w m S, requires the applicant for such permit to file a signed statement that TOTAL `� IPPERMIT TO I
he is licensed pursuant to the provisions of the Contractor's License ,f
Fzi La.(Chapter 9(commencing with Section 70(0)ofDivision 3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 1 V
¢ $ the basis for the alleged exemption.Any violation of Section 70315 1 STORIES TYPE C(YTR.
by anyappliwm fora permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).)'.
❑ I,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 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 SD,FT.FLOOR AREA TOTAL ACREAGE
7 himself or through his own employees,provided that such improve.
mems are not intended or offered for sale.IG however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owncr-
'y builder will have the burden of proving that he did nut build or im- IGAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
provy-for purpose am'.). RES IND CON PB Orha,
1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 0 0 0 0 0
IN
d contractors to emmuuct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a conlmetul(s)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00
the Contractors License Law. - TRACT NO. PARCEL NO.
❑ Idmexemptunder Sec. ,B.&P.C.forthis reason WATER HEATER W/VENT 6.00
Owncr D-11,� WATER SYSTEM 5.00
ACC.OATE ACC.FILE NO.
WOR ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.L
Policy No.--Company
O ❑ Certified copy Is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC- REFER TO ORD.
O Applicant Y N Y N
Cry CERTIFICATE 01:EXEMPTION FRONI WORKERS' PERMIT ISSUANCE -1&100 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. �i
CL O his section need not he Completed if lite permit is for one TOTAL Q Y Y [D No
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL tmit is issued,I shell not employ any person in any munner so as to T.
U 5 become subject to the Workers'Compe radion Laws of California
W Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.Q PLAN CHECK
provisions of the Labor Cade, you most forthwith comply will, FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 SEISMIC FEE ,3 Q
I hereby affirm dial there is a construction lending agency lin, EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.1B.50 '^
Lender's Address ELECTRIC d0
1 certify that I have read this application and state that the above �. VENTILATION FAN (SINGLE) 4.00
\ information is correct. I agree to comply with all city and county PLUMBING
111 ordinances and stale laws relating to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00Ik
hereby authorize representatives of this city to enter upon III I,
BOILER-COMP (Over lOgOOOBTUISEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes. `�
(We) agree to save, indemnify and keep harnleas the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE ggp0 CONST.TAX
may in any a clue against said City in consequence of the p2
mnting O fr 1. MECH.CONT. LIC.NO. TOTAL L / 0
Signalu Inant/Contractor SUatc �d,L TOTAL F[
OFFICE COPY
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