18353 :POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER -
CITY OF CUPERTINO 18353
INSPECTION DIVISION.
JOB INSPECTION RECORD.
yp I^ �j - - PERMIT EXPIRATION
JOB ADDRESS 6 D� nIl�• .J✓�z 1A..Z ti+ V UNIT# A_LOT# PERMIT EXPIRES IF WORK
- OWNER 0 {JG CONTRACTOR p p_ _ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD ' '180DAYSOFPERMITISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGESHALLBE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. )
GARAGE SLABS PAID
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - 4
UNDERGROUND /SLAB' NOV or, IqBq -^
PLUMBING - \' `i ,t •,1 t x
ELECTRICAL . pi n - ISSUANCE DAre/w
MECHANICAL _ BLDG ELECT.I PLG. :41 MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
•• INFORMATION;
WOOD FLOOR VALUATION -nsWT.
PLUMBING - `-"Ti'Y- +
µms.-
MECHANICAL - i -T
PERMIT TO
ELECTRICAL
FRAMING Czl
.I
'INSULATION 5; RIES TYPE C NSTR,
• T
OCC.GROUP RES.UNITS`
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.Fn FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - `I+Es No CON Pa 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 0 ❑
ASSESSORS PARCEL NO
ROUGH SAN.q
I, PLUMBING ELECT.ENERGY TRACT NO PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECW ENERGY
ELECTRICAL - ACC DATE ACC.FILE NO
BUILDING ENERGY
FRAMING ELECT.FINAL TEST zoNlNc ENO.SITE NO.
INSULATION - - PLUMBING - ,
GAS TEST. GAS
FIRE SPRINK ENERGY T 24
•' MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ Y N❑ ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE — FLOOD zorvE
INTERIOR SHEAR FIRE DEPT.
u YE N❑ Yo N❑
SHEETROCK ' GRADE FEE SUMMARY
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'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM I '
ARRANGE FOR INSPECTION BY•PHONING 252-4505,. ELECTRIC DD
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
r
'o PLEASE PLEASE GIVE JOB ADDRESS WHEN PHONING. '
Z • MECHANICAL
- SEE PERMIT FOR•EXPIRATION DATE-
IMPORTANT! coNsr.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL /6
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — LISE.BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - �PERMITNUMBER
So LIMING APPLICATION & PERMIT q ^ E�
AD ESS I 3 3
I a &,—A) ��"�( I/�, BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 'r
OWNER'S PLAN CHECK VALIDATION
NAME �//
[;, vHONAYb'07Ud OTV ELECTRIC PERMIT FEE
NAMERACTOR's _ [OUTLETS-SWITCHES=RECEP, 10.00/1.00
sec.No �/Z LIGHTING FIXTURES 10.00/1.00 -
r. NTRACo s /L'_�` SAfl APPLIANCES-RESIDENTIAL 4,00
ADDRESSA��i/ T-Wrx n
WII�/ l s+� HONE76TST PANELS 10.00 DATEOFAPPLICATION
-
ARCHITECT PANELS (OVER 200 AMP) 20.00 ,PLAN CHECK FEE P.C.NO.
OR
ENGINEER -
/V K LOC.No. SIGNS TRANS. .3.00
ADDRESS ENo' SPECIALCIRCUIT 5,00 PER MIT VALIDATION
ZIP TEMP.METER OR POLE INS. - 20.00I_ /-
APPLICANTS - MOTORS J� W'6,G SEE FEE SCH. O,OD II D
ADDRESS ((�� ,1 Lrj
Q, (7jAr )%, O,L SERVICE CHANGE 20.00
wo o LICENSED CONTRACTORS DECLARATION 0-ro'
IS U U I hereby affirm that I am licensed tinder provisions of Chapmr 9 n le.00 .ISSUANCE OAT
N iu (commencing with Section 7000)of Division 3 of the Business apn-d G 6. O BLDG. ELECT. PL MECH.
¢vat f40 -`
H m z Professions Code m license is in full force a �p ❑ El ❑
2 o u,- Licen Cas - _fL__Lie.Num be� '� ���G1. D '3 0.0
H w Datc Contmclo PL
¢ sr !2 BUILDING PERMIT
¢ z w ¢ OWNER-BUILDER DECLARATION INFORMATION
d o d ° MISC.— I ORD -
w ;LL N hereby affirm [hut 1 nm exempt from the Contractor's License VALUATION 5/FT.
1 u N j Law for the fallowing reason(Sec,703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 co
Code:Any city or county which requires a permit to cmishucl,alleq -
¢ ¢ Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.GONER, _ Lpn� (s,lrlq�C
o LL requires the applicant for such permit to file a signed statement that C W.L b D D PERMIT TO
w$w he is licensed putsumtt to the provisions of the Contractor's License
ri> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe e_
- ¢ Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5,00
of not more than five hundred dollars(8500),):
❑ I,as owner of the properly,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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,Provided that such improve-
DOarenotintendedorofferedforsale.Il',however,the building GAS EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,lire 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. RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. -30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ 9 ❑ ❑
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. .6.00 _SS E_S_S_0RZ PAR CEL NO.
and Professions Code:The Co It t met.r's License Law riches not apply
to an owner of property who builds or improves Ihercon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a Con t rations)licensed pursuant to. --
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B,&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC._ATE ACC.FILE NO.
//''����yy/pp/.aa��h��.RR//St p�p��rr����pp//E�NSATION DECLARATION WATER TREATING EQUIP. 5.00
I ure6y'uffRiN11 I'ha4a acenifcate of consent to sell-insure, ZONING
or n L ti(ioate n(Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy th • (Sec.3800,Lab.C.L /!_ n—
Po0 Cer. Company�q.,d.
Q ❑ Certified copy is hereby furnished. FIRE$PRINK ENERGY T Zd
Z 2 `f( Ce Rifed PY is d•d i h c s n Division. •.
O ..��s `�:w J�I�� ,�`��,'u MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Applican v N V N
~ w PERMIT ISSUANCE 10.00 FLOOD ZONE A.LUC.
CER'I'I FICATIi OF IiXIiMPfION FROM WORKERS'
L COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG.' y N Y N
0- Z IThis section need not be completed if the permit is for one TOTAL ❑ ❑ ❑ ❑
Hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
L H mil is issued,I shall not employ any person in any manner SD as to
U become subject to the Workers''Compensation Laws of California. BUILDING
tL Datc Applicant ALTER OR ADD TO MECH. 5.00
>_ W NOTICE TO AI111LICANT: If,after making this Certificate n(Ex-
emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. " AIR HANDLING UNIT(TO 10A00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000QEM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
tire wo
e performance of the rk f r which this permit is issued(See. MICROFILM
3097,Cle.C.). w) � ( HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 . ELECTRIC 167-OD
I certify that I have read this oppliaation and slate that the above VENTILATION FAN (SINGLE) 4.00
1 information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or t00,0008.LU.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and ,
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCA. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- " - REFER TO ORD.
uper ino against liabilities,judgments,costs and expenses which PERMIT ISSUANCE '10.00 CONST.TAX
may in any way accrue against said City in consequence of•the
ntin_y.of thi' mit MECH.CONE.•- LIG NO. MECH.
TOTAL I �•, '
_/_1A,1TOTAL `
azure o p icent/ o tactor at
OFFICE COPY '