18177 POST THIS CARD NEAR FRONT OF BUILDING
PERFllT NUM1BEN
CITY OF CUPERTINO 18177 .
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS_ Ul Ov v p-e � UNIT# LOT#
"" �� 77 /• PERMIT EXPIRES IF WORK
OWNER L CONTRACTOR 1/V .1.�'� tea('/ IS NOT STARTED WITHIN'
INSPECTION DATE 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 PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS .rM
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 6 7
PLUMBING
UNDERGROUND /SLAB E -' '•
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT. PLG. MEC.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING `
MECHANICAL -
ELECTRICAL PE.MIT TO ^
FRAMING
INSULATION STORIESTYPE CONSTR
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SD.TT.Fl_ OR AREA TOTAL ACREAGE
T DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USB
ROOF SHEATHING .ES IND CON Pe OR,,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L L ❑ L 1:1
ASSESSORS PARCEL NO.
ROUGH - SAN.N
PLUMBING ELECT.ENERGY
TRACTNO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO.
GAS TEST - GAS
MECHANICAL FIRESPRINK ENERGY T.2A
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING I NLI ` L' N�
EXTERIOR SHEAR I ELECTRICAL RELEASE per. FLOOD ZONE A UC.
INTERIOR SHEAR '. FIRE DEPT.
11 ry[:] Y L ryL
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH ' TEMPORARY APPROVALS BUILDING
M
SCRATCH COAT JELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Zoo
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL
IMPORTANT! CONST.TAX
• PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT I'' 1 �� q� •.
poo Ess I I
Ue 8 65'
�� D C_- A1
n ! BUILDING -ELECTRICAL-PLUMBING-MECHANICAL C�' .
NAMEo NERs ,
PLAN CHECK VALIDATION
U DTV. ELECTRIC PERMIT FEE
�^ 0A vNo
CONTRACTOR'$
NAME C''/o UTLETS-SWITCHES-RECEP 10.00/1.00
'e- QL LIc.N 0.3 LIGHTING FIXTURES 10.00/1.00
CONTR CTons n PPLIANCES-RESIDENTIAL 4.00
DDTR JJ ��J M / IU.
ilo *11"00 t PRONE3772 Z3 PANELS 10.00 DATE OF APPLICATION -
08cerscT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
goo ESS ens SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
noon Ess
APPLICANT a MOTORS SEE FEE SCH. l/S/ 0'1•' �/
SER VI E CHANGE p 20.00
o o LICENSED CONTRACTORS DECLARATION
a i i I hereby.Him, r11at I am licensed under provisions of Chapter'1 LANCE DATE
¢ wJUN MECH.
BLDG. ELECT.
H (commencing with Section 7000)of Division 3 of the Bualmess Oil PLG.
F m z Prefcssiom Cody.�and hccnse is in full to feel., / ❑ ❑ ❑
Z D�, - License Class_(..:-/✓ Lic.Numbc��V,J T _-.
0-
,
y H w Dam Cnntracmr. / 7 as�
¢ m s R BUILDING PERMIT
It rt w OWNER-BUILDER DECLARATION INFORMATION
E ?
a N I hereby affirm that 1 am exempt from the Contractor's Lic,rsc MISC.- REFER TO ORD
u O ¢ Law for the following rcason.lScc.]031.5,Business and 1'mfcssions VALUATION S/FT.
- PERMIT ISSUANCE 10,00 ZaoD
Code'.Any city or county which requires.permit tr cunslfucl,aIle"
QQ ¢ IrrlprOv0.derrI011Sh,O!repair any structure,prior t0 its iaananC0.0Iw ELE0.CONTE. LIC.NO. ELEG /� Q
o u requilne the applicant for such permit to lite a signed statement that TOTAL
e. w w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Ez >
Law(Chapter 9(commencing with Section 7000)of Divisiou 3 of the
¢ Business and Professions Code)or that he is usempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r 0 the bails for the alleged exemption.An
ge p the
Of Section7031.5 STORIES TYPE C NSTR.
a 3 by any applicant for a permit subjects the applicant toes civil penalty
of not more than five hundred dollars[$5000f: ALTER-DRAIN.&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
chat wle compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7144, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cale:The Contractor's License Law does not apply to an owner of
11 property who builds or improves t hereon,and who does such work FIXTURES-PER TRAP 5.00 So,FT.FLOOR AREA TOTAL ACREAGE
'l himself or through his own employees,provided that such improve-
ments are not intended or offered let salt.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 EASYSTEM OVER 4 (EA) 200
builder will have the burden of p - . - . .
roving that he did not build or ice- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,. Owner of the Profit"Y,um exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7144,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code: rhe Contractor's License Law does not apply
to an owner of property who built,or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmetorts)licensed pursuant to
the Contractor's License Lw, SEWER-SANITARY-STORM EA:2001t/10.00 TRACT NO. PARCEL NO.
rc O 1'elnexcrnpt un der ler,-,B.AP.C,for this WATER HEATER W/VENT 6.00
.son
Owner Dale WATER SYSTEM 5.00
ACC.DATE ACG FILE N0,
WORKERS'COMPENSAI'ION DIiCIARAIION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certifiwle of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
robe No. Company
Curlilicd 'opy i'bcroby furni had. FIRE SPRINK ENERGY T-24
Z 2 ❑ Cert it is Is OIeJ with,tbe city inspection Division. MISC.- REFER TO ORD.
F O dppicanl .�LI�Q�c,/,� Y E] No Y ❑ N❑
w+ PERMIT ISSUANCE 10.00
� - CER'I'I FICA'1'E 01'EXI MPTION I7ROM WORKERS' FLOODZONE A.L.0 C.
LU 7 COMPFNSATION INSURANCE. PLG.CONTE. LIC.NO. PLG. V� N� Y
Z (This section need not be completed if the permit is for ane TOTAL N
hundred dollars(S100)or less.!
L) O 1 certify that in the performance of the work for which this per- Qac MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall ,or employ any parva in my mmmcrso.s to
become subject to the Workers'Compensation Laws of California.
Q w
a Dec Applicant BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of rix- ALTER OR ADD TO MECH. 5.00
Z caption,you should htcoae subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, YOU nest torthwith comply with FEE
U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10=CF.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.16.00 SEISMIC FEE
I hereby affirm that Bare is u construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the pen.mwnce of the work for which this peimit Is issued ISne. MICROFILM
3197.Civ.C.T HEATING UNIT(TO 100,000 B.T.U.) 8.00
ender's Na
Lme H EATI NG UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC Or OD_
�^ I certify tlmt I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
- into,Nation is comet. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-CDMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP Over l(Ki BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpoua.
(We) agree to eve, indemnify and keep harmless the City of MISC.- REFER TO ORD.'
Cupertino 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
entm l MECH.CONT. LIC.NO. MECH. '
TOTAL TOTAL �7on
Signature of ppb t/Contractor Da
OFFICE COPY