17112 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
12 INSPECTION DIVISION �1
JOB INSPECTION RECORD
I .
PERMIT•E XPIR`AATlTI_ON
JOB ADDRESS (_fh- AveUNITA-LOTlt
PERMIT EXPIRES IF WORK
OWNER u Qr-plyl CONTRACTOR CS GD K,( IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 130 DAYS OF PERMIT ISSUI
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF APER&III VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS. ..y r -
a _ '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IMAR 2 y m _ 2-
UNDERGROUND /SLAB
PLUMBING /
ELECTRICAL - �-st avow
ISSUANCE DA I E
MECHANICAL BLDG ELECT PLG. MECH
/ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL-ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL U`V
ELECTRICAL PERM I TO
FRAMING _
INSULATION STORIES e TYPE CONSTH
OCG GROUP IVES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SIT rr,rLooH AUI:A TOTAL ACIIcnc,E
ROOF NOTE FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDINGUSE
ROOF SHEATHING Hes IND LON PB DP...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ E-1 ❑ E]
ASSESSORS PARCEL NO.
ROUGH SAN.q
PLUMBING ELECT.ENERGY
.
TUBS 8 SHOWER PAN � PLUMBING ENERGY 1 HALT NOPARCELNO
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 FIRE SPRINK ENERGY r 2<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE] ` E] "❑'
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE •A.L U.C.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y•❑ N❑
SHEETROCK ' GRADE
FEE SUMMARY
• EXTERIOR LATH � BUILDING �y
INTERIOR LATH TEMPORARY.APP OVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDMG FINAL'ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu
� 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 �U9
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
P:11LDING PROJECT IDENTIFICATION .PERMIT NUMBER euumnc APPLICATION & PERMIT
APPLICATION
NOTE
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL �, 1711 2
NwNER 5 C/ PLAN CHECK VALIDATION
"AME ry QTY. - ELECTRIC PERMIT FEE
Lv PRonl�sZ-
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
WA6 S (/W/S /! LIC.NO10G12p LIGHTING FIXTURES 10.00/1.00
CONTR
ADORE ACTORS APPLIANCES-RESIDENTIAL 4.00
CONTRAS
"czLQ PRonI "- PANELS 10,00 DATE OFAPPLICATION
ARCHITECT PLAN CHECK FEE .C.NO.
OR PANELS (OVER 200 AMP) 20.00
EN
c SIGNS TRANS. 3.00
ARC
ADDRESS LNG
SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH. 3-Z?�V .�
ADDRESS
SERVICE CHANGE 20.00
a a
LICENSED CONTRACTORS DECLARATION
a it w I hereby affirm that I am licensed under provisions of ChaptcT 9 ISSUANCE PATE
h < vi (commencing with Section 7000)of Division 3 of the Business and 1A MINU DG, ELECT. PLG. MECH.
H � z I'rufv o C CoJc my license is in lull for ❑ ❑ ❑
o f'�',W Dahc c Class Lic. a b 3
Z'R Date Conla' _
ta secit �of -'-"- BUILDING PERMIT
¢ ¢ w < OWN@R-BUII.DER DECLARATION INFORMATION
K
; a. H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
H ¢ O J Law for tlm following reason(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUanON 5/FT.
Code:Any city orcotmty which requires a permit to conamet,alter, 10.00
c, Q o improve,demolish,or repair any structure,prior to its is mance,also ELEC.CONTR. LIC.NO. ELEC.
O ¢ requires the Applicant for such pemlit to Fit,a signed statement that TOTAL
d se in m �` he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
w Law(Chapter 9(commencing with Section 7000)of Division 3ofthe ' nF
F ¢ o Business and PrTdcssions Code)or that he is exempt therafrom and QTY. PLUMBING PERMIT FEE
¢ I- � the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TVP CONSTR.
a 3 by any applicant for a permit subjects the applicant lou civil penalty
of not more than five hundred dollars(55001.): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,m owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
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 dos such work FIXTURES-PER TRAP 5.00 SG.FT.FLOOR AREA TOTALACREAGE
himself re through his own employees,Provided that such im building
himself
are not throuhh is on efered formployee , le proi,huwwegthe building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is.sold within Hire year of completion,the ower- GAS EASYSTEM OVER 4(EA ) 200
builder will have the harden of proving that he did not build or.r - . - . .
BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 REs IND CON PB OMP,
C1I,as owner of the property,am exclusively contracting with ❑ ❑ D 0
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
Ind to anruwc erans Code,The of property hoohuilds r License Law
thercon oes nand who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a eonlraclons)licensed pursuant W
the Contractor's License Law, SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO, PARCEL NO.
❑ l um exempt under Sec.-,B.&P,C,for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK 17RS'COMPI:NSAT1ON DECLARATION WATER TREATING EQUIP. 5.00
I hereby After that I have a etirlificam ofconsenl to uaGimure, -
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thercof(Sec,3800,Lab.C.).
Policy No. Compmry
O ❑ CerIf here y fu she .
Z Z y�C y eJ I cit' i cclian division. FIRE SPRINK ENERGY T 24
FO n-ppfc- MISC.- REFER TO ORD. Y ❑ N❑ YE] No
to CER'I'IIICAIIi0171 XIiMNI'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (Phis section aced not be completed if the permit is for on. TOTAL Y D N Y E] N
Z hundred dollar,IS 100)or less.)
U 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,I shall not employ any person in any manner m as to
O w Isccol ne subidect to the WcrkvHCompensation Laws of Glifomia. ,.xQ
a Date Applicant BUILDING
} to NOI'ICF TO APPI.ICANT: If,after making thin Certificate of fix- ALTER OR ADD TO MECH. 5.00
Z emption;you should become subject to the Workers'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 10=1C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNR(OVER 10=C.EM.) 6.00 SEISMIC FEE IrTJG,
1 hereby affirm that there is a construction lending agency for 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.)9.50
Lender's AddressELECTRIC
I cert ily the 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
ordinances and stale laws relating to building construction, and
BOILER-COMP(3 H.P.Dr 100,000 B.T.U.1 6.00
hereby emhorue representatives of this city to enter upon the BOILER-COMP (Over 10O.O 0 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree m save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlia. a 'est Iia ilitics, 'udg ts, costs and expenses whidl PERMIT ISSUANCE 10.00 CONST.TAX
nay ay 'me io IJ C' in consequence of the
r is lie MECH.CONT. LIG NO. MECH.
n TOTAL TOTAL
Si at sec of Applicant/Contactor Ualc
OFFICE COPY