15551 POST THIS'CARD NEAR FRONT OF BUILDING,. E PERMIT NUMBER
CITY OF CUPERTINO 15551
' INSPECTION DIVISION '
JOB INSPECTION /RECORD
Zo -;-' /U�-//—/.1_=/3—/`f PERMIT EXPIRATION
JOB ADDRESS "MIL L/tc� ^1/E UNIT# LOT# '
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR �'iQ/f-,Q)j /c—I/, IS NOT,'STARTED WITHIN
INSPECTION DATE JINSPECTOR INSPECTIONS RECORD 180 DAY'S OF PERMIT ISSU--
'FOUNDATION - ANCE OR 180 DAYS FROM
6 NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITHTHE APPROVED PLANS AND CITY OF PERMIT VAUDATION
CUPERTINO STANDARDS.
GARAGESLABS L - "
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - 27 -
UNDERGROUND /SLAB O)
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL - - BLur, ELECT,. PLG. MECH.
,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
N INFORMATION
WOOD FLOOR.: LI-VAwnnoN siFT.
PLUMBING - - -
C�� O "d
MECHANICAL '
_ ELECTRICAL - PERMIT TO
FRAMING \^_- , _ 14'
INSULATION - .. STORIES SPE CONSTR
UCCGROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED,
SO.FT FLOOR ARLA TOTAL ACREACE
-- ROOF ,NOTE:NO,FINAL INSP.SHALL BE MADE BEFORE- • .
DIAPHRAGM - - THE,CONSTRUC.TION TAX IS PAID
BUILDING USE
:. ROOF SHEATHING - RE:s IND ,CON PB OII,N,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ED ElElED ID
n55ESSORS PARCEL NO
ROUGH SAN.# - -
PLUMBING - ' ELECT:ENERGY , '
TRACT No, PARCEL No
TUBS&SHOWER PAN -- PLUMBING ENERGV
MECHANICAL ' - MECH.ENERGY
- ELECTRICAL BUILDING ENERGY..' - ACC DATE ACC.FILE NO
FRAMING - - ELECT.FINAL TEST -
ZONING ENG.SITE N0.
INSULATION PLUMBING
GAS TEST - GAS - -
MECHANICAL '" ' — FIRESPRINK ENERGYT.an
-
COVER NO WORK UNTIL ABOVE HAS BEEN.SIGNED HEATING . Y [:] N❑ ° ED NE]
FLOOD70NE �A'.LUC.
EXTERIOR SHEAR - - _ ELECTRICAL RELEASE
INTERIOR SHEAR - FIRE DEPT. ' v❑ 'N❑ YC N❑
" SHEETROCIC 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
ARRANGE FOR INSPECTION<BY PHONING 252.4505, ELECTRIC
LU
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z -PLEASE GIVE JOB ADD RES&WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL .
IMPORTANT! coNsr.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
BUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
BUILDING E' APPLICATION & PERMIT 15551'
ADDRESS S
_ . z BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,
DINNER'E PLAN CHECK VALIDATION
.
NAME DTV. ELECTRIC PERMIT FEE r
vuoN Q �
NAME cTORs UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL - 4.00
aooREss
S PNO PANELS . 10.00 DATE OF APPLICATION : .
ARCHITECT • -PLAN CHECK FEE - 'P.C.NO.
on - PANELS (OVER 200 AMP) 20.00 _
ENGINEER
'uc.No. ISIGNS TRANS. 3.00
ADDRESS ENG . SPECIALGIRCUIT 5.00 _ PERMIT VALIDATION'
- ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS I _
SERVICE CHANGE . 20.00
-00 LICENSED CONTRACTORS DECLARATION /
a U u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
a Q y (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r w i Professions Code,, my license is in full fora�.y�
OZ i rn o LicenseCCJ'- Lic.Number_.'G. yO-'YS' ❑ ❑ ❑ ❑'
w Date Contractor ,
¢ D
¢M M¢ a OWNI>R-B UILDF.R-DGCLA RATION '
BUILDING PERMIT
¢ d u INFORMATION
La � I- hereby affirm flint I am exempt from the Contractor's License MISC.- REFER TO,ORD
F .. oUm AWATION
¢ Law for the following reason.(Sec.70305,Businessand Professions PERMIT ISSUANCE -10. }
Code:Any city or county whichfequires a permit to construct.alter, J
aca¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. IJ ;Via
ca DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E:
m he is licensed pursuant to the provisions of the Contractor's License
F z a Law(Chapter9(commencing with Section 7000)of Division3of the
12 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
byanyapplicantfor u permit subjects ilia applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500),): -
❑ I,as owner of(Ile property,or my employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will do the work,and the structure is not . .
OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conrmctor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SY$TEM-11NC.40UTLETS 6.00
ments are not intended or offered for Sale.If,however,the budding
or improvement is sold within one year of completion,the owner-
builder
wner GAS EASYSTEM OVER 4 (EA.) 200 -
builder will have the burden of proving that he did not build or an. - . - . .
- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON P9 ' Otba,
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct tlm 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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ 1 amexempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Data WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 5.00
hereby affirm that P hase:.certificate ol'conSeat to self-insruI,
or a certificate of Workers'Compensation InI a Rcelri
fied ,
ZONING ENG.SITE NO.
copy thereof
PolicyCezl__ C.). N�
O
rafted copy is hereby furnished. - FIRE SPRINK ENERGY T 24
Z Z ❑ ,Certified cypy a inspection division. Y ❑ ry❑ V ❑ N❑
(7� Applicant ��«�.-_ - MISC.- REFER TO ORD.
~ �+ PERMIT ISSUANCE 10.00
UJ - CCRTIFICATIiONSATIOTINS FROM WORKERS' FLOOD ZONE A.L.U.C.
W COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. pip,
Z IThis section need not be completed it tile permit Is for one TOTAL Y❑ N❑ Y ❑ No
hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per. DTV MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of Califomia.
0 y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 63
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of-ilia Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be detailed revoked. AIR HANDLING UNIT(TO 10ACC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE �a
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 -
tlse performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). 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 Address ELECTRIC
. I certify that l have read his applicm ion and state that the above VENTILATION FAN'ISINGLE) t 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction,and BOILER•COMP 13 H.P.or 100,000 B•T.U.I 6.00
hereby'aulhorim representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, 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
mntingo is ii. MECH.CONT. LIC.NO. r MECH. 'fix
_ TOTAL TOTAL S V
Signa re of Appffcant/Contractof Data
OFFICE COPY