15173 POST THIS CARD NEAR FRONT OF BUILDING eR.,;ITNNh,aER
CITY OF CUPERTINO .15173
INSPECTION DIVISION
JOB INSPECTION RECORD
/ ,/ PERMIT EXPIRATION
JOB ADDRESS d a 7 SQA-�1 k,l Q?h C7 UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER �9✓J�-FC , �7(i(J �g CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I I SPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ' NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGE SLABS -+--
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL BLDGELECT PLO. I.IMECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
v ALUAiION SIFT.
PLUMBING
MECHANICAL '
ELECTRICAL Iw PERNIT TO
FRAMING - Mp` -
INSULATION C1� P q B STORIES TYPE CONSTR,
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sO.FT FI.DOI+AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING BUILDING USE
RES SND CON PB Ume,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 13 -❑ El .CD El
ROUGHSAN.q ASSESSORS PARCEL NO
,
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ^, AcCDArE ACC.FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING zoNlNc ENG SITE No.
GAS TEST GAS
MECHANICAL _ FIRE$PRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ v ❑ -ID ° ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUc.
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ . N❑
SHEETROCK GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING QUA S
INTERIOR LATH TEMPORARY APPROVALS _ BUILDiryG v
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 FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
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
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -
BUI LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING '' / APPLICATION & PERMIT 1517 3
PDpRE55 1�T�'�s�l //•L .Lf�-µd
/Ud 2 J O Lam- BUILDING-ELECTRICAL-PLUMBING -MECHANICAL +'
OwrvE 5
DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
NAM
n. CONTR, 0 Go^£E/IE
NAME Its
$
vHDN
NAME (4 C.e£/2S' OUTLETS-SWITCHES-RECEP 10.00/1.00
9 JaLs f. uc.No, /✓°�� LIGHTING FIXTURES 10.00/1.00
CONOns
ADRESa PPLIANCES-RESIDENTIAL 4.00
TRA
PHONE PANELS 10.00 DATE OF APPLICATION
ARRCHITECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00 -
ADDREssENc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
ADDRESS
S
AMOTORS SEE FEE SCH.
ORE
X i
SERVICE CHANGE 20.00 7/W
o �/8(/
,00 LICENSIiU CONTRACTORS DECLARATION
a u I hereby affirm that 1 am licensed underpp,,mmnsof Chapter9 ISSUANCE DATE
y 3 m (contnamcing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H w z Professions Code,and my license is in full force and effect ❑ ❑ ❑
0 i wW License Class e LiNumber
m r Date Contractor
Q c E J
Ix w a OWNER-BUILDER DECLARATION BUILDING PERMIT
F. O' " MISC.- REFER TO ORD INFORMATION
w g LL y 1 hereby collo that I am exempt from the Contand Pis License VALUATION
u o j Luw for the following reason.(Sec.7031.5.Businussand Professions S/FT.
- PERMIT ISSUANCE 10.00
v, Code:Any city or county which requirese permit m construct alter,
Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
- O M requires the applicant for such permit to file a signed statement that TOTAL PERMIT
E
$ he is licensed pursuant to the provisions of the Contractor's License
r Z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe A /�Z
4 o Business and Professions Code)or that he is exempt thereupon,and OTV. PLUMBING PERMIT FEE /L
ce n-o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
aim by any applicant for a permit subjects the applicant fair civil penalty ALTER-DRAIN&VENT-WATER'IEA.) 5.00
of not more than five hundred dollars(9500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW 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,GOND. 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 sir IT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 6.00
or improvement Is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA,) 2.00
builder will have the burden of proving that he did not build or an. BUILDING USE
prove lot purpose ofsalc.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
O 1,as owner of the property,am exclusively contracting with ❑
licensed contractors to construct the project(Sec. 7044,Basins, LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
and Professions Code:The Contr,clor's License Low does not apply ASSESSORS PARCEL NO.
to an owner of property who builds or improves thriven,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts bar such projects with it coutractorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
` ❑ Tut xempl under Sea ,B.&P.C.lin this WATER HEATER W/VENT 6.00
re
Il, OwneaSen '/tE ante WATER SYSTEM 5.00
ACC.GATE ACC.FILE N0.
wORKIiRs'COMPIiNSnTION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm that I have a ernificale It consent to wqF-in,m,,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See 3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hcrehy furnished.
Z Z ❑ Certified copy is filed with the city inspection division. FIRE SHRINK ENERGY T-24
F O Appllc:uit MISC,- REFER TO ORD. Yo N❑ Y [:] NEI
N CERT IFICA9'Ii OF Ii XEMPTION FROM WORKERSPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
r LU > COMPENSAT10N'INSURANCE. PLG.CONTR. ❑G.NO. PLG.
F 1 O 1'I'his section vend nor be completed if the permit is for one T O Y NY ❑ N�
::) Z hundrad dollar,(S100)or less)
U O I certify that in the performance of the work for which lluv per-
LL 1- mit is issued, I shall not employ any person in any manner so as to DTV• MECHANICAL PERMIT 1 FEE SUMMARY
O L) become subject to the Workers'Compensation laws of California.
Q. Dat` npphT: I ALTER OR ADD TO MECH. g 00 BUILDING
} Z NOTICE TO APPLICANT: If,alter making this Cert ificarc of Ex-
F. _ caption,you should become subject to the Worker;Compensation APPLIANCE PLAN CHECK
U provision, f the
Labor
bor Code, you must forthwith comply with FEE
such p hrpermit shall be deemed revoked. AIR HANDLING UNIT(TO 10030C.F.M. .00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVFR,tOP00C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT- x 5.00
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 9.00
Lender's Name
Lender;Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have mod anis application in,state that the above VENTILATION FAN (SINGLE) 4.00
• information is correct. I agree comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state lues rehiring to building construction, and
hereby authorize representatives this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection tion purposes. MECHANICAL 3
(W agree to save, i0 enm(fy,and keep harmless One City of MISC.- REFER TO ORD.
up ino against liahili ,judgments, costs and expenses which CONST.TAX
m 'n any way nccr,i against said City in consequence of the PERMIT ISSUANCE 1.0. �a
I ag of this - it MECH.CONT. LIC.NO. MECH.
..S /
y 7hd TOTAL TOTAL
ignature fApplicant/Contractor Date lJ
OFFICE COPY