15906 POST THIS CARD NEA,R.FRONT OF BUILDING
PERMIT NUMBER .
CITY OF CUPERTINO 196
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS �O9 s•TC'��A`AL �+V UNIT#
LOT 4t
PERMIT EXPIRES IF WORK
OWNER 34-n/A/L Lam/ CONTRACTOR EL �R..� IS NOT STARTED WITHIN
INSPECTI 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
GARAGE SLABS CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED f- - -•
UNDERGROUND /,SLAB
PLUMBING
ELECTRICAL - IssunrvcE UAre
MECHANICAL BLDG ELECT. PLG. MEC.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING � vnl.unnary � I
MECHANICAL
ELECTRICAL - - •• Pew Mlr To
FRAMING
INSULATION STORIES TYPECONSTR,
, 5k
' OCC,GROUP RES UNITS,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ' • r'
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SD.I T.FLOOR ARTA TOTAL ACREAGE
DIAPHRAGM, THE CONSTRUCTION TAX IS PAID .
ROOF SHEATHINGREs IN FJ}DING USEPe OL.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE 'INSP. 0 El El Cl El
ROUGH SAN.k
A SS ESSOR S PARCEI.NO
• •'
PLUMBING ELECT,ENERGY
TRACT NO. PARCEL NO
TUBS 8 SHOW RPA PLUMBING ENERGY
MECHAN ICAL MECH.ENERGY '
ELECTRICALACC.DATE ACC FILE NO
BUILDING ENERGY
FRAMING ELECT.FINAL"TEST
INSULATION PLUMBING
ZONING ENG.SITE NO.
-Z
GAS TEST GAS '
MECHANICAL
FLE SPBINK IENERGY T,24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .Y � ' NEJ ` E) N�
EXTERIOR SHEAR - ELECTRICAL RELEASE FlooO zow: ALL DO,
INTERIOR SHEAR - FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH IBUILDIOG -
INTERIOR LATH' TEMPORARY APPROVALS BUILDING
SCRATCHCOAT ELECTRIC PLAN CHECK '
GAS FEE -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIGFEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING I NSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING -,,v-
PLEASE !
o SEE GIVE JOB ADDRESS WHEN PHONING.
z 'MECHANICAL_,
- PERMIT FOR EXPIRATION DATE -
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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER -
AD DRESS APPLICATION & PERMIT 1 G(� O C
AOO�® I J J U
9 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAM'E-,//r/-/r '///� �I, OTV. ELECTRIC PERMIT FEE
. - Y 39N �✓OIS PHONEYS
NAMFRAcroR� UTLETS-SWITCHES-RECEP 10.00/1.00
Fl FORD 11C NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS nn PPLIANCES-RESIDENTIAL 4'.00
A00 SS IO vR. PHONE PANELS ' 10.00 DATE OF APPLICATION
ARCHITECT r PLAN CHECK.FEE
. OR PANELS (OVER 200 AMP) 20.00
ENGINEER
Lrc,NO ISIGNS TRANS. 3.00
ADDRiESS erva SPECIALCIRCUIT 6.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
AE aMOTORS SEE FEE SCH.
ADDROREss
le i
SERVICE CHANGE 20.00
r
02 LICENSED CONTRACTORS DECLARATION ZZ,
a u. 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Naw (Commencing with Section 70001 of Division 3 of the Businc55 and BLDG. ELECT. PLG. MECH.
F N z Professions Code.gn4 my license is in lull fore�` ]1 c e t ❑
Z
0 m o License s-_¢'11 Lie.Number
�_P- 0-
y H_ Dulc �_�-_� Cnntraclorq_�-
Q u s a� BUILDING PERMIT
¢ ¢ w a OWNIi R-BUILDER UILD1iR DGCLAR
MISC.- REFER TO 0. INFORMATION
IF
;LL N I hereby affirm that 1 am exempt from the Contractors License LUATION•
ec 0¢ Law for the following•reason.(Sec.7031.5,Business and Professions $/FT.
Code:Any city or county which requin,,r permit toc.exturel,alter, PERMIT ISSUANCE 1990' p
¢ Q improve,slemeish,or repair any,tractive,prior to its issuance,also ELEC.CONTR. LIC.NO. ELECTOTAL. / J�
O LL requites the applicant for such permit to file a signed statement that
wPERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License ///,,,��7 ,
F z a Law(Chapter 9(commencing with Section 7000)of Division 3 critic ELS7 V ry��
E i 0 Business and Professions Code)or that Ire is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ r$ the basis for the alleged exemption.Any violation nl'Sect ion 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($500)):
❑ 1,as owner of the property,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 docs such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTALACREAGE
hinssclf or through his own employees,provided that such inmrove-
mentsare not intended proffered forsale.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-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int. BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
❑ ❑ ❑ 1:1licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ❑ ASSESSORSPARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or Improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(,)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00
lire Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sea ,BAP.C,for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affum That 1 have a certificate of consent to snl&insme,
or a certificate of Workers'Compensation Insurance,or a cc ifieA ZONING ENG.SITE NO.
espy thereat(5ec.3800,Lab.Q).
Policy No. Cmnpnny "C.t•N'��
O ❑ CertiliL copy is hereby Him'she FIRE SPRINK ENERGY T-24
Z Z ❑ Cei-ifed copy is I nh .i speclion division.
- O APPlicant - _ MISC.-' REFER TO ORD. Y❑ N❑ Y ❑ No
W
CERTI 01.1 XIiM N PROM WORKIiRS' PERMIT ISSUANCE d9cB0 pj '-' FLOOD ZONE A.L:u.C.
LU > COMPENSA'1'10 INSURANCE: PLG.CONTH. LIC.NO. PLG.
CL O (This section need not be completed if flee permit is for one TOTAL Q Y❑ N❑ Y❑ N❑
:DZ hundred dollars IS 100)or In,,.)
'C� O I certify that in the performance of Bre work I'or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL b- mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
a Date Applicant BUILDING
} r4 NOTICE 1'0 APPLICANTS. If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
Z f- emplion,you should become subject to the Workers'Compensation_ APPLIANCE 5.00 PLAN CHECK
provisions U the Labor Code, you must forthwith comply with FEE such provisions or this permit,boil be deemed revoked. AIR HANDLING UNIT(TO 10,000OF.M.) 4.00
CONS'T'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10.00OC.EM.) 6.00 SEISMIC FEE
I 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.C.). HEATING UNIT ITO 100,000 B.T.U.) 8.00
Lender's Name
Lender's padres, HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC
I C /y
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 /�
information n correct I agree to comply with all city and county BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
0-0
ordinances and state laws relating to building construction.city
co and
herebyauthorize representatives tut ties of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH: MECHANICAL
above-mentioned properly for tativsp of ion Purposes. '
(We))-agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upetlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way Scene aga'tst said City in consequence of the
rantingofflo rm'. MECH.CONT. LIC.NO. MECH.
TOTAL
Bignalur fApPlcanf/ TOTAL
OFFICE COPY