14722 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER,
CITY OF CUPERTINO 14722
INSPECTION DIVISION
JOB INSPECTION RECORD
• � I,, S W 1 b - PERMIT EXPIRATION
JOB ADDRESS---I-l/l Z3 N ty I
UNIT# LOT# PERMIT EXPIRES IF WORK
• awrvER W .k ���. Q CONTRACTOR Q IT �. CL, 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
TO COMPLY WITH THE APPROVED PLANS AND CITY OF Phi Mlr VALIDATION
PR EGUNIT.E - - CUPERTINO STANDARDS. '
GARAGE SLABS - ; .y ,..t-•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL 'J ISSUANCE DATE
MECHANICAL /BL❑DG. ELE❑Cr PLG, MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR .VALUATION S/FT.
PLUMBING
MECHANICAL PAID
PERMIT TO
ELECTRICAL l
FRAMING
INSULATION - STORIES TYPE CO STR.
Citi of I
IDD OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
,• ROOF - NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID I
BUILDING USE
ROOF S} EATHING REs. IND CON PR ow..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. F-1 ❑ ❑ ED " 0
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY I
.
ELECTRICAL BUILDING ENERGY ACC.DATE ACCFILE NO,
FRAMING ELECT.FINAL TEST zorvwc ENG SITE No.
INSULATION PLUMBING
GAS TEST - GAS - -
FIRESPRINK ENERGY T 2
MECHANICAL -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ Nv E] N�j
FLOOD LONEE A L U C,
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y NEI Y ❑ N[3
SHEETROCK 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
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o)
PLEASE GIVE JOB ADDRESS WHEN PHONING. '
z MECHANICAL - - .
— SEE PERMIT FOR EXPIRATION DATE
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ° y TOTAL Jd
CALLING FOR FINAL INSPECTION. '
OFFICE COPY /
APPLIC`AM TO 4(L � IU it I� AT "1 N F D_LIN ES =USE BALL POINT PEN ONLY
r IBUILDING frFiOJECT IDENTIFICATION APPLICATION & PERMIT PERMITNUMSER
So HOMING 14722 A ^
•, 123 ���ADDRESS
WO Cp.= AD BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
O NEH'S Q
i NAME �(�Ov l PLAN CHECK VALIDATION
Lv1_=STF/itEo� /A/ _ l CITY. ELECTRIC PERMIT FEE
ON
CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00
NAME N1 I I 4/,31
-bWoolo /E 5=04Ic.NOS3LIGHTING FIXTURES 10.00/1.00
ADDRESS O ACofw4
ADDRESS PPLIANCES-RESIDENTIAL 4.00
/I L'unbc PANELS 10.00 . DATE OF APPLICATION
ARCHITECT
DR PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO.
ENGINEER .
ARCH,ORENG. L16.NO, SIGNS TRANS. 3.00 -
ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR.POLE INS. 20.00 ♦'C�
ADDRESS APPLICANT s MOTORS 2-
SEE FEE SCH. `
(SI SERVICE CHANGE 20.00 `
,00 LICENSED CONTRACTORS DECLARATION
to< u w 1 hereby affirm that I am licensed antler provisions of Chapter')
FLAW
Nay (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
ar an e�l�sseffs in full force, d e LOG. ELECT. PLG. MECH.
z O" t YL1p.Numb L' ❑ ❑ faT
4 m t Dale Contractor, yy'1p� / A ♦ LIQ
w 'OWNER-BUILDER DECLARA IT ONBUILDING PERMIT
w0`y ,1 hereby al firm 0mt I am exempt Iron the Contractor's License MISC.- O ORD AtY INFORMATION
F
a. Ow Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION $/FT.
i '">f Code:Any city or county which requires a permit to construct,alteq 10.00
ac to s-D improve,demolish.or repair any structure,prior to its 1ssca ce,a]50 ELEC.CONTR. LIC.NO.A. W W LL requires the applicant for such permit to file a signed statement that TOTAL
he is licensed pursuant to the provisions.1 the Contractors License PERMIT TO
H z rt
Law(Chapter 9(commencing with Section 7000)of Division 3of1he
4 O Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE e�
M H 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CON R.
e- ; - by any applicant for a permit subjects the applicant tua civil penalty
of not more than five hundred dolims($5001); ALTER-DRAIN -WATER (EA.) 5.00
❑ I,as owner of the property 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 does such work FIXTURES-PER TRAP 5.00 so.PT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
menuarcnotintended or offered for sale.l L howeveYthe building GAS-EA.SYSTEM-111NC.4OUTLETS 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 im- BUILDING USE
prove 1,aso neeose of sale.). - INDUSTRIAL WASTE INTER. 30.00 ❑ IND❑ ❑N PB❑ Other❑
❑ L as owner of the prstruct ons exclusively contact lug with
and Ptd contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
and Professions Coop:The who
Contractor's License Law docs not apply ASSESSORS PARCEL NO.
_ to tr owner uu property who builds tr improves thereon,and who LAWN SPRINKLERS=OVER 5(EA.) 1.00
contracts for such projects with a conlractoR s)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200tt/10.00TRACT NO. PARCELNO.
❑ lam exempt muter See ,B&I'.C.for tliis
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKS that I h vita se TION DECLARATION WATER TREATING EQUIP. 5.00
I hereby ate of that 1 have a ce Compensation
In consent orfc, .certified
ora certificate of Workers'Compenvlion Insurance,or a certified ZONING ENG.SITE N0.
MIN 3g00 Lnb.0},� I
❑ Certified copy i Isere by urnished.
Z Z �-C red qpY is Ill�•,1 v.ty,,t�y�1y, e lion Jivieion. FIRE SPRINK ENERGY T-24
F p Applicmr� e"f-f D-Y7 f 1' C( -` MISC.- REFER TO ORD. Yo No Yo N[3
DC D CERTIFICATE OF EXEMPTION FRONI WORKERS' PERMIT ISSUANCE dfte0 p
LOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG.
0. Z (This section.need not be Completed if the permit is for one TOTAL Y❑ N� Y No
O hundred d.1Ims(SI00)or less.)
I certify that h the to employ
of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
0 U mit is issued,1 shall not employ any person in any manner so is to
Q W become subject to the Workeri Compensation Laws of California.
to Date Applicant}, ALTER OR ADD TO MECH. 5.00 BUILDING N NOTICE APPLICANT: If,alto making this Certil'icum of
emption,you should become subject to the Workeri C...Penticton APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r-F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 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 1'Ur which this permit is issued(Sec. MICROFILM
30979 00C.). �ny.��LI�1 HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name 1�
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I cnnify nhal l haveread this application andstale that the above VENTILATION FAN ISING LE) 4.00
` information is correct I ague to conmply with all dity and County PLUMBING `
fl\ ordinances and state laws relating to building const action, and BOILER-COMPOH.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER,COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL S
(We) agree to save, indemnify and keep harmless the City of MISC.c REFER TO 0RD.
Cupertino against IiaM1ilities,judgments, costs and expenses which CONST.TAX
!tui any way accrue against said City in consequ of the PERMIT ISSUANCE 10.00
t ting of this permit. .COOT LIC.NO. MECH.
f n[ on actor-
Date ` TOTAL �S� TOTAL
KJIOFFICE COPY