17082 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMdER
CITY OF CUPERTINO 17082
INSPECTION DIVISION
�. JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADOR ESS _ UNIT# _LOT#
PERMIT EXPIRES IF.WORK
OWNER V �T�"•�`� CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ,
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.'•
LIFER ALL GRADING AND DRAINAGESHALL BE.INSTALLED r
PREGUNIT.E TO COMPLY WITH THE,APPROVEb PLANS AND CITY OF PERMIT VALIDATION,
CUPERTINO.STANDARDS. 'i
GARAGE SLABS �- 'I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING _ J
a
ELECTRICAL ISSTLC-L-L,,;
MECHANICAL tay pi p li]BU=lLDINcG
G. Mfi CH,•
o .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED PEaMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL 1 QI)e oa I
ELECTRICAL - PERMIT TO
FRAMING
INSULATION - - STORIES TYPE CONSTR,
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
1 - 50.FT FLOOR AREA. TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM , THE CONSTRUCTION TAX IS PAID -
BUILWNG USE
ROOF SHEATHING RES IND CON PB Co",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DATE INSP. ❑ ❑ ❑ ❑ Z
ROUGH SAN.p
ASSESSORS P ARCEL N01
' � '
PLUMBING ELECT.ENERGY TRACT No, PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY.
MECHANICAL MECH.ENERGY - '�-
I. 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 74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y'❑ N❑ ❑ ^ND
- EXTERIOR SHEAR
ELECTRICAL RELEASE - FLOOUZONE A.L.UC.
INTERIOR SHEAR FIRE DEa
Yo N❑ - Y ❑ ❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDI
INTERIOR LATH APPROVALeuILDwG
SCRATCH COAT AELECTRPLAN CHECK '
• GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE"
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F�LEI'•
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL --�"
- SEE PERMIT FOR EXPIRATION DATE-
IMPORTANT! coNsr.rnx
PLEASE READ REVERSE SIDE BEFORE �T`,.'" 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
- APPLICATION & PERMIT '
avvN1RADDREI ° 1 17 0 8 2
�> �yo BUILDING — ELECTRICAL_PLUMBING—MECHANICAL I, 7VS
OWNER'S. .PLAN CHECK VALIDATION
rvAME ^ v 4IS OTV, ELECTRIC PERMIT FEE - -
1/ �1c
CONTRACTOR'S
NAME t CLf.J` OUTLETS-SWITCHES-RECEP 10.00/1.00
Nb' 1 LIGHTING FIXTURES 10.00/1.00
ADDRESS TOR's APPLIANCES-RESIDENTIAL 4.00
HONE. PANELS 10.00 DATE OF APPLICATION
aRCHITE PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 .
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG.
aooREss SPECIAL CIRCUIT 5.00 PERMIT VALIDATION.
NTS ZIP EMP.METER OR POLE INS. 20.00
nooRESs MOTORS SEE FEE SCH.
— SERVICE CHANGE 20.00
o 0 i
r O o LICENSED CONTRACTORS DECLARATION
st U U I hereby affirm that I am licensed under provisions of Chapter 9 -
H Q H (commencing with Section 7000)of Division 3 Of the Business and - ISSUANCE DATE'
,BLDG. ELECT. PLG: MECH.
Professions Code and license Is in full for a and effect ❑ ❑
H z C
0 i _,o License Class Loc.Number�c3�1 . /�,
w r Dale Contracmr City of 4Upert
a
w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
-
w0 >
3 0 In I hereby at that I am exempt from the Contractor's License MISC.— REFER TO ORD
LL o ac Law for the following reason.(Sec.703 L5,Business and Prof omas VALUATION $/FT.
r — PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to mnstrucl,alter,2M t
a < improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO.
'
S 0 ac requires the applicant for such permit to file a signed statement that TOTAL j PERMIT TO
w y he is licensed 9pursuant(commencing the with provisions Of the Contractor's 3ocense
H z a Law(Chard Professions
de)or that
is 00)exempt
D theren3 of the
f 4 o Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE
rc r $ the basis for the alleged exemption.Any violation t too
oclion malty STORIES TYPE CONSTR,
a3 by any applicant for apermitsubjects S500),licannoacivilpenalry ALTER-DRAIN of not mare than five hundred dollars(my em: -
❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
their sole compensation,will do site work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
Or Improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) -2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES • IND CON PB Other
. .
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ _ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSES$o RS 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 conlrector(s)licensed pursuant to - -
theContractor'sLicenseLaw. , SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 'P am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT - 6.00 ,
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP.- 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO."
copy fhereof(Sce.3800,Lab.0.). - -
Policy No. Company -
O . ❑ Certified copy is hereby furnished. ' FIRE SPRINK ENERGY L24
Z Z �Certof7, .��y os BI t e city in ectmn division.
O Applicant L,Li led
L-' I MISC.- REFER TO ORD. y❑ N❑ y ❑ N❑
� T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE • ' 10.00 FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCEPLG.CONTR. LIC.NO. PLG,
1 O (This acmioo need not he completed If the permit is for one _ .TOTAL V❑ N❑ VI❑ N❑
Z hundred dollars IS 100)orless.)
V O 1 certify that in the performance of the work for which thus per- QTY. MECHANICAL PERMIT 'FEE FEE SUMMARY
LL F 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.
y Date Applicant - - BUILDING
} to NOTICE'TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F ? emption,you should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
(,1
provisions of the Labor Code, you must forthwith comply with FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO'10,OODCF.M.) 4.00
- CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWGEM.) 6.00 SEISMIC FEE -5—
I hereby affirm that there is a construction lending agency forIt
EXHAUST HOOD(WITH DUCT) 500
the perform .
performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.0.). HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATING UNIT(OVER 100,000_B.T.U.)9,50
Lender's Aadrcss ELECTRIC
I certify that I have read thisapplication and state(bat the above VENTILATION FAN (SINGLET 4.00 -
. informationm correct.I agree to comply with all cosy and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinancesancesand state laws relating building construction, and
hereby entioed representatives of this city es enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL --�
above-mentioned property for inspection purposes.
(We) agree to save, emnify and keep harmless the City of MISC-- - REFER TO ORD. -
uperti gainst liab' ie dgrl�ents, costs and ex arses which CONST.TAX
may a way a g ' st said Cit in cone encs f the PERMIT ISSUANCE 10.00
r ing this per, 1. ' MECH.CONT. - LIC.NO. - MECH.
TOTAL TOTAL aC(
Sig u of ppli n on actor fe � I
OFFICE COPY