17332 POST THIS CARD NEAR FRONT OFBUILDINGPERMIT NUMBER
CITY Of CUPERTINO 1.7332
INSPECTION:DIVISION
JOB INSPECTION ERER COD
'` " • n gi E R I PERMIT EXPIRATION
JOB'ADDRESS L U41 � �••� V.IO�F \�. UNIT# ` LOT*f '
(/]] pp LL11- 1.-V _PERMIT EXPIRESAF WORK
Opt
OWNER , pt GI- WJ CONTRACTOR •L[T' , PL . e IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOAD 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 PERMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS. - - p
GARAGE SLABS - �`.-s 1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB-
PLUMBING C9
ELECTRICAL' ISSUANCE DATE
- BLpG ELECT. PLG. MECR„
MECHANICAL El 11 ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILD RM PERMIT
• INFORMATION.
WOOD FLOOR .VALUATION .SIFT.
PLUMBING -
MECHANICAL - revMlT To
ELECTRICAL
FRAMING- STORIES TYPE CONSTR.
INSULATION - -
OCC,GROUP -RES UNITS.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SC FT.FLOOR AREA TOTALACRi EAGE.
DIAPHRAGM - THE CONSTRUCTION TAX IS'P61D pTFr . T
BUILDING USE --
- ROOF SHEATHING. ' RES IND CON PB GO—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 L L ' L
ASSESSORS PARCEL NO.
ROUGH SAN.N -
PLUMBING - ELECT.ENERGY L
TRACT NO. PARCEL NO
TUBS 1,SHOWER N - PLUMBING.ENERGY'
- MECHANICAL -may-sy MECH.ENERGY -
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY -
;+
-FRAMING - ELECT.FINAL TEST ZONING ENG.SITENO.
INSULATION IPLUMBING
GAS TEST ' - - GAS
- - MECHANICAL 1 ✓ FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N[]
EXTERIOR SHEAR , ELECTRICAL RELEASE - - FLOOD ZONE " A.L.uc.
INTERIOR SHEAR' FIRE'DEPT. Y NL Y L N❑
SHEETROCK GRADE - _ FEE SUMMARY
EXTERIOR LATH .. ' BUILDING . . - -BUILDING
INTERIOR_LATH TEMPORARY APPROVALS
� . SCRATCH COAT ELECTRIC
FEEPLACHECK
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SE ISMIC'FEE
OCCUPANCYOF BUILDING IS.NOT.PERMITTED UNTIL BUILDING.FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION-BY
PHONING 252-4505, ELECTRIC
L ONE,WORKING DAY BEFORE REQUIRED•INSPECTION.
0� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMeInc 6a
Z - - MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE—
' IMPORTANT :, , CONST.
TAx
!.
PLEASE READ REVERSE SIDE BEFOREWIT,
TOTAL Ulm
•,
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -'USE BALL POINT PEN ONLY
BUILDI NO PROJECT I DENTI F16ATION PERMIT NUMBER'- ,
aDILOINc APPLICATION & PERMIT 17 3
aoDREss Na BUILDING - ELECTRICAL-PLUMBING-MECHANICAL •:s 1 1 � V•Z .
6\23 Lt/ tf
OWNER'5 - PLAN CHECK VALIDATION
NAME
E QTY. ELECTRIC PERMIT FEE
Aii .`�� PHON
CONTRACT
OUTLETS-SWITCHES-RECEP '10.00/1.00 ,
/*VC LOC.No. LIGHTING FIXTURES 110.00/1.00
ADD
ActoR's PPLIANCES-RESIDENTIAL 4.00
aoGREss WS - S(Og�/�Iq _ ..
- Q/� PHONE •77�� PANELS 1 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMM.' 20.00 PLAN CHECK FEE P.C.NO.,
OR
ENGINEEfl
uc.No. SIGNS TRANS. 3.00
nooeess END. . SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
rte-
' SERVICE CHANGE -' 20.00 ' J �h✓'
woo LICENSED CONTRACTORS DECLARATION '
rt u u I hereby affirm that I ant licensed under provisions of Chapter 9 ISSUANCE DATE ".r
w¢ $ (conmmncing.with Section 7000)of Division 3 of the Business and BLDG. ELECT. `PLG. MECH.
F H z Professions Code and in, icensc is in full for a r-
• '¢ Z w o - License Class_.` _(�,Lie.Number - - ❑ 1:1
-❑
o m I-w Dale =Z -g2_Conlract ,
¢ x s BUILDING PERMIT
in Ix w ¢ OWNER-BUILDER U ARATION INFORMATION
wo a ° REFER TO ORD ' -
;LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.- VALUATION $/FT.
I- LL O< Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 •`
Code:Any city or county which requires a permit to construct,alter,
rc rt ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELED..
So O M requires the applicant for such permit to file a signed statement Thal TOTAL PERMIT TO
m he is licensed pursuant to the provisions of the Contractor's License
w
in, Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT _ FEE v
in I-$ the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars(8500).1: -
❑ I,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 far sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 x`00 -
.. Code:The Contractor's License Law does not apply to an owner of - C '
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.
'cuts are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-I INC.4 OUTLETS-6.00
or improvement is sold within one year of completion,the owner- - GAS-EA.SYSTEM-OVER 4(EA.) 2.0 s�: auILDIrvG uSE
builder will have the burden of proving that he did not build or int- R ry,IND CON PB Other
prove for purpose of sale.). INDUSTRIALWASTE INTER. j30.00 ,
❑ 1,as owner of the property,mm exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractor, to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC'5 V:B. 6.00ab OttESSORS PARCEL NO:, {
and Professions Code:The Contractor's License Low does not apply -to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.0
' i contracts to,such projects with a contructor(s)licensed pursuant to - • .20ft/1000. ,
the Contractors License Law, SEWERSANITAR YSTORM EA -0TRACT NO. PARCEL NO.
❑ I am exemptunder Sen-,RAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATEFrSYSTEM 5.00 -
ACC.DATE ACC,FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. " 5.00 ,
I hereby affirm that I have a certificate of consent to self-insure, 1••1�r_ ♦.M �' -i ON,NG
or a certificate of Workers'Compensation Insurance,or a certified XQZ41 ENG;SITE NO.
copy thereof(Sec.3800,Iab.C.). A -'
Policy No. Company -
I Q ❑ enified any is hereby furnished. - .FIRE SPRINK ENERGY T$4
Z 2 �en' IIS fd,'d with the�t�jucoon�division.
p APP'^'^'� ✓ L^'� MISC.- REFER TO ORD. "� Y❑ N❑ Y ❑ . NO
pm �- PERMIT ISSUANCE 10.00 �,ILZ FLOOD ZONE - A.L.U.C.
RTIFICATE OF EXEMPTION FROM WORKERS' ,
Lu
Q COMPENSATION INSURANCE P�C T ,yC LIC.NOPLG. �O
(This section need not he completed if the permit is for one /! TOTAL a� Y❑ N❑ Y❑ ry❑
0 Z hundred dollars(S 100)or less.) I
U O , -I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL t. 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.
Date-Applicant ALTER OR ADD TO MECH.• 5.00 PFEE.
}•r0n NO1'10E 'TO.APPIACANT. If,after making this Certificate of F,x-
F Z emptinn,you should become subject to the Workers'Compensation APPLIANCE 5.00
provisions of the Labor Code, you must forthwith comply will'such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10POO C,F.NL) , 4.00
CONSTRUCTION LIiNDING AGENCYAIR HANDLING UNIT(OVER IOPMC.F.M.) 6.00 I'hereby affirm that there is a construction lending agency 1or EXHAUST HOOD(WITH DUCT) v. 5.00
the performance of the work fur which this permit is issued(Sec:3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) - 8.00Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
�^ F Lender's Address
I certify that
1 have read this application and score that the above VENTILATION FAN (SINGLE).' 4.00
information is correct. I agree to comply with all city and county. PLUMBING QaQO•s
BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city. to enter upon thes
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep,harmless the City of MISC.- REFER TO ORD. ,
Caper tino against liabilities,judgments costs and expenses which CONST.TAX may in any way accrue against sa'd it in consequence of the PERMIT ISSUANCE 10.00
ran' This permit MECH.CONT. LIC.NO. MECH. i -
TOTAL TOTAL 'tijO.Oa ;
atureor icant/Contractor - Date
OFFICE COPY ;