15408 (2) ,POST THIS CARD NEAR FRONT"OF BUILDING
PERMIT NUMBER I
CITY OF CUPERTINO. 15408
INSP.ECTION`DIVISION
w JOB INSPECTION RECORD 7.
PERMIT EXPIRATION
11092 , Clarkston
JOB ADDRESS _ UNIT# _LOT#
v` 1.� -PERMIT EXPIRES IF WORK I,
OWNER Yonkatias' Tutush CONTRACTOR - IS NOT STARTED WITHIN,:!
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF-PERMITISSU-a -
' FOUNDATION'S - : ' ANCE"OR A80 DAYS FROM:l
NOTE: - " LASTCALLED INSPECTION.,,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED F
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND"CITY'OF PERMIT VALIDATION
CUPERTINO STANDARDS.' - /,z L.,.
. GARAGE SLABS ' "
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED f '• ;r �,{
UNDERGROUND/SLAB
PLUMBING - +
�i
+ t ELECTRICAL 1 ISSUANCE DATE
MECHANICAL -� ' -BLD ELECT. PLG. MECHn
;dC n1.�❑ ❑ ❑ ❑ "1
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT .
INFORMATION
WOOD FLOOR tTR Q� + �•" =
VALUATION 1 $IFT, 1
PLUMBING'
ME.CHAN ICAL - _ € jt�4i•v's1Si p "w, ;e
PERMIT TO
ELECTRICAL-
t
FRAMING
INSULATION - ^ .� STORIES -TYPE CONSTIR
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.A�. SO FT FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' 'r
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING
ROOF SHEATHING- - - NES IND, 'CON
USE
N PB 00-
El
tlr•
El
APPL'Y,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' ❑ ❑
ASSESSORSPARCEL NO, .
ROUGH SAN.# .I ,
'PLUMBING ELECT.ENERGY
THACT NO. ,PARCEL NO.
TUBS&SHOWER PAN - - PLUMBING ENERGY_ -,
MECHANICAL MECH.ENERGY'
ELECTRICAL - BUILDING ENERGY ACC.DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST'
ZONING 'ENG SITE NO'
:INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK, + ENERGY L]E
` MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ❑' N❑
EXTERIOR SHEARELECTRICAL RELEASE . .FLOOD ZONE A L.u.c.
INTERIOR SHEAR_' FIRE DEPT. Y N❑ Y ❑, N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING •
a1
,INTERIOR LATH ' - - TEMPORARY APPROVALBUILDING_S '
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN$IqN_E& OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY,BUILDING INSPECTOR. MICROFILM
w ARRANGE FOR INSPECTION BY PHONING 252'4505, ELECTRIC'
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z�', ' PLEASE GIVE.JOB ADDRESS WHEN PHONING. .,
v — SEE PERMIT FOR EXPIRATION DATE:-- ^ •MECHANICAL
CONST.TAX •* �
IMPORTANT!,
PLEASE READ REVERSE SIDE BEFORE- J
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY•
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES ' USE BALL POINT PEN ONLY -
_ . -
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT a
AG R� o r s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 15��40'8
BmLD �.
NER's _ PLAN CHECK VALIDATION
bWME ' - QTY. ELECTRIC PERMIT FEE '
4. O// ta-fIgJVHONE
NAMERAcro s OUTLETS.-SWITCHES-RECEP 10.00/1:00 -
/ LIC.NO. LIGHTING FIXTURES ' - 10.00/1.00 - - -
ooeessrO@'S APPLIANCES-RESIDENTIAL - 4.00 -
PHONE PANELS .10.00 DATE OF APPLICATION"'.
ARCHITECT rPLAN CHECK FEE P.C.'.NO.
OR PANELS (OVER 200 AMP) 20.00 . > ,
ENGINEER
LIC,NO, ISIGNS TRANS. , - 3.00
ARCH.OR ENG. - PERMIT V TION
ADDRESS SPECIAL'CIRCUIT 5',00 i. -
AZIP TEMP.METER OR POLE INS. 20.00
S�
A.mme rs
PP ss - MOTORS SEE FEE SCH.
AU
SERVICE CHANGE 20.00
�oo LICENSED CONTRACTORS DECLARATION - ir
qyf
a uu 1 hereby affirm,that I am licensed under provisions of Chapter 9 ISSUANCE- t r'r-J W
;. '4� ' ANCE DATE I.
v, "' (commencing with Section 7000)of Division 3 of the Business'and
,A ¢ n - p••- BLDG. �ELECT. PLG. MECH.
Z w W Professions Code,and my license is in full force and effect ❑41#9111, ❑;
z O License Class Lic.Number ❑'
o H Dale - Contractor •--
s, Y 1 J BUILDING PERMIT
¢ o n O OWNER-BUILDER DECLARATION INFORMATION
X ; � I hereby affirm that I am exempt from the Contractors License MISC.-' REFER TO ORD VALUATION
ruoJ Law for the following reason(Sec.703L5,Businessand Professions PERMIT ISSUANCE 10.00 $/FT.
Code Any city orcounty whichrequiresapermil lD construct,alter, /1 f�
t¢ ¢ a o improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTR. ' ,LIC.NO. - ELEC.
i w owhe
requires the applicant for such permit to file a signed statement that + - TOTAL' .PERMIT T
he is licensed pursuant to the provisions of the Contractor's License
Fz ¢ Law(Chapter 9(commencingwith Section 7000)of Division of the t "IT7V(-Ja7Z, X ,OsFK'
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ I-o the basis for the alleged exemption.Any violation of Secf ion 7031.5 STORIES -.TYPE CONSTR,
n3 !2 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) X5,00 '•'=
of more than five hundred dollars($500).):
I,as owner of the property,or my employees with wages as - BACK FLOW PROTECT.DEVICE 4.00 OCD.GROUP RES.UNITS
I 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,andwhodoes such work FIXTURES-PER TRAP 5.00 SO.PT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended
mprove-mentsarenotintended 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- - GAS-EA.SYSTEM-OVER 4(EA'.) 2.00 BUILDING uSE .
builder will have the burden of provmg-that he did not build or im. RES IND CON PB Olbar .
PIG If purpose of sale.). / INDUSTRIAL WASTE INTER. 30.00 -
1 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 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an'owner of property who builds Grim proves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) .1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.
the Contractor's License Law. 00 TRACT NO. PARCEL'N 0.•-
❑ 1.0y.carpt.nde ec. t ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason Yff 71
'x Ow`nee n - D' • WATER SYSTEM' - - 5.00 I ACC.DATE ACC,FILE NO. j
4CERS' fP ON DECLARATI N WATER TREATING EQUIP. 5.00 -
I hereby affirm that I have a certificate of consent to self-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company -•
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24' '
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- _ 'REFER TO ORD: -
O. Applicant - Y'❑' NQ... Y ❑ N❑
LO COM FLOODZONE A.LU.C.
- PERMIT ISSUANCE 10.00
LU - CERTIFICATE EXEMPTION FROM WORKERS' -
LU > COMPENSATION INSURANCE PLG.cOrvTR. LIC.NO. PLG. �, N Y
Z (This section need not be completed If the permit Is for one TOTAL ❑'. ❑ - ❑ N❑
hundred dollar,($100)orle.I
L) O 1 certify that in the performance of the'work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL h mit is issued,I shall not employ any person in any manner se,as to
U become subject to the Workers'Compensation Laws of California.
0 w' Dale 'Applicant BUILDING 3 a
a ALTER OR'ADDTO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificate of.Ex- - -
F Z emPtiob,you should become subject to the Workers'Compensation APPLIANCE 5.00 y PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE"
C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1O;MC.F.N0 4.00 '
CONSTRUCTION LENDING AGENCY A)RHANDLING UNIT(OVER 10PMC.RM.).6.00 SEISMIC EEE
I hereby affirm that there is.a construction lending agency for EXHAUST HOOD (WITH DUCT) } 5.00
(he
er3097, f Cance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T,U.) 8.00 o MICROFILM'
Lender's Name HEATING U N IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN'(SINGLE) '4.00
information is correct. I agree to comply with all city and county - - PLUMBING
ordinances and state laws relating to building construction, and ' BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereentioned property forinspection purposes.by authorize representatives of this city to enter upon the BOILER-COMP (Over 100,600 BTU)SEE FEE SCH. MECHANICAL
above-m
(We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD. -
+ upertino against liabilities,judgments, costs and expenses which CONST.TAX `
ay,i any way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00
rami d wa r cr MECH.CONT. LIC.NO. MECH.- „ ,ae
TOTAL r
1 TOTAL o2�
ignature of Ap ant ontractor 'Date
OFFICE COPY