15024 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO , 1aQ24
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
%700 A/, �J�%�rzr�
� 1sx JOB ADDRESS 3 UNIT# _LOT# pERM17 EXPIRES IF WORK
OWNER L CONTRACTORIS 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
PREGUNITE 'TO COMPLY WITH THE APPROVED PLANS AND CITY OF, PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - -
• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �'- �iLJ+'f. fd. �Y �• ""'=�
UNDERGROUND /SLAB
PLUMBING
' ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG ELECT, PLO. MECR
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SJET.
MECHANICAL '
ELECTRICAL - - �A PERMIT TO -
FRAMING �'/E.
INSULATION q^�'WyI •sroyles rvPE comsrR.
WV O
Occ.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
A '' ROOF NOTE:NO FINAL INSo.SHALL BE MADE BEFORE. so yr FLOOR AREA TO'AL ACREAGE-'
DIAPHRAGM THE CONSTRUCTION TAX IS PAID - ,
BUILDING USE
ROOF SHEATHING RES IND CON PR 0"'�l
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ED El 1:1 ❑
ROUGH
ASSESSORS PARCEL NO
SAN.a
PLUMBING
ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDINGENERGV ACC.DATE ACC FILE NO
FRAMING. ELECT,FINAL TEST
ZONING ENG.SITE'NO.
' INSULATION PLUMBING '
GAS TEST" - GAS -
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y F] "O Y ❑ '"�
FLOOD ZONE A.L UC'
EXTERIOR SHEAR - ELECTRICAL RELEASE ,
INTERIOR SHEAR FIRE DEPT. �' `'❑ N❑ Y L "❑
SHEETROCK GRADE - FEESUMMARY
EXTERIOR LATH BUILDING r LP BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH.COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE .
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROF.ILM
ARRANGE FOR INSPECTION BY PHIONING 252-4505, ELECTRIC
�1 LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
1., O PLEASE GIVE JOB ADDRESS WHEN PHONING.
w� Z
-'SEE PERMIT FOR EXPIRATION DATE — MECHANICAL ✓�.
IMPORTANT! . CONST.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 ,
yx PERMIT NUMBEROUILDINGPROJECTIDENTIFICATION APPLICATION & PERMIT y
ADDRESSUILDOIC -
ADDRESS BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 15024
I07oo dYJ. _ BLv
OWNER'S PLAN CHECK VALIDATION
NAME
DTV. ELECTRIC PERMIT FEE
I-leOL PH ON O
f�f CONTR
NAME ACTORS
l UTLETS-SWITCHES-PIECED 10.00/1.00
l ST LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S +Z�
ADDRESS S�.J i APPLIANCES-RESIDENTIAL 4.00
a A /4rOL�A AVE PHONE24�f'—�// PANELS 10.00 DATE OF APPLICATION
ARCHITECT -on PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No.
ENGINEER
uc.NO SIGNS TRANS. 3.00
ARCH.OR
RESS END. - SPECIAL CIRCUIT S.00 PER MIT VALI DATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT
ADDRESS MOTORS SEE FEE SCH.
'?eel l9Tv JZ yJ/Z SERVICE CHANGE 20.00
wo o LICENSED CONTRACTORS DECLARATION O
I.hereby affirm that 1 um licensed under rovisimtsof Cha ler9
N2 6 Y p s ISSUANCE DATE
Q (commencing with Section 7000)a(Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H N i Professions Cade,u my license is in full forep a fgpL ❑ ❑
o
0. —o License Class I.E.Number S/
F W H j Date Contractor
a m re a
OWNER DECLARATION BUILDING PERMIT
a ao w u 'INFORMATION
L 3 tE N I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
�.o e Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
S Codi Any city or county which requiresa permit to construct,alter,
SE aa 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC.
i DLL requires the applicant for such permit to file a signed statement that TOTAL - PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
H z i
Late(Chapter 9(commencing with Section 7000)of Division 3 ofthc
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
.a H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
n3 — by any applicant for a permit subjects the applicant lax civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of net more than five hundred dollars(S500t):
❑ 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,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
d Y., property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
w himself or through his own employees,provided that such improve-
P ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
-y 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 proving that he did not build or mi, RES IND CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,BusinessLAWN 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 or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for Such
projects with a'contmctoNal licensed punuant m
the
Contractor's
License aw. SEWER-SANITARY-STORM EA.200ft/10.00
TRACT NO. PARCEL NO.
❑ I am exempt under Sea - ,Il C.for this
WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACO.FILE N0,
WORKERS'COMPIiNSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofe.menl to self-insure. - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.). O
X Policy No. Company O
Q ❑ Cerlilicdcopyisherehyfumished FIRE SPRINK ENERGY T-24
Z Z ❑ Certified opy with the oily inspection Division. MISC.- REFER TO ORD.
O Appliennl� Y N� YF] N�
= b CERT'll'ICATE OI°FXFMI'TI I°ROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
UJ > COMPENSATION INSURANCE ' PLG.CONTR. LIC.NO. PLG.CL Y O N Y N�
Z (' this sedidn need not be completed if the permit is far one TOTAL
hundred dollsrs(S 100)orlessJ _ Q p _
U O 1 certify that in the performance of the work for which this per- OTY ~' MECHANICAE ERMI �! FEE FEE SUMMARY
LL F mil,is issued,I shall not employ any person in any manner so as to
O w become subject to the Workers'Co mpensa t io n Laws of Cali fornix BUILDING
n Date Applicant ALTER OR ADD TO H. 00
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
)... ? tription,you should become subject to the Workers'Compensation APp LIANCE ,00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with - FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT IT FJVU 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOMC.F.NL) 6.00 SEISMIC FEE
1 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(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
f�
information n correct 1 s agreetocomply with all city and county PLUMBING
ordinances and state laws relating to building construction, and 130ILER-Ix3Nlp(3 H.P.of 100,000 B.T.U.) 8.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
t P (We) agree to save, Indemnify and keep harule. the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,costs and expenses whidh' PERMIT ISSUANCE 10.00 CONST.TAX
may in,any wa me against said City in consequence of the
rank of This ermlt MECH.CONT. LIC.NO. MECH.
�3 TOTAL TOTAL
\Signature of Applicant/Con r aid 6 0 7
OFFICE COPY