14855 (2) POST THIS CARD NEAR,FRONT.OF BUILDING
PERMIT NUMBER' "a
CITY -OF CUPERTINO 14655. .`
INSPECTION DIVISION
JOB'INSPECTION RECORD
- PERMIT EXPIRATION
JOB ADDRESS //���u7h�L�"�"�� /:1,✓� `UNIT# _LOT# "
•� PERMIT EXPIRES IF WORK
OWNER Z - Q 'LZ "CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTORy INSPECTION PitCORD 180 DAYS OF PERMIT ISSU-,I,
FOUNDATION - _ - ANCE OR 180 DAYS FROM "
NOTE:' A T LASTCALLED INSPECTION:.
UFER ALL GRADING AND DRAINAGE-SHALL BE INSTALLED
' A t
PREGUNITE „ TO COMPLY WITH THE APPROVED PLANS AND CITY OF .PERNIIT VAIJOn TION
CUPERTINO STANDARDS.
GARAGE SLABS ,,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
° -
UNDERGROUND /SLAB
,- PLUMBING '.
ELECTRICAL - i'SUA CE IATE ' "I
MECHANICAL - - - - BLDG. ELECT, PLGM
. ECH
. � L
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED a" BUILDING PERMIT '
WOOD FLOOR o 'INFORMATION.
PLUMBING
ALUATION $/FTA-
. . � � p,
MECHANICAL - ,Y �!- ''Q`1••� - �' ,C�LII .
ELECTRICAL-
• FRAMING
INSULATION - STORIES IVPE CONSTH,
OCC.AROUP RES.UNITS -
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
1 - - SO.FLfLOORAHI.A TOTALACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
F
ROOF SHEATHING BUILUINGLUSE
- _ .. RES IND CON `Pe ";Q....
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE• INSP. "' ElEl c
ASSESSORS PARCEL NO,
'I" .ROUGH' SAN.#
PLUMBING ELECT.ENERGY.'- 2..
TRACT NG. PARCCI:NO..
TUBS B'SHOWER PAN PLUMBING ENERGY
. MECHANICAL MECH.ENERGY, '�•./y<
ELECTRICAL , BUILDING ENERGY_ ACC DATE -ACC FILE NO"
;'
FRAMING 'ELECT.FINAL'TEST . ZONING , ENG SITE NO.
INSULATION _ PLUMBING -° '- - '
GAS TEST - GAS ,
FIRE SPRINK ENERGY;T 2z
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING (] " Ni IN
_
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD ZONE A.L.UC. '
v L.1 - .
INTERIOR SHEAR - " ' FIRE DEPT. [D, IN L7 N❑
.. .
' .SHEETROCK - GRADE - - a "FEE SUMMARY
- " EXTERIOR, LATH.. 'q' - BUILDING T 'BUILDING
,INTERIOR LATH .TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC ' ' PLAN CHECK-
_ ' GAS. , . _ - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUI LDING IS NOT PERM ITTE D UNTI L BUI LDING F INAL IS SI GNE D BY.BUI LDI NG INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252+4505; ELECTRIC, Q
�� ONE WORKING DAY BEFORE REQUI"RED INSPECTION. PLUMBING
' o PLEASE-GINE JOB'ADDRESS WHEN PHONING
z
'SEE PERMIT FOR EXPIRATION,DATE , „ MECHANICAL' Ue
CONST.TAX
IMPORTANTI
PLEASE READ REVERSE SIDE,BEFORE, '
CALLING FOR FINAL INSPECTION. ." -TOTAL 0d 8
OFFICE-COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-- USE BALL POINT PEN ONLY r_
BU I LDING PROJECT I DENTIFICATI ON - PERMITNUMBER
amILDING APPLICATION & PERMIT _ '
II Iq 50
(NER LANIO AV, C ` u+ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1485 5
OWNER'S _ - - PLAN CHECK VALIDATION
.•y;,r� NAmE CITY. 'ELECTRIC PERMIT FEE '
] I IVf1�IC KO �'
PHONE
'T
CONTRACTORS
NAM F q / UTLETS-SWITCHES-RECEP. 10.00/1.00 '' 0, -
aVGr/� LIc.om. ,7 //4/6 LIGHTING FIXTURES 10,00/1.00
CONTRACTORS
ADDRESPPLIANCES-RESIDENTIAL 4.00
tHOPIE PANELS '10.00
DATE OF APPLICATION..
ARCHITECT - - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 -
+
LIC.No. SIGNS TRANS. "3,00 -
ADDRESS ENG SPECIAL CIRCUIT 5.00 - - PERMIT VALIDATION
Z TEMP.METER OR POLE INS:if •20.00 a ,f
ADDRESS MOTORS' - SEE FEE SCH.
ADDRESS � '-
- SERVICE CHANGE=' � 20.00
r
02 LICENSED CON'T'RACTORS UECLA RATION
¢ i w I hereby alfinv Ihm I lin licensed under prrvkkne,of Chapter 9 ISSUANCE GATE'
4 e (commencing with Section 7000)of Division 3 of the Businessand BLDG.. ELECT- PLG. .MECH.
H w'^ ' i'rol'essions Code, u my license is in full force d•fit n[� I/ �+ ❑
license Class Con Number YY _
O.rn H Uutc=f�_� Contractor
Y - .BUILDING PERMIT "
¢.¢,w OWNER-BUILDER DECLARATION - INFORMATION
+w ; a. I I hereby affrin that I no exempt from IIIc Contractor's Licensee MISC._ REFER TO ORD
I�Oa Law for the following reasonASec.7031.5,Businessand Professions .�-Oo- VALUATION $/FT.
I- -,a PERMIT ISSUANCE - l_
Code:Any city or county which requirese permit To construct,alter'
Q ¢ Q improve,ulemolish,M repair any sUUCtum,prior to its iSaLiaOCO,also ELEC.CONTR. LIC.NO.�' ELEC. /( S, �+I (A,(J
i wx requires the applicant for such permit to file u signed statement that TOTAL. / I•PERMIT TO -
$ - he is licensed pursuant to the provisions of the Conrmctor's License `
,La LawiChaptcr9(commencing with Section 7000)of Division 3 of the
4 0• Business and Professions Code)or that he is exempt therefrom and DTV. - 'PLUMBING PERMIT. FEE • �1 yl-JI�1
¢ HS the basis for the alleged exemption.Any violation ofSeclion 7031.5 - gT IE TYPE CONSTR.
T g by any applicant for a permit subjects the applicant to a civil penalty �{)�.
of not more than five humbed,dollars(S50G.1: ALTER-DRAIN VENT-WATER 5.00 Q . p0
❑ I,as owner Of The property,or my I'll with wages as BACK FLOW'PROTECT.DEVICE 4.00 DGc.O� BEs.UNITS
then sole compensation,will do Ilse work,and the structure is not - -
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00 GXty
Code:The Contractor's License Law does not apply to an owner of '
Property who builds or'wn em thereon,and who Anes such work F IXTUR ES PER TRAP',, 5.00 } SO.FT.FLOOR AREA 'TOTAL ACREAGE
himself or Through his own employeesprovided Otat such improve-
ments are not intended or offered for sale.If,however,the building GAS:EA.SYSTEM:I INC.4 OUTLETS"6.00
Or Improvement is soldwithinone ye,irof completion,life owner- GAS EASYSTEM OVER 4(EA ) 200 .
builder will have the burden of proving that he did not build or fin - . - 4.IEA.) ' ,
- BUILDING USE '
prove for purposeof sale.). II.. RES IND .. CON PB On.,
INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively'contracting with E] ❑
licensed cHaDaclors to construct tlic-project(Sea 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 or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
aantraels for such projects with a contraetorls)licensed pursuant to
the Contractor's License Law. SEWER•$ANITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ' ,B.&P.C.R,,this WATER HE W/VENT 6.00
reason
Owner talc - ` WATER SYSTEM 5.00
. .• 'r. ACC.DATE ACC.FIhENO.
WORKF:RS'COMPENSATION DECLARATIONWgTER TREATING EQUIP. 5.00 �.�
hereby ammo plat I have a certificate of consent To sdf-insure, -or a certificate of Workers'Compensation Iniurancc,'or,u certified - 'v t ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.CT.
policy No.
Co Dant
- f] C rt'lled copy isitliethy oRfl,lied. "'
Z 2 _❑ Cert Tie C I i' Idcd Willi the ulY sl ton division.` FIRE SPRINK ' ENERGYT24
P OI' APphc ml�� Ct�L�s�h .. MI - REFER TO ORD. Y ❑: N� Y•E - NO
CCT CLR'PIFI II.OF iXEMITION FROM' ORLLRS' PERMIT ISSUANCE 10.00FLOOD ZONE A.LUC
LU > _ .COMPENSATION INSURANCE- PLGICONTH:
Z -('Phis wdidn need not be tDom leled it the permit is for one _ TOTAL Y E:] N❑ Y C] N❑
O - hundred dollars 151on)or less.l •-
Icertify that an the parl'ormance of The work for witch Ihis,Fer- CITY .ryjECHANICAL PERMIT FEE _+ FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to
O .. becomesubject to the WorkersiCompensation Laws of California. -
watUxm Applicant �— BUILDING,` p
a ., ALTER OR ADD TO MECH. 5.00 Isy"
} N NOTICE 1'0 APPLICANT: If,after making tills Certificate of lix-
F ? '_ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 j PLAN CHECK-
' provisions of file Labor Code, you mI torihwith comply with , / FEE'
- C„) suchro
pvisions or This permit shall he dee..ad revoked.' AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 p
_ CONSTRUCIION-LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.EM.) 6.00 ! SEISMIC FEE p1
I hereby afURR that there is'a co.anintion leadingagerey for „ EXHAUST,HOOD(WITH DUCT) 5.00
' - the perfornonce of the-work for which This permit is issued(Sec., - MICROFILM
3097,Civ.C.). HEATING-UNIT(TO100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000B.T.U.)9.50 - �p
Leader'sAddress - :"' ,ELECTRIC.
( certify tial l have read this application and stale that The above VENTILATION FAN (SINGLE) 4.00
.r info men l n is corrceV I agree to comply with all city and county - PLUMBING
I"bounce, and slate laws relatfng.lo building construction, and BOILER-COMP(3H.P.or100,000B.T.U.)'6.00 .x /
hereby authorize representatives of this city W enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
9jm A-� above-mentioned property for inspection purposes:, -
Sbvs• (WC) agree To Save;-indco nify and keep,harmless the City of MISC.- REFER TO ORD. ,
upertim, against"liabilities,judgments, costsand expenses which + ` • CONST.TAX
nay in anyway accrue against said City in consequence of the PERMIT ISSUANCE d'-
1
rantingoftpp permit. MECH.CONT. LIC.NO. MECH.
071" wry j�d' DTA .a/�; TOTAL
Si t
Signature pplicanl/Contractor Data - ? 300 ��
" .OFFICE COPY