18418 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 18418
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS' Dd' ��-�- r UNIT j#. _LOT#
' - - PERMIT EXPIRES IF WORK
OWNER , "` M.� ( y�C. CONTRACTOR+ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR . INSPECTION RECORD •186 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
LIFERALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION-
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS PM6 f ) - •�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ! t .
UNDERGROUND /SLAB q J//
PLUMBING J - w .-�+ L^ �i+ll;✓„r- .� _moi
ELECTRICAL - ofowft ISSUANCE DATE.
MECHANICAL "eLoc ELECT. —PLG.
❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 46To t,as 0,)7 . BUILDING PERMIT
INFORMATION
WOOD FLOOR rc:,Qe use L SJ 4
VALUATION 11FT,
PLUMBING ,1. DD
MECHANICAL ro at
ELECTRICAL vER111 TO
FRAMING a
INSULATION TORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO FT.FLOOR AREA TOLYL ACREAGE
�- DIAPHRAGM THE CONSTRUCTION TAX IS PAID
G
ROOF SHEATHING RES IHUILDINUSE
NO CON PB Om.•'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 11 ❑ ❑ ❑ El
ROUGH
ASSL550RS PARCEL NO
SAN.p
- PLUMBING ELECT.ENERGY
TUBS 8SHOWER PAN. PLUMBING ENERGY IHACT NO PARCEL NO
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 724
MECHANICAL Y Ej N� v N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
, EXTERIOR SHEAR IELECTRICAL.RELEASE FLOOD ZONE A.L U C.
INTERIOR SHEAR IFIRE DEPT. Y ❑ N❑ Y D N❑
- SHEETROCIC GRADE FEE SUMMARY
EXTERIOR LATH, BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK ��jjL [(
GAS ' FEE UrLJ. _/-
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE �.�(
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BIT]LDING FINAL IS SIGNED BY;BUILDING.INSPECTOR. MICROFILM
w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING
Z�- PLEASE GIVE JOB ADDRESS WHEN PHONING. 1
v
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL /rr
CALLING FOR FINAL INSPECTION. 7f3
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
+ BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
�. BUILDING APPLICATION & PERMIT
ADDRESS
a O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 18418
OWNER'S PLAN CHECK VALIDATION
NA
DTV. ELECTRIC PERMIT FEE
RD PRONE (
NAMERAcroRs UTLETS-SWITCHES•RECEP 10,00/1.00 ,a,S
uc,NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTOWS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
ADDRES
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
oR PANELS (OVER 200 AMP) 20.00 _ ,
ENGINEER
E( o C.NO SIGNS TRANS. 3.00
ARCH,OR ENG, PERMIT VALIDATION
ADORBss � / iIP S SPECIAL CIRCUIT 5.00
N. T s EMP.METER OR POLE INS. 20.00
APPLI ESMOTORS SEE FEE SCH.
S
ADDRDDRESS
' SERVICE CHANGE mAinilti2o.00
C 2
D
o o LICENSED CONTRACTORS DECLARATION
<u raa I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
II
(commencing with Seclion 7000)of Division 3 of the Business and SEP 11 ISAS
m m Professions Code,and license licme is in full force and effect. DG. ELECT. PLG. MECH.
Z o P - License Class Lie.Number ❑
B n H w Date Contractor
BUILDING PERMIT
M Ica OWNER-BUILDER DECLARATION
c a u INFORMATION
X ;LL H I hereby collo that I am exempt from the Contractor's License MISC.- - REFER TO ORD
✓� VALUATION SIFT.
Law for the following reason.(Sec.7031.5,Business anA Professions
H _ PERMIT ISSUANCE 10.00 ],!Q m
Cade:Any city or county which requirese permit to construct,anL alter, //^^
¢ ¢¢0 improve,demolish,or repair any stmcl are,prior to its issuance,also ELEC.LONTR. LIC.NO. ELEC. W
1 CM
O M requires the applicant for such permit to file a signed statement that TOTAL '!j t sw
a w m u he is licensed pursuant to lire provisions of the Contractor's License PERMIT TO
H Z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of lire p
4 o Business and Professions Code)or that he is exempt themironl and QTY. PLUMBING PERMIT FEE
¢ H the basis for the alleged exemption.Any violation of Seclion 7031.5 STORIES TYPE CONSTR.
a3 _ by any applicant for a permit subjects lire applicant loo civil penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars(5500).): -
1i(( 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
intended or offered for sale (See, 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Coder The Contractor's License law does not apply to an owner of
n�
himself or
buildsorimproves thereon,n,and who
at suchSuch work FIXTURES-PER TRAP 5.60 SO.FT,FLOOR AREA TOTAL ACREAGE
meats are throughde ownemred farsS pe.If,hl fever,the
improve- GAS-EA.SYSTEM-I 6.00
meats are not intended proffered far Sale.If, mpleveq the building
or der will
is sob 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 im- RES IND CON PB Omer
prove fors owner of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusivelyjes (Sec.
contracting with ❑ ❑ ❑ ❑ ❑
license.) contractors to The
the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's improv Law docs not apply
to tr owner of property who builds lr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contracmrtsl licensed pursuant In SEWER-SANITARY-STORM EA.200ft/10.00
the CoDtraCtal iCense Law. TRACT NO. PARCEL NO,
❑ lam c trade .&P.C.for this WATER HEATER W/VENT 6A0
reason_ _ Of
-I- Owner to "Is_ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAT10N DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate ofcnnsenl to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah.0.).
Policy No. Company
00 Certified entry is hereby funsished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with fire city inspection division. MISC.- REFER TO ORD.
p o Applicant Y❑ N❑ Y ❑ N❑
CC W CERIN FICATI:OIs EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10A0 FLOODZONE A.L.LLC.
L COMPENSATION INSURANCE PLG.CONTR. LIC,NO. PLG.
Q (This section need not be completed if the permit is far one TOTAL v❑ N❑ Y❑ No
hundred dollars(S 100)or less.(
U 0 1 certify that in the performance of the work for which Blis per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL it- mit is issued, I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. 4
U w Dare Applicant BUILDING- O� ��
a ALTER OR ADD TO MECH. 5.00
} m NOTICE TO APPLICANT: If,after making this Certificate of lix-
Z emption,you Should become subject to the Workers'Compensation1 /I r- provisions of the Labor Code, you must forthwith comply with APPLIANCE 5.00 PLAN CHECK �-1 V
U Stroh provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE '86
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction Iending agency lot 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 HEATING UNIT 100,000 B.T.U.)9.50 O T`Q
Lenders Address ELECTRIC
I certify that I have read this application and slate Ila,the above VENTILATION FAN (SINGLE) 4.00
' information n correct"I agree to comply with all oily and county PLUMBING
information
and slate laws rending to comply
with
construction,an ion, nttl BOILER-COMP 13 H.P.or 100,000 B,T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperhno against liabilities,judgments,costs and expenses which
trPERMIT ISSUANCE 10.00 CONST.TAX
oy, sea cc a against Said City in consequence of tiro
r m is pen MECH.CONT. LIC,NO, MECH.
TOTAL TOTAL 7
Ignalure of IT icunl 'ontracmr Date
OFFICE COPY