15624 (2) POST THIS CARD,NEAR FRONT OF BUILDING PERMIT NUMBER
- : CITY OF CUPERTINO
INSPECTION DIVISION 502 4
"!
JOB'INSPECTION RECORD
.• - s�,'r,a "le./ PERMIT EXPIRATION•
JOB ADDRESS �O�oL.3 Wol A) n UqNIT# - LOT 9t 'PERMIT EXPIRES IF WORK
OWNER GR.�C 4" CONTRACTOR W'c ',f�G��7-e tC. -IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF;PERMIT'ISSU-'
FOUNDATION ANCE OR 180 DAYS FROM '
i. NOTE: LASTCALLED INSPECTION.
LIFER 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 °• .1.-:.,t'.^'- �¢"''"`-0�'
UNDERGROUND,
/SLAB
PLUMBING
IA'
ELECTRICAL . ISSUANCE DATE
SLOG, G.,, MECH
MECHANICAL i _ EL CT PLEC
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
INFORMATION
WOOD FLOOR � . '. jk VALUATION $FT
PLUMBING - - -
MECHANICAL
PERMIT TO
ELECTRICAL .�
FRAMING
INSULATION ' .. STORIES." .TYPE CONSTR„ I
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn Fr.FLOOR AREA -roTAL ncR EAce
DIAPHRAGM ' THE CONSTRUCTION TAX IS PAID
BUILD I NO USE
ROOF SHEATHING - HES -IND CON PB oma,
APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - DATE INSP. ❑ ❑ . 11 ❑ ' ❑`
ASSESSORS PARCEL NO.
ROUGH SAN,N
PLUMBING . - - - ELECT.ENERGY - '
1
TUBS'&SHOWER PAN PLUMBING ENERGY THACF rvo., PARCEL No.
'I MECHANICAL ' MECH,ENERGY
ELECTRICAL .•a'7^ .BUILDING ENERGY Acc,UnrE Acc.EaENo,
-
.FRAMING ELECT.FINALTEST
. .
!INSULATION _ PLUMBING
ZONING ENG.sITE.No';.
'GAS TEST' v' GAS -
• MECHANICAL EIRE SPRINK -ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ ”❑" `"Y ❑ "❑
.
- EX'TERIORSHEAR " - - ELECTRICALFL.ODD ZONE . AL.0C,
RELEASE � t
INT RIOR SHEAR ,I FIRE DEPT. - Yo ";❑ Y ❑ "❑' '
SHEETROCK GRADE' FEE SUMMARY
EXTE IOR LATH ' BUILDING -
INTE IOR, LATH EMPORARY APPROVALS BUILDING -
SCRATrH COAT LE a(�,o� ' PLAN CHECK'
_ AS - FEE
G . ..
NO TAIIE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - -SEISMIC FEE- '
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM'
uJ . ` ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC O S!
1-- ONE WORKING DAY BEFORE'REQUIRED INSPECTION. PLUMBING .•
\• Z,. , PLEASE GIVE JOB ADDRESS WHEN.PHONING.,'
i
- SEE,PERMIT FOR EXPIRATION DATE- MECHANICAL
I IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
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 r
w BUILDING APPLICATION &'PERMIT
ADOREss - .. -
//i
O�Z3 GJDGfE nt , BUILDING -.ELECTRICAL-PLUMBING-MECHANICAL ' 15624
OWNER'S - - , PLAN CHECK VALIDATION:
NAME r. QTY, ELECTRIC PERMIT FEE
' .e e S. R.. PHONE.
�. C TRACTOR'S. - • --
rvAMnE r� 7 �ZZ. LITLETS-SWITCHES-RECEP 10,007''00
COOL-T GL-�Grtk,(�.'m No. s7 LIGHTWGFIXTURES 10.00/1:00
CONTRACTORS' APPLIANCES-RESIDENTIAL 4.00
' - /0✓ � PHONE 77 PANELS 10,00 DATE OF APPLICATION -
ARCHITECT PLAN CHECK FEE - ,P.C,NO. ,
DR GINEER67aA./ 1�A1-G Gq - PANELS (OVER 200 AMP) � ' 20.00
EN
Lm.NO. SIGNS TRANS, 3.00ARCH:OR
'
G ADDRESS ENG. - SPECIALCIRCUIT 5.00 PERMIT VALIDATION -
zIP TEMP.METER OR POLE-INS. 20.00 �+ -
APPLICANT'S v -
aooREssL- MOTORS SEE CH. '�
SERVICE CHA
NGE 20.0
w00 LICENSED CONTRACTORS DECLARATION! r (� 1` l��
vv 1 hereby affirm that I am licensed finder provisions of Chapter 9 S /
2 w Cc ISSUANCE DATE ^
y rt (commencing with Section 7000)of Division 3 of the Business and
F 7 2
'or
Code nd m license is in full forceyl f;,ct��- _ BLDG. ELECT, PLG. MECH.
14
z o H-- 'cense Class Lia Number/7 G�17 c., 1 0El
8 w -D Date _ Contractor V
rc rc
It 4 OWNER-BUILDER DECLARATION BUILDING PERMIT
a o P_ -INFORMATION
MIS - REF
x 1 hereby affirm that I am exempt front �o C. ER TO ,
w 3 Y p f .5 the i manta r License VALUATION
u O¢ Law for the fallowing reason.(Sec.requires
a,permit
to construct,nd Professions $/FT.
r - � PERMIT ISSUANCE -: '�
E w > P Code Any city or county which str a tune, prion o uanalter,
K Q O improve,demolish,or repuioany structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTALS-
w$ he is licensed pursuant to provisions of the Contractor's License PERMIT TO
z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the
f E D Business and Professions Code)or that he is exempt therefrom andQTY. PLUMBING PERMIT FEE
rc H o the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
nam by any applicant fire a permit subjects the applicant to a civil penalty ' ALTER-DRAIN IEA.) 5.00
of not more than five hundred dollars($500):):
❑ 1,as owner of the property,or my employees with wages as
their sole BACK FLOW PROTECT. DEVICE .4.00 , OCC,GROUP RES.UNITS compensntion,will do the work,and the structure is ant
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(hereon,and who docs such work FIXTURES-PER TRAP - 5.00 sa PT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- z
builder will have the burden obproving that he did not build or im- GAS-EA.SYSTEM-OVER 4-(EA.) 2.00 - BUILDING USE
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 r ' RES IND CON Pa Omer
❑ 1,as owner of the property,am exclusively contracting with A - O
. . .
licensed Contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 VB ' • 600 ASSESSORS PARCEL NO.
11 El
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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA:200ft/10.00' TRACT No. PARCEL NO.
❑ lam exempt under Sec. ,B.&BC.for mix WATERHEATERW/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WO,RKERS'COMPENSATION DECLARATIONWATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-Insure: -
or a certificate of Workers'Compensation Insurance,or a certified 'ZONING ENG.SITE NO.
copy thereof(Sec.3800,Iab.C:I. - -
r Policy No. Companyur�f1-
O ❑ Ce rtifled copy is hereby turn's ed.
'Z Z �Ce tiff is th 'icy ins, on division. FIRE SPRINK ENERGY T-24
F Applicant MISC.- REFER TO ORD. Y!o No Y ❑' NE]
D7 - CERTIFICATEOF EXEMPTION FROM WORKERS' 'PERMIT ISSUANCE 10.00 FLDDD ZONE a.L.U.C.
LU > COMPENSATION INSURANCE. PLG.CONTIT LIC.NO. PLG.
CL 0 (This section needno[ be completed if the permit Is for one
� Z hundred dollars($100) olessI
U O I certify that in the performanceof'the work for which this-per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL. F 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.
yBUILDING
. Date Applicant ALTER OR ADD TO MECH. 5.00
} w NOTICE,TO APPLICANT'. If,after making this Certificate of fix-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code,-you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) '4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10MC.F.M.) 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
Lender's Address HEAT[NG U N IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
1 information
that I correct,
read this application and state that the above VENTILATION'FAN (SINGLE) 4.00
'• mfonances is state
eG 1 agree to comply with all city and county PLUMBING
oNinances and stat laws'relating m building-construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives ertyforns of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly arsp of this
purposes, '
(We) agree to save, indemnify and keep harmless the City of MISC. REFER TO ORD.
per fine against liabilities,judgments, costs and expenses which -
may io y way accrue against id City id onsequence of the PERMIT ISSUANCE ^ 10.00 CONST.TAX
Car t 'in is !. MECH,CONT. - LIC.NO, MECH.
TOTAL TOTAL
I nature o h an onhac or '
p Date
OFFICE COPY :''