18739- POST THIS CARD NEAR FRONT OF BUILDING'
-
CITY "0F CUPERTIN'
INSPECTION DIVISION ..
JOB INSPECTIONRECORD
JOB ADDRESS �_�O �E/ IDCI C( UNIT# LOT# "
L
OWNER , `C' •r�/✓ CONTRACTOR' I
TERM IT NUMB EH
18739
PERMIT EXPIRATION '
PERMIT EXPIRES IF WORK
IS NOT STARTED. WITHIN
,180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION.
NOTE: •'
ALL GRADING AND DRAINAGE SHALL,BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
LIFER.
PR EGUNITE
PERMIT VALIDATION t
I.. Y,. !T I<'•al rf
ISSUANCE DA IE
_
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
OCT 5:1989'
UNDERGROUND /SLAB
PLUMBING .'
.. F _
,Crit}sof CuportiDD
ELECTRICAL
MECHANICAL
-
BLuc ELECT. PLG. MECH
� ❑ ElA
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- -
'.
BUILDING PERMIT
INFORMATION
WOOD FLOOR -
'VA`UAT ION
SIFT.
PLUMBING
MECHANICAL
ELECTRICAL -
-
PBENUT TO
-)� ..1..
.147
�C
FRAMING
INSULATION
ST )RIe$
I V INSIH,
-
_
-
OCC. GROUP
HES UNITS,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-
' .ROOF
NOTE: NO FINAL INSP. SHALLBE MADE BEFORE.
THE CONSTRUCTION. TAX IS PAID, a
-
III, IT, E LDUII ARLA
IUTfiL ACRLACl
�'
DIAPHRAGM
ROOF SHEATHING -
bulLUlNc use
HE$ ,IND CON VB L)11••1
'1:1 L ❑ L L
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE, INSP.
- ROUGH'
SAN.N.
A$$E$$(JH$ PARCEL NO
PLUMBING
ELECT. ENERGY ..
TUBS &SHOWER PAN )
PLUMBING ENERGY -
TRACT NO.
PARCEL NO
.
MECHANICAL ;
MECH. ENERGY
ELECTRICAL --
BUILDING ENERGY
Acc. DATE -
ACC FILE NO
FRAMING
ELECT. FINAL TEST -
INSULATION
PLUMBING
ZONING
ENG. SITE NO.
GAS TEST - -
GAS" 1
'
MECHANICAL
FIRE SPRINK
°�
ENERGY T94
NL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING.
EXTERIOR SHEAR _
ELECTRICAL RELEASE
ILOOD zoNE
NL
aL.0 c.
I L NL
INTERIOR SHEAR � �
FIRE DEPT.
SHEETROCK •GRADE
. -
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
'.I NTERIOR LATH -
TEMPORARY PPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
.
-:.
GAS,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
_
OCCUPANCYSEISMIC
FEE
Sd
OCCUPANCYOF BUILDING ISNOTP.ERMITTED UNTILBUILDING FINAL ISSIGNED•BY BUILDING• INSPECTOR.
MICROFILM ,
ARRANGE-FOR INSPECTION BY PHONING 252-4505,
F�. ONE WORKING DAY BEFORE REQUIRED INSPECTION'
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOREXPIRATIONDATE'
ELECTRIC.
PLUMBING
MECH
MECHANICAL
/[ a
G O.�
CONST. TAX
IMPORTANT!'
PLEASE READ, REVERSE SIDE BEFORE
' CALLING FOR FINALANSPECTION. -1
TOTAL
U D
OFFICE COPY
I ,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION
APPLICATION &PERMIT
BUILDING - ELECTRICAL- PLUMBING -MECHANICAL),
- PERMIT NUMBER .;
O J (� -
o
eDILDwG"
5 I1REss -
OWNERS
i
PLAN CHECK VALIDATION
NAME ' '
PHONE9 a5
QTY. ELECTRIC PERMIT FEE
DATE OF APPLICATION
rvOMERACTORS
1 (5�,OI ore. rvo. 3,0 O.L 5
OUTLETS - SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
C,ONTRACTOR
ADDRSSS.5-/•
OORES_
54; %1%nvh4JQ PHONE F Yo
APPLIANCES -RESIDENTIAL 4.00.'
r PANELS 10.00
ARCHITECT
ARC .. -
ENGINEER
uc.NO.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. N0.
.
SIGNS TRANS. 3.00
ADDRESS ENG.
CIRCUIT ' 5.00
PERMIT
PERMIT VALIDATION
TEMP. METER OR POLE INS. 20.00
1 , nP
/
lU kvcc
APPLICANT s
SS`9,N
ADDRESS ADOR J
36 a Lo 11Aul
MOTORS SEE FEE SCH.
SERVICE CHANGE20.00
LICENSED CONTRACTORS DECLARATION
PAID.
1 hereby affirm that I tun licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code' my license is it, force q Jiff;cL 9
License Class Lie N'wnber $ads
ISSUANCE DATE
BLDG.
ELECT.
❑
PLG. MECH.
,❑ /E-�
-/�y
Date Contractor s
CI,�
fL-CI
PERMIT
INFORMATION
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor. License
Law for the following reason. (Sec. 7031.5, Business and Professions
Code: An 't hreounl I p
Any city ywatchrerreture omit Loco issuance,also
improve, demolish, or repair any Strad arc, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law lChapter 9(cmnmencing with Section 7000) o'Division 3 ofthe
Business and Professions Code) or that he is exempt thercfmm and
of Cupertino
LlBUILDING
415C. - REFER TO ORD
VALUATION
VV
3'00 .Of1
•
$/FT..
PERMIT ISSUANCE 10.00
ELEG CONTR. LIC. N0.
ELEC.
TOTAL
PERMIT TO e
QTY. PLUMBING PERMIT FEE
1
1STORIES
TVIPE CC5NSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
1
by any applicant for a permit subjects the applicant ma civil penalty
of not more than five hundred dollars(S500t):
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of Ire propert, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees. Provided that such improve
retails arc not intended or offered for sale. If, however, the building
_
F IXTUR ES - PER TRAP 5.00
So. FT. FLOOR AREA
TOTAL ACREAGE
GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or int
piece lei purpose ofsale.).INDUSTRIAL
.❑ 1, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB ower
❑ , ❑ ❑ ' ❑ ❑
WASTE INTER: 30.00'
licensed contractors to construct the project (Sec. 7044. Business
and Professions Code The Contractor's License Law docs not apply
to un owner of property who builds or improves thereon, and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
,
-
contracts forsuch projects with a amtmcto0h) licensed pursuant to
theComolettinSLicenseLaw. -
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
.❑ E at,, exempt under See. ,B.&P.C. for this
reason
WATER HEATER W/VENT 6.00
Owner Date (t- -
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO�
WORK 6RS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00
I hereby affintt that l have u certificate of consent to self -insure.
or u certificate 0 Workers Compensation Insurance, or a certified
-
ZONING
ENG. SITE NO.
copy thereof (Sec. 3800, Lab.C.l.
Policy 'No Company'
❑ Certified copy is hereby famished
Ccrtvic y i.�//_th,led r with the ciiy inspection division,
lican LL,%4q_'=/Q--�� _
_
FIRE SPRINK
Y ❑ N❑
ENERGY T.24 -
Y ❑ N❑
MISC- REFER TO ORD:
CERTIFICATE' OP EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
PLG. CONTR. LIC.NO.
'•
PLG.
TOTAL
COMPENSATION INSURANCE -
section need not be completed if the permit is for one
YE]
YE] NE]
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars (S I00) oI less.)
I certify that -in the performance of the work for which this per-
LOT is issued, I shall not employ any person in any manner so as to
BUILDINGQ
Sa
hectare subject to the Workers''Compensation Laws of California.
�
Date Applicant
NOTICE TO APPLWAN'C If, after making this Certificate of Ex
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
entption, you should become subject to the Workers'Conhpensatiun
provisions of the Labor Code, you most forthwith comply with
such provisions or this pennil shall b, dcem,d revoked
FEE
AIR HANDLING UNIT (TO 10,000 C.F.M.) , 4.00
AIR HANDLING UNIT (OVER 10,000C.F.W) 6.00
SEISMIC FEE
�ff
CONSTRUCTION LENDING AGENCY
I hereby ufl tont mal taco, is a ou,tructicIn Iendlog agency En
EXHAUST HOOD (WITH DUCT)5,00
the performance ofihe work for which "this permit is issued (Sec.
3097, Civ.C. ). '
MICROFILM
-
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATI NG UN IT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
Lender's Name
-
Lender's Address
I cerlify Ilial l have read this application and state tmtmcabov,
VENTILATION FAN[SINGLE) 4.00
information is correc[..I agree to comply,witIT all city and co only
ordinances and state `laws relating to building construction, and
hereby authurio, representatives' of this city to enter upon me
above-mentioned.properly for inspection purposes.
PLUMBING
BOILER-COMPI3 H. Ron 100,000 B.T.U.) 6.00
BOILER -C OMP[ Over 100,000 BTU) SEE' FEE SCH.
-
MECHANICAL
MISC. - REFER TO WD. -
(We) agree to save, indemnify and keep [harmless the City or
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said City in consequence of the
CONST, TAX
-
PERMITISSUANCE 10.00 �.. op
MECH. CONT. �LtC. NO. MECH. -.
TOT L S D
��
TOTAL
3 �•
ailingoflh}permy-,
Signatureo'APpllcan t/Contractor" Date
OFFICE COPY