17259 ' POST THIS CARD NEAR FRONT OF BUILDING . � ' PERMIT NUMBER
CITY OF*' CUPERTINO 17259
INSPECTION DIVISION ,
JOB INSPECTION RECORD
`�� ' exp w - - PERMIT EXPIRATION
JOB ADDRESS
1Ly a UNIT# LOT# PERMIT EXPIRES IF WORK
CONTRACTOR A- IS NOT STARTED WITHIN
- INSPECTION -DATE INSPECTOR INSPECTION RECORD. 180DAYSOFPERMIT ISSU-
FOUNDATION - 'ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE'APPROVED PLANS AND CIT/OF PERMIT VALIDATION
CUPERTINO STANDARDS. ..
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'J•"� �-�'
UNDERGROUND /SLAB
PLUMBING _ ,
ELECTRICAL - PAID ISSUANCE DATE
MECHANICAL - , - BLDG ELECTPLG. NEC..
IANK 2 81989 ❑ a - ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR filly. Of CUpuUno INFORMATION
VALUATION SIFT,
PLUMBING
MECHANICAL
ELECTRICAL. - PERMIT To
�
FRAMING - lU'(Ylbl
... - STORIES - TYPf CONSTR.
INSULATION -
-OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 11
TOTALACREAGE
ROOF NOTE:NO FINAL INSP.SH AD B aR%'-
$a FT FLooR Aaen - -
DIAPHRAGM THE CONSTRUCTION TAX IS PA
BUILDING USE
-
ROOFSHEATHING RES IND CON PB OM.'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 11 ❑ ❑ El 13
ASSESSORS PARCEL NU
ROUGH SAN.# - -
PLUMBING - ELECT.ENERGY. -
TRACT NO, PARCEL NO '
TUBS&SHOWER PANM PLUMBING ENERGYL{)
. MECHANICAL MECH.ENERGY
ACC.DATE ACC FILE NO.
- ELECTRICAL - BUILDING ENERGY"
FRAMING ELECT,FINAL TEST
ZONING ENG.SITENO.
INSULATION - PLUMBING '
GAS TEST GAS
_ MECHANICAL FIRESPRINR ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N❑ - Y C] N❑'
EXTERIOR SHEAR - , ELECTRICAL RELEASE FLOOD ZONE A.LU.C,v NE] vL N❑.
INTERIOR SHEAR FIRE DEPT. •I
SHEETROCK GRADE - - FEE SUMMARY
EXTERIOR LATH BUILDING "! -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
G
FEE
AS r
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occUPANcY !ELECTRIC
ISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UN,TILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. ICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,HONE WORKING DAY BEFORE-REQUIRED INSPECTION. LUMBING od
zo PLEASE GIVE JOB ADDRESS WHEN PHONING.,
i
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! . I'
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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT. 17259
ADORE55 03c2j 1( ,1 1 2 5 BUILDING -ELECTRICAL- 17'//�C9 PLUMBING-MECHANICAL V
OWNER'S PLAN CHECK VALIDATION
NAM + ` V. ELECTRIC PERMIT FEE
PMON
xgMrRAcroRs �� UTLETS-SWITCHES-RECEP 10.00/1.00
LID.No LIGHTING'FIXTURES 10:00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 -
ADOR 5
NE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0,
OR
ENGINEER
LIC,NO, SIGNS TRANS. 3.00
ARCH OR ADDRESS ENG SPECIALCIRCIIIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 A -rye
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 �112I Sq
woo LICENSED CONTRACTORS DECLARATION '-
< u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE ".
w¢ u (commencing Witt Seet'on 7000)of Division 3 of the Business and BLDG.. :ELECT. PLG. MECH.
H D i Professions C license is in full f ld r
2 D T License Clas Lie.Num - ❑ ❑ ' ❑
DNF °w Uatc3�-'�(� Contradoif ICity,of Cupertino
BUILDING PERMIT
rt o i U OWNER-BUILDiiR DECLARATION INFORMATION
X 3, LL n 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL D ¢ Law for the following reason(Sec.7031.5,Businessand ProfessionsVAL
PERMIT ISSUANCE 10.00 - UATION $/FT.
Code:Any city orcounty which requires a permit to construct.alter,
rtQ Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC.
i DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
W$ he is licensed pursuant to the provisions of the Contractor's License ' ITT
F z Q Law(Chapter 9(commencingwith Section 7000)of Division3 ofthe
4 D Business and Professions Cade)or that he Sexempt therefrom and LUMBING PERMIT FEE
¢r W'the basis for the alleged exemption.Any violation Section703LGTV. P
5• STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT•WATER (EA.) 5.00
of not more than five hundred dollars(E500).1:
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 ace.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,AREA,COND. 5.00 -
Code:The Contractor's License Law does not apply to an owner of -
property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 sa FT.FLOOR AREA TOTAL ACREAGE
•
himselforotintenhrough de oroemred for sale.
If,ed however,
the
improve GAS-EA.SYSTEM-1 6.00
meats are not intended or offered for sale.If,mpleveq the building
or improvement is sob within one year of completion, the ownerGAS EASYSTEM-OVER 4(EA) 200 BUILDING USE
builder will have the burden of proving that he did not build or im. - . . . RES IND CON PB Orbe,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ .d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors: construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
to Professions Code:The Contractor's License s thereon.and
apply
to tr owner of property who bulbs ri improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00.
the Co to for is L cense L with ll COpImC1oI(S)licensed pnRllart t0 SEWER-SANITARY-STORM EA.200ft/10.00
TRACT NO. PARCEL NO.
the Contractor's License Low.
❑ lam exempt under Sec. ,BAP.C.for this WATER HEATERW/VENT 6.00 p'1,OC7
reason
Owner Dale WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKFRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm that 1 have a certificate ofconsent l0 self-insure, ZONING
or a certificate of Workers'Compensation Insurmma,or a cert'1cA ENG.SITE N0.
copy the [�yy�j�, Ib.0-).
Policy Nr�-,7JyS"-eFEBItat
O ❑ Cerli led copy is hereby furnished - FIRE SPRINK ENERGY T"24
Z Z rti fi cop is f - wit the cit i s e
O I t MISC.- REFER TO ORD. v❑- N❑ Y No
Fy PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C.
IPICATIi OP Ii%EMPTI WORKERS'
W �_ COMPENSATION INSURAN E PLG.CONTR. LIC.NO. PLc. ❑ ❑ ❑ ❑
d O ('ITus section need or be completed if the permit is for one IOTA Y N Y N
' :) Z hundred dollars(SHM)or less.)
U O 1 certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. mit is issued.I shall not employ any person in any manner so us to
O become subject to the Workers'Compensation Laws of California.
y Dute Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} !A NOTICE TO APPLICANT': If,after making this Certificate of Ex-
? emption,you should became 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 10PMC.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOORM.) 6'.00 SEISMICFEE-
I 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 HEATI NG UN IT(OV ER 100,000 B1T.U.)9.50 ELECTRIC
Lender's Add..
1 certify that I have rend this applicalion and state shut the above VENTILATION FAN (SINGLE) 4,00
information is correct.1 agree to comply with all city and county PLUMBING , �Q
ordinances and state lows relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U) 6.00
hereby authorize representatives of this oily l0 enter upon tlm BOILER-COMP (Over 100,000 BTU)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.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
i a t any way accrue against said City In�consequenee of the -
a li gof h'^) r T. _8a� MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Si t of Ap sant ontrac or a
OFFICE COPY'