17570 POST THIS CARD NEAR FRONT OF BUILDING
. - reanuT NUNISER
� V�O
. , CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
1(� P/ERMIT`EXPI RATION
JOB ADDRESS_ 7r /�--FDS Iht_UNIT# _LOT# .;� -�
PERMIT E PIRES IF WORK
owNER '� CONTRACTOR IS INOT STARTED WITHIN
NSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
LIFER, ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS 1"IID
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED yy
UNDERGROUND /SLAB', APR 2 01989
PLUMBING J ()_ 4.iA !'`�1.
09,6 ',
ELECTRICAL City Of CUperfino ISSUANCE DATE
MECHANICAL BLOC. ELECT I PLG IMECR
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - _ t BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING
VALUATION SIFT.'
� 1 VSO
MECHANICAL .•
ELECTRICAL 1`PEHNin TO
FRAMING - - Z',tl,1/✓pQI�� C
INSULATION STORIES TVPB RLL
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5" `T'FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING BUILDING USE
RES IND CON PB Owr'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 1:1 - ❑ 11,
❑
ROUGH nssessORs vARceL No,
SAN.k
Inn
BING ELECT.ENERGY -
&SHOWER_PAN PLUMBING ENERGYTRACTNovARceL No
ANICAL MECH.ENERGY
TRICAL BUILDING ENERGYAcc DATE AcFELENo
ING ELECT.FINAL TEST
LATION PLUMBINGzON1NG ENC,SITE NO.
EST MECHANICAL TIRE SPRINK ENERGY T-]a
VER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ❑ N❑RIOR SHEAR ELECTRIAL RELEASE .FLOOD TONEALuc.
IOR SHEAR - FIRE DEPT. Y ❑ N❑ ❑ .NTROCK 1 GRADERIOR,LATH, FEE SUMMARY
BUILDINGIOR LATH TEMPORARY APPROVALSBUILDING
CH COAT PLAN CHECK
FEEPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FES Tr ' c0
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
• - MICROFILM
o :�.--
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. � ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
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 ,
BU LD1 NG PROJECT I DENT]FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADORES I �� Dv-; 17 570
C Foe V e BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
4
a OWNERS Iq VALIDATION
NAME W ELECTRIC PERMIT FEE PLAN CHECK
'� ve ko as3-0
O- IC•I3�4
PHONE
CONTRACTORT.FS
'S rat- r
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
uc.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR s PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER _
uc.No. SIGNS TRANS. 3.00
ADDDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00
APPLICANT U LDDDRMOTORS SEE FEE SCH.
I
SERVICE CHANGE
Foo LICENSED CONTRACTORS DECLARATION
FL,w 1 hereby affirm that I am licensed under provisions of Chapter 9
4 - (commencing with Section 7000)of Division 3 of the Business and 1 ISSUANCE DATE
F D a Professions Code,and my license is in full force and effect. BLDG. ELECT. PLG. MECH.
Oi 0 o License Class umber
m t� Late Contractor ❑ ❑ ❑
a x City Of Cuperh Q BUILDING PERMIT
E, w u h =1 I:R DECLAR 'PION INFORMATION
w3 LL y I hereby affirm (hat I am exempt from the Contractor's License MISC.- REFER TO ORD
LLD Law for the following reason.(Sec.7031.5.Bushrexsand 1'rol'essions VALUATION
PERMIT ISSUANCE 10.00 SIFT.
Code:Any city or county which Tenures a permit to construct,alter, ��
R t p improve,demolish,Or repair any sto lur0.prior to its issuance,also E EC.CONTR. LIC.NO.
ELEC.
S, rattnlrCS the applicant For lath permit t0 file 0 signed statement Iltal TOTAL PERMIT TO
n w m
lie is licensed pursuant to the provisions of tile Contractor's License `�.
F z i
Law(Chapter d Professions
de)with Section 7000)is
the,efoun the FEE' �wV (/[C
LF i o Business and he alleged eCode)or that he is exempt therefrom t.5 Q V. PLUMBING PERMIT
¢ Fg thenyap'or the alleged aJermit subjects
Any violation o tooction 703L5 STORIES
i3 by any applicant tura permit dollars($5000.)
ton civil penalty
of not more than five hundred property,
o fmy employees
ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ Las owner of the will do ti or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensafimt,will do the work,and The structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 _
Code The Contractor's License Law does not apply to an owner Of
property who builds or improves Thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedfl,sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or ins GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
p(oye for purpose of soled. INDUSTRIAL WASTE'INTER. 30.00 REIT IND CON PB Omer
1C7Dlt a as Owner of the propend,am exclusively.7044,Bat h ❑ ❑ ❑ ❑ ❑
PX
colons Cod to construct the project(Sec.7044,Bast
ply
LAWN SPRINKLERS-1 INC'5 V.S. 6.00
td Professions Code:The Contractor's License Law docs nota ply ASSESSORS PARCEL NO.
( anowneproperty who builds arimpraes Thereon, who LAWN SPRINKLER$-OVER 5(EA.) 1.00
cues acts forrsusuch projects w'Ih a contruclnrts)licensed puts
um to
uta c,, is Uanse La SEWER-SANITARY-STORM EA.200f[/10.00 TRACT NO. PARCEL N0.
❑ I a • 'rpt under Se . ,B.&' f r this
reewn WATER HEATER W/VENT 6.00
Owner ):n WATER SYSTEM 5.00
ACC.GATE ACG FILE-NO
woRK1;RS'coMPliNsn'noN DIicLA RA'r10N WATER TREATING EQUIP. 5.00
1 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,Lab.C.).
Policy No. Company
0 Crtilily isbcrc-d lir ishcd. /1
Z Z ❑ Cenifie cd coy is I the c' iI x.�for FIRE SPRINK ENERGY T.24
Fdivision. '
O Mmplicunt I MISC.- REFER TO ORD. YE]ME
E] YE) NE]
w 'IFICATI:OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ONE A.L.U.C.
L COMPENSATION INSURANCE PLG.GONER. LIC.NO. PLG.
C O 'this section need not be completed if the permit is for one TOTAL N y N
Z Imndrud'failurs 15100)ar Icsx)
V O 1 certify that in The performance of the work for which(his per-
LL 1- OUT is issued, I shall not employ any person in any manner so as(n D MECHANICAL PERMIT FEEEE SUMMARY
O W become subject to the Workers'Compcnsutiun Laws of California. -
o, Date.Applicant ALTER OR ADD TO MECH. G ��
} res NOTICE 'f0 APPLICANT: If,after making this Certificate of Ex- 5.00
? emption,you should became subject to the Workers'Compensation App APPLIANCE 5.00 HECK
provisions of [hc Labor'CoJe, you must Forthwith comply with ��such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.NL) 4.00CONSTRUCTION LENDINGAc' AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 FEEI hereby' a construction lending agency for EXHAUST HOOD(WITH DUCT) 5WREFERTOORD.
00 [the perlonnance of[he work for which This permit is issued(Sec.3097.Civ.C.). M
,000 B.T.U.) 8.00 ILM �-
Lcndcr's Name
Lender's Address 100,000 B.T.U.)9.50 IC1 certify that 1 have readThis application and slate IhuT Ora aboveNGLE) 4.00inforrnetion is correct. I agree (o comply with all city'and countyNGordinaces and state laws relating to building construction, and00,000 B.T.U.) 6.00hereby authmn representatives of this city to enter upon theabove-mentioned property for inspection purposes. 000 BTU)SEE FEE SCH. ICAL
(We) agree m save, indemnify and keep harmless the City ofREFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which
may FT a way accrue against said City in conseglrenee of the PERMIT ISSUANCE 10.00 CONST.TAX
ranting tI is permit MECH.CONT.
-; LIC.NO. MECH.
TOTAL TOTAL ZIJ 1 ro
gnature of Applicant Contractor Uate
Ka
OFFICE COPY
, l