18566 POST THIS CARD'NEAR FRONT OF'BUILDING
PERM T NUMIBER
CITY OF`. CUPERTINO 1 $566
INSPECTION DIVISION
JOB INSPECTION RECORD
,' n ✓' PERMIT EXPIRATION
,JOB ADDRESS_� {%� ' �ZA \ KNIT# _LOT# Cr GI
�--= PSEq MI;,l PIKES IF WORK
' OWNER A (Q CONTRACTOR' /'—g� - I NOT STARTED'WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CAL/EO.ISPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATI N_
PREGUN ITE CUPERTINO STANDARDS.
+ GARAGE SLABS /l iF.T;�✓�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 7
UNDERGROUND /SLAB ./' l?
PLUMBING (
G/�// .l
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG. ELECT. I PLO. MLCI+
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - - VALUATION s/Pr.
'PLUMBING . /y�
MECHANICAL 15
ELECTRICAL
PERmn ro
i
FRAMING
STORKS rYPE CONSTR.
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO Ir FLOORAll[A TOTAL ACHFAIL
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM 'THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PD O'l.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE . INSP. ❑ ❑ ' ❑ ❑. ❑
ASSESSORS PARCEL NO •.
ROUGH SAN,#
PLUMBING ELECT.ENERGY i
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCELNO.
MECHANICAL MECH.ENERGY
' ELECTRICAL. . BUILDING ENERGY ACC DATE ALC FILE NO
FRAMING ELECT.FINAL TEST'
INSULATION PLUMBING
ZONING ENG,SIRE NO.
. � -- '
GAS TEST GAS
MECHANICAL
FIRE SPRINA ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - [] "o ` I] "�
_
EXTERIOR SHEAR � ELECTRICAL RELEASE ' FLOOD ZONE A.L U C.
INTERIOR SHEAR FIRE DEPT. v ❑ NEI Y ❑ "❑ '•
SHEETROCK` GRADE FEE SUMMARY
EXTERIOR 1.;4TH BUILDING
INTERIOR LATH TEMPO AR APPROVALS ' BUILDING
SCRATCH COAT ELECTRIC PLAN CHECKr74-
G
FEE
AS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
_ ARRANGE FOR INSPECTION BY PHONING 252.4505,. ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMeINc
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
"
— SEE PERMIT FOR EXPIRATION DATE —. MECHANICAL
IMPORTANT! ;
CONST.TAX • -
-
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
,PERMIT NUMBER
BUILDING PROJECT lDENT[FICATION /APPLICATION & PERMIT 9'`
Br ` 18566
a ADD ooD 4424 Dem 1 1 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
_. -- - - OWNE ; PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
il PtV 10 1-
ie GNONE -
CONTRACTOR'9
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
L
sect No. LIGHTING FIXTURES 10.00/1.00
rory AcroRs
APPLIANCES RESIDENTIAL 4.00 r
AOOREss
PRONE,- - PANELS 10.00 - DATE OF APPLICATION
ARCHITECT0. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEET7 .C.NO.
ENGINEER - '/
sec.NO. SIGNS TRANS, 3.00
ADDRESS ENc. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIA TEMP.METER OR POLE INS. 20.00
AMOTORS SEE FEE SCH.
DRESS Eau
ADnR
SERVICE CHANGE 20.00
w2
0
Foo LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that I am licensed under provisions of Chapter 9, ISSUANCE DATE
H G vAi (commencing with Section 7000)of Division 3 of the Business unit - BLDG. ELECT. PLG. MECH.
F 0 z Professions Code and my license is in full rule and effect. ❑ ❑ ❑ ❑
zo z�o License Class Lic.Numbtr 1 `!fit
Fs, F J Da.e�=ll=gy__Comructor kyCfg--T_ r
Y a OWNF,R-B UILUER DECLARATION sky�,o�his BUILDING PERMIT
A o d U INFORMATION
w 0 1 or I hereby.aft inn that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL O v, Law for the fallowing rcattm.(See.7031.5,Bluinessnnd Professions
VALUATION E/FT.
� - Cale:Any city ser county which requires a permit to constmet,alter, PERMIT ISSUANCE 10.00 �Ms/x
G p improve,demolish,or repair any structure,prior to its i cu rece,also ELEC.CONTR. LIC.NO. ELEC. W
O n requires the applicant for such permit to Gk a signed statement that TOTAL
d w m m he is licensed pursuant to the provisions of the Contractor,License' PE MIT TO
Fzr
Law(Chapter 9(commencing with Seclimn 7000)of Division 3 ofOn w'/ _ �h
a Business and Previsions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE /�
F $ the basis for the alleged exemption.Any violation of Section 7031.5 STORs TYPE CONSTR.
n3 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more man Five hundred dollars(s500).):
❑ 1,as owner of the property,or my employees with wages as ' BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure n not DEC.GROUP REE.UNITS
'mended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
- - Cale:The Contractor's License Law docs not apply to an owner of -
pro(N:rly who builds of improves thereon,and who does such work FIXTURES-PER TRAP 5.00 6Q FT.FLOOR AREA TOTAL ACREAGE
himscll re through his own employees,provided thatsuch improve-
mentsarenotintendedorofferedforsale.if.however.the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00
or improvement is sold within Pro year of compldiot the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will improvement
the burden n proving that he did not hue w ion. BUILDING USE
prove forpurposcofsale.). INDUSTRIAL WASTE INTER. 30.00 REs IND CON PB Om«
,❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed mnlrrIelors to construct the projeet.(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and PodeWours Cale:The Ctintracmr's LunI Law dace not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts l'orsuch projects with a cunlrator(sl licensed pursuant to SEWER-SANITARY-STORM EA.2001t/10.00 .
the Contractors License Law. TRACT NO. PARCEL NO.
o tum exempt under sec. ,B.h1'.C.for this WATER HEATER W/VENT 6.00
awll
Owner - Dove WATER SYSTEM 5.00 ACC.OATE ACD.FILE NO,
W'ORKERS'COMPENSA'I ION DECLARATION WATER TREATING EQUIP. - 5.00
I hereby alien 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,Lath C
1'01icy Nn, Company Q I LF-
O ❑ Certified copy is herehy furnished.
FIRE EPRINK ENERGY T-24
Z Z ❑ Cen'Bed copy lileu Ih the city inspection division.
F, O APPhculn' p_�- w�e� MISC.- REFER TO ORD. v ❑ N❑ v ❑ No
CC LO CERI'IFICA'I'E OF FXEhtPI]ON FROM WORKERSPERMIT ISSUANCE 10.00 FLOODZONE A.L.UA.
W > COMPENSATION INSURANCE PLG.CONTR. - ❑c.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
hundred dollars 1$100)cur Ices.)
U O 1 certify that in the performance of the work for which this per- QIP MECHANICAL PERMIT FEE FEE SUMMARY
U- I- mit is issued,1 shall not employ any person in any manner w as to
Q w bcromy` b'ecj I.the Workers'C�ppp��pp ofttppq Laws q(California. -
n Date l_jj2 Appficant-IY]/ll�p l� � BUILDING S`�
} Fin NOTICE 'r0 APPLICANT: If,after nw'Ing I s Cen ifcule of fix- ALTER OR ADD TO MECH. 5.00
Z eruption,you should become subject In the Workeri Compensation APPLIANCE 5.00 - PLAN CHECK
provisions of the Labor Code, you most forthwith comply with 77S
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 FEE �y^
CONSTRUCTION LIiNDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE o5"D
'I hereby affirm that there is a esimlmcllon lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit s issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER I B.T.U.)9.50 ELECTRIC
1 I cenify that`I have read thisapplicatiun and stale that the above tBOILER-OOW(3H.P.orlOO,ODOB.T.U.)
TILATION FAN (SINGLE) 4.00
cedar...inn is ilateL 1 s Rl to, 1. b with sell city and county PLUMBING
ordlnaneee and oral, laws relating to building construction, and 6.00
hereby eulhorim representatives of this city m enter upon the LER-COMP (Oxer 100,000 BTU(SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.(We) agree Fin save, indmnnlfy and keep harmless the City of C.- REFER TO ORD.
Cupertino against liabilities,judgrnents, costs unit expenses which CONST.TAX
pgyy any way ."coneagainst said City in consequence of thePERMIT ISSUANCE 10.00of this Permit MECH,CONT. LIC.NO. MECH.
9_ _ TOTAL TOTAL. qe of ApplicantIC ntraclor Date tr f
OFFICE COPY