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17289 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17289 INSPECTION DIVISION JOB INSPECTION RECORD APERMIT EXPIRATION JOB ADDRESS_l_I 3� slJ ➢/CIN I//T•y�# LOT#- PERMIT EXPIRES IF WORK OWNER �� - . CONTRACTOR l_l � IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. /h POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �+ v UNDERGROUND /SLAB PLUMBING v v' ELECTRICAL ISSUANCE OAT[ MECHANICAL Bluc ELECT. PLc.1:1MEC+ ❑ - 11 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION PLUMBING MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION - `— STORIES PE CONSTR. OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING II+Es INu LON PB um... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ROUGH SAN.a ASSESSORS PARCEL NO � PLUMBING ELECT.ENERGY 1:" + TRACT NO. PARCEL NO TUBS 8 SHOWERPANPLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC.FILE NO. ELECTRICAL BUILDING ENERGY FRAMING - ELECT.FINAL TEST zorvlNc ENc.SITE No. INSULATION PLUMBING R / GAS TEST GAS E MECHANICAL FIRE SPRINK ENERGY L24 ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' E3 NE ` ❑ ND ' EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONI, A UC. INTERIOR SHEAR FIRE DEPT. ! - V'[11 N❑ I ❑ N� SHEETROCK GRADE / FEE SUMMARY EXTERIOR LATH BUILDING I INTERIOR LATH TEMPORARY APPROVALS BUILDING �Ll AVN . SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE �N NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� 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 TOTAL 'I • CALLING FOR FINAL INSPECTION. ,E OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT u. ADDRESS 7/y 4Q R . 5- DRA/`e- e. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ' 8+ OWNERS PLAN CHECK VALIDATION NAME ,ZOOS N. N NIC Ory' ELECTRIC PERMIT FEE oNEx NAMERAcross UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. LIGHTING FIXTURES 10.00/1.00 aooeeSa rolls PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c,NO, NGINEER LIC,No. SIGNS TRANS. 3.00 oolRiEss ENG' SPECIAL CIRCUIT 5.00 PERMIT^V7ALI�ATION ZIP TEMP. METER OR POLE INS. 20.00 APPLICANT MOTORS SEE FEE SCH. Ar t ?73,7 DkAwir _ SERVICE CHANGE 20.00 0 ¢ i F 00 LICENSED CONTRACTORS DECLARATION F -_ 6 V U 1 hereby affirm that I um licensed under provisions of Chapter 9 ISSUANCE DATE N G m (commencing with Section 7000)of Division 3 of the Business and BLDG ELECT. PLG. MECH. H O z Professions Calc,.,ad my license ism full force and effect � 1:1 Elo License ClassLie.Number ZH w Date Centmetnr m BUILDING PERMIT ¢ ¢ w a OWNER-BUILDER DECLARATION u INFORMATION X A H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ar u o g law for the following reason.(Sec.703 L5,Business and Professions pERM1T ISSUANCE 1000 VALUATION $/FT. Code:Any city or county which requiresa permit to construct,alter, I LOD�- ¢ ¢¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O¢ requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO u r z t a he 6 licensed pursuant to the provisions of the Contractor's Licmw L.-(Chapter 9(commencing with Section 7000)of Division 3 ofthe 1 a D Business and Profcesions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ic H the bases for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d3 by any applicant for a permit subjects the applicant toa civil Penalty of not more Blan Five hundred dollars($500).) ALTER-DRAIN&VENT-WATER (EA.) 5.00 X 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole cnmperenion,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 Lw dues not apply to an owner of property who builds or improves thereon,and who doss such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees.Provided that such improve- menuare not intended oroffered for 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- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or ire- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 Es Ino CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construe the project(Sec.7044.BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License law does not upply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a conlracton it licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contraclets License Law. TRACT NO. PARCEL NO. Cl I um exempt tinder Sim.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK FRS'COMPENSA'1'[ON DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sel Ginsore, ZONING or a certificate of Workers'Compensation Insurance.or a certified ENG SITE NO. cup,thereof(Sec.3800,Lab.CA 1Cr.1 Policy No. Company FER 22 - O CICetlif¢d copy is hereby furnished. FIRE SPRINK ENERGY T-]4 Z Z ❑ Certified copy is tiled with the city inspection division. 0 Applicant MISC. city .00D. Y ❑ N❑ Y ❑ NEIN CER'FIFICA'1'1 Ole 1 Xli MPTION FROM WORKERS' PERMIT ISSUANCE - FLOOD ZONE A.L.U.C. W J COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG. CL D (This section need riot be completed if the permit is for one TOTAL Y E] I [:] NEI� Z birdied dollars(SIOO)or le,m) U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued.1 shall not employ any person in any manner sn as to Uw become subject to the Workers'Compensation Laws of California. SL ` IS- C_ Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /W4'1 } w NOIICIi 10 APPLICANT: If,after making this Certificate of lix- � Z eruption,you should become subject to the Niolors''Compcnmion APPLIANCE 5.00 PLAN CHECK U suchtprovisi ns for this bPerm dshall be deemed relvoked`amply with AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE 610 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOO.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency IDr 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 HEATING UNIT 100,000B.T.U.)9.50 Lcndcr i Addm.vs ELECTRIC 1 certify that I have read this application and state that are above VENTILATION FAN (SINGLE) 4.00 ordinances s ^s correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances a d state news agree relating m comply with construction, and my hereby authorise representatives of this city to enter upon the BOILER-COMP(0vto 100,000 BTU)SEE FEE SCH. MECHANICAL Bove-mentioned property for inspection purposes. '(We) agrtt to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which CONST.TAX ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 sling of this permit. MECH.CONT. LIC.N0. - MECH. Signature of Applicant ConTOTAL TOTAL lraclor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17289 INSPECTION DIVISION JOB INSPECTION RECORD APERMIT EXPIRATION JOB ADDRESS_l_I 3� slJ ➢/CIN I//T•y�# LOT#- PERMIT EXPIRES IF WORK OWNER �� - . CONTRACTOR l_l � IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. /h POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �+ v UNDERGROUND /SLAB PLUMBING v v' ELECTRICAL ISSUANCE OAT[ MECHANICAL Bluc ELECT. PLc.1:1MEC+ ❑ - 11 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION PLUMBING MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION - `— STORIES PE CONSTR. OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING II+Es INu LON PB um... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ROUGH SAN.a ASSESSORS PARCEL NO � PLUMBING ELECT.ENERGY 1:" + TRACT NO. PARCEL NO TUBS 8 SHOWERPANPLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC.FILE NO. ELECTRICAL BUILDING ENERGY FRAMING - ELECT.FINAL TEST zorvlNc ENc.SITE No. INSULATION PLUMBING R / GAS TEST GAS E MECHANICAL FIRE SPRINK ENERGY L24 ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' E3 NE ` ❑ ND ' EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONI, A UC. INTERIOR SHEAR FIRE DEPT. ! - V'[11 N❑ I ❑ N� SHEETROCK GRADE / FEE SUMMARY EXTERIOR LATH BUILDING I INTERIOR LATH TEMPORARY APPROVALS BUILDING �Ll AVN . SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE �N NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� 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 TOTAL 'I • CALLING FOR FINAL INSPECTION. ,E OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT u. ADDRESS 7/y 4Q R . 5- DRA/`e- e. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ' 8+ OWNERS PLAN CHECK VALIDATION NAME ,ZOOS N. N NIC Ory' ELECTRIC PERMIT FEE oNEx NAMERAcross UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. LIGHTING FIXTURES 10.00/1.00 aooeeSa rolls PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c,NO, NGINEER LIC,No. SIGNS TRANS. 3.00 oolRiEss ENG' SPECIAL CIRCUIT 5.00 PERMIT^V7ALI�ATION ZIP TEMP. METER OR POLE INS. 20.00 APPLICANT MOTORS SEE FEE SCH. Ar t ?73,7 DkAwir _ SERVICE CHANGE 20.00 0 ¢ i F 00 LICENSED CONTRACTORS DECLARATION F -_ 6 V U 1 hereby affirm that I um licensed under provisions of Chapter 9 ISSUANCE DATE N G m (commencing with Section 7000)of Division 3 of the Business and BLDG ELECT. PLG. MECH. H O z Professions Calc,.,ad my license ism full force and effect � 1:1 Elo License ClassLie.Number ZH w Date Centmetnr m BUILDING PERMIT ¢ ¢ w a OWNER-BUILDER DECLARATION u INFORMATION X A H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ar u o g law for the following reason.(Sec.703 L5,Business and Professions pERM1T ISSUANCE 1000 VALUATION $/FT. Code:Any city or county which requiresa permit to construct,alter, I LOD�- ¢ ¢¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O¢ requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO u r z t a he 6 licensed pursuant to the provisions of the Contractor's Licmw L.-(Chapter 9(commencing with Section 7000)of Division 3 ofthe 1 a D Business and Profcesions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ic H the bases for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d3 by any applicant for a permit subjects the applicant toa civil Penalty of not more Blan Five hundred dollars($500).) ALTER-DRAIN&VENT-WATER (EA.) 5.00 X 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole cnmperenion,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 Lw dues not apply to an owner of property who builds or improves thereon,and who doss such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees.Provided that such improve- menuare not intended oroffered for 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- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or ire- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 Es Ino CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construe the project(Sec.7044.BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License law does not upply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a conlracton it licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contraclets License Law. TRACT NO. PARCEL NO. Cl I um exempt tinder Sim.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK FRS'COMPENSA'1'[ON DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sel Ginsore, ZONING or a certificate of Workers'Compensation Insurance.or a certified ENG SITE NO. cup,thereof(Sec.3800,Lab.CA 1Cr.1 Policy No. Company FER 22 - O CICetlif¢d copy is hereby furnished. FIRE SPRINK ENERGY T-]4 Z Z ❑ Certified copy is tiled with the city inspection division. 0 Applicant MISC. city .00D. Y ❑ N❑ Y ❑ NEIN CER'FIFICA'1'1 Ole 1 Xli MPTION FROM WORKERS' PERMIT ISSUANCE - FLOOD ZONE A.L.U.C. W J COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG. CL D (This section need riot be completed if the permit is for one TOTAL Y E] I [:] NEI� Z birdied dollars(SIOO)or le,m) U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued.1 shall not employ any person in any manner sn as to Uw become subject to the Workers'Compensation Laws of California. SL ` IS- C_ Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /W4'1 } w NOIICIi 10 APPLICANT: If,after making this Certificate of lix- � Z eruption,you should become subject to the Niolors''Compcnmion APPLIANCE 5.00 PLAN CHECK U suchtprovisi ns for this bPerm dshall be deemed relvoked`amply with AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE 610 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOO.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency IDr 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 HEATING UNIT 100,000B.T.U.)9.50 Lcndcr i Addm.vs ELECTRIC 1 certify that I have read this application and state that are above VENTILATION FAN (SINGLE) 4.00 ordinances s ^s correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances a d state news agree relating m comply with construction, and my hereby authorise representatives of this city to enter upon the BOILER-COMP(0vto 100,000 BTU)SEE FEE SCH. MECHANICAL Bove-mentioned property for inspection purposes. '(We) agrtt to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which CONST.TAX ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 sling of this permit. MECH.CONT. LIC.N0. - MECH. Signature of Applicant ConTOTAL TOTAL lraclor Date OFFICE COPY