16504 POST THIS CARD NEAR FRONT OF-BUILDING
�• 3 PERMIT NUMBER
CITY OF CUPERTINO " 16504
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
(� t
JOB ADDR ESSO4tV�- /E'7�L� ' UNIT# - _COT# PERMIT EXPIRES IF WORK
OWNER -34 ov CD ku tx rTo r(( __ - CONTRACTOR \ r r. IS NOT STARTED WITHIN
IN TION ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE OR 180 DAYS FROM '
NOTE; , LAST CALLED INSPECTION. '
UFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED _
-PR EGUNITE- TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAI.IDNTION
• CUPERTINO STANDARDS. PAID
GARAGE SLABS i C
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED L, f Q 1989
UNDERGROUND,/;SLAB Q .
PLUMBING - ' - _ yt.L //I
ELECTRICAL' City of CBpBrhDD, ~�• �
yISSUANCE'DATE /
MECHANICAL Bu) ELecT. PLc. MECH
'❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
WOOD FLOOR. INFORMATION.
PLUMBING
VALUA ION SIFT
' .. - ��;, . ,
MECHANICAL
ELECTRICAL - I P . rO�
FRAMING , - - Cj{,
• INSULATION - STORIES TYPE CON R.
- OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ! '
SG.FI.FIW.RARLA TOTALACREAG� I
i ROOF : NOTE;NO FINAL INSP.SHALL BE MADE BEFORE '
DIAPHRAGM• THE CONSTRUCTION TAX IS PAID t
• BUILDING USE
ROOFSHEATHING RES IND , CON PH ITE"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE •INSP. 'D 13 ❑ ❑ ❑
A SSESSORS PA.A CE L NO.
' .ROUGH - ' " ^ � - SAN.N' -
PLUMBING ELECT.ENERGY
TRACT'.NO, PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY,
MECHANICAL' MECH.ENERGY
ELECTRICAL ' NCC,DATE ACC.FILE NO
• BUILDING ENERGY '
FRAMING'' - ELECT.FINAL TEST
INSULATION • ZONING ENO,SITE NO.
. - PLUMBING;,
GAS TEST ' " GAS '
MECHANICAL '. FIRE SPR INK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y E] N❑ ` N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L.0 C.
INTERIOR SHEAR. - FIRE,DEPT, Y L N❑ - Y ❑ No
SHEETROCK - - GRADE - FEE SUMMARY
EXTERIOR LATH • ' BUILDING. ,
INTERIOR LATH - TEMPORARY APPROVALS . BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK ^
GASNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING'FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ` QQ
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST. rnx
PLEASE READ REVERSE SIDE BEFORE p
CALLING'FOR FINAL INSPECTION'. TOTAL
OFFICE COPY
r,
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION "P.E,RMITN'UMBER -
o°"s APPLICATION & PERMIT
Sit IO 1 1U[ 0 /nore BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S ^OO �/ //(��� 11}�� PLAN CHECK VALIDATION
NAME A99LC COM 017w-
�x1 I414-L%42-
CONTRACTORS
m QTY. ELECTRIC PERMIT FEE
♦�/ M 1 WW PHONE -L% 2
NAMERacroRs UTLETS-SWITCHES-RECEP 10.00/1.00 76.0
\1(V-111sib e- LIG.NG.3B69-13 LIGHTING FIXTURES 10.00/1.004 '0
ADDRESS R'$a,y /•y„Z PPLIANCES-RESIDENTIAL 4.00
ACOREAS .�^7�) // �i'�/ AQ
5A*ZA OrvE 1*-144.4 1 PANELS 10.00 OATE OF APPLICATION'
on - ^� N, r l PANELS (OVER 200 AMP) 20,00 100. PLAN CHECK FEE' P.G ND.
ENGINEER A )G[-Tf
LIC.NG.012(4qI SIGNS TRANS. 3.00
ARCH.OR ENG. �-y� PERMIT VALIDATION
ADDRESS �� S• T 300 SPECI AL CI RCU IT 5.00 (y 7aJ s+
M5 eI I(1j - frEMP.METER OR POLE INS. 20.00
APPLICANT So MOTORS. SEE FEE SCH. 3=F.60
DRESS
ADCR EAA
SERVICE CHANGE 10A1020.00 \\ -{-
0 0 0 LICENSED CONTRACTORS DECLARATION [�� �' kwTo
U
rLz u I hereby affirm that I am licensed under provisions of Chapter r) _ OOH - ISSUANCE DATE
4. (commencing with Section 1000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.'
r y i Professions Code, d license is in full for �J cf
R v, - License Clas'. Lic.Number_ EP
Z Uam_J.� Cmvracmr i� `� Y O Q(IP.rI�� �-
Q Y F J
X 4 OWNER-BUILDER DECLARATION BUI DING PERMIT
w
MISC.- REFER TO'ORD INFORMATION
; u r I hereby affirm that 1 am exempt from the Contractor's License
u 0¢ Law for the fallowing reason.(See 7031.5,Businessand Professions . VALUATION $/FT.
- J PERMIT ISSUANCE 10.00 Z.vD
Code:Any city or county which requirese permit m construct,alter,
.2 a ¢ improve,demolish,or repair any structure,prior t0 its issuance,also ELEC.CONTR. LIC.N0. ELEC.
ar 0 LL requites the applicant for such permit to Ole a signed statement that M s J L- 38b ''3 TOTAL
A. w ca he is licensed pursuant to the provisions of the Contractor's License I�V / T M4JAII
F z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the p
- Business and Professions Code)or that he isexmnpt therefrom and GTY. PLUMBING PERMIT FEE 7i ga"
W I- $ the basis for the alleged exemption.Any violation ol'Section 7031.5 - STORIES TYPE CONSTR.
c3 by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more Oran five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OCC.GROUP REB.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,CON D. 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 S0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended or offered for sale.If,however,the building 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 im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ E 0 El
licensed contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 -
contracts for such projects with a contractors)licensed pursuant to
the Contractor's Then.Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for thislease WATER HEATER W/VENT 6.00
Owner - D'ate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO..
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of eunsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof ISec. Co Lab.C.1. �A�• �•-,�
Policy ere Company-ureTel�l[9]1
O ❑ ertifled copy is hereby furnished. FIRE SPRINK ENERGY RZ4
Z Z Certified py i�- ('Iled y1I Ili the cit'y/ 1n�pcyDon division.
H O Applicanl� iyLWx4E=1 MISC.- REFER TO ORD. Y ,N Y ❑ N❑
CC W CERTIFICATE/O/F EXEMPTION FROM WORKERS' ,PERMIT ISSUANCE 10:00 . FLOOD ZONE A.LU.C. -
W > COhIPHNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
da ('Phis section need not be completed if the permit is for one TOTAL Y 0 N[JY EJ '11
D Z hundred dollars(S 100)or Icss.) -
U Q 1 certify that in the performance of rhe work]or which tins per, QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is issued,1 shall not employ any person in any manner so as to
Q w become subject to the Workers'Compensation Laws of Calilornia.
Q. DateApplicant BUILDING
} N NOTICE TO APPLICANT: IL after making this Certificate aI'Ex- ALTER OR ADD TO MECH. -5.001
-
F ? emption,you should become subject to the Woikers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor COde, YOU must forthwith comply with FEE
U ash provisions or his permit shit[]be deemed revoked. AIR HANDLING UNIT ITO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE r
I hereby affirm that there is a construction leading agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work I'or which this permit is issued(Sec. MICROFILM
3097,CY.C.), HEATING UNIT(TO 100,000 B.T.U.)' 8.00 '
Lender's Name �� r
Lender's Address HEATING UNIT(OVER.100,000 B.T.U.)8.50 'ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) . '4.00
information is correct. I agree to comply with all city and county PLUMBING '
ordinances and state laws relating to building con
stfuetion, and BOILER-OO 1v ,H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city m enter upon the BOILER-COMP.IOver 10D,0008TU7 SEE FEESCH. MECHANICAL t
above-mentioned property for inspection purpos<•s.
(We) agree to save, indemnify and keep harmless the City of MISC.- 'REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which CONST.TAX
may in any way accrue gminst said City In consequence of the PERMIT ISSUANCE 10.00
rhnli of this pe MECH.CONT. LIC.NO. MECH. -
TOTAL TOTAL
g halure of A p can moor Ua[e i '
OFFICE COPY