18299 POST'.THISCARD'NEAR F,RONT''OF BUILDING
f A *PERMIT NUMBER
CITY OF CUPERTIN&0
.INSPECTION DIVISION, 8299
"
JOB INSPECTION RECORD
IT
�P I
MIT XP RA N!
LOW ESS y UNIT# - LOT#
//- - PER IT E�PIRES IF WORK
OWNER `�.' L•L/'�/ Ii/ coNlRncTOR; '6yv G0/+�T,- - {1S> NO ST,ARY,ED WITHIN
INP ION DA E" INSPECTOR INSPECTIOWRECORD ieo'Days:oF PEaMIT,Issu q `
FOUNDATION' - -ANCE OR .780 DAYS FROM,A'
NOTE:: LASLCALLEDINSPECTION-
UFERt" - ALL GRADING AND`DRAINAGE'SHALL BE.INSTALLED'
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF, Peun41T vnLmAnGN
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIG cuPERrwos7ANoARos.. .. '
GARAGE SLABS '•' - S
ot
SIGNED . !�. - _c'Y- .9•it,o.,
`. - UNDERGROUND.
/SLAB
PLUMBING ' ''
ELECTRICAL ,'o ' _ r • - ISSUANCE DATE
MECHANICAL
BLD(;. ELECTS PLG MECH.
El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
,WOOD FLOOR: a'
VALUATION. i;•1 $/FT.
PLUMBING
MECHANICAL j
TO
ELECTRICAL. - .: _ -7,- PER MIT
FRAMING, _ - r. . U. t.PC. �^'.,.. •d"n,rx.{a1
' - INSULATION - o lest PE Ns R ,
OCC GROUP ,RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SG FT,FLOOR f'.A � TOTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
Ca 0 .
�!
THE CONSTRUCTION TAX IS PAIDIA
, �. .,,•
* DIAPHRAGM _
BUILDING use
,.' ROOF SHEATHING ` - � '_`Hes ,INDCON - PB 00—
APPLY=NO ROOFING.UNTIL,ABOVE,HAS BEEN SIGNED ,',IFINALS,,. ,-�DATEr„' ''INSP „ ,E ❑ E.
` ASSESSORS PARCEL NO.
ROUGH SAN.#.
`PLUMBING ELECT,ENERGY~
• TUBS,&SHOWER PAN' - PLUMBING ENERGY TRACT NO PARCEL No
.T MECHANICAL_ VECH.ENERGY,. - ,+ Acc.DATEAcc.FILE No:
.ELECTRICAL :BUILDING ENERGY
FRAMING ELECT.RNAL TEST zoNiNc ENG.SITE NO
INSULATION . PLUMBING
GAS TEST - GAS
'FIRE SPRINK. - ENERGY T-20
. . . .. . .. .. - MECHANICAL ' T .. V Y ❑ iN❑ Y ❑ NQ
COVER NO WOk UNTIL ABOVE,HAS'BEEN SIGNED ' HEATING '.
_ EXTERIOR SHEAR - 'ELECTRICAL RELEASE � '�i ELGOD zoNE� ',A L U C.
INTERIOR SHEAR - • FIRE DEPT. Y 0', 0.0 Y ❑ No "
SHEETROCK ojj r GRADE �_:. • " FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH - - h BUILDING'.
•:,i . . . .
T.EMPORARY•APPROVALS - `
SCRATCH COAT :, ELECTRIC -PLAN CHECK', '
.., . . GAS'.;. 'FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY, SEISMIC FEE fj CC
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR: MICROFILM-
LU FOR INSPECTION BY PHONING~252-4505, ELECTRIC
' F� ONE WORKING DAY'BEFORE REQUIRED INSPECTION': PLUMBING
z PLEASE GIVE JOB`ADDRESS WHEN-PHONING
—.SEE PERMIT FOR EXPIRATION:DATE MECHAnIcn p
..-IMPORTANT! coNST.TAx
PLEASE.READ REVERSE SIDE BEF.ORE`. TOTAL Fz
CALLING FOR FINAL INSPECTION:;
OFFICE.COPV
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
- -' '
�DILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT
' '
18299
` AnnREaa //a41S f�1�� _ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 R Q
OWNER'S PLAN CHECK VALIDATION
NAME
UrUrNT _, I^k '"''r`•�OTV. ELECTRIC PERMIT FEE 1 '
- PHONE PAW _
CONTRACTORS ,
NA}M'yE� " OUTLETS-SWITCHES-RECEP', 10.00/1.00 /J 37, 7R�
✓�/NWII_ �� �QE�.Io. 31►ql(n3 LIGHTING FIXTURES 10.00/1.00 ` �p
CONTRACTOR'S
ADDRESS rjrjS LOS COeNEiS � APPLIANCES-RESIDENTIAL, 4.00
0$
HIL?n_A%g4`G'�GNE(4Md O PANELS 10.00 / GATE OF APPLICATION
ARCHITECT - - PLAN CHECK FEE P.C.NO.
GR [{..�,T PANELS (OVER 200 AMP) 20.00
ENGINEER .l,v✓'os
.LIc.NO SIGNS SIGNS TRANS. 3.00
ADDRESSARCH OH END SPECIAL SPECIAL CIRCUIT S.00' PERMIT VALIDATION
44 cle �l sr• R ui
. A ca rP EMP.METER OR POLE INS_. 20.00 -
ADDRESsTs(k-z MOTORS SEE FEE SCH:
SERVICE CHANGE 20.00 -
O ¢ z
FOO LICENSED CONTRACTORS DECLARATION -
a u u I hereby'affina that I am licensed under provisions of Chapter9
z w ISSUANCE DATE
w a vat (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. - MECH.
H N z Professions Code and my license O m full for e f•�^ct��J}.....
i n p Licensej'(ass Lic.Number f `++FI0 E3
o Ume-/J Contructnr OCT J 1989
s z w ¢ / OWNER-BUILDER DECLARATION vvA
BUILDING PERMIT
- o t O 'INFORMATION
E:
g LL I hereby afl7nn That I am exempt from the Contractor License MISC.- Ci FER TO ORD
LL O a Law for the following reason.(Sec.7031.5,Business and Profession's - VALUATION $/FT.
L - PERMIT ISSUANCE .10.00 O Am
3 N>E Code:Any city or county which requires a permit to construct,alter,SIM( 70 o a t7
¢ ¢ R O improve,demolish,or repaicany structure,prior to its issuance,also ELEC.CONTR. LIC.NO. _ TEL
O ¢' requires the applicant for such permit to file a signed statement that TOTAL
u w u heir licensed pursuant m the provisions of the Contractor's License PERMIT TO O�
F z Ir
< Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
,E i O Neatness and Professions Code)or that he is exempt therefrom and GTV. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation of Section 7031.5
o; F by any applicant for a perm it subjects the applicant to a civil penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollmS($500)J: -
❑'1,as owner of the property,or my employees with wages as -BACK FLOW PROTECT.DEVICE 4.00 1' OCc.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 on owner of
property who-builds of improves thereon,and who does such work FIXTURES-PER TRAP 5.00. SO.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- D 6D 0
menta are not intended or Offered For Sale.If,however,the building GAS-EA.SY_STEM-I INC.40UTLETS 6.00 D
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 f BUILDING USE
prove for purpose ofsele.). INDUSTRIAL WASTE INTER. 30.00 _RES IND CON PB Omar
❑ 1,as owner of,the property,am exclusively contnwting with - - O 1:1 ❑ O 0
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(ir improves thereon,and who. LAWN SPRINKLERS-OVER 5,IEA:) 1.00
contracts for such projects with a centreetoos)licensed pursuant to
One Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I um exempt under Sec.,FL&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Dale WATER SYSTEM - 5.00 ACC.GATE ACC.FILE NO.
v ' WORKIiRS'COMPIiNSAT10N DECLARATIONWATER TREATING EQUIP. 5.00 I'
I hereby affirm that 1 have a certificate Ofcousenl to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy-thereof. .(Seq.J@0.0,Lab.C.l. - - -
Policy No. pony A�l'1'FkT1A
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYT-74
z Z �Ce rtified copy is Bled with th, City inspection divisimn.
p Applicant L _ � _ MISC.- REFER TO ORD' v
. [:] NE] Yo No
CC y CERTIFICATF.OFEXEMPT10N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE q.L.U.C.
L COMPENSATIONS INSURANCE PLG.CO NTH. LIC NO., PLG.'
d O . (This section need not he completed if the pernnil is for one TOTAL Y❑' IN Y[] NEI
�,O hundred dollars($100)or IcSs.) ,
I certify that in the performance of the work fur which this per GTY MECHANICALPERMIT FEE FEE SUMMARY
LL F- unit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
a Date Applicant ' ALTER OR ADD TO MECH. ' 5.00 BUILDING 63
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F,Z emption,you should become subject In the Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
C.1 such provisions or this permit shell be deemed revoked. AIR HANDLING UNIT(TO'10=C.F.M.) 4.00 FEE �•
CONSTRUCTION LF:NUINC AGENCY AIR HANDLING UNIT(OVER IO,OODC.RM.) 6.00 SEISMIC FEE
I M1erchy affirm that titer, 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.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Add.... HEATING UNIT(OVER 100,000 B.T_.U.)9.50 ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
informolion is correct. I agree to comply with all city and county BOILER H.P.OT 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stale laws 'relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL-
(We)
ECHANICAL(We) agree to save, indemnify and keep harmless the City of MISC.,- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence Of the +k PERMIT ISSUANCE 10.00
noting of this permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL ,2,f/
igna[ure Applicant/Con[raaor - Ualc � � ' .�
OFFICE COP