17659 POST THIS CARD NEAR FRONT OF BUILDING RMT NUMBER
CITY ,,OF CUPERTINO 17659
INSPECTION DIVISION
JOB INSPECTION RECORD _
'' I l O�CYQ/ /E�• /�C A _ /�/ PERMIT EXPIRATION
d
JOBADDRESS / H'NGP�/— I
• ""� UNIT# _LOT#
OWNER ' 1c��7/ ..TRACT PERMIT EXPIRES IF WORK
IS NOl"SY'K'�RTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
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 PE MIT VALIDATION
CUPERTINO STANDARDS. /��
GARAGE SLABS /..Jt:A,Ir� y(�ldel
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '- �C! '('I7 GS�
UNDERGROUND /SLAB
PLUMBING - -
ELECTRICAL.' - — .
.ISSUANCE UAiE
MECHANICAL - BLuc ELECT I PLG. MECH
WN 0 El 171
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION,
WOOD FLOOR CI of Cu eruno VALUATION
PLUMBING -
MECHANICAL OQV
ELECTRICAL PERMIT TO
FRAMING FINALED IN srW4� to
INSULATION A SIONIES T�c7STH
/V= . I /�I
Occ GROUP HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED DAT
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SU.FT.FLOOR..F. TOTALACREAGE(G3�_ ,
DIAPHRAGM THE CONSTRUCTION TAX IS PAID iY
BUILDING USE
ROOF SHEATHING. - - HES IND CON PB UII,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 11 El ❑ F-1ROUGH'
aSSESSORSPAHCEL NO
SAN.#
PLUMBING ELECT,ENERGY
TUBS 8 SHOWER PAN '
PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL - MECH.ENERGY
ELECTRICAL ncc DarE acc.FILE NO
BUILDING ENERGY
FRAMING ELECT.FINAL TEST .
INSULATION, PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
FIRE SI'RINK ENERGY T'24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r N� °'❑.. NF '
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOOZONE A.L.UC.
INTERIOR SHEAR FIRE DEPT. - N❑ ° ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR ,LATH, IBUILDING BUILDING
ANTERIOR LATH ' TEMPORARY APPROVALS .
SCRATCH COAT ELECTRIC - PLAN CHECK
+ GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE .�
1 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM ---
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu
� 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 AIN
CALLING FOR FINAL INSPECTION. yv
OFFICE COPY '
- - 4
-APPLICANT 10 FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
_
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
I 5 M
BUILDING o� (� A APPLICATION & PERMIT k
ADDIEO O 1 __
�P�'1"') J� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
73YI` OTY. ELECTRIC PERMIT FEE ^
V�-IW-• (.� \ ff� PHONE T �Q5✓
NAMECONTRACTOR'S .\/ UTLETS-SWITCHES-RECEP 10.00/1.00 C,J
DCA (( LIC.No, LIGHTING FIXTURES 10.00/1.00 �II�
GONTRACTO
ADDRESS - '1(J PPLIANCES-RESIDENTIAL 4.00 �^ .
'� �. `••((�f Af� PHONE7381fggw PANELS 10-00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
OR
4VtW% Lm,rvo.C" Q SIGNS TRANS. 3.00
ARCH.OR ENG. I PERMIT VALIDATION
ADDRESS ISPECIAL CIRCUIT' 5.00.
ILA L-LUTA ZIP TEMP.METER OR POLE INS. 20.00 J 14'
APPLICANT'S MOTORS : SEE FEE SCR. v1
ADDRESS I/ V9
'7L} Q SERVICE CHANGE 20.00 6 3-UY
w o o LICBNS-D CONTRACTORS DECLARATION -
¢u I hereby affirm that I am licensed under provisions of Chapter 9 BAD
- ISSUANCE DATE
a
4
y y (Commencing with Section 7000)Of Division 3 of the Business and BLDG ELECT. PLG. MECH.
t- N i Professions Code,and my license is in full force and effect. WN o ❑ ❑ ❑i m W License ClassI.E.Number x
Dale Contractor
a m a BUILDING PERMIT
¢ rt w ¢ OWNER-BUILDER DECLARATION INFORMATION
A OaD MISC.- __ ORD
X 3 a w 1 hereby affirm that I am exempt from the Contractor's License �- --'-- VALUATION $/FT.
u0¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 '
� yat Code.Any City orcounly which requires a permit to construct,alter, ODD
Qa, Q 2O Improve,demolish,or repair any Structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC.
w y 0 s requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w$ he ie licensed pursuant to the provisions of the Contractor's License
Fi>
Law(Chapter 9(commencing with Section 7000)0f Division 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONS
n3 by any applicant for a permit subjects lire applicant to a civil penalty ALTER-DRAIN (EA.) .. 11
of not more titan five hundred dollars($500t):
❑ 1,as owner of the property,or my employees with wages as '
ggCK FLOW PROTECT. DEV ICE 4.00 oce.GROUP RES.uNlrs
their Vile compensation,will do the work,and the structure Door
intended or offered for sale (Sec. 7044, Business and Professions DRAINS.FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner oI'
property who builds or improves ffiecon,and who docs such work FIXTURES,PER TRAP 5.00 So,IT.FLOOR 7REA TOTALACREAGE
himself or through his own employees,provided that such improve- I.
mend$are not intended or offered for sale.IG however,the budding GAS-EA,SYSTEM,1 INC.4 OUTLETS 6.00 f�5 54
r
or improvement is Sold within one year of completion,lire owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
Cl 1, El ❑ ❑ ElI,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 gSSESSORS 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 IT mmu ctons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL N0.
. ❑ l am exempt under Sea ,B.&RC.I'or Ibis WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
' I hereby affirm that I have a certificate of consent to sell'-insure, ZONING ENG.SITE NO.
or a certificate of Workers',Compensation Insurance,or a certified -
copy therc.f(Sec.3800,Lab.CJ.
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division.p: MISC.-- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ Nir ❑
rnPERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
CERTIFICATE OF EXEMPTION FROM WORKERS'
Lid > COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG.
EL 0 (This section need not be completed if the permit is for one TOTAL Y E] N❑ Y E] No
:D Z hundred dollars IS 100)or less.) -
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,I shall not employ any person in tiny manner so as to
U Leconte subject to the Workers'Compensation Laws of Californ a.
y Date Applicant ALTER OR ADD TO MECH. 5.00 'BUILDING !_s
} ED NOT'ICE '1'0 APPLICANT: If,after making this Certificate of li x. _ Yl
FZ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 'PLAN CHECK '
provisions of the Labor Code, yon must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE .�
I hereby affirm that there 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,). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) - 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state taws refuting to building construction. and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE$CH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
apeman against Iia i ies, 'udgmen", costs mrd expenses which PERMIT ISSUANCE 10.00 CONST.TAX
I ' ac ue a st sa' City in consequence of tiro -
•r ming a t 'per s MECH.CONT. LIC.NO. MECH. A iI �O
�3 TOTAL TOTAL �(0;
Signe re pplicanl/Con roc or Date t '
OFFICE COPY