9341POST THIS CARD NEAR FRONT OF BUILDING
CITY11F CUPERTINO..�_,;, rb,
INSPECTION -DIVISION ,;f ,,
JOB INSPECTION RECORD
7II- /p/,�//'' pp .: • - - <
JOB ADDRESS 7171 ✓l i0/I. 'place,-' UNIT# � LOT *f -
. -�.4c'y,, -
owNERJ1UC'K�r{'IPii '5 �(I�" 'CONTRACTOR Com•"C S 71-Y\ -'
+ TPFRNITNUMBER'-
j
934 F
PERMIT EXPI RATION
PERMIT EXPI<REi IF WORK'.
IS NOT'STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM.
I
AST CALLED INSPECTION:
PBHMIT VALIDATION
"
NCE Ir r E
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION -
- -�.�'^n^•'•�^`--- �'
UFER
PREGUNITE .-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' UNDERGROUND /SLAB:.
PLUMBING ' - -��
- '{
ELECTRICAL .,
MECHANICAL'
B UG
ELECT.
PLG:=
kf
MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED-
-
-
BUILDING PERMIT
+ INFORMATION 3
WOOD FLOOR
VALUATION
'$TFT.
PLUMBING 8J_=_
MECHANICAL r
ELECTRICAL
i -. - •'�
PE�M)IT To
FRAMING -
INSULATION - ,�,
-. + -
STORIES+ •fTOTA�
ONSTFL
T
- -
•OCC OR CUPUNITS'~
-
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
{I -'ROOF
50 Fi, FIOOR ARCREaGt.
- .
DIAPHRAGM
".BUILDING USE
RES IND CON, PB Om,
' EY '�
'�
_
<
_.APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
SP
ASSESSORS PARCEL NO.
..
'ROUGH
-
PLUMBING lo R Yr 1611
TRACT NO:
_.i .."
PARC
-,
GAS TEST
•. .. ,-
MECHANICAL �Qy
'ACO.DATE
'ZONING
ACC FILE NO.
ELECTRICAL Qom. _
_
FINALS 'DATE INSP.
FRAMING'eK
SAN # :,.,f • _
'
ENG. SITE NO.
INSULATION - -
PLO
GA .. r-
-; FIRE SPRINK
'
Y.� N❑
ENERGY T 24'
` Y, �" N❑
M CHANT AL -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
H TIN '.;
•FLOOD ZONE
v.� NE]
:Q
I] IN
LATH -'INTERIOR
EL RICAL l c
LATH -EXTERIOR' 'p_
FIRED EPT. �'
Y.
FEE SUMMARY
SHEETROCK`
_'GRADE
SHEAR INTERIOR
BUILDING ' -
'BUILDING
SHEAR EXTERIOR . IQ-
VAS
-' TEMPORARY AP.P,ROL
FIREWALLS -
ELECTRIC
PLANCHECK..
FEE
' ..
GAS,
SEISMIC FEE ,• ' ....r
14; '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY .. -
OCCUPANCY OF BUILDING IS NOT.PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTORMICROFILM.
•, • �'
uJ :,i ARRANGE FOR INSPECTION BY PHONING 252-4505," ',
ONE WORKING DAY BEFORE REQUIRED`INSPECTION. .
0� _ PLEASE GIVE JOB ADDRESS WHEN PHONING. -
Z - _ '- �'
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING-
• '/� Ur.
MECHANICAL
; Y i,ti✓
CONST. TAX•'.
.._ +
y - IMPORTANT!' ,'•:,
PLEASE READ REVERSE SIDE BEFORE -,I
CALLING -FOR FINAL INSPECTION.'`
. TOTAL
- S
�. � - -?
OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
A�
l�.
BUILDING
ADDRESS
-7771
O NE S
PLAN CHECK VALIDATION
NAME
[^d ONE
OTV. ELECTRIC PERMIT FEE
NAMERAcroRs
6TLETS- SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10:00/1.00
uc. rvo.0
cory Tri'
ADDRESS
4-00 r
--?-APPLIANCES
I1
�Q
PANELS ,00
PRONE [
DATE OF APPLICATION
RCMITE
OR
ENGIN R
- LIC. NO
PANELS (OVER 200 AMP( 20.00
P.C. NO. LAN FEE
CHECK ,;r
f
SIGNS TRANS. 3.00
ADDRESS !`�
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
METER OR POLE INS. 20.00
ZIFEMP.
Ar
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
�t
LICENSIA) CONTRALTO RSI )ARA ION
TEMP. POLE 30.00
I hereby uflinn that 1 am licensed under provisions o'Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, J my license is in full force and effect
License Class__ Lic. Number
ISSUANCE DATE
BLDG.
®
ELECT.
QI`LIC-
PLG. MECH.
Datc_�.y.t /�qie-CotOrSctor
BUILDING PERMIT
OWNfi R -BUILDER UECLA i,
1 hereby air,,... that I am exempt firm the Comm me Liccnsc
Law for the following o-eon.(Sec. 7031 ,5, liusinessand Professions
Code: Any lily or county which re-gnResa permit to construct, altcq
improve, demolish, or repair any stroll are, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
9 pP P 6
he is licensed pursuant en the provisions of the Contractor's License
Law (Chapter ndprocommenCde)cing lir Section is 00) exempterefrom he
and
Business and Professions Code) or that he is exempt therefrom and
INFORMATION
MISC.- REFER TO ORD
VALUATION
// f' J
+
r
S/FT.
PERMIT ISSUANCE L�.QO
ELEC. CONTR. LIC. N0.
ELEC.
TOTAL /}/
6 j
PERMIT TO
...
DTV. PLUMBING PERMIT FEE
STORIES
TVP 4EONSTR.
the basis for the alleged exemption. Any violation of Section 7031.$
by any applicant for a pernih subjects the applicant to a civil penalty
of not more than five hundred drllara ($500).)'.
ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ Las owner ol'thc property, or my employ ccs with wages as
their sole rm' pcnsdtion, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. - 5.00
intended or offered I'or all (Sec. 7044, Business and Professions
Code rhe Contractor,, License Law dons nm apply ho an ..in of
property who builds or improves thereon, and who does Such work
rC J
FIXTURES - PER TRAP 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
himself or through his own employees, provided that such improve-
mentsare not intended or offered for all. If, however, the building-
a(o3U
GAS-EA.SYSTEM-11NC.40UTLETS.
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-
prove for purpose of sale.). -r--- -.
❑ I, as owner of the property, am exclusively contacting will,
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB o,be,
❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct lire project (Sea 7044, Business
and Professions Crcle: s' he Contractor's License Law does not apply
to an owner of property who builds or improves thereon. and who
contracts for such projects with a conlactmoo licensed pursuant to
the Contractor's License Law.
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
_
ASSESSORSPARCEL NO.
Q
J 6 t
- LAWN SPRINKLERS - OVER 5 (EA.) 1.00
SEWER -SANITARY -STORM EA. 200ft/10.00 j/'.--
TRACT NO.
PARCEL NO.
❑ lamesemplunder Sec. ,B.&P.C,RRthI,
reason
WATER HEATER W/VENT §,00 A.Z.
OwnerDate
WATER SYSTEM 5.00 a..e
ACC. DATE
ACC. FILE NO,
WATER TREATING EQUIP. 5.00
WORKERS -COMPENSATION DECLARATION
I hereby ofin, that I have acclinicalc of consent to Self -insure,
or a certificate of Workers Compensation honrdmea, or a certified
ZONING
ENG'. SITE NO.
o thereof (Sec. 3800, Lab.CJ)
copy
Nr. CompdpY 7✓lia�5�a
FIRE SPRtNK
V❑ N❑
ENERGY T-24
Y❑ N❑
❑ Certified Copy is hereby furnished.
Q� Cenifr •d copy is fled with the city inspection divisiciij
A�Bcdnt��
MISC.- �i REFER TO ORD.
CERTIFICATE 01: EXEMPTION PROM WORKERS'
PERMIT ISSUANCE 10.00 ,.-
FLOOD ZONE
A.L.II.C.
PLG.CONTR. LIC. NO.x
MP'
PLG.
TOTAL -7k N1
COMPENSATION INSURANCE
('Chis section need not be completed if the permit is for one
V ❑ N❑
Y ❑ N❑
hundred dollar, (S 100) or Iv,,f
1 certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
OTY. .MECHANICAL PERMIT FEE
+
FEE SUMMARY
BUILDING
become subject 10 the Workers' Compensation Laws of California
Date - Applicant
ALTER ORtADD TO MECH. 5.00
NOTICE TO APPLICANT: If, after making this Certificate of Iix-
APPLIANCE 5.00
PLAN CHECK,
en,ption, you should become subject to the Wnrkeri Compensation
provisions of the Labor Code, you most forthwith comply with
such provisions or this permit shall be deemed revoked.
'
FEE
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
AIR HANDLING UNIT (OVER 10MOC.F.M.) 6.00
SEISMIC FEE
S
CONST RUCTION LENDING AGENCY
I hereby affirm thus there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued (Sea
3097, Civ.CT,
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
Lender's Name �s]4'j/F-al�
Lender's AJdres. �^^��
I certify tire,p a
I have read this apmton ms a
, te that thR"ea o
information is correct I agree to comply with all lily andg.�ounty
ordinances and slate laws relating to building construc11 n, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER-COMP13 H.P. or 100,0008.T.U.) 6.00
BOILER -COMP (Over 100p00 BTU) SEE FEE SCH.
MECHANICAL
`�9 6�7
hereby uu0mrve representatives of this city to enter upon the
above-mentioned property for inspection purposes
m
misc.- REFER TO ORD.
CONST. TAX
(/
(We) agree to save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which;1
may in any way accrue against said City in conseyuence of the
PERMIT ISSUANCE 10.00
granting of this pefmRMECH.
ot �- 3 -SS"
CONT. LIC. NO.
MECH.
TOTAL30 GAS
TOTAL ..,T/�3OC
Igna re i an n r Dale
i
INSPECTOR COPY