17331 POST:TH'IS CAR D.:NEAR"TRONTSOFyBUIEDING
.r (� PFRMIT NUMBER
; CITY: OF CU.PERTINO 17331
INSPECTION DIVISION ,x
' JOB INSPECTION RECORD;
'` I ! "� x PERMIT EXPIRATION
JOB ADDRESS •� 9�0. v ���rs" } UNIT# LOT#
'PERMIT,EXPIRES IF WORK
owNea .,, �� ",.'" conlTR ncroR 'l s 'h. , a • v IS NOT STARTED„WITHIN
, ',INSPECTION . DATE" INSPECTOR INSPECTION RECORD., "'iaoDAYS oFPERMIT.Issu�,;^
s r.. ANCE'OR 180 DAYS'.FROM'.,,
FOUNDATION NOTE: . LAST CALLED INSPECTION '
.
UFER, z ,� 't; f ALL GRADING AND DRAINAGE'SHALL'.r•BE INSTALLED
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAEI DATION ;
CUPERTINO,STANDARDS" "
- .'
r
GARAGE,SLABB .:y = - + s. .F 's� �`—.�sT,,g
POURAO CONCRETE UNTIL ABOVE HAS BEEN SIGNED'' '' + y, •, y ,+ '
UNDERGROUND/SLAB :a"`• "
PLUMBING
ELECTRICAL .. N „* "x'•�` ISsunrvcE OATS,
(MECHANICAL _ BEDG,< EEEcr- PLG. MECH
D0.NOT POUR FLOOR UNTIL,ABOVE HAS BEEN SIGNEO - BUILDING PERMIT
` WOOD FLOOR •4 +' ” T^, v INFORMATION
'Y VALUA IPN.
;5(Fr.
PLUMBING r,.. .{
!MECHANICAL F?. i t'... • ;t�.
• Z _ "� PEHMII TO
ELECTRICAL r r. ;• � �� '
'B�a
FRAMING ) ._A - r+• rjr
.STORIESw v TYYPSE'CONST\R•:
INSU LATION , 'y _ . . , • 't •eA.. p _ +v,' ,
aF ,
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED. '' ^ •�
SO r'T FLOOR AREA TO TAE'ACR EAGE
ROOF x -..�t° NOT,E'NO FINAUINSP',SHALL'BE MADE BEFORE, ',r
.DIAPHRAGM .< + sp,' THE CONSTRUCTION TAX IS PAID-4
" ••4 , = r r{ •7 BUILDING USE
ROOF SHEATHING '. :a a ".� '.w. REs 'IND 'CON, ,PB D
,.,APPLY,NOIROOFING'UNTILABOVE.HAS'BEENSIGNED"It�,"„`nhgFINALS�',',I�", -" �' ' ❑`�:❑ ❑ •❑ ❑ °
w„d 1 x n DATES Ca,A.,INSP,y ASse ssoR5 PARCEL.NO. ..
ROUGH' x _ 'SAN.N
PLUMBING ELECT.,ENERGY - - ^ ' -
THACTNO PARCEL NO
TUBS&,SHOWER PAN';. ` PLUMBING ENERGY•
MECHANICAL ",;;' . ; e ';,� .MECH:ENERGY
ELECTRICAL- , BUILDING ENERGY,. .SEs Acc.DnrEy -Acc.FIFE No, '
FRAMING ' ECECT�FINAL TEST', ' zoNwc � .ENc.SITE No.
+INSUL'ATION ,, "i T „ .'+'. PLUMBING 'n' yrj}�• '
n
LASTEST.' E'.
s .a GAS,,. " •,- '
r } 4, ', I •,• r„ Y�FIR E SPR INK ENERGY'T24
MECHANICAL - iijt'-v ❑-' N❑. v ❑ . ' N❑
' COVER NO WORK,UNTIL ABOVE HAS BEEN SIGNED, HEATING;,'
EXTERIOR:SHEAR ,� ^' ' „ �_. ELECTRICAL RELEASE EooD Ne A.I O'c
ZONE
v ❑ "❑ ` Y ❑ N❑
INTERIOR.,SHEAR RIRE.DEPT.
SHEETROCK - GRADE _ FEESUMMARV
EXTERIOR`LATH ' T r - BUILDING
INTERIOR LATH, z .'TEMPORARY,APPROVALS BUILDING^ }- "r'
SCRATCH-COATm� ELECTRIC ^��(j'.' PLAN.CHECK
FE
'NO.TAPE OR PLASTER UNTIL ABOVE,HAS BEEN SIGNED OCCUPANCY-$ _ - . ^'SEISMIC FEE '
OCCUPANCYOF.BUILDINGISNOTPERMITTED UNTILBUI LDING FINAL IS SIGNED.BY BUILDING INSPECTOR. MICROFILM,' . x •
.d'°. « ,._' t ^_ • ELECTRIC.. .
ARRANGE FO:R�INSPECTION'BY PHONING-2524505;
ONE'WOR KING.DAY, BE FIORE::REQUIRED.INSPECTION' PLUMBING
o PLEASE GIVE JOB ADDESS,WHEN PHONING
Z = SEE PERMIT FJR EXPIRATION DATE MECHANICAL -
,r
TCONSTs TAXL '.
IMPORTANT! r'
PLEASE'READ REVERSE SIDE-T ,T:,BEFORIEs_ TOTA
"= d ° 2
?. :.CALLING-FOR FINAL INSPECTION. L ' c
" OFFICE COPY
APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES -,USE'BALL'POINT PEN ONLY.
-'� , BUILDING PROJECT I DENTI FICATION �PERMITNUMBER _
. .. "_
So'
ILDING r, APPLICATION & PERMIT' "
ADDRESS
/ ` --�oGfia p / BUILDING'- ELECTRICAL' PLUMBING -MECHANICAL 2,f . 7
icOWNER' - t-✓/J PLAN CHECK VALIDATION
NAMEi ' ' [ 1. ELECTRIC PERMIT FEE '
PRONE ) .t - 1 X -A jl,•
1 - CONTRACTOR'S .. . .. {
NAME, {��,/` OUTLETS-SWITCHES-RECEP 10.00/100 e
.ND. • LIGHTING FIXTURES: t.10.00/1.00
CONTRACTORS (fir a PPLIANCES-RESIDENTIAL : 4.00
�I
PHON + PANELS 10.00 DATE OF APPLICATION
AR HITECT - - 'PLAN CHECK FEE
„ OR - 30,3' PANELS (OVER,200 AMP: .+ 20.00
ENGINEER
LIC:NO. SIGNSTRANS. '9 3.00
ARCH OR ENG. , - 'PERMIT.VALIDAT ION
ADDRESS - SPECIAL CIRCUIT ' 5.00
- - ZIP" EMP.METER OR, INS. 20.00 LS Zj'=�-•=Q� .
APPucnrvrs MOTORS - SEE FEE SCH.
ADDREs
SERVICE CHANGE 20.00 �� '�•• -
W
' r
02 LICENSED CONTRACTORS UfiCLARA'I'ION
T V'U I beteby al firm:hal 1 am licensed tinder provisions of Chapter 9. + ISSUANCE DATE
Z'w I onuncrem,w t Section 7000)of Division 1 of the Buslmss and r^r
'Q y - BLDG. ELECT. PLG MECH
r O z Professions Cod•'al license is in full fore d effect., ❑ - ❑ ❑
zo 0 O Lcens Cla Llc Nunlher ,
r w Dat Contactor ,
r BUILDING PERMIT -
A o a _ OWNER-BUILDER DECLARATION - _ ,INFORMATION •r'
X LL R I hereby"Fr.. that I nm exempt from the Contractor's License MISC.- " REFER TO ORD VALUATION
$/FT. +
u O.¢ - Law for the following reason.(Sec.7031.5.Business and Professions
R._ W U PERMIT ISSUANCE -10.00 CfD - 'i
w Code:'e,d mty or county which sequitur a P prior
it o its)issuance,
c oiler
¢ ¢ improve,demolish,or rep it sticture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. I1 "• "`
W
O ¢ rCtlnnl'S LIIC JppllCilnl fns SllCh pClmll(D file a Signed StattnlCllt that - TOTAL +tom \ ..E..�- 'PERMI(T�.TO� �
A w m he is licensed pursuant t0 the provisions of the Contractor's License
Law(Chapter9(commencing with Section 7000)of Division 3 of the ^ •"V �-
-'g 4 et Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT - FEE, 7.
¢ I-oro the basis for the alleged exemption.Any violation of-Section 7031.$
ca - _ STORIES, , - ., TVPE,CONSTR.
,. by any applicant for a permit subjects the applicant loa civil penalty ALTER-DRAIN -WATER (EA.) 5.00
afoot more than five hundred dollar,($500L)
): fel°
❑• I,as owner of tire property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 . i,:
their sole compensation,will do the work,and the structure is not - OCC.GROUP _ ,RES.UNITS
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 •",(• -:'.. - ,I.'.
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP - 5,00 SO.FT FLOOR AREA +TOTAL ACREAGE
3` himself or through his own employees,provided that such improve-
meats are net intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
- or improvement is sold within one year of completion,lire 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 RES ' IND -CON -PB • Deter
D .I,as owner of the property,on exclusively contracting with - Q ,Q �+. : ,Q IT
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5.V.B. 6.00 - ASSESSORS PARCEL ND.•ar
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 - ^ -
cwauiGtS for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 -
-' the Contractors License Law. TRACT NO. - PARCEL NO.
o , ❑ 1'am exempt under Sec: ,B.&P.C.for this
WATER HEATER W/VENT
reason
Ow net Date WATER SYSTEM E ACC.DATE ,t ACD,FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP;Y 5.00
' I hereby affirm that I have a certificate of consum to self-Insure. ZONING .ENG.SITE N0. '
- or a certificate of Workers'l._.I u[on Insurance nr, a ccrtirul _ t
copy thereol(Scc 3800 lab C) - f � + p ,1.
e, la 13OIIcy No.-Company,'7Ll}Y
Certllled o Is hereb f nish
O (f .0', copy Y FIRE SPRINK ENERGY TQ4
Z Z - D Certified copy is fled with the city inspection division.
O i Apphcdnt MISC. TO ORD: v 0 N El. ,pv.El N�. ,
~ w - PERMIT ISSUANCE - 10.00 --
2 CIiRTI PICCOMP P EKEh1 N INSURA M WORKERS' FLOOD ZONE:-, A L.0 C. ,
EL , COMPIiNSA1'ION INSURANCE PLG.CONTR. LIQ NO. pro
, 'ON \ <Y~"Q ❑
EL Z {•(':'his section need not be completed if tie jcrn it is for one TOTAL - a+ N
hundred dollars($100)or less.)
0 1 Lenity that in the perfonimou a of the work for which this per- DTY. MECHANICAL PERMIT' FEE.-� .FEE SUMMARY '
U_ {- alt is issued,I shall not employ any person no any manner so as to _ -
0 W become subject to the Workers'Compensation Laws of California.
a Date Applicant BUILDING'
} W NO1'ICI: 1'0 APPLICANT: If,after making INS Certificate of fix- ALTER OR ADD TO MECH. 5.00
Z
emir 0on,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK.
- - provisions of the Labor Code, you must forthwith comply with
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.)" 4.00 FEE '
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE J ',
^ CONS'I'RUCI'ION LIiNDINC AGENCY. '
I hereby affirm that :here is a corotrction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 -
. the,perlbnnance of th/eS,'work for which this pelnut is issued(Sec. - - MICROFILM
3097,Civ.CJ. /� - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nume_ HEATI NG UN IT 100,000 B.T.U.)9.50 s
Lenders Address •ELECTRICin
I 'crtify that I hav rad thisapplication and state that the above VENTILATION FAN (SINGLE)' 4.00 r, -
It
ordinances
rs i,street I agree to comply with all city and county PLUMBING
ordrmatio and. rrec laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 '
hereby authorize representatives of this city m enter•upon the BOILER-COMP :Over 100,000 BTUI SEE FEESCH. +. MECHANICAL .
hereb autlo riz property for vespe f the purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.,- REEFER TO ORD. -
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any way accrue against said'Gly in consequence of the PERMITISSUANCE
10.00
^ •t Ling of this P'nnit ' MECH.CONT. LIC.NO, MECH. '
'I g lure fA ant/Conlracfor ul TOTAL •• I, - T6TAL , t1�1�„
L
OFFICE COPY 4