17419POST THIS. CARD;NEARrFRONT.OF BUILDING.- '''•—.
.
,.' PERMIT NUMBER. -•�',
'CITY. -OF CUPERTINO
• A �
INSPECTION DfVISION`
JOB'INSPECTION RECORD, !3 -
„�'
•.� "�
- S-
PERMIT EXPIRATION,•
JOBADDRESS' UNIT,# _LOT#
•'
'PERMIT, EXPIRES IF_WORK
OWNER- „ CONTRACTOR"
•DATE'.
IS NOT STARTED WITHIN -
180 DAYS'OF PERMIT ISSU-:'
ANCE OR 180 DAYS;FROM,;
INSPECTION • INSPECTOR
INSPECTION RECORD -
FOUNDATIONC
NOTE: -
ALL'GRADING AND DRAINAGESHALL BE.INS7ALCED
TO COMPLY -WITH THE APPROVED PLANS AND CITY OF,
. LAST CALLED INSPECTION'.
UFER - -.'.
PREGUNITE " -'
'. PERMIT VALIDATION' ,I
CUPERTINO STANDARDS.'
-
�•.}.. �-�}"Iil,..tsl+•���-'I '•
" Issu ANce DAT[
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
- -
'- -UNDERGROUND/SLAB
PLUMBING
i1.
-
ELECTRICAL 'i- -
MECHANICAL- - - C.
BLDG,,
❑
ELECT.
LN
PLG MECR.-
❑ " GY
DOAOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
` ' PArD
BUILDINGPERMIT
TION
-
WOOD -FLOOR
rvnwnnoN -
•�
SIFT.
PLUMBING
AAy
- -•
,MECHANICAL - '
ELECTRICAL - •..
pp
- e
•PERMIT TO.
'-- `• �
FRAMING f
INSULATION
STORIES
ry PE coNsn+. .
O/G O/
OCC, GROUP .
RES.jUNITS.
PLACE•NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-
' - - ROOF '
NOTE: FINAL.INSP. SHALL BEpMADE BEFORE
THE CONSTRUCTION TAX IS PAID!','
SO. FT ,FLOOR AREA
TOTAL AGREAI:L
'
DIAPHRAGM -
ROOF SHEATHING
• BUILDING USE
nes .-IND CON. PB' .oul,i
� ;❑ 0''.❑ ❑ - ❑
�.'
.'APPLY NO ROOFING.ANTIL'ABOVE HASBEEN SIGNED
FINALS-• e. ,.,,_,„DATE„i.c. „,�INSP,.�-,�„
- - "ROUGH
..+r
BAN.N
ASSESSORS PARrEL, NO,:,
PLUMBING °
ELECT. ENERGY”
TUBS & SHOWER 'PAN
PLUMBING ENERGY•- ''..
iR ACT;NO.
.
PARCEL NO.
;
(`...
'
MECHANICAL -' -'
MECH:-ENERGY'
ELECTRICAL
BUILDING ENERGY -
ACc:,DATE.
r
ACC. FILE NO
'FRAMING -
ELECT.;FINAL TEST”
INSULATION - ',,;
PLUMBING-
ZONING'. _
ENGISITE N0.'
i-;
GAS TEST -
GAS
-
MECHANICAL 67
FIRE SPRINK
Yo 'No
ENERGY T'194
o NEI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR•• -
ELECTRICAL' RELEASE
. FLOOD ZONE
Y❑ N❑
A.L.uc.' -
.
Y,7No
INTERIOR SHEAR � �
FIRE'DEPT.
SHEETROCK '.GRADE
" .+
FEE SUMMARY "
EXTERIOR LATH' -
BUILDING
-
BUILDING', +
'
INTERIOR LATH -TEMPORARY
APPROVALS
SCRATCH COAT •
ELECTRIC
PLAN�CHECK
FEE
.. - -.
GAS
-
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
,.
DccuPANcY
SEISMIC FEE
OCCUPANCY,OF BUIL'C1ING IS NOT PERMITTED UNTIL BUILDINGTINAL ISSIGNEO BY BUILDING INSPECTOR.
MICROFILM
`-
ARRANGE FOR INSPECTION BY PHONING 252-4505'
ELECTRIC
`
wyy ONE WORKING DAY BEFORE•REQUIRED INSP.ECTION.'- �
�
P':UMBIN_G-'
Off\ I,• I
PLEASE GIVE JOB'ADDRESSMHEN PHONING:
Z ••:
— SEE PERMIT FOR EXPIRATION -DATE -'
1
MECHANICAL'
CONST. TAX
,
} :,
IMPORTANT.
.' 1 Y
PLEASE READ REVERSE SIDE -BEFORE'
TOTAL
CALLING, FOR FINAL INSPECTION. -
-
OFFICE'COPY
Arr4.IU ANI IU TILL IN INI'UFIIVIA I ILJIN w1 I NIN ntu LINES'- USE BALL POINT PEN ONLY
BUI LD1 NG PROJECT I DENTI FICATION
-' " ' -
- APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING -MECHANICAL
• -.PERMIT NurvaEn ,
'
- t 7
BUILDING
aoDRESS
OWNER'S
A E
RV.
l.'K. �lrnan PRONE G
U -O �o •
1
QTY. ELECTRIC PERMIT FEE ,
PLAN CHECK VALIDATION
•'e'
_
'
DATE OF APPLICATION �.•E
CONTRACTOR'S+
NAMES `
Ac T`aJ: LIC. NO. SW�p
OUTLETS -SWITCHES - RECEP ' 10.00/1.00
LIGHTING FIXTURES 10.00/7.00
/.7
CONTRACTOR'S 'S-�•-14U Y4
LO'41y1 rCl'4 T•' PHONE 73 -sa1/fp
APPLIANCES=RESIDENTIAL '.4_.00 +.
PANELS (Uoell ilovcsa' .Ia-JO
CHI
a�\ - -
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.TECT
ENGINEER--;�.. "
SIGNS TRANS:' "3.00
UC. No.
ARCH.ENO.
ADDRESS
SPECIAL CIRCUIT .6.60,,
PERMIT VALIDATION
' zIP
EMP. METER OR POLE INS. 20.00
7� '
�: AN�IL.NIXG+
none SSTsMOTORS
SEE FEE SCH.
f� �S
1121 a
,t .
SERVICE CHANGE [�A(�.00
LICENSED CON 'IBACTORS DFCLARATION
I hetchy affirm that 1 an, licensed under provisions of Chapter YIJS%�
(commencing with Section 7000) of Division 3 of the Business and,
Professions Code, u np 17ny license is in full force .n d eC-f;et -
Cla C LU Lic.Number _ J✓
Date
Date �J�Comnctor }14 S
ISSUANCE DATE
"BLDG. ELECT. PLG: MECH.
❑ , ❑
I
- Clty Of �I1p91�1IO
C
_ +- OWN 1; DECLARA'T'ION'
I hereby al l'in, Thal I um exempt Dont the Con tractor's License
Law for t he following reason. 4See. 703 L 5. B osiness and Professions
Code: An city or count
Any ywhich mquiresa Permit to conslnmL al[eN
-
BUILDING PERMIT
'INFORMATION
MISC. - REFER TO ORD
PERMIT ISSUANCE
VALUATION
SIFT.,
ELEC CDNTR, LIC. NO.
„
ELEC.
TOTAL
improve, demolish, Or repair any structure, prior TO its issuance, also
requires the applicant for such permit to rile a Signed statement that
he is licensed pursuant to the provisions of the Contractor's License
'
,
PERMIT TO
Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or thin he is exempt therefrom and
'
QTY. PLUMBING PERMIT FEE
" E�s-E_.T MSH
the basis for the alleged exemption. Any violation of Section 7031',5
subjects N5000.)cannoacivil pcoelty
by any 'redia I se hundred -'�
of not more than five hundred dollars (my
- }
STORIES -
TYPE'BONSTR.
-' '
-)
ALTER -DRAIN 5.00
❑ I, as owner of the property, or my employees rust wages as
employees
their sole compensmioq will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP •
RES. UNITS
intended or Offered for sale (Sec. 7044, Business'snd Professions
Code: The Contractor's License Law docs not apply to an owner of
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
--,
+- "
,
FIXTURES - PER TRAP 5.00
GAS - EA.SVSTEM - I INC. 4 OUTLETS 6.00
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
.carsure not intended or offered for sale. If, however; the building
SO: FT. FLOOR AREA
TOTAL ACREAGE
,
or improvement is sold within one year of completion, Ile• owner.
builder will have the burden of proving that he did not build or im.
prove for purpose of sale.).
❑ I, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
- BUILDING USE
RES IND . CON PB, ONS,
O ❑ E . 0
INDUSTRIAL WASTE.INTE R. 30,00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
- LAWN SPRINKLERS -OVER 5 (EA.) 1.00
licensed contractors to construct the project (Sec.7044, Business
and Professions Code: The Contractor's License Law does not apply
to,an owner of property i4o builds or improves Thereon, and who
ASSESSORS PARCEL NO:
contracts for such projects with a contractors) licensed pursuant to
the Contractor's License Law.
❑ I am exempt tinder Sec. BAP.C. for This
reasgn
SEWER -SANITARY -STORM EA, 200ft/10.00
TRACT NO.
-
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner '- Dam
WORKI:RS'COMPENSATION DECLARATION
WATER SYSTEM 5.06
T
ACC. DATE
-
ACC. FILE NO.
WATER TREATING EQUIP. - 5.00
I hereby affirm that 1 have a certificate of -consent ro scl Ginsure.
ZONING -
ENG. SITE NO, j
or a certificate of Workers' Compensation Insurance, or a i'crtified
copy Ihere�n�f �(SpeQc. 3,t800, Lub,C.I
m,2
PolicylsCompanY
CCyy CertiNed copy is hereby furnished.
`6= Certified cop is fled with the city inspection division.
A lwa it,} A.
-
FIRE SPRINK
vQ NO
ENERGY T-24.
�.'D N❑
.MISC.- REFER TO ORD:
PERMIT ISSUANCE 10.00
CERTIPICATEOF EXEMPTION FROM WORKERS'.
- COMPENSATION INSURANCE - "
CHus mctiou need not be completed if the permit is for o
FLOOD ZONE
Y ❑ N ❑
A,L.U.C.
v O N ❑
PLG. CONTR. LIC. NO, -
PLG,
TOTAL
hundred d.11...( S 100) or lass.)
- -
I certify that in rite performance of tire work for which this per-
mit is issued, I shall not employ any person in any manner so as to
QTY. MECHANICAL PERMIT FEE '
-
FEE SUMMARY ,
-
become subject to the Workers' Compensation Laws of California.
ALTER,OR.ADD TO MECH. 5.00 --
nam Applicant - -
BUILDING
NOTICE TO APPLICANT': If, after making this Certi(icare of Iix-
APPLIANCE _ 5.00-
AIR HANDLING UNIT (TO 110MC.F.M.) 4,00
'PLAN CHECK
FEE'
+
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE'
CONSTRUCTION LENDING AGENCY
I herebyaffirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performans of the work for which this permit is issued (Sec.
3097,Civ.CJ.
MICROFILM
-
HEATING UNIT (TO 100,006 B.T.U.) 'Cl.0'0
Lenders Name
Lender's Address
-
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
ELECTRIC'
'e.2
VENTILATION FAN (SINGLE) 4,00
I certify rims I five read this application and stale that the above
lnforinatiotris correct. 1 agree to comply will ail city and county
-rhmnces•and stale laws relating to building construction; and
hereby authorivc representatives of this City es enter upon the
above-mentioned property tar resp ofth i purposes. to.
BOILER - COMP (3 H.P. or 100,000 B.T.U.) 6,98 ,UA
PLUMBING
BOILER -COMP (over 100,000 BTU) SEE FEE SCH.
MECHANICAL
�t7.Oei-
(We) agme'lo save, indenmilly and keep harmless the City of
Cup tin''against liabilities, judgatents; costs and expenses which
may,tn any way accrue against Said City in consequence of the
gra bink, of this perm)
C ,y �B/ . ])are
nature of Appbcan Contractor Datc
MISC. - REFERTO ORD.
.
PERMIT ISSUANCE. Z b.00
-
CONST . TAX
`-
MECH. CONT.. LIC. NO. MECH. ' i
TOTAL
30 0o a'
j
'TOTAL
_, -^
L�ZJ
OFFICE'COPV