17572's
- POST THIS CARD NEAR FRONT OF BUILDING
'
CITY OF CUPERTINO
INSPECTION DIVISION
JOB, INSPECTION RECORD
JOB ADDRESS — LL/..i�t� UNIT#i _LOT#
L D 0
J T,
OWNER � �A/L_ CONTRACTOR Qr` `AGI✓
PERMIT NUMBER
17572
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
I
LIFER
PR EGUNITE
PERMIT VALFDA NON
�J - '�• �"�/
U'—I,
ISSUANCE DA 111
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
SEP 271989
UNDERGROUND/SLAB
PLUMBING^^.
Gl�L,,
CRY Of WtjPO
C
ELECTRICAL
MECHANICAL
..
BLDG
❑
ELECT
❑
PLO
❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
' WOOD FLOOR
VALUATION
SIFT.
PLUMBING
/,z—
.—ELECTRICAL
MECHANICAL
ELECTRICAL
�
+
FRAMING
INSULATION
STORIES
TYPE CONSTR.
UCC GROUP
-
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SO FT FLOOR AREA
TOIAL ACREAGE
DIAPHRAGM
ROOF SHEATHING
BURUM USE
Res IND CON ve 00—
Q E ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ASSESSORS PARCEL NO
ROUGH
SAN.#
PLUMBING
ELECT. ENERGY
TUBS & SHOWER PAN
PLUMBING ENERGY
TRACT NO
PARCEL NO
MECHANICAL
MECH.ENERGY
ACC DATE
ACC. FILE NO
ELECTRICAL
BUILDING ENERGY
FRAMING
ELECT, FINAL TEST
ZONING
ENG. SITE NO.
INSULATION
PLUMBING
GAS TEST
GAS.
FIRE SPRINK
YF] No
ENERGY T 24
I Q NEI
MECHANICAL — —
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .
HEATING
vuwO ZONE
N[]❑
ALuc
No
EXTERIOR SHEAR
ELECTRICAL RELEASE
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
F
EE
GAS
SEISMIC FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
`aO
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL-;
-Da
'OFFICE COPY
r
O
Zz
_
0
X
LU -
ao
z
00
LL U
0 a
} rn
F Z
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
IPERMIT
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING -MECHANICAL
NUMBER
7[
I JJ
172
BUILDINGy�j] o/� Al
aoo�7V Imo.(/.
OWrvOWNERSPLAN
NAME
�NIDF_.(/I COIj?P
OTY-ELECTRIC PERMIT FEE
CHECK VALIDATION
DATE OF APPLICATION
PLANCHECK FEE P.C. NO.
CONTRACTORS
NAME
L LIc. ND
OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
roqqrvqqT�f1R1Acrors
�f ry(/f/ vHONE
ARCHITECT
OR
ENGINEER
LIC. NO.
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
PANELS (OVER 200 AMP) 20.00
SIGNS TRANS. 3.00
ARC H. OR ENG
ADDRESS
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
EMP. METER OR POLE INS. 20.00
ZIP
q�- ��--
APPLICANTS
aOORESS
MOTORS SEE FEE SCH,
SERVICE CHANGE 0.00
1TI-'
LICENSLD CON "f RACTORS DECLARATION
1 hereby off nn That 1 am licensed under provisions of Chapter 9
ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business uric
1'rofessinns Codrg�Mart1 license is in lull lore ff
License Class CC.•iL`(((,// Lie. Number_
f ;p Contract.,- iG_
[)al -f-;p
/'
G.
❑
ELECT.
❑
PLG. M CH.
❑
�r/ �/�r
ay. of cu�u
BUILDING PERMIT
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor s License
Law for the following reason. (sec. 7031.5, BUsineSa3nd PP tCs Ions
INFORMATION
MISC.- REFER TO ORD
VALUATION
4/FT.
PERMIT ISSUANCE 10.00
Code: Any cityor county which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to Its Issuance, alsoELEF
CONTR. LIC. N0.
ELEC.
requires the applicant for such permit to file a signed Melemenl that
he is licensed pursuant to the provision of till Contractor's License
LawI(Chapter 9(commencing with Section 70001.(Division 3 of tat
BBusiness and Profession Code) or that he is exempt therefrom and
usiness
basis for the alleged exemp lion. Any violation of Section 7031.5
TOTAL
PERMIT TO
'^
ec_• l
GTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
ALTER -DRAIN & VENT -WATER (EA.) 5.00
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars 155001.1:
❑ I, as owner of me property, or my employees with wages as
their sole conhpehaation, will du the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
BACK FLOW PROTECT. DEVICE 4.00
DCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
Code: The Contractor's License Law does not apply to all owner of
properly who builds or improves thereon, and who does such work
F IXTUR E$ - PER TRAP 5.00
sO. FT. FLOOR AREA
TOTAL ACREAGE
himself or through his own employees, provided That such innprrreg
ments are not intended or offend for sale. If, however, the building
GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within line year of completion, the owner-
builder will have the burden of proving that Ile did not build or int-
prove for purpose of sale.)_
O I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project IS,,. 7044, Business
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Omer
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
and Professions Code: 'fhe Contrac(or's License Law does not apply
to an owner of properly who builds or improves thereon, and who
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts 1'or such projects with it contructods) licensed pursuant to
the Contractors License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
--TRACT No.
PARCEL No.
WATER HEATER W/VENT 6.00
❑ I am exempt under Sec... BAP.C. for this
reason
Owner Datc
WATER SYSTEM 5.00
ACC.OATE
ACC. FILE NO.
WORKF' PS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00
1 hereby affirm thin I have a certificate of consant Rh SLIFlnxure.
or a certificate of Workers' Compensation Insu once, of a certified
copy thcrcy�7 17 Lab.y /a.�yJ7j. �.i//1�
v�s�
ZONING
ENG, SITE NO.
Policy N, (mpany
❑ Certified copy m Hereby furnished.
❑ CertifjP9�¢cy/�y jhleh(yl�lion division.
nnplicam iIGI"�T/V a
FIRESPRINK
Y 0 N �
ENERGYT24
Yo NEI
MISC. - REFER TO ORD.
CI"RT11'ICA1'17OI' IiXI:MPTION 1'ROM WORK[?RS'
PERMIT ISSUANCE 10.00
PLOOD ZONE
A.L.0 C.
PLG. CONTfl. LIC. NO.
PLG.
TOTAL
COMITNSATION INSURANCIi
(Phis section need not be completed if the permit is lir one
Y� N�
Y� N�
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars IS 1001 or less. )
1 certify that in the performance of the work for which this per-
mit is issued, I shall n01 employ any person in any manner so as to
become subject to the Workers Conhperoation Laws ol'Culifnr.
Dale Applicant'ALTER
NOTICI! TO APPLICANT: If, after making this Certificate of Ex-
emption, you Should become subject to the Worker Compensation
provisions of the Labor Code, you must RothwM1h comply wit
such provisions or this permit shall be deemed revoked.
BUILDING
OR ADD TO MECH. 5'.M -fiiir�
APPLIANCE
PLAN CHECK
FEE
AIR HANDLING UNIT (TO 10,0MCF.M.)
AIR HANDLING UNIT (OVER 10,0MC.F.M.)6.00
SEISMIC FEE
CONSTRUC'f10N LE NDING AGENCY
EXHAUST HOOD (WITH DUCT) 5.00
1 hereby affirm that there is a construction lending agency for
the performance of the work lir which this permit is issued (Sec.
3097, Cis ,C. ).
HEATING UNIT (TO 100,000 B.T.U.) B.00_MICROFILM
HEATING UNIT (OV ER
ECTRIC
-
Lender's Name
Lendcr's Address
1 certify that I have read this application and state that the above
information is correct. 1 agree to comply with all city and County
ordinances and state laws relating to building construction, and
hereby uuthonie representatives of this city to enter upon the
above mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
upertino against liabilities, judgments, costs and expenses which
nay in any way accrue ago' st said City in consequence of the
VENTILATION FA (SINGLE) 4.0Cr
BOILER-CUMP(3 H. or 100,000 B.T. .) 6.00
MBING
BOILER -COMP 214100,000 BTU( SEE -
ME ANICAL
ONST, TAX
7 MISC. - , REFS
PERMIT ISSUANCE 10.00 CZQU
ECH.CONT. I NO. TOTAL
2
TOTAL
�-p0
anti this permit.
Signa arc of Applicant/Contractor Date
-
OFFICE COPY' ✓v