17209 (2) POST THIS CARD NEAR FRONT OF BUILDING =" z
'� •. y PERMIT NUMBER
CITY 'OF CUPERTIIVO ` 17,209
INSPECTION DIVISION "•
JOB INSPECTION.RECORD "
PERMIT EXPIRATION _
JOB ADDREESS_(U L6,. 'S�� UNIT# _LOT# -'pERM1T•E'XPIRES IF WORK
- .OWNER .M1� �;(�l - coNTRncToa°'; � IS NOT•STARTED WITHIN:.
INSPECTION DATE - INSPECTOR - INSPECT ON R CORD180 DAYS OF PERMIT ISSU
1 FOUNDATION - . ANCE OR 180 DAYS FROM
NOTE: r - + LASTCALLED INSPECTION
UFER - ALL GRADING.AND DRAINAGE SHALL BE INSTALLED
•PREGUNITE '`,`'• - +TO COMPLY WITH THE APPROVED.PLANS.AND,OITY OF. - :PERMIT VALIDATION
CUPERTINO STANDARDS. , I {'
'GARAGE SLABS -
' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
.` UNDERGROUND/'SLAB j jilt
PLUMBING, r,. - >?. �'IA � III'E,/C�•• .
ELECTRICAL - ISSUANCE DATE +
MECHANICAL . y. BLuc- ELBcI, PLG:. MECH.
El
DO NOT POUR FLOOR UNTILABOVE•HAS BEEN SIGNED , 1 - 'BUILDING PERMIT
INFORMATION ' '
: -WOOD'F,L00 RvnwnnoN s/F,T.
PLUMBING L, • _ - •' r + o!/
MECHANICAL :• " y + ' - 1 `•OD1'� : 1:
ELECTRICAL - d rE++nin ry
FRAMING I'
INSULATION - �'.t STCHIES TYPE CCNSTR. ,
UCC.GROUP RES,UNITS
-� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED :lO d r- -
SO.FLFLOOR<NFA ,iOLAL 4CPEAO L.
;• ROOF ;' 'NO :N FI L INSP.SHALL BE MADE BEFORE
DIAPHRAGM, TH ONSTRUCTION-TAX IS PAID t
` ROOF SHEATHING BUILDING USE'
- .. - tics :JND CON PB
APPLY,'�NO.ROD FING•UNTIL ABOVE HAS BEEN SIGNED FINALS DATE-" INSP. - ❑ Q E 'E E
ROUGH , SAN.p - -
ASSESSORS P PARCEL NO
PLUMBING - 'ELECT:ENERGY'. 1
- TRACT NO - PARCEL NO
n TUBS 8 SHOWER PAN :• PLUMBING ENERGY`
MECHANICAL MECH.'ENERGY
ELECTRICAL" ACC DATE ACC FILE NO.
`BUILDING ENERGY,
FRAMING _ ELECT.FINAL TEST - ZONING ENG.SITE No
INSULATION - PLUMBING' .
GAS TEST - - GAS '
_ FIRE SPRINA ENERGY T 74 -i
' - MECHANICAL 1
.. - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING • Y �' N� "�
FLOOD 2pNC ALU Cf'
- EXTERIOR SHEAR - ELECTRICAL RELEASE v� , N Q Y LJ m❑
'INTERIOR SHEAR - FIRE DEPT.; -
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH. - BUILDING'.
INTERIOR LATH, , TEMPORARY APPROVALS- ,,' .' BUILDING pp ;
SCRATCH COAT' 'I•- ELECTRIC. - PLAN CHECK -
.. _ _+ FEE GAS '. `.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE,
' d OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIPINED 13Y BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY, PHONING 252-4505;
ELECTRIC ,d0
��. ONE WORKING DAY BEFORE REQUIRED INSPECTION. . y PLUMBING jd A(2
z PLEASE GIVE.JOB ADDRESS WHEN PHONING.
— SEE PERMIT,FOR EXPIRATION DATE —'- NecFANIDAL
,IMPQRTANTI coN`sT.TAX
:PLEASE READ REVERSE SIDE BEFORE , ,,TOTAL q
n CALLING FOR FINAL INSPECTION h '7-Tr -
rq r' OFFICE COPY', "�•,
APPLICANT TO:FILL' IN INFORMATION WITHIN REDLINES - USE BALL- POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION a. PERMIT NUMBER
Ball1a ' 1 c. - - APPLICATION &PERMIT 1'q'rj.OJ
ADDRE ss <_1 [�� J
O C) yT .Zkj BUILDING-ELECTRICAL=PLUMBING-MECHANICAL 6f.
OWNER'S U PLAN CHECK VALIDATION
NAMt OTY. ELECTRIC PERMIT FEE
DNE 73�-
croRs
NAME � - OUTLETS-SWITCHES-RECEP 10.00/1.00 '
NAME
m. . LIGHTING FIXTURES , • '10.00/1.00
CONTRACTOR s APPLIANCES:-.RESIDENTIAL ' 4.00,
AO DRESS
i E 'J PANELS 10.00 ' DATE OF APPLICATION SM&
ARCHITECT ���V'/[L' p PLAN CHECK FEE P.C.NO,
OR 1 trrtLE PANELS (OVER 200 AMP) 20.00 '1
ENGINEER / LICN01 SIGNS TRANS., - 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS - SPECIAL CIRCUIT _ 5.00 ppp
- "zip TEMP.METER OR POLE INS. 20.00
APPLICANT s. , MOTORS SEE FEE SCH:
q.
I► SERVICE CHANGE 2000
o'0_ p Inipc� '
'F 0 o LICENSED CON'I'RACIOHS DECLARATION -- �
¢ U U I hereby affirm that 1 in licensed under provlslons of Chapter 9 - ISSUANCE DATE
rHn z L, (commencing with Section 7000)'of Dismal 3 of the Business and. `
¢ O` BLDG. ELECT: PLG. MECH.
H w i Professions Code, my licvnsy is in full fo��? ff�w, - FEU ®, ❑
pi w u License lass ilia.Number.'79" � - -
r m H J
Date ' Comractor_�.I t{ -
.' ¢ m ¢ ¢
OWNER-BUILDER DIiCLA RA'f10N - I QI Capertm BUILDING PERMIT
M aa U INFORMATION
w g LL N I hercby.afflrm that Lhmm
m exempt from the Comoor's License MISC.- REFER TO ORD
LL0¢ law for the followingreamn.(Sec.7031.5;l3usinessan1Pr.fessiuns pERMIT ISSUANCE % 10.00 ,VALUATION $/FT.
� - Code:Anycily oreconty which requires a permit to construct.alter, ' - r
QIc ¢p improve,demolish;or repair any structure,prior to its issuance,also E GC TR." ..LIQ NO. ,FLEE: , '
al
0 rc r pores the applicant for such permit to I lle'a signed statement that . 7 TOTAL Q�
u w m u - t PER MIT TO'
lie Is hecnwd pursuant to the Provisions ns f the C ant rotor's License -
H > Law(Chapter.9(commencing wlthSeel o17000)ofDrsision3 fthe
i o Business and Professions Cole)or[hill hand
e is exempt therefrom OTY. " PLUMBING PERMIT .','FEE
¢ F$ the basis for file alleged exemption..Any%iolalloa MSection 7031.5 1, , - 4,,` STORIES. TYPE CONSTR.
a ; by any applicant for a permit subjects file applicant to a Civil PenallY ALTER-DRAIN 5.00
m _
of not ore than five handled dollars($500).): - -
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE•: 4.00
their Sale 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,COND., 5.00
Code:The Contractor's License Law does not apply to an owner of _
properly who builds or improves fhemn,and who doessuch work ' FIXTURES-PER TRAP 5.00 . 't Db so.FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
Rents are not intended or offered for sale.If,however,the,building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 + "
or improvement is sold within one year of completion,the owner-
builder
wner GAS-'EASYSTEM OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving that he slid not build or ani- . - . .
REB IND z CON. - PB . Omar
prove for purpose of salt) - I NDUSTR IAL WASTE INTER. - ,'3000
❑ 1,as owner oftire pnip rly air xclnivly�contractnng with - El. ,❑' -.❑• 1:1
.❑
licensed coivractors to.cnnstr t the pmjcct(See. 7044.Bcsincss, LAWNISPR INK'LERS- 1' INC 5 V.B:;"").6.00 -,IgsSEs6DRSPARCELNo.-
and Professions Code:The Contractor's Liceasc,Law does not apply - -
toimownerrof properly who builds or Improves thecoh,Slid who LAWN SPRINKLERS-OVER 5(EA.) . 1.00 '"
contracts for such projects with u contractor(s)licensed pursaanl to SEWER-SAN EA.200ft/10.00 "
the CO n tnctof s License Law. _ •TRACT NO. PARCEL NO.
❑ I am exempt under Sec. e.&P.C.far this WATER HEATER W/VENT 6.00 '
Denson
Owner -Date
WATER SYSTEM - 5.00 . - ACC.DATE. ' Acc.FILE No,
WORKERS'COMPEiNSA'I'ION DECLARATION ,WATER TREATING EQUIP.. 5.00 ,
1 hereby affirm first 1 have a certificme of consent to self-insure,
or a Certificate of Workers Compensation Insunmee,or a cerfificd ZONING - ENG.SITE NO.
copy thereof(Sec"3800,Lab,C.). - _Policy No • Company ••t
❑ grlied copy is hereby furisll 1 FIRE SPRINK - ENERGY T-24
Z Z' C1/Lerl"id up,is Ja w' Ih Illy I. ff yi�o dry a MISC.'- ' REFER TO ORD '
o APpbcnn _ �� Y ❑ N❑ Y ❑ �N❑
LU - - PERMIT ISSUANCE - 10.00 ,vD
� CI>RTIFICATEOE-1. oMFIION I-ROM WORKERS' • L. FLOOD ZONE N.C.U.C.
W �• COMPENSATION INSURANCE PLG.GOTH LIC.NO�f PLG. ' /
d O (IN, section need not be complete,[ if 116 P,.rmll is j(or one - / TOTAL 6( L� V❑ N❑ Y ❑ N❑
D Z hand red dollars IS 100)or less.) 1 ,
L) 0 I certify that in the performance of the work for which this Per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY a`
LL F mit is issued.I shall not employ any person in any manner so as to -
0 L) become subject to the Workers'Compensation Laws of California: Q
d Ditc Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING; 63"lob
}rfn NaO'I'ICE TO APPLICAN"1': If,after making this Certificate of Ex-
f- Z emption,you should become subject to the Workers'Compensation APPLIANCE - s15.00 PLAN CHECK„
provisions of file Labor Code, you mast forthwith comply with FEE t
U such provisions or this permit shall be dcerfad revoked:'a AIR HANDLING.UNIT(TO 10SMC.F.M.) ' 4.00
CONSTRUCTION LEMAN(!AGENCY ' AIRHANDLINGUNIT(OVER10MOOF.M.) 6.00 SEISMIQFEE
I hereby ull'arn that there is a construction lending agency or EXHAUST HOOD(WITH DUCT) 5.00 -
the performance of the work for which this pernnh iss
is issued(Sec. MICROFILM ^
3097,CIv.C.7. H EATI NG UN IT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC Y 1 r '10
I certify filar l have, this application and state filar the above VENTILATION FAN (SINGLE) .• ', .4.00 /
information is correct. I agree to Comply with all city and county PLUMBING 6 e 0.V
ordinances and state laws relating In building construction, and BOILER
H.P.Or 100,000 B.T.U.) 6.00 r
hereby aufhorme`representatives of this city-to';enter upon.the BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes,
(We) agree,to save, indemnify and keep harmless the*City of MISC,-. • 1 REFER TO ORD. r Cupertino.against liabilities,judgments, costs and expenses which' PERMIT ISSUANCE - . '10.00 CONST.TAX
may In any way accrue against said City in consequence of tile- _
•ranting of thio pe MECH.CONT LIC NO.. MECH ' s,
7-
TOTAL TOTAL
_ , sem.
'ignatureuf Applican` Strada, Date
OFFICE COPY