16680 POST THIS CARD NEAR'-FRONTOF BUILDING'. PERM Ir NUMBER
CITY OF CUPERTINO 1 fi6$0
INSPECTION DIVISION
JOB INSPECTION RECORD
•� •�1• Q p,,/ _ PER
B IT' ^�E PRg�ION
JOADDRESS f--23-2Z kd ht {..` UNIT# ' L'OT#
�},� //• PERMIT EXPIRES.IF WORK
OWNER, 'D .er (�- °L- 1`/f. coNTRACTop- IS, NOT,STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- -'
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: .< < LAST CALLED INSPECTION.'
LIFER - ALL GRADING AND DRAINAGE'SHALL BE INSTALLED
PR EGUN ITE, TO COMPLY WITHJHE APPROVED PLANS AND CITY O PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABSZ Z.J �" •�. "
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB "f ��vGG�-� '
PLUMBING -
ELECTRICAL. - �, ISSUANCE DATE--
• MECHANICAL - BLDG. ELEC1, PLC
, ❑ ❑ ❑ 'I �
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - +, - BUILDING PERMIT ,
` INFORMATION I
e'' WOOD FLOOR VALUATION S/FT.
PLUMBING . - a 0
MECHANICALI
` ELECTRICAL - , - PeNmiT ro
FRAMING
INSULATION - {+' V, 51ORILS TYPE CONSTI+.
OCC,GHOUP RES UNITS
PLACE NOSUBFLOORUNTIL ABOVE HASTEENSIGNED' ` SOfT.FLOOR AHEA TDIAL ACHEAGL
® ` - .. . ROOF 'NOTE:NO FINAL INSP:SHALL BE MADE BEFORE +
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUI,DING USE
ROOF SHEATHING • '" I,Es IND I CON Pb Ou,.,
11
—APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE:. INSP. ❑ El ' ❑
ASSESSORS PARCEL NO
ROUGH
PLUMBING ELECT.IENERGY
TRACT NO. PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL c MECH3ENERGY.,' '-
ELECTRICAL ' `BUILDING ENERGY i - ACC,DATE AcccILE_No.
FRAMING - A 'ELECT.FIN .zuwrvc . eNc.slrB No,
INSULATION PLUMBIN
GAS TEST GAS waft
: FIRE sPRINK ENERGY Tz+
MECHANICAL
'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING / `Y ❑ N❑ ' � ❑ No -
EXTERIOR SHEAR- ELECTRICAY RELEA FLOOR ZONE , , A,L.U,L.
INTERIOR SHEAR FIRE DEPT. • ,`"❑ ' N[3 1. ❑ N❑;
' SHEETROCK - GRADE T FEE SUMMARY
EXTERIOR LATHBUILDING "
INTERIOR` LATH. - TEMPORARY APPROVALS euILDINc?
SCRATCH COAT ` ' ELECTRIC PLAN'CHECK
GAS ... FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL.BUILDING FINAL IS SIGNED BVBUI LDING INSPECTOR. 'MICROFILM
ARRANGE•FOR INSPECTION BY PHONING 252-4505, sf ELECTRIC
N� ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING
OPLEASE'GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE MECHANICAL
--' IMPORTANT! coNsr.rnx
PLEASE,READ REVERSE SIDE BEFORETOTAL ,1
CALLING:FOR FINAL INSPECTION.
iOFFICE COPY ' Y F
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION - .PERMIT NUMBER
BUILDING APPLICATION & PERMIT
aooREss BUILDING _ ELECTRICAL—PLUMBING—MECHANICAL
_ aa3zz �� 166.88 .
OwNER'S r PLAN CHECK VADATION
—� Nam�E LIQTY. , ELECTRIC PERMIT' FEE
CONTRACTORS ////
NAME - OUTLETS-SWITCH ES•RECEP` 10.00/1.00 : ( �(
+ LIC.No. LIGHTING FIXTURES 10.00/1.00 rl ,
CONTRACTOR'S
ADDRESS PPLIANCES-RESIDENTIAL 4.00
" PHONE PANELS - 10.00 DATE OF APPLICATION
AHCHITECT PLAN CHECK FEE P.GiN9
2N0]NEER ( PANELS (OVER 200 AMP)' 20.00 -
-n LIC.NO. SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 � -7
.. ZIP EMP. METER OR POLE INS.'•, •20.00 �(�L_] —�y
noxa SSTs MOTORS 'SEE FEE SCH.
A SERVICE CHANGE 0.00 r
oaz
Foo LICENSED CON'T'RACTORS DECLARATION '
< i w I hereby affirm that 1 am licensed Under provisions of Chapter 9 z
is ¢ Cen nmencing with Section 70001 f Division 3 of IIIc Business and ISSUANCE GATE 0 o- Professions Code,and my license is in full fort and effect. ` LOG. ELECT. PLO: MECH.
.�
z0 i _ Lease Class I Number r -
r w Dalc C nr[a for
a m s ' City of, CUQ21l111 F El El
BUILDING PERMIT
¢ ¢ w OWNER-BUILDER R-BUILDIiR DIiCLA KATION - INFORMATION
La ;u H I hereby affirm That 1 am exempt from the Contractor's License MISC. REFER TO OR_D - '
LL o`� Law for the following rclumn.(Sec.7031.5,Businessand Professions VALUATION
PERMIT ISSUANCE S/FT.
Code:And city or county which requirau permit to construct,u0er, - 10.00 -
Ge. improve,demolish,or repair any stuctilre,prior to its issuance,also ELEC.CONTR. LIC.NO.f _ �D (�QD
%m u ,' r IuirC9 the appf ant or,uch peraul to file a slgnuA statement that - TOTAL - PER MIT TO
he is licensed pursuant to the provisions of the Co nr¢lot's L¢cnse - - -
. Hza
hale(Chapter 9(cotnmencing with Section 7000)of Division 3 of the - - � 1 11
Q � '. f�//
F 4 p Business and profession,Code)or that he is exempt theafrom,Ind DTV. PLUMBING PERMIT FEE'" 1A r
-�¢ H$ the basis for the alleged exemption.Any violation of Secl ion 703 L5 STORIES TYPE CONSTR.
i ; - by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN;&VENT-WATER IEA.) 5,00 '
of not more than five hundred dollars(8500).): - _ -
❑' L isowner of the property,on my employees with wages as gACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the Structure is not OCC.GROUP RES.UNITS
r
intended ooffered Joe sale (See 7b44, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 .
Code:The Contractors License Law does not apply town owner of
properly who builds or improves thereon,and who(Ines such work
himself or thiouFIXTURES-PER TRAP .5.00 SO.Fr.FLOOR AREA TOTAL ACREAGE
gh his own employees,provided That such improve- -
ments are not intended proffered for sale.IL however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 .
or improvement is sold Within ):se year of completion,the
builder will will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
P E BUILDING USE
prove 1:asofor net of sale I. + � INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
Ix I;as owner of the property,am exclusively contracting with O 0
- - - _
licensed contractor to construct the project(Sec. 7044, Business LAWN SPRINKLERS-1 INC 5 V.B. " 6,00 - ASSESSOES PARCEL No.
' and Professions Code:The Contractor's License Law.dnes nor apply-
' to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to - - -
C- the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 ' TRACT NO. PARCEL NO.
❑ i am exam under Sec. ,B.&P.C.for This
re;lspn - WATER HEATER W/VENT 6.00
Own _ Date WATER SYSTEM 5.00
ACC.DATE' ACC.FILE NO.
W ERS'CO 1'ENSATION DECLARATION WATER TREATING EQUIP. - 5.00
I hereby affirm that I have a certificate.(consent to sdf-insure,
• or a certificate of Workers'Compensal ionA isurance,or a certified ZONING h r ENG.SITE NO. -
copy thereof(Sec.3S00,LahC.).
policy'No. Company
O ❑ Certified copy is hereby furnished. .
Zr,Z ❑ Certified copy is filed with the city inspection division. RE SPRINK ENERGY T@4
-
� O Applicant - MISC.- REFER TO ORD. y� N� 'Y � N� -
� N CISR'I'114CA'I'fS OIr IiXEMPT10N FROMWORKIikS• PERMIT ISSUANCE .10.00 FLOOD ZONE A.L.U.C.
LU•�. COMPENSAT'ION INSURANCE PLG.CONTE. LIC.NO. PLG. _ '
Q. O (This section aced not be completed if the-permit is for one - TOTAL Y❑ ' N O Y 0 N
wiz hundrm1 do11urs 1S 100)or less.)
00
1 terrify that in ore performance of the work for which this per- CITY. MECHANICAL PERMIT FEE' FEE SUMMARY
per-
LL I- (nil is issued,I shall not employ any person in any manner so as to
O L). become subject to the Workers;Compensation Laws of California. -.
rl Date ICAN Il anr - BUILDING
},tit
NOTICE TO AI'1'hAppb If,niter making This Ccr[ifcldc of fix- ALTER OR ADD TO MECH. 5.00 7"U'v
F ? emprimn,you should become subject to the Workers Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with _
U such provisions or this permit slmll be deemed.revoked. - AIR HANDLING UNIT(TO 10p000FEE
CONSTRUCTION
4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000C.F.M.)'6.00 SEISMIC FEE 17a
I hereby.affirm that Hien
is a conslrucrlou lending agency for EXHAUST HOOD(WITH DUCT) 5.00
He
perli+rmance of the work for which this permit is issued(Sec. MICROFILM
-' 3097,Civ.G). ' - - HEATING UNIT'(TO 100,000 B.T.U.) 6.00
Lenders Name'
Lcuduris Address - v HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
® I cattily IhaYl have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
n(otnation is correct.,) agree tO cons Ply with all city and County PLUMBING
ordinances and state 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 to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL..
(We) agree to save, indemnify and keep harmless the City of MISC. REFER TO ORD.
r Cupertino against liabilities,judgments, costa and expenses which CONST.TAX
ay in,any way Seem ngal said City in consequence of the PERMIT ISSUANCE - 10.00
ranting of perrtti[' MECH,CONT. LIC.NO. MECH.
!o yy TOTAL TOTAL' 117
---'-1A I nature Applicant/Co tractor ale 1�•
OFFICE COPY