17013 POST THIS CARD NEAR FRONT OF-,BUILDING
•PERMIT NUMBER
CITY OF CUPERTINO 17013
INSPECTION DIVISION',
JOB INSPECTION RECORD _ \\
�j // PEyA•11 T�'EXP7 f{ 10'(J
JOB ADDRESS" ID�(r� SC2 LIG d) IV� . ;'UNIT# -LOT 4t
PERMIT EXPIRES IF WORK
OWNER t.(yVl/ �,., CONTRACTOR .,S 6.`ry\2 - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION 45 - ANCE OR,180 DAYS FROM
NOTE' LASTCALLED INSPECTION.
I UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF v[Im+lr VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS PAID ..x
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �r
UNDERGROUND /SLAB - 1
PLUMBING 1
- `J �•�aAaV+ ,.LL
ELECTRICAL h
CI ISSUANCE SSUANCE Uq Tq ti11/
ME HA ICAL �I y 11_111, ELecr 1, PLO I MECH
V p1
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - �-I BUILDIN ERM
WOOD FLOOR INFORMATION
PLUMBING - VALugrloN IFT,
MECHANICAL ���
PERMIT r0
ELECTRICAL.
FRAMING r
INSULATION ZTo srURlrs TYPE CONSTR.
OCC.GROUP RES UNITS
9P.L-ACE NO SU BFLOOfl UNTIL ABOVE HAS BEEN SIGNED
50 Fi.FLOOR AREA TOTAL REAGE
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE y�7 S'.1_ V
+ DIAPHRAGM - - THE CONSTRUCTION TAXIS PAID
- -•^"" ROOF SHEATHING - +Is
IND ILDINNGI USE
PB o,n,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS tDATEINSP. El ❑ ❑ ❑ ❑
ROUGH
ASSESSORS PARCEL NO,
SAN.# 357-
PLUMBING, Q' JR-6 /� ELECT.ENERGY
'
TRACT NO. PARCEL NO
TUBS 8 SHOWER PLUMBING ENERGY
MECHANICAL -1 - IMECH.ENERGY °
'qCC-DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING' E
INSULATION PLUMBINGLECT.FINAL TEST
7ON1Nc ENG:SITE No.
GAS TEST GAS
MECHANICAL EIRE STRINK ENERGY T.24
COVER NO WORK UNTIL AB V S BEEN SIGNED HEATING - Y ❑ "❑ Y ❑ "❑I
EXTERIOR SHEAR
ELECTRICAL R LEASE FLooDZINE A.Lu.c.
INTERIOR SHEAR 1 FIRE DEPT. Y 11 NCI Y ❑ N❑
SHEETROCK GRADE 'FEE SUMMARY
EXTERIOR LATH 2• BUILDING Lk
.INTERIOR LATH .Z1_ TEMPORARY APPROVALS BUILDING
SCRATCH COAT - d ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. .....��'
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC '~
' F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. _ PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION.DATE - MECHANICAL. D '
CONST.TAX ,
IMPORTANT!,
PLEASE READ REVERSE SIDE BEFORE TOTAL " P2
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
' APPLICANT.TO FILL IN INFORMATION,WITHIN,RED LINES,- USE BALL:.POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER
UILOING APPLICATION & PERMIT 4 17013
ADDRESS
Of9$ $GEI✓K RL VD BUILDING-ELECTRICAL-PLUMBING-MECHANICAL - E✓w'
OWNER'S PLAN CHECK VALIDATION
NAME 1 9qq// OTY'. ELECTRIC PERMIT FEE
G eI ROWN PHONE rf0- 7ZZ
CONTRACTORS
NAME A . OUTLETS-SWITCHES-RECEP 10.00/1.00 rC1 �J
r Q-L/ R.D(4JN CON•Sf LIC.NO.a '/l LIGHTING FIXTURES 10.00/1.00
n DRESS OR's APPLIANCES-RESIDENTIAL 4.00
ADDRESS •/ �f��FF))'t
2112-1 ,R_#g1J , A ✓GPHONE � -3721 PANELS 10,00 DATE OF APPLICATION
0ncHlTeci - - PANELS 200 AMP) 20.00 PLAN CHECK FEE ,"P.C.No.
ENOINEERL-I,aL. C pen `
4.. .J uc.No. SIGNS TRANS. 3.00
noon"Ess ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPucgrvrS MOTORS SEE FEE SCH. d
ADDRESS
SERVICE CHANGE 20.00 I s
0 0 o LICENSED CONTRACTORS DECLARATION V- �r1✓C-L6�/
U I hereby afl'inn[hat I utn Ilcensed tinder provisions of Chapter 9 ISSUANCE DAT
yw (commencing with Section 7000)of Division 3 of the Business and
Q y'
F. o z Professions Code, my license is in full ford ELECT. PLG. MECH.
r fe ll/ '
BLDG.
z; O L - License Class Lic.Number •.I.
9 y r w Date Centocor Ile
a sa 8 , BUILDING PERMIT
rc m w u OWNER-BUILDER DECLARA PION
w0 'm 1 hereby affirm that I am exempt from the Contractor's License MISC.- EFER O ORD INFORMATION
F u O J Law for the following reason.(Sec.7031.5,Business anJ Professions Vq LUATION $/FT.
Code:Any city or county which requires a permit to construct,alter, PERMIT ISSUANCE 10.00 �Q ^[_ oil
K Q 0O improve,demolish,or repair any structure,prior to its issuance,also EIEC CONTR. LIC.NO. ELEC. �D
0 LL requires the applicant for such permit to fil...igned statement that TOTALP�E'R/M�IT TO
E
es lie is licensed pursuant to the provisions of lire Contractor's License -/-/ /
Fz4Law(Chapter 9(comnwncingwith Seclion 7000)of Division 3 of the 1 Y
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
r o the basis for the alleged exemption.Any violation of Section 703I.5 STORIES TYPE CONSTR.
i ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than fivehundred dollars($500)J)
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
Intended or offered for sale(Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
propery who builds or improves thereom and who docs such work FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve- 7 r J
S- U
melts are not intended or offered for sac.IL however.the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner. GAS-'EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING uSE
builder will have the burden of proving that he did not build Or im RES IND CON PB Curia,
lot purpose of sale.). INDUSTRIAL WASTEINTER. 30.00 E:1 F-1 ❑ ❑ ❑
O Las owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'rhe Contractor's License Law does not apply G n
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 '7,5^,- W-I -
contractsforsuchprojectswithacontramor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00 W
the Contractors License Law. TRACT NO. PARCEL NO.
❑ Iain exempt under Sec. ,If&P.C.fur this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COffi ry55{y�Tlpy� L ATp19N WATER TREATING EQUIP. 5.00 _
I hereby affirm f ve:( reit Car �c Sim tir self-insure,
or a certificate orkers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof ec.3800,Lab.CJ. s
Policy No. Company�/e&,`07 /A1DE/WIT/
Q .r ❑ Certifiedcopyisherebylurnishal. FIRESPRINK ENERGY T-24
Z Z ❑ Certified d s filep w'th a Iry i action division.
O Applicant �/Z $ �O4/3'�. MISC.- REFER TO ORD. - Y ❑ N❑ Y ❑ N❑
CC N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. , PLG.
Z (This section need not he completed if the permit isfor one TOTAL Y E] NE] Y [DN❑
hundred dollars(5100)or less.)
V O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I. mit is issued,I slmll not employ any person in any manner so as to
O W become subject 10 the Workeri Compensation Laws of California.
a Date Applicam ALTER OR ADD TO MECH. 5.00 BUILDING /2.76 S�
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
�. ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK c
provisions of the Labor Code, you must forthwith comply with FEE'
U _ such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 15 , ') y
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
r the performance (it the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT ER 100,000 B.T.U.)9.50ELECTRICjU • 33
Lender's Addreas
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct f agree to comply with all city ucti county - PLUMBING
information
and state laws ve to
to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
' heieby authorize representatives of this city to enter upon the BOILER-COMP(Over ,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. 100 .��
-(We) agree to save. Indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay in any way accrue against said City in consequence of the
ranting of this permit ^ MECH.CONT. LIC.NO. MECH.
Z Z / OTAL TOTAL Q
ISignature of Applicam Contractor Date
OFFICE COPY
a `
4ELECTRIC SERVICE NOTICE P.O.a E.COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
19
To i
l J JI
� You are hereby authorized to Conners electrical service for
Owner or Tenant. �P
At
• No.of Wires Size of Wires 'Size of Switch Af -I z
iMotor Load Voltage Phase ,
Heating load K.W. Voltage -
��
Light Service
New See Reconnea
No.01 Meters ((11 Heot 120_Three Wire More Service—
No.
ervice No.of Add.Meters 1 Power Three Phow Move Meter. "
O- ELECTRICAL INSPECTOR.
.+ - v •�xc.;n.:ams...-:Y1'i.+.i'..a.�p _ ,'t • - �
•? .1.2.9., ..