18772 ,
POST THIS CARD'NEAR FRONT OF BUILDING
PERMIT NUMBER
- : CITY OF CUPERTINO
+'.
INSPECTION DIVISION *• 18772
JOB INSPECTION RECORD ,
I/�/`"' ' Y PERMIT EXPIRATION -
JOB ADDRESS �Q l�" S��vGY1, CUNIT# LOT# `
+p ��•• ` # r ` ✓` . PERMIT EXPIRES IF WORK
_ OWNER' C.l-?' S'fL CONTRAcroR'.t p Ud IS' NOT STARTED WITHIN
INSPECTION DATE -INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 'P s ANCE OR 160 DAYS FROM
NOTE:" LAST CALLED INSPECTION.
- .UF,ER ALL GRADMG�AND DRAINAGE SHALL,BE INSTALLED
--
PR EGUNITE `. TO COMPLY WITH THE APPROVED PLANS AND,CITY OF PERMIT VALIDAr1GN
.. " TK
RTINO STA DA • C
GARAGE SLABSRDS.
.
"POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDI -
UNDERGROUND /"SLAB '
PLUMBING
ELECTRICAL - -
City nf 11 YP+ rs
A sunNCE ON 1.
6T: • f ' V
MECHANICAL .. .. ECR."
BLDG. E .PLG, M
• DOFNOT POUR FLOOR UNTIL LABOVE HAS BEEN SIGNED >' • - , BUILDING PERMIT „
INFORMATION.,
• .WOOD FLOOR.. - .. VAcunnoN' siFT.
PLUMBINxm
G
MECHANICAL, -
* R •
ELECTRICAL PEMIT TO
� V?4� � � -
4.
- FRAMING '�TG i.
INSULATION I
ORIES - TYPE CONSTR.
.. OCc�GROUP RES.UNITS
• PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,f TFLOOR ARIA TOTAL CREGL
- ROOF.; NOTE NO FINAL INSP,SHALL BE MADE BEFORE
- DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USTi
ROOFSHEATHINGP, REs wo coN PB' 0,.
APPLY,NO ROOFING UNTIL ABOVE;HAS BEEN SIGNED,;. FINALS' , DATE., INSP., ❑ El - ❑ Cl EI
• nssessOTvs PARCEL No,
ROUGH ; SAN.N
PLUMBING ELECT.--ENERGY, _ TRACT NO. ".•rnRCEL No.
TUBS,&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
' ELECTRICAL •.ACC,,DATE ACC.FILE No,
BUILDING ENERGYt ' - ,
FRAMING ELECT.FINAL TEST '
20NING ,. ENG.SITE NO.
• ' INSULATION' � � � - PLUMBING '," �'
GAS TEST GAS -
FIREBPRINK ENERGY T@4
' - ' - MECHANICAL'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [:] "• I "❑' -
-F LOOD TONE" .. .
EXTERIOR SHEAR" " � : E LECTR I CAL,RELEASE 'A.L.0Cl I
�
INTERIOR SHEAR . FIRE.DEPT. L:
'Y,❑ N❑ Y N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR'LATH - BUILDING
INTERIOR LATHTEMPORARY APPROVALS BUILDING —
'SCRATCHCOAT " ' ' ELECTRIC PLAN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE'HAS BEEN SIGNED' OCCUPANCY ., SEISMIC FEE
OCCUPANCYOF'BUILOING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
'ARRANGE FORTINSPECTION BY, PHONING 252-4505, ELECTRIC
w;.a F '
O~� ONE WORKING'DAY BEFORE-REQUIRED INSPECTION PLUMBING
Z PLEASE _GIVE-JOB,ADDRESS WHEN PHONING
SEE.PERMIT'FOR EXPIRATIOMIDATE ='. MECHANICAL da. ,
;,,.IMPORTANTI CONST.TAX -T
- PLEASE;READ,REVERSESIDE'BEFORE
'CALLING.F.OR FINAL INSPECTION. i - •TO
TAL
OFFICE COPY
.. . T -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,.-,USE BALL POINT,,PEN ONLY
` BUILDING PROJECT IDENTIFICATION ' PERMIT NUMBER
- BUILDING APPLICATION & PERMIT-
ADOREss �D ree, BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 4 877 [L
PLAN CHECK VALIDATION
NAME �9mASlr✓S /Gy ,QTY. `:' ,,ELECTRICPERMIT '' '-.FEE, ;
_ CONTRACTOR S
ONTO CTORS
xA.E . ,,„ UTLETS-SWITCHES-RECEP. 10.00/100
uc.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS
PPLIANCES-RESIDENTIAL 4.00 - -
flE55 J7y -
3 `Of �f/ +PHONE �Z Q7 PANELS " 0.00 DATE OF APPLICATION'•1
aRCRITEci - - PLAN CHECK FEE P.C:NO.
oR'. ••�-. � T J PANELS (OVER 200 AMP( 20.00
ENGIREER'�y/r ssB�I/1'f{✓'
LIC.NO. SIGNS TRANS- - 3.00
ARCH.OR ENc� �. �K�i SPECIAL CIRCUIT 5.00 r ,PERMIT VALIDATION
` ADORE ss . /S(✓0
EMP.METER'OR POLE INS._. 20.00
APPLICANT'S - MOTORS.
ADDRESS SEE FEE SCH.
- '
SERVICE CHANGE PAID . 20.00 - 11 I,s�
� 0�0 LICENSED CONTRACTORS DECLARATION - V- '�LA�
a D . I herehy affirm-that I am licensed under provisions of Chapter 9 - (, ISSUANCE DATE
a fcomineneing with Section 7000)pIr Dickio. 3 of the Biom,as and _
G y BLDG. ELECT. PLG." MECH.
H
D Professions Cole,mWLmy liana is in lull force and ffe L
Gi�o License Chrss $_Contractor
Date enntmet°r City of Cupertino 1.
0 11 El
w ¢ OWNER-BUILDER DECLARATION -` BUILDING PERMIT
O L D ? - 'INFORMATION
wg LL v, I hereby affirm that I am exempt from the Contractor's License MISC.- '^ REFER TO ORD ,
LLo ¢ Law for,the following reason.(Sec.70315,Business and Profcssos VALUATION $/FT.
- ter, , PERMIT ISSUANCE 10.00
Codec Any mulish county whiny requiresaura permit prior
loconslmc F,UISO • -
2 ¢ ¢-0 _
improve,he applicant repair anystructure,pa sign its iataanco.also ELEC.GDNTR. .LIC.NO. ' ELEC...-
- D LL requires the applicant for such permit to fie'a signed slalement that n �•' TOTAL PERMIT TO
X$u, lie is licensed pursuant to the provisions of the Contractor's LicensL '
HI >
Law(Chapter 9(Commcocingwitlt Section 7000)of Division dol'the I
" ^
a ' Business and Professions Code)or that he is exempt thcrefrom.:und OT,V: _ • PLUMBING PERMIT,. FEE c v
'K F o the basis for the alleged exemption.Any violation of Sectiou 7031.5 �' - t STORIES TYPE CONSTR.
a 3 m by any applicant for a punnit subjects the applicant Iuaeivilpenalty. -
ofGot more than fivehundred do1lars($500)J: ALTER-DRAIN&VENT-WATER (EA.) 5,00
❑ 1,as owner of the property,or my employees•wilh 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,CON D. 5.00 -
Code:The Contractor's License Law floes'not apply to an owner of
property who buildsof improves thereon,and who does such work FIXTURES-PER TRAP .-. 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
,cuts are nal intended proffered forsale.IL howeveq the building GAS'-EA.SYSTEM-I INC.4 OUTLETS 6.00 -
t�. or improvement is sold within one year of completion, the owner- GAS-'EA.SYSTEM-OVER 4 IEA_) 200 BUILDING USE
budder will have the burden of proving that he did not build or int- - . . RES IND CON PB 'Ome.
prove for purposeol'sale.). INDUSTRIAL WASTE.INTER. 30.00 f'
❑ I,ns owner of the property,um exclusively contracting with ❑ 0 ❑ D D
B6
contractors to construct the project(See,I7044,Business LAWN'SPRINKLERS-1 INC 5 V.B. 6.00 A85ESSORS PARCEL N0.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves(hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with.if U,oraclons)licensed Pursuant to
the Contractor's License Law.' SEWER-SAN ITAR V-STORM EA:200h/10.00
TRACT NO. - PARCEL NO.
❑ lam exempt under Se .&
c. ,BP.C.for this
rfmv WATER HEATER W/VENT 6.00 '
0
Owner_ Hate WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
WORKI;RS'COMPENSATIONUtc1.ARATION• WATER TREATING EQUIP. ,5.00
I hereby ul Erm (hut 1 have a certificate of consen Lip self-insure, -
if a ecrliliaute of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copyLA
.C.).
3800,L .C.).
Policy No. -Comp:ry -. -
O ❑ Certi ed copy is he eby famished FIRE SPRINK ENERGY T 24
Z Z' Certified a•+ tied with the ity ina+•`lion division. , -
O Applicant _ �,py.�-(y� �� MISC.- REFER TO ORD. ' ;-.y 1' NQ. . ,..Y<[] No
1 PERMIT ISSUANCE '10,00
K -
CERTIFICATE COM OF SAILI N INS PROM WORKE RS', . 'FLOOD ZONE" A.L.U.C.
'W +COM111'IiNSAI'ION INSURANCE PLG.CONTE. LIC.NO. PLG,
CL 0 (This section need not he completed if the Pcrmil is for one c 'TOTALY E] .' N E V E3N 11
D Z hundmddoIIms($I00)0rlcx,.) - - ' "
U.O hcertify.,Natorl,the pert ormance of the work for which this per- OTV - MECHANICAL PERMIT FEE _ '
' LL I- nut is issued;1 shull•nul employ any person in any manner sous to - FEE SUMMARY
O W become subject.to the Workers'Compensation Laws of California. - II
n Dafc Applicant - O BUILDING
}•W' N01[CF.TO•APPLICAN"I': if,after making this Cert ficate of 19x- ALTER OR ADD TO MECH. 5.00
♦- Z '• emotion,you slmulJ becolnc'subject m the Worker)Compcnsal ion APPLIANCE !5.00 - PLAN CHECK
provisions of the Labor Cotte, you must forthwith comply with • FEE
U' such provisions or this permit Shull be deemed revoked.. AIR HANDLING UNIT(TO 10=C.F.M.) 4'.004Z,t)
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
'. CONSTRUCTION LIiNUING'AGENCV J
�I heiu6y affirm,that them is.'construction lending agency,for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. MICROFILM
3097,Civ,C.), r HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lendr's'AAAress ELECTRIC '
I certify that I have read this application nd state that the above VENTILATION FAN (SINGLE) - 4.00 O
infornmllon is o ect I agree Ip comply with all city and county - ,PLUMBING. -
Ordinances and state laws relating to building ronstrucllOn, and BOILER-COMP(3H.P.or100,000B.T.U.1 6.00
• hereby aulhonzL representatives,of this cit ❑r enter upon the ':,BOILER-COMP (Over"100,000'BTUI SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes ,0 V
(We)'agrec to save, indemnify and keep harmless the City of MISC.- i REFER'TO ORD.6 E
upertino against liabilities,judgments;costs and expenses which '.CONST.TAX
ma.Ue
may in any way accrue against said City.in consequence of the PERMIT ISSUANCE 10.00 _
'ranting of this permit. ) MECH'.CONT. LIC.NO. MECH ' q
�l�7 TOTAL 'TOTAL (' O
Signature of APP(can/Contract/
Lau, • ^ • `'t' • " ' -' .r:
v
0FFICE COPY