18536 POST THIS CARD NEAR FRONT OF BUILDING
PFRnuT NUMBER
CITY OF CUPERTINO 18636.
INSPECTION DIVISION
JOB INSPECTION RECO`RC 3 S_
SSS PERMIT EXPIRATION
JOB ADDRESS_Q_-=+.1S `� V 4U !—UNIT#` _LOT# 'PERMIT EXPIfiE51F WORT(
owrvER .CjJ ONTRACTOR G� IS NOT STARTED WITHIN
INSPE TION DATE INSPECTOR - INSPECTION RECORD IOU DAYS OF PERMIT ISSU
ANCE OR 18R DAYS FROM
FOUNDATION NOTE: LAgj�ALLVOINSPECTION.
UFER ALL GRADING AND DRAINAF VE INSTALLED a
PR EGUNITE TO COMPLY WITH THE APPR S AND CITY OF PERMIT VALIUATION
.CUPERTINO STANDARDS.
GARAGE SLABS . `
. .yir7'.
. .SEP Y 1989
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB Of
PLUMBING - Jt' .. {' U.i
V/
ELECTRICAL ISSUANCE DATE
MECHANICAL AR,
EL cT PLG. W.C.
J� ❑ ❑
DONOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING - A
MECHANICAL
ELECTRICAL ERMIT TO �r-
FRAMING VIAL GiiOC
STORIES TYPECONSTR. .
INSULATION
OCC IGHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE sa 11.aaml AIIPA coral.ACH[aCE
DIAPHRAGM' THE CONSTRUCTION TAX IS PAID
6uaOI ON USE
ROOF SHEATHING
HLB IND CON Pp Owr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.. ❑ ❑ .11 ❑ ❑
ASSESSORS PARCEI.NO
ROUGH SAN.N
PLUMBING - ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY -
- MECHANICAL, MECH,ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.TILE No.
FRAMING ELECT.FINAL TEST
ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST - GAS' .
MECHANICAL
f PRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r ESN,O
.L U
EXTERIOR SHEAR - - ELECTRICAL RELEASE FLOOOZONE AC.
INTERIOR SHEAR FIREDEPT.
YO NYO N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDINGAl, . .BUILDING { O D
INTERIOR LATH • TEMPORARY-ArrMUVALZI
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE .
Zli
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING.IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
1 ARRANGE FOR INSPECTION BY PHONING'252-4505, ELECTRIC
J o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z I MECHANICAL —�^�-•
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX _..._-
PLEASE READ REVERSE SIDE BEFORE TOTAL ',
CALLING FOR FINAL INSPECTION.
OFFICE COPY "
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USETBALL POINT PEN ONLY
' BUILDING PROJECT IDENTIFICATION .
PERMIT NUMBER
EU L ss °' _ y�Q - APPLICATION &;PERMITADI _ 1 O C e�C
ST �- CQE35 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 18536
OWNER'S - PLAN CHECK VALIDATION
NAME
nn ONE Y DTV. ELECTRIC PERMIT FEE I
' U �12nNG1 Ca l.eM• /S"5707,yp -
coNTRACTaRs 1.
- OUTLETS 10.00/1.00
NAME ,
(„ LIC.No.''37S-9ir 6 LIGHTINGFIXTURES - ' 10.00/1.00
CONTRACTOR'S . - PPLIANCES-RESIDENTIAL 4.00' `
ADDRESS �/� „
r,S
1.600 0411 IPUJ. 491 ONEEI/ '�J6 Q PANELS 10.00 ' DATE OF APPLICATION
ITC • _ PLAN CHECK FEE P.C.NO.
oft - PANELS (OVER 200 AMP) 20.00 y0
ENGINEER ,
- DID NO 7�3(e0 SIGNS TRANS. 3.00 ' .32
ADDRESS ARCH OR ENG,pp SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
SPL/OPr Ci [i nP940I EMP.METER OR POLE INS. 20.00
APPLICANT
ADDRESS MOTORS' SEE FEE SCH. C
�• y,�
X00 C71-A-143 O Sn //IACD SERVICE CHANGE 2000. ,
r O O LICENSED CONTRACTORS DECLARATION `
a v w 1 hereby affirm.that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
W a Icommeneing with Section 7000)of Division 3 of the Business andSEP 7 1989 BLDG. EL'ECJ PLG. MECH.
-H w-i Professions Code nd my license is in full Porc�ypru_ep e-t. -
o 0"o License .lass Lia Number ]Yr 7 y J - -
Da[e Contractor �' +
MV W1.CUOMO
.¢ ¢w a - OWNER-BUILDER DECLARATION BUILDING PERMIT
'w ;u I hereby affirm that 1 am exempt from the Contractor's License
MISC.- - __ REFER TO ORD INFORMATION
LL o A Law for the following reason,(Sec.7031.5,Business and Professions D VALUATION $/FT.
H - PERMIT ISSUANCE 10.00
Code:Any city or cor rep which requirese permit to construct,,also
a improve,demolish,Or repair any shucture,prior to its issuance,also ELEC.CONTR. LIG.NO. ELEC.
d
DLL requires the applicant for such permit to filet signed statement that TOTAL2 b,�0 PER MIT TO
w m he is licensed pursuant to the provisions of the Contractor's License
HiQLaw'(Chapter 9(commencing with Section 7000)of Division 3 of the
s 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Ito"C49II /CL
Mthe the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
is. „- by any applicant for a permit subjects the applicant to a civil penalty IEA.) 5.00
of not more titan ALTER-DRAIN&VENT-WATER
an five hundred dollars($5001): Y
❑ 1,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 Oce.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 does not apply to an owner of
property who builds or 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- - -
'� ' menu are not intended or offered for site.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion Al e owner- GAS-EA.SYSTEM-OVER 4(EA.) _ 2.00
builder will have the burden of proving that he did not build or ITT BUILDING USE
p rove for purpose of sale). RES IND CON PB Orher
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 D 0 0- 0 0 -
licensed contractors to construct the project(See..,7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law docs not 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
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL NO.
❑ l am exempt under Sec. ,BAP.C.tin this WATER HEATER W/VENT 6.00
reason
Owner Date _ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERSICOMPENSATION DECLARATION WATERTREATING-EQUIP. 5,00
1 hereby affirm that I have a certificate of consent to Sell mane, -
nr a certificate of Workers'Compensation Insurance,or certified ZONING ENG.SITE NO.
copy thereof(Sec.3900,Lab.C.I Z����
Policy NoY1YY7/_NJMnpany &Iiize t6we 11 wet [a -
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-29
-Z Z ❑ Certified opy D dad with the .1Y mspu I division. •V N
Applicant a '�q'ru [ ire. MISC.- '.REFER TO ORD:
~ OPERMIT ISSUANCE 10.00
'
N CRRTIPICATEOF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
"LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG.
'd O (Phis section need not be completed if the permit is for one TOTAL V Ej N[ Y NO,
D Z hundred dollar,IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE - FEE SUMMARY
U_ F- mil is Issued,I shall not employ any person in any manner so as to
Q W become subject to the Workers'Compensation Laws of California. - -Z-
emptier,
- )) D
t Date' Applicant ALTER OR ADD TO MECH. 5.00 - 'BUILDING
NOTICE TO APPLICANT: If,after making this Certificate of F.x-
Z em tion,you should become subject to the Workers Com ramation
�-- - P. . v j p APPLIANCE_ - 5.00 PLAN CHECK
pr visions io the Labor Code, you must forthwith comply with FEE
such provisions or this permit shall he deemed revoked. _ AIR HANDLING UNIT(TO 10,000OF.M.). 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 -SEISMIC FEE 7 T
J hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 1
the performance of the•work for which this permit is issued(See MICROFILM .
3097,Cry CA HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T',U.)9.50 26
Lender's Address � - - ELECTRIC .L
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) - 4.00 .
information n correct. cos rel ti comply with all city and county BOILER- H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, andmy -
hereby authorize reperty.fatives'of this city es'toter upon the .BOILER-COMP love,100,000 RTU)SEE FEE SCH. .MECHANICAL
above-mentioned pDe Pcsentatins*oftnparposes. -
(We) agree to save, indemnify and keep liarnless the City of MISC.- REFER TO ORD. _
mpertino against liabilities,judgments, costs and expenses which - PERMIT ISSUANCE " - 10.00 CONST.TAX
9;9�tractor
gainst said City in consequence of the '
MECH.CONT. LIC.NO. MECHCy419y_/ TOTAL TOTALactor Date - ( `-^
OFFICE COPY .