17239 PO9T T.HIS,CARD NEAR FRONT OF BUi'LDING "'
' PE RM IT NUM BER.
CITY OF."COPERTINO'
K
•1 9
. 723
INSPECTION DIVISION f .i
JOB INSPECTION RECORD
p,
PERMIT EXPIRATION
JOB,ADDRESSUNIT#- LOT 4t' { ' •"
PERMIT;EXPIRES IF,WORK
owNER+ ,' ,� C9 • �, ".corvrrigcroR C�,W �• 4 l"t L�L� _ IS 'NOT 'STARTED WITHIN
I" INSPECTION DATE INSPECTOR INSPECTION RECORD i8o:oAVS of PERMIT*SSU. ."
FOUNDATION, - ANCE q,R.180'DAYS FROM
NOTE:: LASTCALLED INSPECTION.
UFER ; �_, ALL GRADING'AND DRAINAGE SHALL BE INSTALLED "
1 - TO COMPLY WITH THE APPROVED PLANS AND CITY OF d" - PERMIT VALIDATION
.;PR EGUNITE' - " CUPERTINO STANDARDS.
GARAGE SLABS : . • ; - .I �"N t
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /
UNDERGROUND /SLAB FEB Z d ry�3 ' "
PLUMBING ��.�••'.A ���'). 1,14-C:I
ELECTRICAL' . -
' 'City;of CupertinoI$$UANCE llAiE '.
MECHANICAL - BLuc. 'e Lecr. PLG. MEER,
' - r ❑ ❑ 121E
'• DO'NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ,', - .-- - - BUILDING PERMIT
'WOOD FLOO R „ INFORMATION
' PLUMBING -
VALUATION $/FT,
MECHANICAL s. - - • ry_. .x .
. ELECTRICAL - PERnuTT
FRAMING + - - E D A`.
�. INSULATION STORIES, t,PE CI sTR.
DEC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
F"
ROOF_ NOTE:NO FINAL INSP.SHALL BE MADE BEFORE•, so.r*.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM• THE CONSTRUCTION TAX IS PAID.
ROOF SHEATHING _ - BUILDING use
~ HES- •IND .CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑ ' - ❑ - ❑ •J
ROUGH SAN.I ASSESSORS PgRCEL NO.
' PLUMBING ELECT ENERGY-
'
TUBS&SHOWER PAN _ PLUMBING ENERGY - TRACT No..; PARCEL NO
MECHANICAL - .. MECH.ENERGY 1
• ELECTRICAL ' _ BUILDING ENERGY ,Acc.onrE ACC,FILE No.
FRAMING ELECT.'FINAL TEST
INSULATIONPLUMBING ZONING, •.ENG.SITE NO.
GAS TEST
--FIRE RE SPRINK' ENERGY T.1a
.. •COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .HEATING `❑ "❑ ° ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD T.ONE � :A,Lu
INTERIOR'SHEAR
_ FIRE DEPT. - `' +❑'' "❑ ❑ N❑
SHEETROCK:'.1 GRADEFEE SUMMARY
EXTERIOR LATH - BUILDING
.INTERIOR.LATH - TEMPORARYAPPROVALS , BUILDING
SCRATCH COAT' ELECTRIC - - PLAN,CHECK
- GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ', - - SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED•BY BUILDING INSPECTOR. . MICROFILM ^'
ARRANGE'FOR INSPECTION BY PHONING 252-4505, ELECTRIC
~� ONE'VJORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O
;i PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
SEE
-'SEE PERMIT FOR'EXPIRATION DATE >
.. IMPORTANT!
CONST.TAX
A
PLEASE READ REVERSE SIDE BEFORE +y
CALLINGTOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLY O LLQ I RM I H ED LINES,— USE BALL ROINTePEN ONLY vF
1 .r
.•� ✓O,BUIL_ DING PROJECT IDENTI FICATION 0 - :1� ? -. PERMIT N4MBER
BUILDINGCATION & PERMIT
, '
AOOflIss'. ' BUILDING'—ELECTRICAL—PLUMBING-MECHANICAL 'A'h
W e
OwrvER'S . , ' n .PLAN CHECK VALIDATION
""MV7/'�S �C�•�/ ��E 2`yOg� ` ` TY. : ELECTRIC PERMIT FEE �" }
P. CONTRACTOR 4 }
MMM Na Mp �q y�� OUTLETS-SWITCHES-RECEP 10.00/100
(:� �!`)�-0 /'t�•—�Ck.'rvo. '/ - LIGHTING FIXTURES
10.00/1.00
CONTRACTOR'st55o'S�,co A'W ' .APPLIANCES. RESIDENTIAL .400
AOOR ESS. �+ 1
PANELS "J, .v .•10.00 DATE OF APPLICATION
ARCHITECT - PLAN CNECK FEE :' ,P..C.N0.
OR PANELS (OVER 200'AMP) "'2000 t
ENGINEER
- uc:NO. 'n''. SIGNS TRANS. _ 300
ARCH.OR ENG: a "S.00 PERMIT VALIDATION '
ADORE +, { SPECIAL CIRCUIT
ZIP 1 EMP.METER OR'POLE INS.- , 20.00 �._�
APPLICANT'S
AOORESS, MOTORS SEE FEE SCH
SERVICE CHANGE 2000
- - I p� Wv0 oGC,
o o _, LICENSED CONTRACTORS DECLARATION n ^ `V
a v w I hereby affirm that I'am,hcensed under provisions of Chapter 9 U - -v IbSUANCE'DATE '
r z (eomme ting with'Section 7000)of Division 3 of the Business and
w¢ n 'BLDG. .ELECT ,PLG MECH.'
F m z Professions Co and my tic is in full furc�Lrd e(f��. ' ❑, ❑ 7�, 9
0 o v, License —1 Ic Number \iy.-._,.14 C��y of Cupertino I-yMl
m r o Dela' Contractor '
H'. � J
BUILDINGTERMIT
¢ o a C ' OWNER-BUILDER DECLARATION, -}, -"' - ' INFORMATION
wg u H "'I hereby aff`vm that I am exempt Irons tiro Contractor's License MISC.— . 1REFER TO ORD
Oa Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE, . � C10.00 ' VALUATION. $/FT:'-
Code'.Any City or county which rec""Resa permit to construct alter, ' I
SE Q,¢o improve,demolish,or repair any structure prior to Ifs issuance,also ELEC.CONTR. _ LIC.NO. ELEC.
w
0 LL requires rhe applsant for such permit to file a signed statement(hal y . . " TOTAL "' t
u w he.is licensed pvtsUanl to the pmwsions of the ConB K[Or's License _ ' ' . q PERMIT TO
r Law(CIf C 9(wmmencinI wI 'Section 7000)of Division3of the ` Qp I'
Ei o Business and Piofine'. a Code)or that he Is exempt therefrom and QTY. PLUMBING PERMIT - FEE
¢ 1-o the basis for the alleged exemption.Any violation ofSection]031.5 - - - I STORIES ;,TYPEC STR. -
u by any applicant for a permit subjech9he applicant to a civil penally' - - -
ofnotmorethav,five hundred dollars(5500).)'. ALTER-DRAIN -WATER IEA.)' 500, {,' ,
❑ 'I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE' - A.00
their sole,compensation,will do the work;'and the structure is not ` OCC.GROUP REB UNITS
intended or offered+for sole`(Sce. 7044, Business and Professions DRAINS--FLOOR,ROOF,AREA,CON D.', d
Code: The Contractor's License Law does not apply to an owner of - q
A property`who builds or'improvesthereon,and who does such work. " FIXTURES-PER TRAP t q" 5OO •'r SO.FT.FLOORAREA ,,TOTALACREAGE, •t
himself or through his own employees provided that such improve'
mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 600
or improvement is sold within one year of completion,the owner-
Le
wner .t. '
wvY:'++ builder will have the tiurden of proving that he did nobbuild or iia- GAS-EA:SYSTEM-OVER 4(EA.) 2.00 r BUILDING USE
1+' ose _ RES • IND , +CON. PB Otho,
prove 1,as Owner
of the pro ... INDUSTRIAL WASTE INTER. 30.00
❑ d as owner oL the property,he exclusively contracting with
licensed contractorsCod to The
project(Sec does:Business ` LAWN SPRINKLERS-1�INC 5 V.B. 6.00 ' ASSESSORS PARCEL NO.
and Professions Code'.The Contractor's Licensc Law docs not apply - 'i_
toan trowner ofpropertywho builds trimproves thereon.and who LAWN SPRINKLERS-OYER 5(EA.), 1.00Con -the Contractor's
ctor'sor hcenectswithhcontraetots)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/1000
the Conhactoi s License Luw. - TRACE NO ',PARCEL NO.
❑ lamexemptunder Sec' • ' ,B.&P.C.for this WATER HEATER W/VENT 6.00 - '^
reason'
Owner - Date WATER,SVSTEM 5.00 ACC.DATE ACG FILE NO.
WORKERS'COMPENSATION DECLARATION; - WATER TREATING EQUIP.' 5.00
I hereby affirm that'] haves certificate of consent to self-insure, - ' -
or a certificate of Workers'Comp/uuation,lnsurance;'or a certified - ZONING 'ENG SITE N0. f
copy the Po' SG
- Policy p Ci-'NERAL _ ,r
Q: ❑ Certified copy,ls II re y furnished.
❑ Certified copy is Bled with the cit P FIRESPRINK ENERGY T:24
'z_ Zy.inspection div¢mn. -
Q Avplicant _+' + ;y MISC.-, REFER TO ORD. ..1 -- - v Q^ m 0 Y ❑ -'N�
~�H t�' F PERMIT ISSUANCE ' '1000 jr—
FLOOD ZONE A.L.U.C.
'� CERI'IPICAIEOF F,XEMPTION.FROM WORKERS':
'llJ'� COMPENSATION INSURANCE L PLG.CONTR ' ,LIC NO. .PLG. :
CL 0 (This section e d not°be completed if the permit is for one T1 - TOTAL V❑ N❑ - V ❑' NE]
� 2 hundred dollars($100)or less:) ' v "
U O .I certify that m the'permrmance of,the work fur which this ver- QTY MECHANICAL PERMIT EE FEE SUMMARY
LL H 'mit is issued,1 shall not employ any person in any manner so as to
O L) " became subject m the Workers'Compensation Laws of California. '
Date Avplicant'` BUILDING
IL ALTER OR ADD TO MECH. .5.00 _-�.
} IL NOTICE'o'O AI'PLICANT:'If;alter making this Certificate bf lix-
F;2 emptioh,you should become subject to.the Workers'Compensation APPLIANCE ` 5.00 -' PLAN CHECK' +y
provisions of the Labor Code, you'must forthwith comply with FEE'
U' such provisions or this permit shall be deemed revoked. AIR.HANDLING UNIT(TO 10=C.F:M.)7- 4.00 ,^
` CONS TRUC'TION LENDING AGENCY:1, z 'AIR HANDLING UNIT(OVER 10)=C.F.M.) 6.00 SEISMIC FEE
+ I hereby affirm that there is a construction lending agency for -EXHAUST HOOD(WITH DUCT) 5.00 I
! the performance of the work for which this peimit is issued(Sec.` - MICROFILM
1 "+ 3097,CivC) ' " i HEATING UNIT(TO 100,006 B':T.U.)' 8:00
Lender's Name lJ 7✓l��/bL1Ha� - HEATING UNIT 100;000B.T.U.)8.50 ELECTRIC '
Lender's Address -
( certify that l have read this application and state that the'.above VENTILATION FAN,(SINGLE):e 400 6
information is orrecLl agree to Comply with all city and'county_ ♦. PLUMBING 1q,
/(�
°�-a
ordinances and state laws relating tr building Construction ,and BOILER-COMP(3,H.P.or 100000B.T.U.) 600
f hereby authorize representafi es ofdhis city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE'FEE SCH MECHANICAL
Chen
-i above-mentioned properly for inspeChen purposes. '` - _J
(We) agree to save, indemnify and keep I armless.the,City of MISE.- REF_ER TO'ORD.F s'
upertin0 against Ii abilities,judgments, costs-and expenses which PERMIT ISSUANCE - `'10.00 CONST.TAX
in any wiz ecrue against said City in consequence of[he
to n,of a it, • ' /gy pp ME CONT. LIC NO .T• ,MECH +
,y It 'app 2-/�—Cl cDW .� �; TOTAL •
i alure o licanl Con tactor Date e rj3 •Z ' TOTAL 3
OFFICE COPY ..