17551 `r POST THIS CARD NEAR FRONT OF BUILDING ,
PERMIT NUMBER
CITY OF- CUPERTINO 1`7551
►, INSPECTION DIVISION
JOB INSPECTION RECORD
// hh PERMI.7 EXP ATION
JOB ADDRESS ��` Z'3 Ar �0 L K� •. UNITU.,#' _LOT# ��` s � � �' '
� (Y' PERMIT EXPIRES IF. WORK-
OWNER CONTRACTOR 0 �' CD h C IS NOT STARTED WITHIN.
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF-PERMIT ISSU-'
. FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER - .ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE,' - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION.
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED M�
UNDERGROUND /SLAB RIAY 1 2 lqRq
PLUMBING - JT 1, YI iOYVU C„C. f .
ELECTRICAL C4 of - ISSUANCE DATE -
MECHANICAL . BLDG, ELECT.. PLG.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING - - VALUATION $/PT.
MECHANICAL '.
l� vnal.
ELECTRICAL PERK I IU �I-
FRAMING
INSULATION - STORIES - r PE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ,
SO,FT,FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
,BUILDING USE-
ROOF SHEATHING - RES - IND - CON PB an”,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP, I] E El ❑ 'cl
ASSESSORS PARCEL NO.
ROUGH SAN.H
PLUMBING ELECT.ENERGY
. TRACT NO PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY
MECHANICAL - MECH.ENERGY -
HCC.
ELECTRICAL BUILDINGENERGY ACC.DATE FILE NO.
FRAMING - ELECT.FINAL TEST
ZONING ENG,SITE No.
INSULATION - PLUMBING - --GAS TEST - - GAS
MECHANICAL FIRE SPRINK ENERGY T 2a
,COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "7 ° "�
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A Uc,
' INTERIOR SHEAR FIRE DEPT. , - r "❑ v ❑ ""�
.. SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING ' BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT - ELECTRIC PLAN CHECK "
- - GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ,
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGEFOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o�.. PLEASE GIVE JOB ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE - !MECHANICAL'
IMPORTANT!- CONST.TAX .
PLEASE'READREVERSE SIDE BEFORE
I� ...'4,{ TOTAL'
CALLING FOR FINAL INSPECTION. ,
OFFICE OWY . J.
APPLICAN+ TO FILL IN INFORMATIONVITHIN RED LINES - USE BALL POINT PEN ONLY .
r
BUILDING PROJECT IDENTIFICATIONPERMIT NUMBER
BUILDING APPLICATION & PERMIT 7[[17551 1
ADOR I 1 J iJ
l- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S /a PLAN CHECK VALIDATION
NAma RS CITY. ELECT RIC PERMIT FEE
G✓1 7.
� E
CONTRACTOR'S -
NAmE OUTLETS-SWITCHES-RECEP '10,00/1.00 U '
Co c. LIGHTING FIXTURES 10.00/1.00 ,
CONTRACTOR'S
oREss'7 /1 //� PPLIANCES-RESIDENTIAL 4.00
/ /� U,PHONE Ia PANELS 10.00 DATE OF APPLICATION T
A CHITECT PLAN CHECK FEE P.C.NO.
oR �A. PANELS,(OVER 200 AMP) - 20.00 .,
E E SIGNS TRANS. 3.00
llJ� . LIC.NO
ARCH.OR ENG. -
DORE55 �.�{/-�/,(� SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
EMP.METER OR POLE INS. 20.00 �••-� E�`y
T S
ADDRESS /' OG.y� MOTORS SEE FEE SCH.
�7N Ca Y: p „108 I(Af- SERVICE CHANGE. 20.00 1 ,f
o o LICENSED CONTRACTORS DECLARATION 'T r (`���V«�
¢ u.opt I hereby affirm that I am licensed under provisions of Chapter 9
H 2 wI MAYISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. ECH..
r y i Professions Code,19d my license is in full fo IMLEfF4�1 _ _
o C m o License Class Lic.Number `7`ft 7 y,I a �_ -
F m w Data Contractor Cly Of Cupertino
Q y f J
E 0 w a - 10-
OWNER-BUILDER DECLARATION BUILDING PERMIT
- o a O - INFORMATION
E
g N I hereby affirm that 1 am exempt from the Contractor's License MISC.- 'REFER TO ORD
u o¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
- m PERMIT ISSUANCE 10.00 _
Cade:Any city or county which requires permit to construct,,also
Q ¢ Q p Improve,demDljsh,or repelr any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O
n a u requires the applicant for such permit to file a signed statement that NOTAL
w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
HiQ Law(Chapter 9(commencing with Section 7000)Of Division 3 of[he 'T� 1�-
54 p Business and Professions Code)Or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE �«--l"Vh e v
X 1- m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES - T E CONSTR.
a3 _ by any applicant( mit ora persubjectsthe applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more thug five hundred dollars($500).)'.
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
their sole compensation,will do the work,and the structure is no[
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
f-
Code:The Contractor's License Law does not apply to an owner o "
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP "5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mends are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6,00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4(EA.) 2.00
builder will have the burden of proving that h - . -
e did not build or im- . BUILDING USE.
prove for purpose of sale.). RES IND CON PB Other
❑ I,as owner of the properly,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec, 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 . ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS_-OVER 5(EA.) 1.00
contracts farsuch projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tum exempt under S"..,B&P.C.for this
reason WATER HEATER W/VENT - 6.00
Owner - Date WATER SYSTEM 5.00
ACG DATE ACO.FILE NO.,
WORKERS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00 ,
hereby affirm that I have a certificate Of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy therOAA
Policy Nov", oArrebyT .7/LL1C
❑ Certified copy is hereby furnished.
Z Z ❑ CerFIRESPRINK ENERGY T-24
O Applicanttif c is 61eeL.witl cit ns e iiVY - Y C] N❑ Y�❑ NE]
CSC/ Ci MISC. REFER TO ORD.
-
jr- W CERTIFICATE.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00FLOOD ZONE A.L.U.C.
ION
LTJ > (This section need not beTco nple ed R'If�tl a permit is for one PLG.CONTR. LIC.NO. TOTAL V❑ N C] Y❑ N❑
ao
0 Z hundred dollars IS 100)or less.) -
U O I certify that in the performance of the work for which this per- TY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ F mit is issued,I shall not employ any person in any manner so as to
O W Date subject to the Workers'COmpensulion Laws of California.
y Date ' Applicant BUILDING r1
} W NOTICE TO APPLICAN'(: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 G
Z emption,you should become subject to the Workers'Compensation APPLIANCE
l- - 5.00 PLAN CHECK
provisions io the Labor Code, you most drevoke comply with
FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT,ITO iD,00D C.F.M.)'" 4.00
CONSTRUCTION.LENDING AGENCY AIR HANDLING UNIT(0VER 10MOC.EM.) 6.00 SEISMIC FEE IDS
1 hereby affirm.that there is a construction lending agency for EXHAUST HOOD (WITH DUCT), 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UN IT(OVER 100,006 B.T.U.)9.50 ELECTRIC
1 certify flat 1 have read this application and stag that the above VENTILATION FANASINGLE) 4.00
information is correct. I agree to comply with all city and eoun.Y 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 BOILER-COMP hove,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. "
W
e to save, indemnify and keep harmless-the City of MISC.'- REFER TO ORD.ainst Babilities,jird eats, cats and expenses which , CONST.TAXw ctue a' sid City in cons ire a of the PERMIT ISSUANCE 10.00 MECH.CONT. - LIG NO. TOTAL Lpplicam/Contractor to ��7,4y._
OFFICE COPY