17850 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17Bap
INSPECTION DIVISION
JOB INSPECTION RECORD
1
I. PERMIT EXPIRATION 1
o JOB A6DRESS- 01 ` ! UNIT# 41 ' I I
_LOT# PERMIT EXPIRES IF WORK
OWNER I�T'T� QC.IrC{ � NTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPE OR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180,DAYS FROM
NOTE: LASTCALLED INSPECTION.
' UFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF EenIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS ...J'T1 , n ,�-P/Llvl
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDI
-UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL ISSUANCE DATE
MECHANICAL MAY 2 8 1989 EL G ELECT I PLG, M[CR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED cify. at em,UB6BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING' VALUATION I .. $EFT,
- -. � / yy
MECHANICAL
ELECTRICAL PI�;RnvT,ro,��
FRAMING 11b1'�GI Fr"
INSULATION STUDIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FL FLOUR AREA TOTAL ACREAGE.
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID
I• B W LDI USE
ROOF SHEATHING � Res IND CON Pe D,oa
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ L ❑
ASSESSORS PARCEL NO
ROUGH SAN.k
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING - ELECT.FINAL TEST
ZONING ENG SITE NO.
INSULATION � PLUMBING
GAS TEST GAS
MECHANICAL FIRESPRINK •ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N[:)
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U C
INTERIOR SHEAR FIRE DEPT:
L NLV L ryL
SHEET.ROCK' GRADE , FEE SUMMARY
EXTEJFUOR LATH IBUILDING BUILDING
INTERIOR LATH- TEMPORARY APPROVAL
SCRATCH COAT ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY " SEISMIC FEE �Ccd
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING;FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE -
MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. ' (.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
,
' BUILDING PROJECTIOENTI (CATION PERMIT NUMBERAPPLICATION & PERMIT 17850
BUILDING }�1 (R/' 47
ADORE [�f�(-TI
P E p BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
O NTS �_ PLAN CHECK VALIDATION
NAME �A L rrIO7571=Pµ
- f� X530 DTV. ELECTRIC PERMIT FEE y`., •ynG�B
CONTHACTOR5
NAME -OUTLETS-SWITCHES-RECEP 10.00/1'.00 SI5I8�
LIC,NO, LIGHTING FIXTURES ' 10.00/1.00
CONTRACTOR APPLIANCES '4,00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP( 20.00 -
ENGINES
��RUi NoC'002 SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
SPECIAL CIRCUIT 5.00
L•Tq'�/!/vd i 1� ' EMP.METER OR POLE INS. 20.00 J• k)CGl /L*1
APPLICANTS MOTORS SEE F SCH.
AOOREs/s� �^I'23 Sq
-l' 1 ryE 0 E SERVICE CHANGE
o O LICENSED CONTRACTORS DECLARATION 1
a u I hereby affirm that I am licensed under provisions of Chapter 9 xa ISSUANCE DATE
y w (commencing with Section 7000)of Division 3 of the Business and
¢ ,A„ g BLDG. ELECT. PLG. MECH.
w z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
o i,n o License Class Lic.Number
Date Cmanctor
BUILDING PERMIT
K a
OWNER-BUILDER DECLARATION
a o a u INFORMATION
Z_
3'a w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u_ o ¢ Law for the followiugrcason.(Sec.7031.5,Besmessond Professions PERMIT ISSUANCE 10.00 VALUATION ) $/FT.
L- _ Code:Any city or county which requires a permit to construct,ulter, -
2 < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.,
11
w0, requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
.9 w he is licensed pursuant to the provisions of the Contractor's License
.r Z> Lew(Chapter9(commencing with Section 7000)of Division 3 offle
¢ Business and Professions Code)Or that he is exempt therefrom and DTV. PLUMBING'PERMIT FEE
o
MY the basis for line alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
iE of any applicant fora permit subjeclsthe applicam loacivil pelialry ' ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred rty,Eo(my em):
❑ Las owner at the property,or my employees with wagesas
et BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
inter sole compensation,will(S the work,and the structure is mol
intended or offend for sale (Seca 7044, Business and n owner oS DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply 4r an owner propwof
ork
DRAINS:
FLOOR,
or through
h Euih his own employees,
m loyees,provis thereon, ded
that who oes Such improve"h work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ALREAGE
meats are oroughhiso or offered
If,
however,the
lding GAS-EA.SYSTEM-I 6.00
r mems Bre not intended or thin on for sale.IL however.the building
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 ice- RES IND CON PB Omer
prove for purpose of e - INDUSTRIAL WASTE INTER. 30.00
CI
owner of the pe property,am exclusively contracting with
licensed contractors to construct the project(Sec. do. Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The who
builds o License Law docs no,apply
to tr owner of properly who builds tr improvesthereon.uand who LAWN SPRINKLERS-OVER 5(EA.) 1.00
tine Co is for such License
with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
lite Contractor's a.exempt
pi<eNdc Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,8..&I'.C.lett this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent loself-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
10 ❑ Certified copy is hereby furnished.
FIRE SPRINK ENERGY T-Za
Z Z ❑ Certified copy is Ned with the city inspection Division.
F' -MISC. REFER TO ORD.
O Applicant -' v[3N� v � N�
rn PERMIT ISSUANCE 10.00
LU CIiRTI FICAI'1> E IiAI IM 111ON'INS(ROM WORKIiRS' - FLOOD ZONE A.L.U.C.
W > COMPIiNSA1'ION INSURANCE PLG.DONTR. LIC.N0. PLG.
1 O (This section need not he,completed if file permit is t'a-one TOTAL Y N P V C] N
=1Z handled doll...(1100)or lc,,.)
U O 1 certify that in the performance of rite work for which his pct- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any mannertur as m
O W become subject to the Workers'Compensation Laws of California. r-n
0. Data Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
H ? emptiob,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MDC.F.W 4,00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.F.M.) 6.00 SEISMIC FEE 30�
I hereby affirm that there is a construction [calling agency fill EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this pound Is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50
de
Lenr's Address ELECTRIC
I certify that I have read this application and stale that the above I VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction,and BOILER-COMP(3 H.P.Of 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP 10ver 100,000 BTU)SEE FEE SCH. MECHANICAL
abovomentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
any way accrue against Said City in consequence of the
r II�ALii (biet,e j „- - oA- TOTAL MECH.CONT. LIC.NO. MECH. TOTAL
if nature fApp11ya1I G Iy��
xAllfx S S^O7 V I�J\\JJJ
licanf/C1nn[racmr Date q
9O - 4 47-0 S 3 Z0, OFFICE COPY, /