18237 (2) POST THIS CARD NEAR FRONT OF BUILDING dq
PEFWIr NUMBeR
CITY OF CUPERTINO �
INSPECTION DIVISION
JOB INSPECTION;RECORD. , �
�/�- - F PERMIT EXPIRATION .
JOB ADDRESS_II `S�� �� �/V(oS '�M..I1N 1T4 LOT# PERMIT EXPIRES IF WORK
OWNER CONTRACTOR' IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LAST CALLED INSPECTION. '
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
�PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
'GARAGE SLABS ,///r /�D/✓h. '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ���
PLUMBING
ELECTRICAL _ ISSUANCE DATE
BLUE ELECL PLG. NIECH
MECHANICAL'. � '
❑ I ❑. I ❑ 1 ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT _
' - INFORMATION
WOOD FLOOR
VALUATION SIFT.
_ PLUMBING ^
MECHANICAL
ELECTRICAL
FRAMING
INSULATION STORIES TYPE�C/O'NSTR
OCC GHOUP RES UNITS
PLACE NOSUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - '
ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE s°,rT.FLoun AI+EA nc HL Ar,e
TOTAL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -
!® BUILDING USE
ROOF SHEATHINGRES' IND .CON PB O,�L
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 0 ❑
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING : I - ELECT-ENERGY
TRACT No. PARCEL NO
TUBS&SHOWER PANPLUMBING ENERGY
MECHANICAL MECH.ENERGY
.
ELECTRICAL � � BUILDING ENERGY ' ACC.DATE ACCFILE NO,
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
. INSULATION PLUMBING
GAS TEST IGAS
FIRE SPgINK ENERGY TQ<
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING " E]
COVER
EXTERIOR SHEAR ELECTRICAL RELEASE FLoou torvE aL.u.c.
INTERIOR SHEAR FIRE DEPT.
SHEETROCK - - GRADE rFEE SUMMARY
EXTERIOR LATH ' - BUILDING - _
INTERIOR .LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDINGFINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,`� ELECTRIC
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z 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— 1�S'G3
OFFICE COPY
j, APPLICANT TO FILL IN INFORMA7101V WITHIN hED LINES - USE BALL PUIN I iruv -
7 BUILDING PROJECT IDENTIFICATION
APPLICATION &'! . ' '''r+' f '-E7;d I ' ?ERMIT NO
MBER
1
BUILDING I ,I "t,. PERMIT i
"i
ADDRESS h t BUILDING -ELECTRICAL-PLUMBING -MECHANICAL ))PLA j� �18ZI�37
I /.' S. 5 L . Sr vh J Slav s tic
OWNER'S 1", Ijr',.I - '.',1.-f }r' ,, r.- .n : °t.3�t- CHE DATION
NAME ,/ _ p ply; 1,.:.l -I -ELECTRIC PERMIT _r FEE'aIr
Q % �. VoGT PNDNE7 z,5% rt
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
uC.No ILIGHTING FIXTURES 10.00/1.00
r.DNTRACToms - PPLIANCES-RESIDENTIAL 4.00 ` 'I I� '!'� -•�
ADORE63 PHONE r. PANELS ' 10.00 DATE OF APPLICATION r
' ARCHITECT PANELS IOV ER 200 AM P) 20.00 PUNCH cKR E c.N .
OR
ENGINEER se3.DD I A
LIC.NO. SIGNS TRANS.
ARCH.OR ENG. 5.00 - PERMIT VALIDATION
ADDREv SPECIAL CIRCUIT - I
ZIP EMP.METER OR POLOINS. 20.00 •' I -7st:/I
AnucANT'S MOTORS
ADOAEv
S�Afr 0 t OVa:. SERVICE CHANGE 10.00 nn ^^
Woo LICENSED CONTRACTORS DECLARATION r•
a v u I hereby affirm that I .,I, licensed under provisions of Chapter 9 - uANCE GATE
a n Icommencing with Section 7000)of Division J of the Business anJ LDG. ELECT. PLG. MECH.
D" Profcssiuns Code,and my license is in full force and effect. ❑
z o T License Class Lic.Number - A ❑ r'❑
( O Date Contractor - -
•' ¢ a m g OWNER-RUILDERDECLARATION 51 i r 'fir .1 ip,r I r4 B INFORGATION T"1
A o A MISC.-
REFER TO ORD f f"/� dNF,ORMATION •td 'if••
a a- LL rr I hereby affirm that I se exempt from the Contractor's License S/FT:
p H ,. Oj.. Law for the following reason(Sec.7031.5,Busincssand ProfesdonsPERMIT AAE
E 10.00
Code:Any city or county which mquims.Permit In construct,alter,
improve,demolish,or repair any structure,prior to its hltiamce,.1w ELEC.CONTR. LIC.NO. _ ELEC. 1 �'y' '
O ac reyuirca IIIe applicant for such permit to f ale a signed statement that TOTAL ' I ! 1 rfFMArf( i1r
A w m he is licensed punuanl to the provisions of the Contractor's License AV
Hai
Law(Chapter 9(commencing with Section 7000).f Uivlstonn 3afthe i' +
OT
Business and Professions Code)or that ha e exempt thcrclrmn unit 'PLUMBING PERMIT,j 'I-'I) FEEaf'
F s O r1 r' r!'tri.• ` " - � i's51 STORIES I TYPE CONSTR,
R the basis for the alkeed exemption.Any violation of5ect on 7031.5 - - I t
e , by any applicant fora permit subjects the.pplicant toacivilpott"Y ALTER-DRAIN&VENT-WATER IEA.) 5.00 °' X•7;i : ; b;-. e _
four more than Free hundred dollars(5500).):. +
❑ I,us owner of the property,or my employees with wegn as BACK FLOW PROTECT.DEVICE 4.00 _ ? OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is nut ,I I I I
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR;ROOF,AREA,COND.'' 5.00
Code:The Coot,.emr's License Law don not apply to an owner of
property who builds or improves thereon,unit who does such work FIXTURES-PER TRAP 15.00 8O.IFT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-I 6.00 't
j mesh are not intended or offered for sale.If,howeveq the building .
or impruve,nent is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE I
builder will have the burden of proving,that he did nm build 8h041- - V711,
ES NO'..,CON I. PB. ILOrher ,
MprpvF for Purpore,of sale.).y•- j;q'� �r r3l xa'; 1 .-•• •� "rA'° INDUSTRIAL WASTE INTERrL - ,:A;;30.00 i i M
1' e I.-.s owner of[III properly.am exclusively canlrncting walla " ❑•' -❑''- !❑ I'❑
rased contraclors 10 construct the,project(Sec. 7044,Business LAWN SPRINKLERS=,1 INC 5 V.B: 6.00 ASSESSORS PARCEL NO.!' ;
r and Professions Code:'rhe Contmetor's License Lew doesnot apply `- 1
to an owner of property who builds or insprovn thereon,and who LAWN SPRINKLERS-OVER 5(EA.) • 1.00
I o"on'is lot such projects with a contractor(,)licensed punsoan(to SEWER-SANITARY-STR
: ( TRACT NO. PARCEL NO.
tile Contractor's License Law. -
,❑ lam exempt on rSec. .B.&P.C.for this
WATER HEATER W/V - ,.y". it ,
'd' reason_ r
i Owner Ume WATER SYSTEM ACC.DATE ACC.FILE NO. .
WOR I:RS'COM ENSATION DECLARATION WATER TREATING•E . - 1j t
I •
I hereby afOrn (hut I have a certificate of consent to sell-insure, 20NINGi ENG.SITE NO.
•(g, - or a certificate of Workers'Compensation Insurance,or a cer(ifled
copy lhmeof(See.3800,L.b.C). - 'A+t �� .'i '1
Policy No, Company '
Q Cr Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 -'❑ Certified copy n filed with the city inspection division. MISC.- ;y � q� y � N�
O Applicant - e .
F" sea PERMIT ISSUANCE` 10.00 . - A FLOOD ZONE A.L.U.C.
i• cc CERTIFICATE OF EXEMPTION FROM WORKERS' '
LU > COMPENSATION INSURANCE " - PLG.CONTR. LIC.N0. PLG, Y[:]- ! �; N❑ Y C3N❑
' d a (This section need not � completed If the permit Is for trite 'I - TOTAL
I' 2 hundred doll..(3100)on less.) -.r ' I"'R:
O1" 1 certif that in the performance of the work for which this per, 'tea' 'I i . � A ,' (.. I t, �' ��, (�FEE SUMMA Vr; ' ric
1 I'U y sun in any manner so as to 6Tr' MECHANICAL',PERMIT s•� i, j; FEEf1.
'l0 heconhill is a subjeued,ct tlo�tthe Workl not ri Compenvtion Laws of Callfornu. a s,( 1t "" vh' �A ` - ,
I; w Date Applicant BUILDING
n ALTER OR ADD TO MECH. 5.00
I } res NOTICE TO APPLICANT': IL after making this rs'Comte su Ex-
f- Z emptiin,you should become subject)p the W forthwith
Compensation APPLIANCE. " - 5.00 PLAN CHECK
provisions io the Labor Code, you most forthwith comply with FEE i
C) such provisions oUhn pennil shall be deemed revoked. AIR HANDLING UNIT(7040,000GF.M.) 4:00
CONSTRUCTION LENDING AGENCY, ''`� AIR HANDLING UNIT(OVER 10MIC.EM.) 6.00 SEISMIC FEE , .)
1 hereby affirm that there is• consuoetion lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
t 3097,Civ Q. I '- HEATING UNIT (TO 100,000 B.T.U.) '8.00 '
Lcndeiv Name
Lender's Address HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC
I I certify Ila,I have read this application and sleet that the above VENTILATION FAN (SINGLE) 4,00
r informalian is correct.I agree Io comply with all city and county BOILER-COAT(3 H.P:Of 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws rclating'to building construction, a
hereby authorire representatives of This city W enter upon (Irnde BOILER-COMP(Over,log000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
I
(We) trance to save, indemnify and keep harmless. the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any w accrue Bg:dnst said City in usnseyurnce of the PERMIT ISSUANCE"' 10.00
j �"nlin I I •rout. { MECH.CONT. LIC.NO. MECH.
;r /y TOTAL ( i� 1 TOTAL' I U8a
Sign.tir PfA'pplicm lu oinctor- Vale
APPLICANTS COPY