18336 POSTTHIS'CARD NEAR FRONT OF BUILDING
PEHmIT NUMBER/
CITY OF CUPERTINO PAID
18336
.INSPECTION DIVISION No 3 ,0113611 q .
JOB INSPECTION RECORD
7
cit�< �,T^^FARO : 'PERMITEXPIRATION
'JOB ADDRESS� �� ( ` ' `�— ' UNIT# _LOT#
PERMIT EXPIRES IF WORK
owNERD ; CONTRACTOR a-( (� IS NOT STARTED WITHIN
I SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: -
LASTCALLEDINSPECTION.
_ LIFER ALL GRADING AND'DRAINAGE SHALL BE INSTALLED
'• PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT.VALIDATION
CUPERTINO STANDARDS.' r ('
GARAGE SLABS l " - ( �—• '"3 (�)--, '/.
- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB. ' ,n (kit �L'ytVti
PLUMBING. _
ELECTRICALW
-IssuANce uArE
MECHANICAL 'd ' BLDELECTPL
, c. MECH.
T ' ❑G. '❑- D
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- '. INFORMATION
WOOD FLOOR VALUATION S/FT.
PLUMBING
MECHANICAL -
PERNUT 10
ELECTRICAL
FRAMING - I
src IEs rvvE CONSTR.
INSULATION
OLC.GROUP•� •' RES.UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FL FLOOR AREA TOTAL ACREAGE
� . ROOF - NOTE:NO FINAL INSP.SHALL'BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
-RUi LDING USE
ROOF SHEATHING Res NO CDN' PB', U,P,
APPLY NO ROOFING.UNTIL ABOVE HAS BEEN SIGNED FINALS- DATE INSP. 0 ❑ ❑ 0
ASSESSORS PARCEL NO,
ROUGH SANA - - -
PLUMBING ELECT.ENERGY - •
1 HACT NO. " PARCEL NO '
TUBS 8 SHOWER PAN. PLUMBING ENERGY . \
MECHANICAL MECH.ENERGY '
- ACC.DATE ACC FILE NO.
ELECTRICAL - BUILDING ENERGY -
FRAMING ELECT.FINAL TEST zONING ENG.SITE NO.
• INSULATION„ - PLUMBING
GAS`TEST GAS -
FIRESPDINK ENERGY T,24
MECHANICAL Y ❑ 'N❑ 4 � ❑ N❑. •,
_
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
- FLOODZONA A.L.U.c.
EXTERIOR SHEAR ELECTRICAL RELEASE
Y
INTERIOR SHEAR - � FIRE DEPT. V❑ .❑ .❑ No
SHEETROCK GRADE FEE 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 OCCUPANCY .' SEISMIC FEE' '
OCCUPANCY OF BUI LDING.IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESSWHEN PHONING. .
z
MECHANICAL
A�
' SEE-PERMIT FOR-EXPIRATION DATE —
MEC
MPORTANT! coNsr.rnx
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
BU I LDING PROJECT IDENTIFICATION vERMrrNumeER -
BUILDING APPLICATION& PERMIT
ADDoso 18 3 3 6
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S t� - PLAN CHECK VALIDATION
",`r"yE ✓v'*a7 QTY. ELECTRIC PERMIT FEE ,PAI
D PHONE
CONTRACTORS /a,� / / OUTLETS- ITCHES 10.00/1.00 NOV ,3 01989
NA �[� 'Hob �-fofo
7/as g� uc.NO. LIGHTING F TURES -10.00/1.00
CONTRACTOR'S APPLIANCES- SIDENTIAL ''-4.00 [ '
7A/DRREss y.-� yy,� 61 '1'�q DS/lo Citi! Isl (r1r^91'tina . .
,5 16M 'rV PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
OR PANELS(OVER 200 MPI '20.00
1
ENGINEER
LIC.NO SIGNS TRANS. 3.00
ARCH.OR ENG. -O PERMIT VALIDATION AUDREss SPECIAL CIRCUIT 5.00 '
ZIP TEMP.METER OR POLE IN. 20.00
APPucarvrs.A MOTORS' EE FEE SCH.
A DREs .
SERVICECHANGE 20.00 (���f IIIikv('_C.4
w00 LICENSED CONTRACTORS DECLARATION +•t W.
¢ v v I hereby affirm that I am licensed order provisio us of Chapter') ISSUANCE DATE
4 w (commencing with Section 7000)of Division 3 of I Busincs an BLDG. ELECT. .PLG. MECH.
w z Professions Cod&dD9v license is in full Corce ff
z o T- License Class Lam(/ I Number Cy
O Z H w Datc_ r Contractor_
a y E /�✓ 7iS BUILDING PERMIT
¢ ¢ w OWNER-BUILDER DECLARATION
E O a MISC.- REFER TO ORD INFORMATION
wg u ca 1 hereby off nn that I am exempt from the Contractor's License
¢ 0 4 Law for the following reason.(Sec.7031,5,Business and Professions PERMIT ISSUANCE - 10.00 - VALUATION S/FT.
� - J Code'.Any city or county which requires a permit to eonst"LLatlee r•
¢ an a Q improve,demolish,br repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
ca
0 ¢ requires the applicant for such permit to file a,signed statement that TOTAL PERMITTO
a w m LL Ire is licensed pursuant to the provisions of the Contractor's License
HZQ Law(Chapter 9(commencing with Section 7000)ofDivision 3of1he p '^
Business and Professions Code)or that he is exempt thereaum and QTY. PLUMBING PERMIT FEE
¢ Fo the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
seam by any applicant for a permit subjects the applicant m a civil penalty ALTER-DRAIN, -WATER IEA.) 5.00
of not more than fivehundred dollars($500).):,
❑ 1,as owner cd tie property,or any employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the.structure is not
intended or offered for sale(Sce. 7044.Business and Professions DRAMS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law docs not apply to an owner of
property who build,or improves thereon,and who does such work F IXTU S-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve - _
»,�^ mmhowever,es are not intended or offered for sale.H.hoev ,the building GAS-EA. YSTEM 1 INC.40UTLETS 6.00 -
or improvement is.sold within one year of completion,the owner- GAS-EA.S TEM-OVER 4 (EA.) 2.00 BUILDING USE
buildm will have the burden of proving that he did not huild or ion- RES
prove for purpose of sale.). INDUSTRIAL ASTE,INTER. IND CON PB' 30.00 R IN CO O Dmer
❑ '1,as owner of the property,am exclusively contracting with
heen,rd con Ime ors to consNuct the project(Sec. 7044,Business LAWN SPR IN KL S- 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
contractsl'orsuch projects with it contractor(s)licensed pursuant in - SEWER-SANITARY-S RM EA.200ft/10.00
the Contractor's.License Law. TRACT NO. PARCEL NO.
❑ Iantcxcmptundcr Sec. ,B.&P.C.for this WATER HEATER W/VE 6.00 `
Owner - Date, _ WATER SYSTEM 5.00
ACG GATE ACC:FILE NO.
WORK Ii RECOMPENSATION DECLARATION IWATER TREATING EQUIP.-' 5.00 ' -
I hereby affirm that I have a certificate of consent to self-insut,. ZONING
or a cenifcate bf Work'a'CH
Conttyyration Insurnoc,oar/n ce..r/{-If• - ENG.SITE NOq
copy theKyyl.ab.C.l.\r)� ,�, .�D!`/E Q../
Policy Nw� ComFlanY J%��' `
O ❑ Certified copy is lurehy fumishfJ. RE SPRINK ENERGY T24
L Certifie"y���c''���y a filed 11 rty inspection cividon. MISC.- REFER TO ORD.
zo Ap nc�ant___lLcf + S- V N� V NO .
to CERT''IFIC,,ATE OF EXEMPTION PRL W'ORKIiRS' PERMIT ISSUANCE 10.00' FLOOD ZONE A.L.U.U.
Lu COMPENSATION NSURANCE PLG.CONTR. LIC.NO. PLG. - y N v q
CL CL 0 ('Phis section need not be completed if the permit is for one TOTAL
hundred dollars IS 100)or less.)
U O 1 certify that in the pe,fonnmice of the,work for which this per- QTY. .MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is isiaed..I slmll not employ any person in any manner so as to
U become subject to the Workers Compensation Laws of California.
Cal Dale Ap II am - BUILDING.
IL p is - ALTER OR ADD TO MECH. . 5.00
} W NOTICE'1'0 APPLICANT: H.after making this Certificate of lis- -
r Z_ emption,you should became subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
m o,kioms of the Labor Code.•you most forthwith cangdy.with FEE -
U such provisions or this permit shrill be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I 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,
3097,
3097,Civ.0.). HEATING UNIT(TO 100,000 B.T.U.) '8'00 / 19 0
Lender's No HEATI NG UN IT 100,000 B.T.U.)9.50
Gender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 '
•• information is correct 1 agree to comply with all city and county PLUMBING
ordinances and slate laws.relating to building construction, and BOILER-WMPI3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize represnatatives of this city to enter Upon the /r oD
above-mentioned property for inspection purposes. BOILER-COMP'(Over,1OQ000 BTU)SEE FEE SCH. .MECHANICAL.
(We) agree to save, indenmify and keep harmless the City of misc.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and ex enses which' CONST.TAX
may in my accrue against said City in cense fence f the PERMIT ISSUANCE 18:00 !Q'0
ranting 1 tenni(. MECHICONT. LIC.NO. MECH.
TOTAL J/ TOTAL a�• (l9
Sign'tu of \pplicant/Contractor Vale N\/
OFFICE 6OPY