17315 POST THIS CARD'NEAR FRONT OF BUILDING "
' PERMIT NUMB ER
CITY -OF :CUPERTINO : 1.7315
INSPECTION DIVISION
JOB INSPECTION RECORD . 1.
.
- + •�n-1 L , ., • ,i PERMIT EXPIRATION
JOB ADDRESS °�-j� q 0 ^'L'`�L"�v IINIT# _LOT# + . •-t
- r_ . . _ ,�?,EWII# E1(PI RES,IF WORK
OWNER �Q�/�L7 j rx�G//�1 CONTRACTOR - , - IS NOT STARTED WITHIN
INSPECTION DATE :I INSPECTOR INSPECTIONRECORD I ' 180-DAYS OF PERMIT ISSU-
IFOUNDATION -ANCE !OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ' ' ALL GRADING AND,DRAINAGE�SHALL'BE INSTALLED
PR EGUNITE - -
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAL iOATTON
CUPERTINO STANDARDS.
!GARAGE SLABS' - - j1
a yN jl'I3��t a i
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - _ �-•• t
UNDERGROUND /SLAB
PLUMBING •* . , IYI M`l. 4 989 ' .
(ELECTRIC ' - - - VS(• &I ISSUANCE
IMECHANICAL' ELE PLG.
MECR AL
El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED : • BUILDING PERMIT 7.
i1N FORMATION
WOOD FLOOR r,VALUl ATION+ SIFT
( PLUMBING _ J
]MECHANICAL
'!ELECTRICAL _ I - I .• PERMIT TO
IFRAMING,
I INSULATION ` , - STORE S TYPE CONSTR
: r W_
,
,OCC GHCUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - • _ I -
5
ROOF � ",I NOTE: FINAL INSP.SHALL BE MADE BEFORE .�,'0 FT TLOOR AREA TOTAL ACREAGE'
THE CONSTRUCTION TAX IS PAID
tl dull.UlNG USE
(ROOF SHEATHING I - �-' LIES' INU ION PR -Omr•
I APPLY NO ROOFING UNTIL ABOVE•HAS BEEN SIGNED FINALS I aDATE INSP: '" .0- 'o ' 0 0
ASSESSORS PAHCFL NO
I ROUGH SAN,a p
PLUMB(NG ' .I
[TUBS&SHOWER PAN (ELECT.ENERGY 7fi-+ l��r ! `
THACT NO PARCEL NO
I I PLUMBING ENERGY �. I
MECHANICAL >
_ (1 'MECH ENERGY
ELECTRICAL - _ I�_ I BUILDING ENERGY I I ACC•DATE •nCC,FILL NO
FRAMING ('ELECT:FINAL TEST I �.. I ' . ,• • -
p ZONING "ENG SITE NO
INSULATION I\n.V ,(PLUMBING I�
' GAS TEST. I' - ' I IGAS ( I
' I
]MECHANICAL' I FIRE. .Nh ,ENERGYTea
• 'I, COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ]HEATING .I ,I r � 'N� � ❑• NO
FLOUO ZUNI . nCu c.
[EXTERIOR SHEAR ELECTRICAL RELEASE( - I i'
(INTERIOR SHEAR - l -T, IFIRE DEPT. I ''/ I I v .ENE .r L7 N�
ISHEETROCK n �E�f� ` (� (GRADE
L I / * I FEE SUMMARY
IEXTE RIOR LATH Q I ' `L Q� (BUILDING IL� 94JCfI , •.
I
INTERIOR'LATH 10 `17 I' TEMPORARY'APPROVALSj BUILDINGN�y_;_
(SCRATCH COAT rvIrm -ElU'_,` -,(ELECTRIC • PLAN CHECK,; � •
IGAS. FEE L
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCV , i SEISMIC FEE I
":(OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING'FINAL IS SIGNED BY BUI LOING INSPECTOR. ' p I I,•
MICR -,
ARRANGE FOR INSPECTION BY PHONING.252-'4505, I ELECTRIC T�I
Uj i.— ONE WORKING DAY'BEFORE REQUIRED INSPECTION; I PLUMBING;
Z .' PLEASE GIVE JOB ADDRESS WHEN PHONING'.
— SEE_'PERMIT FOR EXPIRATION DATE ,— I MECHANICAL I I
IMPORTANT! . I CONST.TAX I I.
I' PLEASE READ REVERSE SIDE BEFORE I TOTAL
CALLING FOR FINAL INSPECTION.- �,
.OFFICE COPY
Is
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
' ADDRESS
Z-777L/o t4CGQLdEQn BUILDING —ELECTRICAL=PLUMBING —MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
NAME/nJ //!��/� !!�� �/Q CITY• ELECTRIC PERMIT .'FEE
/C�l./✓�� 390WA) PHONEZS'7r /9o.&''. . '
CONTRACTORS
NAME - OUTLETS-SWITCHES-RECEP 10.00/1.00 eD,F.JC .
LIC NO,, 3 LIGHTING FIXTURES 10.00/1.00 I , �(- � 1 / D 1 7<
noonESS TORS APPLIANCES-RESIDENTIAL 4.00
PHONE., PANELS _' .110,00 DATE OF APPLICATION
ARCHITECT . — - PLAN CHECK FEE P C NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER' ,
LIC NO SIGNS TRANS. 3.00 ,
- ARCH OR END �.,
ADDRESS I SPECIAL CIRCUIT 5,00 PERMIT VALIDATIyO�N/�
ZIP TEMP.METER OR POLE INS. 20.00 �171V(Y
APPLICANT'S a 7•�
ADDRESS I MOTORS •SEE FEE SOFTr
• SERVICE CHANGE. 20.00 I I +
yy
o o LICHNSCD CONTRACTORS DECLARATION ` I � -�JV.4i
Q v w 1 hereby affirm that I am licensed crude(pNwxmris Of Clmpler 9, , - ` ISSUANCE DATE
y < w Iconunencmg with Section 7000)of Davis,..3 of the BllilllCS,and' , - BLDG. EL�E,CFT: PLG. ,MECH.,
r D z Poflessmus Code,and my license is in lull force and effect. �� Muperum
o 0 Oo o License Class Lic Numh-
Uatc Contractor
Q e J +. . ,
X Q w o OWNER-BUILDER DECLARATION, - •• BUILDING PERMIT
I°xu ;LL N I hereby affirm that I am exempt from the Contractor's License 1 MISC.— REF_ER TO,ORD I " ' �� /gµ.INFORMATION,
r LL'0 J Law for the followmgreason.lSec 703 L5,Businessand l'nifessions rERMIT ISSUANCE Ia, '�L/Lane/v S/FT.
Code.Any city Or county which requires a Fenno to cons)mct al ter,
fe R¢Q improve,demolish,or repair any structure,prior to Its issuance,also ,E LEC.CONTR. LIC.NO.' ELEC. C�
0 u requires the applicant lilt such permit to file a signed slalmnent that TOTAL
A w he Is licensed pursuant t0 the provisions of the Contractor's License _i PERMITTO , t
rzi LnPi(Chaptef9(CalmllenCingwHh Section 7000)01 Division3cl'lire) +
E i o Business and professions Code)or that he Is exempt there)tom and CITY. PLUMBING PERMIT FEE
itf$ tire basis for the alleged exemption Any violation ofSecHun 70315 Y _ '' STORIES TYPE CONSTR.
u3 � by any applicant for a permit ulbjecls the uppllcant to I Cair ALTER-DRAIN -WATER (EA.) 5.00 .
' o[gol more than five hundred dollars 155001 1' - „ i
(air I,as owner of the property,or my employees will, wages as BACK FLOW PROTECT. DEVICE 4.00 ' OCC.GROUP. RES UNITS
' d air sole compensation,will do the work,and the structure is not
- intended or offered for sale (Sec 7044, Bnsmess and Pmfessmns DRAINS-FLOOR,ROOF,AREA,COND. 5.001
Code' 'fire Contractors License Law does not apply to an owner of
property who builds or improves thereon.and who does such work FIXTURES-PER TRAP 5.001
himself or through his own employees,provided that such imprO L I + ISO FT,FLOOR AAREA I TOTAL ACREAGE'
merits are net intended or offered for sale.If,however,the budding I -1GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.001
or imp,ovei, it is sold within one year of completion,the owner. `f 'N+•-�'
builder will have the burden of proving that he did not build or Iii-I IGAS-EA.SYSTEM OVER 4 (EA.) , 2.001 eOILDING USE
prove for purpose of sale) - I INDUSTRIAL WASTE INTER. ,30001 RES IND CON PS Core,
C 1,as owner ut the property:am exclusively contracting wish ❑ ,❑ .�,.
• licensed CO mmeto" to construct the ,imect(Sir 7044,Buslness LAWN SPRINKLERS-'1 INC 5 V.B. 6.001'' ASSESSORS PARCEL'NO.
and Professions Code.The Contractor's License Luw'Joes not apply
to an owner of property who builds or improves thereon,and wha LAWN SPRINKLERS-OVER 5(EA.) 1.001 '
contracts lot such protects will,n contraclor(sl licensed puisunnt to
the Contractor's LICC1aC Law SEWER-SANITARY-STORM EA.200ft/10.00I TRACT NO. . PARCEL NO.
'O I am exempt under Sec ,tl&P.C.f7ihn WATER HEATER W/VENT 6.001 -1
mason le 111
Owner /t dAt�)7! Fu.o W1) Ua" WATER SYSTEM 5.001 Ace DATE Ace FILE NO
W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP.- .•5.001 ' � '• � I
' hereby at Oro that I have a certificate of consent to welt-Insure,
or a eCH f,aIC of Worker'Cum ensotmn Insurance,Orr.)celtif ied ZONING
p 1 1 I ENG.SITE NO. '
copy Ihereol'f5ec 3800,Lab.C.l.
PoIICY No. L'OlnPany
O' O .Certified copy is hereby lurmshed FIRE SPRINK ENERGY T-24
Z Z O CCrt,I,cd copy is fled with the city iospei tiun dlvisum I -
♦- O APIA',a, MISC.- '.;REFER TO ORD. v1] N❑ YC3 , N1]
� N CER7IFICA1E OF EXEMPTION PROM WORKFRS,— ,PERMIT ISSUANCE -10.00 777 FLOOD ZONE A.L.0 C.
W � - COMPIiNSAI'ION INSURANCE = PLG CONTR LIC NO P[G '-
-) O IThis'sretidn need not be completed If the permit n fur one I TOTAL N Y N 1]
�.Z hundred dollars(S1oo)or less l -
U O 1 certify that o Brio pedunn:mce of the work for wlmab this per- CITY.' MECHANICA FEE L PERMIT - FEE SUMM
LL U not is Issued,I shall not employ any person In any manner so as to � '
become siIM1)vat Io the W'orkcrs'Compensation Laws of California x _ �.
O w� ram npplicam ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE 10 APPLICANT 11,uHer a ukmg Ihn Certi a,.de of IS. 1'
Z emphon,you should become subject to the Workers'Compensation APPLIANCE 5.001 PLAN CHECK
provisions of the Labor Code, you must forthwith comply wit'
U such provisions or this permit shall be deemed revoked, 1 AIR HANDLING UNIT(TO 10)"C.F.M.) - 4.001 I FEE !)
CONSTRUCTION LENDING AGENCY '' AIR HANDLING UNIT(OVER IO,OWGEM.) 6.0bI SEISMIC FEE r'SC&!
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.001 -
the lierfurmmnce of the work lot which this Permit Is issued(See
3097,CN,C 1 HEATING UNIT(TO 100,000 B',T.U.) 8.001 I MICROFILM
Lender's Nam+
Lender's Add,— HEATI N UN IT(OV ER 100,000 B.T.U.)9,501 I ELECTRIC 2D47
' I ertify'that I have read Ihns application and slate that the above VENTILATION FAN (SINGLE) 4.00 _
reformation ...correct I agree to comply will)all city and count, BOILER H.P.Or 100,000 B.T.U.) 6x00 PLUMBING
ordinances and state laws relating to budding construction, and
hereby suthnnresreprescntatives of this cuy tO enter upon the BOILER-COMP IOVet 100,000 RTU1 SEE FEE SCH i MECHANICAL
uh.se-mentioned property for msPecliin purposes _
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against hablhties,judgments, costs and expenses which CONST.TAX
may an any wayaccnle against scud City In cunscqucnce of the PERMIT ISSUANCE, 10.001
;mntl flhispermll., l l MECH.CONT. LIC.NO_ MECH,
--r, - 7�/Zy/ i I TOTAL TOTAL a
Signatureor Applicant/Contractor 1 �/
OFFICE COPY , i: f