18250 POST THIS,CARD NEAR FRONT OF BUILDINGrEr ' ,[miBr.R
s� CITY OF CUPERTINO " ` 5I $250
INSPECTION DIVISION _
�u JOB INSPECTION.RECORD -
` _ PERMIT EXPIRATION
'\'y; JOB ADDRESS �—b�—� ` UNIT# LOT
Ito t.��
�-•+� /PERMIT BXPIRES.I F•WQRK
.
OWNER ��t�, CONTRACTOR oWQ�„ �'I IS NO ST RTED WITHIN
INSPECTION DATE INSPECTOR I INSPECTION RECORD I' 1fi8'D,YSRMIT
NOTE ISSU-
IFOUNDATION r,• , . - ; ANCE'OR,•180 DAYS FROM
- I UFER 'y "' ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED I NSPECTION.
PREGUNITE •1. •I TO COMPLY WITH THE APPROVED'PLANS AND CITY OF Pt HNUT VALADATDN
CUPERTINO STANDARDS.
GARAGE SLABS s _ i
I
YOUR NO CONCRETE UNTIL ABOVE HAS B :EN SIGNED x.•
" I UNDERGROUND/SLAB 'S '�7J// •
!PLUMBING P .� Y.�
(ELECTRICAL ,I, - .I / �ISSUFmc[uAte
IMECHANICAL ' , 'I I BLOC ELECT, Pur MI CH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I BUILDING PERMIT (
WOOD FLOOR
I _ INFORMATION
- VALUATION $&T, -
' .I PLUMBING - - � � - 1 - � r ^'���y� .,� �j
IMECHANICAL' - I ! , - I •>'."'�.�- If 3o
I ELECTRICAL ` , I PERMIT dO
I FRAMING' .0'ro;, (_(Colo
INSULATION .. i sTOF+lfs rn•E CO"siR
°+• OCC GROUP REST.•NITS
PLACE NOISUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1'
I I ROOF. , NOTE:NO FINAL INSP.SHALL BE MADE BEFORE Su IT vu,Dl, +1 A *o+AL AcnEAGE
� I THE CONSTRUCTION TAX IS PAID `I
(DIAPHRAGM;' P I � `
BUILDING USE II
IROOFSHEATHING I ; RES IND CON PB om.,
1-`APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINAL'S-, `""DATE ' �1 'INSP. El .❑ . ❑ 1:1 11
A H
1 ASSESSORS BAHClL NO
y, I' SN. .J
`
PLUMBING ,� ELECT.ENERGY - .I, I PARCEL NO
!TUBS&SHOWER PqN I` PLUMBING ENERGY I I !' I TRACT NO
IMECHANICAL ,\ I MECH.ENERGY I I' I •
,!ELECTRICAL -�, _ _ I BUILDING ENERGY I { ACC DATE ACC.FILE NO
tI FRAMING \ I I ELECT,FINAL TEST . I II ZpNMGENG.SITE NO
IINSU,LATION .\1 I (PLUMBING I I
(GAS TEST. I IGAS I , I I .I
' \I I IMECHANICAL 1 , FIRESPRINK ENERGY T"T1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATING I I I• ` 0' "E .'° ❑ N❑
E LOGO ZONE A Luc.
IEXTERIOR.SH EAR - I `�,.',. I E LECTR I CA L RELEASE( I •*
I INTERIOR SHEAR T \ IFIRE DEPT. I _ I -° ❑ .N❑ :N•'❑ "❑
ISHEETROCK , ti!,• IGRADE I '' -�i I FEESUMMARY
(EXTERIOR LATH I IBUILDING'
, .• y�,y '
I INTERIOR LATH . '; � � � � I �'��=I, I TEMPORARY APPROVALS 'BUILDING
SCRATCH COAT I (ELECTRIC _ , PLAN CHECK.
'1 IGAS( FEE `
NO TAPE OR PLASTER UNTIL-ABOVE HAS BEEN SIGNED (OCCUPANCY , I. "I SEISMIC FEE I pz�fl
(OCCUPANCY OF.BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS N
'SIGED BY BUILDING INSPECTOR:
I MICROFILM
I •''I, ELECTRIC .h
_ ARRANGE FOR INSPECTION-BY PHONING 252-4505, ' - '
' ONE WORKING DAY BEFORE REQUIRED INSPECTION: "
1 0� PLEASE GIVE JOB ADDRESS WHEN PHONING.' Ir,'PLUMBING
' Z - SEE PERMIT FOR EXPIRATION'DATE - I MECHANICAL �
IMPORTANT! I CONST.TAX I y
PLEASE READ'REVERSE SIDE BEFORE, TOTAL ^�
CALLING'FOR FINAL INSPECTION.' ' • : I 76 RO
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADjBl11LD .- APPLICATION.& PERMIT' 18250
9�� �LC.92.+�iP BUILDING -ELECTRICAL-PLUMBING-Mr I CHANICAL
C1P y OWNER'S PLAN CHECK VALIDATION
I NAME �j, QTYt ELECTRIC PERMIT FEE
•a 00 zlisek 'HON J� _..�lS�fn
ICONTRACTORS y
Nam. OUTLETS-SWITCHES,-RECEP 10.00/1.00 13. .�C h
�• ��//7�dQ�F 1IC NO I _TLIGHTING FIXTURES 10.00/1001 Z S'T'
CONTRACTOR S - I APPLIANCES-RESIDENTIAL 4.001
Aooness I', � 0
PHONE�� 2f�f PANELS 10.001 r p EO APPLICATION '
ARCHITECT PLAN CHEEK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.001 C Ill
ENGINEER . `
sec.NO SIGNS TRANS. 3.00 _
ARCH OH END , PERMIT VALIDATION
-ADDRESS SPECIAL CIRCUIT 5.00
'ZIP ' . 6EMP. METER OR POLE INS.•e 2000
'APPLICANT-s • iv MOTORS FEE SCH.
ssx
AoR C• ' I '
�/2- 1601/601/ /Ls , d_ SERVICE CHANGE _ 20.001
oo LICENSED CON'FRACI�EC ION T v �- / 3 (�y1" p 'Ax
Q v w _ I hereby allirm that 1 ant licensed under provisions of Chapter 9 ,` - ^ ISSUANCE GATE
y G w (commencing with Seel ion 70001 of Divioun 3 of the Business.mJ ' •f x -, BLDG: ELECT PL G. ;MECH.
F ,z Professions Code,and my license is In full force and ellect. 1111--,IT'4LD J
z o,n- License Class Llc.Number IEAf.T�
9 w F Date Contractor >" x -
'a BUILDING PERMIT
¢ Q w OWNER-Ii UILIMIR DECLARATION
1 ' MISC.- REFER TO ORD 1 I ° INFORMATION ,
w ;¢H 1 hereby allirm that I am exempt from the Contractors License _ ,VALUATION .
ce o j Law for the following reason (Sec.7031.5,Hasmessand Professions o ,S/FT.
- .' ERMIT ISSUANCE 10.00.1 12.170
Cope: e,Y mulish county which structur e P riot to is issuance,,also } Aw./•city or rt K G Q Improve,demolish,or repair any structure,pour No i0 issuance,ulw I ELEC.LDNTR. LI C.NO •' ELEC. 7.X0
LL requires the applicant for such permit to file a signed statement that TOTAL (/ PERMIT TO '
A ca °m lie is licensed pursuant to the provisions of the Contractors L¢-,._.
Fz a Law(Chapter9(cammencing with Section 70001nf Division 3 olthe — �- - Ar, bI 1-
. 4 o Business and Professions Code)or that hE is exempt Ihcmfrom unit QTY. PLUMBING PERMIT - FEE / " A �1
m I-m° -the basis for the alleged exemption.Any vmlal ton of Section 7031 5 t STORIES TYPE CONSTR ?(
s3 - 6y any applicant for a permit subjects the applicant t0 ac111 penIDly ' ALTER-DRAIN& VENT-WATER (EA.) 5.00,k,M ;
of not nmre Noun five hundred dollars($5001.)
❑ 1,as owner of the property',or my eniployees with wages a= BACK FLOW PROTECT. DEVICE - 4.00
their sole compensation,will do the work,and the structure is not ,OCC.GROUP RES,UNITS
intended or offered for sale (Sec. 7044, Business and Professions 1 DRAINS-FLOOR,ROOF,AREA,COND. ,5.00
Code:The Contractor's License Law does not apply to an owner of tan. s J
'•f•�pa a' '.?p property who builds or Improves lhercon,nnd who does such work 3 FIXTURES-PER'TRAP w5,00 �j. D17 ll
1Y himself or through his own cmployces.provided that such,mprove- SO.Fr.FLOORa Ea TorALACREfiAGE
�`•f •menis are not intended or offered for sale 11,however,the building GAS-EA.SYSTEM-11 NC.40UTLETS 6.00 UO
1 �}
1�(
or Improvement is sold within one year of completion,the owner,
i y1P budder will have the burden of proving that he did not build or Im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.001 BUILDING USE . .
pravefor purpose of side 1, RES ' IND CON PR, Omer
I,as owner of the property,am exclusively contmcRngwith (INDUSTRIAL WASTE INTER.' 30.001 ❑ •❑ ❑ ❑
lieense,l contractors to construct the project(Sec. 7044,Busies l 1LAWN SPRINKLERS-1 INC 5 V.B. 6.001 ASSESSORS FARCE
and Professions Code The Contractor's License Law does not apply - .•
to an owner of properly who builds or improves thereon,and who LAWN SPR INKLERS-OVER 5,(EX) 1.00 - � '•'i (�� '=1;Its
LOTHTECls for such proR'cls with a contraciorls)licensed pursuant to 4
the Contractor's LicenseL _ SEWER-SAN ITAR V-STORM EA.200it/10.001 _ TRACT NO. PARCEL NO..
❑ lam ' II ,Ii.tiPC .far this
(WATER HEATERW/VENT- 6.00 _00 t
Dat�%`{ f/ I WATER SYSTEM 5.001 ACC DATE - ACC.FILE NOI
~ ,WORKBRS'Cfk .NSnTION DE:CLARA'nON WATER TREATING EQUIP. 5001 '
mrchy at Ulm than 1 hale i Lerbficale ul consent lu ne11-enure' ,• I ZONING END SITE N0.
nr a cendield,of Workers'Comfmrx.H m Insurance,or a cerlil7ed _ "
copy thereof(Sec.3800, pang
Pal icy No m pany Co �-
❑ CErtihed copy is hcreby'IUrnislicd 1 FIRESPRINK ENERGYT24
Z Z ❑ Certified copy is filed with the city Inspection division v❑ N❑ v ❑ N❑
F 0 Applicant MISC.- - '.REFER'TO ORD. .•t- I.-
CC .CERTIFICATE OI'EXEMPFION FROM WORKBRS' PERMIT ISSUANCE r i '10.00^.00 FLOOD ZONE ALUC.
Q-
LU > COMPENSA1ION INSURANCE PEG CONTR LIC NO (PLG. �,
0 1'I his section need not be completed if the permit is for one I • TOTAL 0 o YE] N❑ Y ❑ N❑
U Z hundred dollars(S 100)or less I
U O t is pa certify that h the to employ an of the wink for which this per OTV. r MECHANICAL PERMIT FEE 'FEE SUMMARY
LL H and Is paced.I shall not Employ any person in any manner sc as to -
O w nine subject to the Workers'Compensation Laws of Cahfonua.
y Die Applicant BUILDING
} w NO I'I CE TO APPLICANT' II,alter making this CErtl6cate ALTER OR ADD TO MECH. 5.00
F ? empt ton;you should become subject to the Wnrkeri Q,mpensal ion APPLIANCE ' 5.00 i PLAN CHECK
provisions of the Labor Code, you muss forthwith comply.set
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10000CF.M.) 4.00
CONSTRUCTION1.I:ND1N(-.ACENCV - AIR HANDLING UNIT(OVER 10=C.F.M.) 6.001 ', SEISMIC FEE
I hereby affirm that there is a construction lending agency for 1 •. I EXHAUST HOOD (WITH DUCT) 5.001
the performance of the work for which this permit Is issued(Sec MICROFILM
3097,Cle C.). -HEATING UNIT(TO 100,000 B.T.U.) 8.001��•00
Lender's Nam•' r HEATING UNIT ER 100,000 B.T.U.)9.50
-Le nd dis•==let's Ad I ELECTRIC �Z7 8�
' •{' ( sry 1 certify that I have read this application and state Ili at the above VENTILATION FAN (SINGLE) 4,00 1 4-N V '
'j l -inlbrmmmn n,currecL I agree no comply will, my and county PLUMBING I -;I
k• nrdinanms and.slate laws relating io building constructimi,'unJ BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00 ++ I` ^' 1
4: hereby aulhorire',represen tatives of this city to enter upon the, I BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. ] MECHANICAL
above-mentioned property for Inspection purposes -
(We) agree to save, indemnity unit keep Imnnless the City at MISC.- REFER TO ORD.
Cupertino against I I I dgmeIT Costs and expenses which - -- _ _---- CONST.TAX
may�m D way a see agal sb said City m c�.ppc� the 1 ' PERMIT ISSUANCE', 10.00 1Z�0
/�+��ntg of W RL MECH.CONT. LIC NO. MECH
er /•Sign eofApplicanl/ or L TOTAL:?
«l/////l�///��//J' OFFICE COPY P