18369POST THIS CARD NEAR FRONT OF BUILDING'
' -
PERMIT NUMBER
�• CITY``.OF- CUPERTINO
18369
I NSPECTI ON• DI;V ISI ON
JOB,INSPECTION RECORD ,..
' '' I - L •` ,
� V UNIT#
JOB ADDRESS '
PERMIT E XPIRATION
`
�l— '✓ -�--K �— ` LOT 4'
_ - -
'4
PERMIT EXPIRES IF WORK
owNEA a„lk coNTRACTOR S n
IS NOT. STARTED WITHIN
180 DAYS OF PERMITISSU`
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
." INSPE ION -
DATE,
I INSPECTORS
INSPECTION RECORD,
FOUNDATION
(NOTE:, -
ALL GRADING -AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
UFER -
PR EGUNITE
•..
PERMIT vnu on rroN,.
!
CUPERTINO STANDARDS. v PAMD,
`GARAGE ' •' -
-.
,.
SLABS .'•
,.
POUR NO
CONCRETE UNTIL ABOVE HAS BEEN
SIGNED
J', ULT'r 1989
•,...' UNDERGROUND /SLAB
PLUMBING
-
-(�
Q.��
ci�v� "p°°"'
IssunrvcE.uA rE 4��
ELECTRICAL _
_.
MECHANICAL
--
$l.{a GTi K O L � 1
BuTC.
E•L,F(:T. Pu;. MecH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
L-•p'r E} dPC L6-'.
151+r-
BUILDING PERMIT
F
INF OR�MATIO%aNFf
` - WO.O' D'FLOOR
VALUATION 4- SIFT. . - -
r a
aMECHANIC 0 '
' PLUMBING
•
�rAL
ELECTRICAL•-
FRAMING
INSULATION -
STORIES -
TYPE CONSTR
r
UCC GROUP
,'HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 'J -
NOTE: NO FINAL'INSP.'SHALL BE MADE BEFORE
THE CONSTRUCTION TAXIS PAID .,
•1 ::
5(I IT. I LOOK AHL!A
IUT AL ACRF.AI.E.'
,
DIAPHRAGM, _
'.. ROOF SHEATHING `.' .:
. , + I)
BUILDING USE
dus, IND CON PB "O e
❑ ED ❑ ❑ Q
:APPLY NO ROOFING UNTIL,ABOVE HAS BEEN SIGNED
- FINALS
'DATE
INSP.-
ROUGH` _:
SAN.k
SSORS PARCEL NO
PLUMBING ' e'
/
ELECT. ENERGY
- TUBSBSHOWER PAN-
PLUMBING ENERGY-
-'
i14ACT NO
PARCELNO
MECHANICAL "' -
MECH. ENERGY,'
ELECTRICAL
L
BUILDING ENERGY
-
ACC DATE
ACC. FILE NO.
FRAMING. + ..
-
ELECT. FINAL•TEST •.
INSULATION'
I -
-
PLUMBING
.-
CONING
,ENG. SITE NO.•
GAS TEST
<
GAS;;
MECHANICAL
Y `
FIRE SPRINK
N[_
ENERGY i.24
"�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
_ •
ELECTRICAL RELEASE
FLO0DZONE
Y❑ "E]
A.Lu C,
Y ❑ NE]
INTERIOR SHEAR
/
,FIRE DEPT.
-
'SHEETROCK ,
GRADE s
�.—
FEE SUMMARY
EXTERIOR LATH
BUILDING
-
BUILDING
INTERIOR LATH, + _
-
-
- TEMPORARY APPROVALS
SCRATCH COAT,
'
ELECTRIC. -
PLAN CHECK
FEE
'.
GAS .. -
NO TAPE'OR PLASTER UNTIL ABOVE HAS BEEN SIGNED I.00CUPANCY
'.
-
.SEISMIC FEE
!'
OCCUPANCY OF BUILDING IS NO TPE RMITTED UNTIL BUILDING FIN AL IS'SIGNED By BUILDING INSPECTOR.
MICROFILM-•.
r,
1 INSPECTION
.a ARRANGE FOR BY PHONING 252 - 4505,,
ELECTRIC
�•
U-1
1—� ONE WORKING DA•Y,BEFOR,E REQUIRED INSPECTION.
P.LEA$E GIVE'JOB.ADDRESS WHEN PHONING.
PLUMBING
MECHANICAL
, ..00.
Z P ''
=.SEE PERMIT-FOR EXPIRATION DATE _
colvsT.TAx
a
.'IMPORTANT!
;} PLEASE -READ' REVERSESIDEIBEFORE
CALLING FORIFINAL INSPECTION.
TOTAL
OFFICE COPY'..
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
�BUKLDI NG PROJECT I DENTI FICATI ON
APPLICATION& PERMIT
BUILDING - ELECTRICAL - PLUMBING - MECHANICAL
PERMIT NUMBER
I
A
` 1� 8369
aBILDIrN( I {
- ♦�ORESS .ter Ta
6 J( 1L�J
OWNER'S
NAME �. l/}(,�e I G -f,�
PRONE
&Y.
-
ELECTRIC PERMIT
'
FEE
PLAN CHECK VALIDATION
-
DATE OF APPLICATION
CONTRACTOR'S
NAME NG
'V •µ"! 'll•u•'�' .N . 7i
UTLETS - SWITCHES - RECEP 10.00 /1.00
S U
LIGHTING FIXTURES 10.00/1.00
^1
roNTRACTOns, Q WA
r AO R5
PHONE
PPLIANCES - RESIDENTIAL 4.00,
r
PANELS 10,00
ARCHITECT
OR' r '
ENGINEER
LiC.NO.
PANELS (OVER 200 AMPI 20.00
PLAN CHECK FEE P,C. No..
..-
'
ISIGNS TRANS. 3.00
ARCH OR ADDRESS ErvG,
ZIP,
SPECIAL CIRCUIT 5,00
', 'PERMIT VALIDATION
p V50- )vLLL ')
N *t 1� W
ISSUANCE DATE
BLDG. ELECT. PLO. MEC
'
TEMP. METER OR POLE INS. 20.00
ADDAessr s.
• ,;
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSHD CON] RACTORS DECLARATION
'. I hereby affirm that I am licensed under Priwisions of Chimun, 9
(colpmencing with Section 7000) of Uivieion 3 of the Busipcss and
Professions Code, Amy license is in full turn e�l l.•y�
License Class _ /�']_ -� =Con Number' (7L.3 �'r{'
Omc' Contractor -
_
city of Cuner^w
1^J WIr�
OWNER - BUILDER DECLA RA I' ION
1 hereby affirm that I am exempt from the Contractor's License
Law for the following a•'so
b one an'. (see. 1.5, Business Sena Professions
Code A, demolish, ly coo ntywhiny structure priort o tonsuance, also
requiresthe apliOt fop suchprmit to Fe prior tOn s issuance, also
requires ne applicant for such permit to file a signed a nt nSe
he is licensed pursuant to the provisions i, the ).fD, Contractor's License
Business (Cha and professions C.de) th that lie isf exempt the of o and
Business and he alleged xempt on thus he it ti ofSectron 70 1.5
the basis for the alleged exemption. Any violation of Section malty
of oreIaa fora hundred subjects the applicant toacivil penally
of not more than five hundred dollars (my employees
❑ Las owner at the property, or my employees with wages as
in fen sole compensation, for will (S the work, and the structure is not
in or offered for Luce (Sec 7044, nosiness and o
Cods: The Contractures License Law does not apply to an owner wner o of f
property who builds or improves there n, add who does such work
himself or through his own employees, provided that such improve-
ments are net intended orofferedforsole . If, howeveo the building
' or improvement is sold within one year of completion, the o! 1.
builder will have the burden of proving that he did um build or an-
prove for purpose of sale.).
❑ I, as owner ol'the property,. am exclusively contraeling with
I licensed contractors to construct the projecl (S,E. 7044, Business
and Professions Cod,: The Contractor's Livens, Law does not apply
to an owner of property, who builds or improves thereon, and who
contracts lot such projucts with a contructory) licensed pursuant In
th,Cmdramores Li=Sc Law. a. .
❑ lam exempt under Sec. ,8. &P,C. for tbtL
reason
BUILDING PERMIT ,
INFORMATION
MISC. - REFER TO.ORD
. PERMIT ISSUANCE -10.00
VALUATION
'.O
D
$ /FT. -
ELEC. CONTR. * LIC. NO.
ELEC
TOTAL �0.
PERMIT TO '
E- `s _O dp l
OTV..
- - t
PLUMBING PERMIT
ALTER-DRAIN E
( A.) .5.00
FEE 1
(ljj
STORIES
TYPE CONSTR.
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS- FLOOR, ROOF, AREA, COND. 5.00
FIXTURES -PER TRAP 5.00
GAS- EA.SYSTEM-,1 INC.40UTLETS• 6.00
A bb
$o. FL FLOOR AREA
TOTAL ACREAGE
GAS - EA. SYSTEM -OVER 4 (EA.) ' 2.00
BUILDING USE
RES IND CON PB Other
..
INDUSTRIAL WASTE INTER. 30.00'
-
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
- -
LAWN SPRINKLERS - OVER 5 (EA.) - 1.00
SEWER- SANITARY- STORMEA.200ft /10.00
TRACT NO,
PARCEL NO.
WATER HEATER W /VENT 6.00
Owner Date
WATER SYSTEM 5.00
WORKF-RS'COM1'I7NSATION DECLARATION
I hereby affirm limit Lha'vo a intif icate of,.rwnt to s'ulf- iusurc,
or a certificate of Workers' Compensation Insurance, or a certified �
copy lhercof(Scc. 3800,'Lab.C.).
Policy.No. Compmty " -
ACC. DATE
ACC. FILE NO.
_
WATER TREATING EQUIP. 5.00
�
ZONING
ENG. SITE NO.
-
"' ^'
-
MISC. - REFER TO ORD.
CertitIe copy lerehy l'uiisil d: -
Certified c p Ied' i I`p�glly inapectiun division.
Ap,dicant
�
FIRE SPRINK
v N
•ENERGY T 24
v [] NEI
CCIt'1'11 C 'I 'I? OF EXEMPTION FROM WORK Ii RS'
COAIPCNSATION INSURANCE
,Cfhis section need not be c. ..... leled if the permit pis for one
hundred dollars IS 100) or less.)
I certify that in the perloorance-`of the work I'or which this par
mit is issued; I shall not employ any person in any manner so as to
become subject to the Workers' Compensation any of California,
Rohm
PERMIT ISSUANCE 10.00
ODD 20NE
Y [] No
A. L. U.C. "
V IN [D
pLG. CONTR. uC. N0.
'PLG.
TOTq iQb
DTV
,
MECHANICAL PERMIT
FEE,
FEE SUMMARY
BUILDING
3 O A
U
ALTER OR ADD TO MECH. _ 5.00
r
NOTICE '1'0 APPLICANT: II; after making this Certificate of nix-
APPLICANT:
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you nst forthwith comply with
w
such provisions or this permit shall he cleaned revoked.''
CONSTRUCTION LENDING AGI;NCY
°I hereby affirm that there'is a cmulmctiim lending agency for
the performance 'of the work I'or which Ibis permit is- issued (Sec.
3077, Civ.C.)..
Lender's Name
APPLIANCE 5.00
PLAN CHECK
FEE
p
r.]
AIR HANDLING UNIT (TO 10=C.F.M.) . 4.00
AIR HANDLING UNIT (OVER 10= C. EM.) 6.00
SEISMIC FEE
EXHAUST HOOD;IWITH DUCT) 5.00
MICROFILM
-
HEATING UNIT (TO 100,000 B.T.U.)•' 8.00
Lcnder'sAddress'"
H EATING UNIT (OV ER 100,000 B.T.U.) 9.50
ELECTRIC -
.I certify that Ihave read thisapplicalionand state that theahove
information is correct: I agree to comply with all city and county
ordinances and slate laws relating to building construction, and
hereby 'authorize representatives nis of this city to enter. upon the
above- mtntio d property for insp ctiun purrynms.
(We) agr t save, indion, I keep harmless the City of
Cupertino' ai liabilities, jo enls, costs,und expenses which
uy,i a accrue anal s Sa' in consequence of the
rantin t r t
VENTILATION FAN(SINGLE) 4,00
BOILER- COMP(3 H.P. or 100,000 B.T.U.1 6.00
OQ,
PLUMBING
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
-
MECHANICAL
r o 6
..
MISC..,- - REFER TO'ORD.
, CONST. TAX'-
'
PERMIT ISSUANCE - 10.00
DU
MECH. CONT. I LIC. NO, MECH.
TOTAL?
,'TOTAL(.Si
Signal r p c at onf actor Date -
OFFICE COPY,
l