18351 POST THISCARD. NEAR FRONTOF''BUILDING eRmITNDmsed
CITY OFI 'CUPERTINO 18351
,.
INSPECTION.DIVISION.
.JOB.INSPECTION RECORD
.R-�✓a '-PE RMIT E XPIRATI ON
+ 'JOBADDR ESS S UNIT# _LOT#
J-' PERMIT EXPIRES IF WORK
' OWNER CONTRACTOR SQV CO : L� L„ IS NOT STARTED WITHIN
..INSPECTION - DATE` IJU,$PECTOR I INSPECTIONRECORD . 180DAYS'OFPERMIT ISSU-
' FOUNDATION " + NOTE: , ANCE OR 180 DAYS FROM
.! (:
UFER � � �, ALL,GRADING AND DRAINAGE SHALL BE INSTALLED
ALLED LASTCAL LED INSPECTION.
• PR EGUN6TE TO COMPLYWITH THE APPROVED'PLANS'AND CITY'OF reumn vA+.mn noN
� ' CUPERTINO STANDARDS. eznOQT -
GARAGE SLABS - - . 1'�M�r s ,,�.•
POUR,NO CONCRETE UNTIL'ABOVE HAS.BEEN SIGNED
i ��vsc v4s61�49c 13g
UNDERGROUND /SLAB
PLUMBING ... •, ..,,{{. .• �. Y,,. i C Y1.rJCL
ELECTRICAL w '
ISSUANCE UA IE
? pL 4^ [CECT PLG. MIiCH, ,
MECHANICAL•' I, ., _
0
• DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �D� vY9 1Z G UILDING PERMIT.
. WOOD FLOOR to � r/j�F/ 12 T��5INFORMATION
u
PLUMBING.' _ GG y„� vA nnNN S/FT.
MECHANICAL n. .i • L' �L
C ' 4� PLH M111i TO
ELECTRICAL-
jEj
FRAMING - - - -
INSULATION' i^. sroHlls PE oNSTn.
• •• - • • .+ I/It ,, OCC GH( UI' RES.UNITS .
• PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:N. . '! IN A O E. SO FT:FLOG AREA TOTAL ACREAGE
•
6
DIAPHRAGM " °' TH O $ I XI
1 UILDING USE
ROOF SHEATHING . •'. i - .',I; I RES j coN Pa '00'00",
APPLY NO ROOFING'UNTIL ABOVE HAS BEEN SIGN .FINALS..:,, - A�. DAT SP. ❑ 0 ❑ ❑
' ROUGH ` SAN.N S50HS PARCEL NO
'PLUMBING +" ELECT. A5 1
ENERGY -
TUBS'&SHOWER PAN - PLUMBING ENERGY 1 TRA T No PARCEL NO
MECHANICAL. : - MECH.ENERGY
ELECTRICAL • BUILDING ENERGY - Cc DATE ACE FILE NO
FRAMING` " 1. - ELECT.FINAL TEST -
- INSULATION - PLUMBING ZONING ENG.SITE NO.
GAS TEST - - GAS. -
_ MECHANICAL• ' FIRE SPRINK ENERGY r24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' f()O
"� Y N❑.
F )ONf: AAL US.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR '+ FIRE DEPT. - "❑ - ° ❑ "❑
. 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
OCCUPANCYOF BUILDINGIS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBV BUILDING INSPECTOR. ' MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC : d0'
I- ONE_WORKING DAY BEFORE .REQUI,RED INSPECTION. . `
ING
I ) PLUMB
Z Y � . PLEASE GIVE JOB ADDRESS'WHEN PHONING';
- SEE PERMIT FOR ,EXPIRATION DATE' MECHANICAL
IMPORTANT! CONST.TAX .
PLEASE'READ REVERSE SIDEBEFORE ft'
CALLING'FOR FINAL INSPECTION TOTAL
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED-TINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
,FiVlLDIfSs9 PROJECT IDENTLFICATION APPLICATION IgE PERMIT I„
Bl11LDING - 18 3.51:
ADORFss BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S _ - - PLAN CHECK VALIDATION
NAME ,_^A QTY 'ELECTRIC PERMIT. ,FEE• I
CONTRACTOR - -
•
R'S
UTLETSO -'SWITCHES-RECEP 11CLOO/1.00
Ng'A�o 111A CVt
LIC.No)•��,/ 3 "LIGHTING FIXTURES .10.00/1.00 ,30 r
CONTHADTgORS
- APPLIANCES-RESIDENTIAL 4.00ADDRESS 10,00iHHDNe -S PANELS
1-7.377
DATE I
OF APPLICATION
ARCHITECT PLAN CHECK FEE,, P:C.i
OR .,. PANELS (OV ER:200•AMP.) 20.00
ENGINEER SIGNS'TRANS - .3.00 -
ADDRESS ENG., - PERMITVAL(DATION '
ADDRESS � �I . SPECIAL CIRCUIT - 5.00 ,
zIP S.C� EMP.METER OR POLE INS.. - 20.00
APPLICANTS - MOTORS SEE FEE SCHu d
ADDRESS .
) ' .
SERVICE CHANGE, 20.00
F o O LICENSIiD CONTRACTORS DECLARATION
a c.w 1 hereby affirm.(hat I am licensed'under provisions of Chapter 9 -
(coencing with Section 7000)of Division 3 of the Business and
ISSUANCE DATE
x BLDG. ELECT. PLG. MECH.
mm
z Professions Code,and my license is in full force and effect. "
z o W- - License Class' LIC.Number - nt�,r -
H I°u Date Contractor - tlY �{(y,,,�F{hn ❑ ❑'.
_ V W.�"1'o'a�� BUILDING,PERMIT
g w u OWNER-BUILDER D2CLARATION INFORMATION
w 3` y I hereby affirm that I am exempt from the Contractor's License MISC.-. REFER TO ORD
I VALUATION $/FT. .�
FUOj' law for the following reason.(See.7031.5,Businessand l'mfessimis PERMIT ISSUANCE 1000 2.tl
Code:Any city or county which requires a permit to construe,alter, . '
Lc"¢ 2O ° improve,demolish,or repair any structure,prior 10 its issuance,also. ELEC.CONTR: LIC.NO. ELEC. •�a{�/
K oil mqulres the applicant for such permit t0 file a signed statement Ilial �� t TOTAL.(r ! O D �pERM T TO
-w m,m' Ira Is licensed pursuant to the provisions of the Contractor c License ,
,F z >
Law(Chapter 9(e.matocingwith Section 7000)of Division 3 of Me
4 i o Business anJ Prol7ssiuns Code):..that he is exempt therefrom and, CITY. PLUMBING PER - •� FEE- G(
t[ r the basis for the alleged exemption.Any violatirin of Section 7031.5 STORIES'. .TYPE, NSTR.
a by any applicant for a permit subjects the applicant to a civil penalty' ALTER-DRAIN -WATER (EA.) 5.00 '
of not more than five hundred Jollars($500).):
. . - ❑ I,as owner of-the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 oCC.GROUP RES,UNITS their sole compensation,'will Jo the work,and the structure is not
- intended or offered for sale (Sec. 7044, Busmess'and Prodessinns DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code: fie Contractor's.License Law does not apply to an owner of
properly who halldS Of Improves thereon,and who lines such work FIXTURES-PER TRAP- 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE,
himself'or through his own employees.provideil that such improve-
ments
mprove- - -
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-,I INC.4 OUTLETS 6.00
nr fmpmvement is'SoW within One year of completion,the owner-
.T builder will have the burden of proving that he did not build or III, GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 r BUILDING USE
prove for purpose'ofsale.). - INDUSTRIAL WASTE INTER3000 RES IND` CON PB other
tu . .
❑' 1.as owner of the property,am exclusively cllrocling with 0 , ❑ O.: 1
licensed contractors to construct the'project(Sec. 7044,Business LAWN SPRINKLERS-.1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
- and Professions Code:*1 lie Contractor',License Law does not apply -
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 "
contracts for such projects with a contractor(s)licensed pursuant to -
the Contractur's'License Law: SEWER-SANITARY-STORM EA.200ft/10.00 - TRACT NO, PARCEL NO.
--' ❑ Iain exempt Linder Sec.- I,B.iRC:for this WATER HEATER W/VENT. - 6.00
mason
Ownrr Date WATER SYSTEM 5.00
ACC.OATE ACC.FILE NO"
WORKERS'COMPENSA'f ION UECUARAT ION WATER TREATING EQUIP, - :5.00 ,
hereby affii'nl that I have a certificate of consen Lto self-insure,
!• or a ce,li0cate of Workers'Co Calton Insurance,or a certified - ZONING ENG.SITE NO.
copy the,yy�.1ff,�•��JJ8QQ Lab
Policy
1
Policy Na!l![)@a13CJflmpany
O ❑ Certified copy is hereby furnished.
. Z Z Cerldm ps fit I 11 the It sp,•cti n dtWsion. FIRE SPRINK ENERGY T-Z4
FO pliinnt �S1 �Qa1 C(-� (t1- MISC.- REFER TO ORD. Y � N❑' Y0 N[]
y - CERTIFICA'fEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W.� COS INSURANCE- PLG.corvrR. • LIC.NO. PLG.
CL 0( This section need not he completed if the permit is for one - TOTAL Y N�- Y F] NC]
hundred dollars(5100)car lass.) - -
U O 1 certify}hat in the performance of the work for which this per, DTV. ' . MECHANICAL PERMIT FEE ' x"FEE SUMMARY
F mit is issue' I shall not crapn person in i lannur so as to I
O w besot tlm !11,eIar
e � �U"'?IoM ptics 'rff/moo3ALTER OR ADD TO MECH. 5.00BUILDING
N'OTI E 1'O AI' I.ICAN'G mukm this Certificate ol'Ex-Sorption;youshouldbecomsubjctrkeriCoAPPLIANCE 5.00 PLAN CHECK
provisionsoftheLaborCbou mint-(.....will annply with FEE
U - such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) - 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,ODOC:RMX6.00 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 permil is issued(Sec. - MICROFILM
- 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) � 8.00
?'. Lancer's Nome c- HEATI NG UN IT 100,000 B.T.U.)9.50
LenJcr's Address ELECTRIC - / pD
I calf., the(have.cul his application and state.h5t the above VENTILATION FAN (SINGLE). 4.00
infatuation is correct. I agree to comply with all city and county
.
• Ninnces and.stale laws relating to-briding construction, and - BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
hereby aulhorira representatives of this city to enler'upon the BOILER-COMP(Over t00,0008TU15EE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
'(We) agree to save, indemnify and keep harmless the City of MISC.- .REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
pl �'
anyway re"
rue against said City in consequence of tie ngo is p•,mnMECH.CONT. LIC.NO: MECH.- -TGTALTOTAL I �Dure of Ap mant'rC�nhoctor Uute t -
OFFICE COPY