17547 POST THIS CARD NEAR FRONT OF BUILDING
' _ -PIiRM1llT NUMBER
' CITY, OF CUPERTINO 17547
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS Z�� - Y.�-L_U\V_% V 1-,p_�UNIT# _LOT#
( PERMIT EXPIRES IF WORK
' OWNER $ , -vi vL� CONTRACTOR J• II IZ IS NOT STARTED .WITHIN
INSPECTION DATE INSPECTOR. INSPECTION RECORD _180 DAYS OF PERMIT iSSU-
FOUNDATION NOTE:
- ANCE OR 180 DAYS FROM
�
LEER - - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.'
PREGUNITE TO COMPLY WITH THE APPROVED PLANS ANDCITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. - u
GARAGE SLABS I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - - •� /.
UNDERGROUND /SLAB
PR 3 1l�34� 7.
PLUMBING p ,..Lw. -
ELECTRICAL - city DIc COpw ISSliANCE DATE
MECHANICAL ' - - BLD(! -ELECT. P1777 MEG..
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR
INFORMATION
wI
PLUMBING VALUATION SIFT.
- � � -
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING - - -
INSULATION - s off ECONSTR.
OCC,GROUP HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP.SHALL DE MADEBEFORE so.fT.aooR AesA TOTALncREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING HES 'IND UOCONusEPB OM"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSEl0 0
P.
ASSESSORS PAHCELNO.•
ROUGH SAN.#
PLUMBING o— p ELECT.ENERGY
THACI NO; PARCEL NO.
TUBS&SHOWER PAN ' - - - - PLUMBING ENERGY -
MECHANICAL L/—/p J' I MECH.ENERGY
ELECTRICAL. - �G ,Tp BUILDING ENERGY -ACC.DATE ACO.FILE NO,
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION - •� PLUMBING
GAS TEST /0 GAS -
MECHANICAL _ FIRE SPRINK ENERGY i;14.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y 0 No Y ❑ N Tl
.
EXTERIOR SHEAR - ELECTRICAL RELEASE - f LOOUZONE A,L.0C. '
INTERIOR SHEAR FIRE DEPT. - Y❑ •N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING.. -
INTERIOR LATH_
TEMPORARY APPROVALS BUILDING ,
SCRATCH COAT . ELECTRIC PLAN CHECK
` GASFEE
I . .
-NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL 16SIGNED-BY BUILDINGINSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC,
b, .V b
LU ONE WORKING DAY BEFORE .REQUIRED INSPECTION. PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
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 LDING PROJECT I OENTI FICATION PERMIT NUMBER _
polp ? . APPLICATION & PERMIT 17547
sAM7M KV BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ,
OWNER'S PLAN CHECK VALIDATION
NAME
' I 11 �� r/g.t TV. ELECTRIC PERMIT . FEE
41
'T •Y� l41 HONE 2,9-7 r
CONTRACTOROG
UTLETS-SWITCHES-RECEP 10.00/1.00 J.,40eS Kw'e. uc.No.,,S,l LI33 - LIGHTING FIXTURES 10.00/1.00 -
CONTRACTOR'S
ADDRESS �j$SS,��'''_pk1, PPLIANCES-RESIDENTIAL 4.00 ' -
U ' L� PHONE `4171"`1Zi PANELS ' ' 10.00
DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.N 1.0.
DR / PANELS (OVER 200 AMP) 20.00
ENGINEER -LIC.NO. SIGNS TRANS." - X3.00 i
ARCH PERMIT VALIDATION
ARCH OR ENG. / - SPECIAL CIRCUIT .5.00 L. DO _
ZIP EMP:METER OR POLE INS. 20.00 �h
APPLICANT Ns
APPLICA MOTORS SEE FEE SCH.
/1 //� Ill
N c-s5 R TBS Cc- 5W3 SERVICE CHANGE � - 20.00 1 - T VL`
00 LICENSED CONTRACTORS DECLARATION J De' Avi r -
c u 1 hereby al Lou.that I an licensed under Provisions of Chu pier 9 'j
rt w ISSUANCE DATE
(Commencing with Section 7000)of Division 30C the Business and BLDG. ELECT. PLC. MECH.
D4 i Professions Code,and my license is in full force and effect ❑ �-y
°m - License Class Lia Number - -
E m H o Dale Contractor - -
a at s a OWNER- 71
BUILDING PERMIT
BUILDER DIiCLARATION
° w ° MISC.- REFER TO ORD INFORMATION
A.
g e w I hereby affirm Ihm 1 um exempt from the Contractor's License
Fu0 < Law for the following reason.(Sec.7031,5,Business and ProfessionsPERMIT ISSUANCE 10.00 VALUATION $/FT,
Crede:Any city or county which requiresa permit to construct,alter, Z/PD
2 Ea p improve,demolish,or repair any shuclure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
° u requires the applicant for push permit to file II signed momma that ' ' TOTAL e r d� PERMIT TIO
F
S' he is licensed pursuant to the provisions Of lite Contractor's License TO
i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
1 a" Business trod Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE e{
ce r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORI T CONSTR.
a , by any applicant fora permit dollars($500r):
oacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars the applicant
❑ 1,as owner of the property,or my employees wi[h•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 (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of -
p.OPerry
Who builds or improves Iherema,and who does such work FIXTURES-PER TRAP 5,1111 SO.FT.FLOOR AREA -TOTALACREAGE
himself a through his own employees, le.If.l ed that such improve
himself a net through
oroffend for sale.If. thatothemprcng GAS-EA.SVSTEM-11NC.40UTLETS 8.00 a OO•
or improvement is sold within one year of completion,the owner. GAS.EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have tiro burden of proving that he did not build or mi- BUILDING USE
1% prove forpurpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB - Other
11I,as owner of the properly,am exclusively contracting with RE Ellicensed contractors to construct the project(Sec. 7044,Nosiness LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESS11
ORS 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
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. - PARCEL NO.
❑ l am exempt under Set.-,R&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACO FILE NO,
WORK FRS'COMPENSA'I ION DECLARATION, WATER'TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsem to selGinsure,
or it certificate o'Work6rs'Compensation Insurance,or a c mitred ZONING ENG.SITE NO.
copy flamol'(Sec.3800,Lab.C.). �((--�p.���.�,�
Policy NO. ComPlmy! ; _Vy_M_ -
.0, ❑ Certified cry is hereby trickled
Z Z ❑ Certified o fed is w' I II spectict division. _ FIRESPRINK ENERGY T 24
� O Applicnt .54s4' � MISC.- REFER TO ORD. v0 N[] v � N�
H CERTIFICATE OF EXEMPTION FROM WORKERS' -PERMIT ISSUANCE 10.00 'FLOOD ZONE A.L.U.C.
W > COMPENSATION NSURANCE PLG.CONTR." -"LIC.NO. PLG.
CL O This section neednal be completed if the permit is for one TOTAL . 01D Y� Na Y E] NE)
� Z hundred dolla,Ii(SI00)nr less.)
U O .I certify pmt in the pertornlnnce or The work for which this per- QTV MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to -
U become subject to the Workers'Compensation Laws of California.
Oa LU Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
). to NOTICE TO APPLICANT': If,after making this Certificate ul'Ex-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 500 PLAN CHECK
provisions of the Labor Code, you must Ibrthwith comply with .
U such provisions or this permit shall he deemed revoked. - AIR HANDLING UNIT(TO 10,0011CFEEF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT)' 5.00 6,
S:
the performmnce'of the work for which this permit is issued(Sec. MICROFILM
3097,Cw.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
LeiWer's Address HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
I certify that l have read l his application and state that the above VENTILATION FAN (SINGLE)
mfon n correct I agree t0 comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances Tranand correct. I a relating In building l city uction,and co and
hereby authorize representatives of this city m enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCM. MECHANICAL
abovehereby
atilli rco propertyforinsp of this
purposes. s
(W ) agree to save, indemnify and keep harmless the City of MISC.; REFER TO ORD.
Cuper in0 against Iiahidities, 'udgm• is. costs and expenses which CONST.TAX
ay i any way accrue a• rest ai City in consegaence.of the PERMIT ISSUANCE 10.00 Z.r. UO
renti ofthis permit I, MECH.CONT.. LIC:NO. MECN.
3=G TOTAL ' TOTAL y F
arc of Applicant/Contractor Dulc 1 8
OFFICE COPY
2� POW
(p
l) �'
IfN
APPI?OVED
IN ACCORDANCE WITH THE CITY OF 1119
CUPERTINO CODE3 AND ORDINANCES
DATEY
SIGNED J O e Amrec
- In
elf vCc(' R'
This set 0i
be kept on the `p"CPf"cati:ns hiUSl
P a a 4t:rs-nd-iC1s on. "�5
lawful t0 msi r, —
y -' r�.s 0r a;<mai'�d"
on same wli — — —
J
bw, ;:o m scion frr,rr. �3�/'. ® L N d
i:nr :yep G(Y L'atpc Lna.
slam,; ng , :i g
p;;ciucatinns i �9`
OALL i;,,t !it ..z., [ , , .,aa c, to bo an f� _
approval W the ;,r nny Provisions
of an ; —
Y City D,tl:nanco ur State Law.
�— fJGa1 VOR��S 0
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