17135 POST'THIS CARD NEAR FRONT OF BUILDINGPF" aMIT NUMBER,
-CITY OF CUPERTINO : 17135
INSPECTION DIVISION
JOB INSPECTION RECORD
• R (� - i�PEAMIT EXPIRATION
JOB ADDRESS— U�� e1� - ✓� ' 'UNIT# _LOT#
_ f•, ��f� - PERMIT EXPIRES IF.WORK f
OWNER co� CONTRAcroR b2.�!'Co Ut CUV..t"t'. IS NOT STARTED;WITHINI';
INSPECTION ATE INSPECTOR INSPECTION RECORD 180 DAYS OF;PERMIT ISSU-
FOUNDATION - - - -- .ANCE-OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
LEER ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
PREGUNITE ,TO COMPLY WITH THE APPROVED PLANS AND CITY,OF PEHMIT VALIDATION
_ - CUPERTINO STANDARDS: c.
' GARAGE SLABS ' � ' • ` ' '; - - r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 3 3O- PRwme RLo +>,b a�(b u 3�1
•• '
UNDERGROUND,/SLAB - ,,QQJJ..4��,�I'.VC.�-•
PLUMBINGi-Av-To P '`PQCrb 'TiD �jH•1
ELECTRICAL
ISSUANCE DATE
MECHANICAL 3) RLuc. ELECT PLG. MECR
`Nc= r ,❑ , ❑ El
DO NOT POUR FLOOR'UNTIL ABOVE HAS BEEN SIGNED �Ns�) 4Tiau �y Gl��_ _ BUILDING PERMIT
WOOD FLOOR p es cc--(,)) P INFORMATION
PLUMBING IL L Ra ^ E VALUATION , SIFT.
MECHANICAL'' T B� OM,-5715 4y 1a0.q-,
vIa owl
ELECTRICAL - - PERMITTO
FRAMING - xw
I , 1 YiIVb/>d.l�
INSULATION - - - STORIES TYPE CONSTR.
CGi'V"9�1.•/G00.. /Tr 3 oca GH(]uP.. RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
Sll.l�i.IL()(1N PREA 'TOTAL ACREAGE
ROOF _ NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID _
ROOF SHEATHING BUILDING USE
- Hes iND CON Pe GO—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑' ❑" ❑ ❑
ROUGH - SAN.h - ASSESSORS PARCEL N O.
PLUMBING I ELECT.ENERGY - ' -
TUBSBSHOWERPAN -
TRACT NO, PARCEL NO,
PLUMBING ENERGY
MECHANICAL I MECH.ENERGY
ELECTRICAL - BUILDING ENERGY - ACC.DATE ,Aca FILCNO•
_
FRAMING" ELECT:FINAL TEST -
'INSULATIONPLUMBING - ZONING""� G.SITE NO.
� EN,
GAS TEST - GAS -
e
MECHANICAL FIRE SPRINK : ENERGY T-44
� '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING „ ❑ "❑ ❑ :• "❑
EXTERIOR SHEAR 'ELECTRICAL RELEASEFLOOD zGNE -
INTERIOR,SHEAR ' - - FIRE DEPT:' - - Y ❑ "❑ °❑ '.N❑'
SHEETROCK - GRADE • - I, FEE SUMMARY,
EXTERIOR LATH ^" BUILDING - t
INTERIOR LATH " - .,TEMPORARY APPROV LS BUILDING - -t/6•
SCRATCH COAT ELECTRIC - PLAN CHECK
ti GAS. FEE -_.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE '6e,O
OCCUPANCYOF BUILDING ISNOTPERMITTEO UNTILBUILDMG FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC '
o� ONE WORKING DAY,BEFORE REQUIRED INSPECTION. . PLUMBING
Z PLEASE GIVE'JOB ADDRESS WHEN'PHONING.
SEE PERMIT FOR EXPIRATION DATE -- t • MECHANICAL
. IMPORTANT,!
CONST.TAX ,
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING•FOR'FINAL^INSPECTION
OFFICECOPV .','
APPLICANT TO,FILL,IN INFORMATION WITHIN RED LINES'- USE".BALL POINT PEN ONLY
'EUU.DI NG PROJECT I D_ENTI'FICATON - PERMIT'NUMBER -
APPLICATION &'PERMIT "
euuDIIvG : _ - • 1.7135
ry.
BUILDING'-ELECTRICAL-PLUMBING-MECHANICAL ,
• OWNER'S AP I r Ca/iPU j��.1 AI.Cv - PLAN CHECK VALIDATION
NAME-,/T/ /�/- �. QTY.- • " ELECTRIC PERMIT FEE a `'
E? '.STS[UA 65/i� ON� 2. �•p�D J069D •.i�8 E
CONTRACTOR S� -OUT /1.
LETS-SWITCHES-RECEP' 10.0000
NAME a ..
n�LIEc NG
399 63 LIGHTING FIXTURES 10.00/1:00 ?
CONTRACTORS •.APPLIANCES.-RESIDENTIAL _ 4.00
ADDRESS .F �' AA�rr •?"
S E -% PANELS 10'00 DATE OF APPLICATION
ARCHITECTpr �¢LV� " PANELS (OVER MO AMP) - 20.00 PLAN CHECK,FEE PG 0.
OR
ENGINEER
91 -S /}/j-/f [7� ., C'_Q ^ ZS
O. ,SIGNS TRANS. 3.00
ARCH.OR ENG. + - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 1
ADDRESS' �• �[ - �}.
to,97I�I EMP.METER OR,P,OLE INS:, 20.00 • ��'�'��"'�
APPLICANT'S >. - MOTORS SEE FEE SCH.
ADDRESS'
�•p �/- � 51 C-A-T�II' SERVICE CHANGE 20.00 1� ^ �tx lS '
w D o LICENSED CONTRACTORS DECLARATION
poZw I hereby affvm th't Intel[I trued under provisions of Chapter 9- - _ _ _ISSUANCE DATE _
F z y (commencing with Se-Oon'7000)of Division 3 If the Business and BLDG. 'ELECT. PLG MECH .
I H o z Professions Cod InY license is in full f - IAAK � ,�A,T
z O r„ - Lcen� Lia Numbc / _ - I7/'�"I ❑ ❑ ❑
O z r w Dote Contractor
.' Qf BUILDING PERMIT
'e- Y ¢ ¢ OWNER B111LUBR UBCLARATION - M INFORMATION
¢ o a ° MISC.�. REFER TO ORD
w 3 u 1 hereby affirm that I am exempt.from[he Contractor s - VALUATION $/FT:.
� LLo¢ Law forthe nycityloriountywh which requires
5,ermitt sand Professions PERMIT ISSUANCE'. � � 10.00 -
Cade:Any coy Or county whiny structur a permit toconsuanc eller, -
E 0 D Iegnues,demolish,oerepau any sticture,prior to its issuance,talso ELEC.CONTR. LIC.NO. ELTA
w
w p O¢ re is licensed
pursuant
t such permit to file a signed StatementthatTOTAL PERMITTO
u,W w y' he is licensed pursuant[O the provisions of the Contractor's License - .„
iz > Law(Chapter9(wmmencingwilh Section 7000)ofiDivislon3ofthe -
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT JEFF -
Se F D the basis for the alleged exemption.Any violation of-Section 7031.5' - STORIES .TYPE CONSTR''
d E$. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
-❑ 1;as ownedof the property,or my'6mployees with wages as BACK FLOW PROTECT.DEVICE 4.00 '
their sole compensation;will do the work,and the structure is not' - OCC.GROUP, RES.UNITS/
intended Or offCrCd,f.r,s.iC (Sec. 7044, Business and Professions . DRAINS-FLOOR,ROOF,AREA,COND. .5.00
Code:The Contractor's License Law does not apply to an owner of -
propetly,wh0 builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA •TOTAL ACREAGE
himself or through'his own employees,provided that such improve-
��• ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS'-EA.SYSTEM'-OVER 4(EA,) 2.00 BUILDING USE
builder will have,the burden of proving that Ile did not build or im- - - RES IND -ION PB. OtM1ar
prove for purpose oh'sale.). = INDUSTRIAL WASTE INTER. - 30.00 '
❑ I,as owner'of the properly,am exclusively contracting with. ❑ •❑ '❑ . ❑ ❑
licensed contractors to construct the project(Sec.7044 BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 p•ASSESSORS 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 _ 'r
- contracts for,srmh projects with a conlraclods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL N0.
E] I am exempt under Stu ,B'&P.C.mr this WATER HEATER W/VENT '_ 6.00 -
reasm
Owner Date WATER SYSTEM: - " 5.00 nee.DATE• Ace.FILE NO.
'WORKERS'COMPENSATION DECLARATION _ WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificateofWorkers'Compensation Insurance,or a'certified
copy thereq((geE�p Cm Lab.C�A1 1
Policy No._ Company /I 00 _
Q ❑iCerlified copy is hereby(I�m��i�shed. t r FIRE SPRINK ,ENERGY424
Z Z . I'l Cetlif��pf�py' �Is��Bled �`" 1.{' eQ�Y1�p��r n.
O, APPlicaot �A/^'�`'^'^' "*'�` -
MISC.,- , REFER TO ORD. Y ❑ N❑ Y ❑ N[_
~ T " `' PERMIT'ISSUANCE 10.00 FLOOD ZONE 'A.L.uc.
LU ;CERT]EIC ATE EXEMPTION FROM WORKERS'
.r W > COMPEF NSkAATION INSURANCE
URANCE PLG.CONTR: LIC.NO. ' PLG.
.1 (''his section need not be•eompleted if.the Permit Is for one _ TOTAL Y C] N❑ Y•❑ N❑
D Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for,which this PC" QTY. MECHANICAL PERMIT FEE FEE SUMMARY-
LL H mil is,issued,I shall not employ any person in any manner so as to
w -
U become subject to the Workers'Compensation Laws of California.
Date-Applicant ' BUILDING f
a ALTER OR ADD TO MECH. 5.00 99
>_ W NOTICE TO APPLICANT: IL after making this Certificaoc-of Ex- _ -
FZ coalition,yen should become subject to the Workers'Compensafion APPLIANCE 5.00. PLAN CHECK '
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY, AIR HANDLING UNIT(OVER 10pODC.F.M.).6.00 SEISMIC FEE �CID
,1 hereby affirm'that there Is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 ,
the performance of,the work lot which this'penuit Is issued(Sec.' MICROFILM '
3097Civ.C.). r - HEATING UNIT(TO 100,000 B.T.U.) 5.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address-. ELECTRIC
I certify that,[have read this application and state lam the above VENTILATION FAN (SINGLE) 4.00 Sv
Information is correct. I agree to comply with all city and County - PLUMBING
ordinances and slate laws relating to building construction and BOILER-COMP.(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the , - BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL -
above-mentioned property for Inspection purposes. -
( e) agree to Save,,indemnify and keep harmless the City of MISC.- _ - - REFER TO ORD. '
Col rtlno against liabilities,ludgments;'cosls,and expenses which CONST.TAX•
m
Vofth
ac tart agamst said City Inconsequence of'the PERMIT'ISSUANCE 10.00' f . MECH.CONT. - LIG.NO. TOTAL'Ap licanl/C seems - Date' I
OFFICE COPY