17436 POST THIS CARD NEAR FRONT OF BUILDING
.PERMIT NUMBER
IT
CITY OF CUPERTINO , 17436
INSPECTION DIVISION
JOB INSPECTION RECORD
" .. * ''//��[[ {��/F / +`'- �P,rh4 - •P PERMIT,EXPI RATION
JOB ADDRESSUNIT# _LO -
v PERMIT EXPIRES IF WORK
OWNER,' - CONTRACTOR,! - - AS NOT STARTED WITHIN
INSPECTION .DATE I INSPECTOR - INSPECTION RECORD- '180 DAYS OF PERMITdS3U- ;
'FOUNDATION ' ANCE OR 180 DAYSFROM
NOTE:`' • '- "LAST CALLED INSPECTION.
LIFER-. ALL GRADING'AND'DRAINAGE SHALL BE INSTALLED I I ±
TO COMPLY WITH THE'APPROVED PLANS AND CITY OF PERMIT VAP r RATION
PREGUNITE +> CUPERTINO STANDARDS " r I^ , x ✓/ 4r'-
GARAGE SLABS • t + ;!thy `t'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1 / yf T r
UNDERGROUND /,SLAB
- -
PLUMBING,. .
S
ELECTRICAL I'
• '� SUAfI DATE •
.MECHANICAL - r BLDG. ,ELECT I PLO MECH.,.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED •.•t BUILDING PERMIT
WOOD,F.LOOR INFORMATION
VALUATION SIFT.
PLUMBING -
MECHANICAL
ELECTRICAL -, _PERMIT TO
r .
FRAMING 4i1 Ee-7iii III -
• INSULATION a1 STORIES TYPE CONSTR
ki pig
q " "' ,• 74U . JV:J •OCC GROUP RES..UNITS
1.
PLACE NO SUBFLOOR UNTIL'ABOVE HAS BEEN SIGNED
r 'SO.IT.FLOOR AREA TOTAL ACREAGE,
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE-. • '
DIAPHRAGM - - - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOFSHEATHING `INDcoN" PB olnv,
-APPLYNO-ROOFING'UNTILA'BOVEHAS°BEEN'SIGNEO `.9'FINAL`S�" `?�,� , DATE, „�INSP.,,,,a El Ass❑SssoR11ARce�No,o-�
ROUGH SAN.N"
PLUMBING - - 'ELECT.ENERGY '
TRACT NO. PARCEL NO
TUBS&SHOWER PAN ±' .PLUMBING ENERGY,
MECHANICAL ., MECH.ENERGY',
ELECTRICAL ACC'DATE ACC.FI CE NO.,
,. BUILDING'ENERGY - - - -
FRAMING ELECT.FINAL TEST
"'INSULATION. -
PLUMBING 7 r zoNlNr, ENG.SITENO,
GAS TEST GAS o +
MECHANICAL FIRE SPRINK, ENERGY T 24
COVER NO WORK.UNTIL ABOVE HAS BEEN SIGNED HEATING:,.. ❑ e.,-El ❑ ""❑
EXTERIOR SHEAR " r,
ELECTRICAL RELEASE FLOOD ZONE • AU U.C.
INTERIOR SHEAR , FIRE DEPT 'Y'❑ ""❑ "_`9 ❑ NO
SHEETROCK -' _ - - GRADE'.'';,'' •.. .`.FEE SUMMARY '•r,',x
EXT,ERIOR:LATH% ± - BUILDING' • +'
,= INTERIOR' LATH •TEMPORARY APPROVALS' BUILDING r•---•^'+.
SCRATCH COAT • r ELECTRIC.'., - ,PLAN CHECK
'r GAS • FEE "..........,.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED' OCCUPANCY; SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PER MITTED'UNTI L BUILDING FINAL ISSIGNED BVBUILDIN GINSPECTORi "
v MICROFILM'
ARRANGEFOR INSPECTION BY PHONING 252=4505;'.` ELEcraic " . s�
' o ONE WORKING`DAY BEFORE REQUIRED INSPECTION.
PLUMBING
Z PLEASE GIVE'JOB'ADDRESS WHEN PHONING
—.SEE PERMIIT'FOR EXPIRATION`DATE MECHANICAL
IMPORTANT!' ' coNST.rnx
r' PLEASE READ REVERSE SIDE BEFORE
CALLING FOR.FINAL'INSPECTION.J TOTAL
.OFFICE'COPY'
:APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE-BALL POINT PEN.ONLY
- ' iP
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
BUILDING APPLICATION & PERMIT ' _ q
ADDRESS
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
o ERa 7436
PLAN CHECK VALIDATION
NAME G n CITY. ELECTRIC PERMIT FEE
/•� l PHONE too A'kil tft
F
NaM
CONTYCIPDR'S _ -
�. OUTLETS-SWITCHES-RECEP 0 �J O
oZ LIGHTING FIXTURES 10.00/1.00 /.p0
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
/y -PHONE 9 ���/ PANELS 10,00 DATE OF APPLICATION
ARc ITELT - PLAN CHECK FEE P.C.NO..
OR PANELS (OVER 200 AMP) 20.00
ENGINE E/r��
/LW1111f/ iilc.No 1_55LI>.J SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VA ATION
ADonets SPECIALCIRCUIT 5.00 yyyppp
ZIP EMP.METER OR POLE INS., 20.00
APPLICANT'S - MOTORS' SEE FEE SCH.
ADDRESS � If(
SERVICE CHANGE 20.00
w
02 LICENSED CONTRACTORS DECLARATION fUI 1
rztw• I he chy affirm that 1 am licensed never provisions of Chapter 9 - ISSUA E DATE r
¢ (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT PLG. MECH.
o " Professions Code nA license"in full force effec ❑ ❑
z .0!2 Licenu CPgss -» Lic.Number �-�
9 L t w Dme�/-/ems -Contractor �
x a BUILDING PERMIT
¢ ¢ w ¢ OWNER-BUILDER DECLARATION
" MISC. REFER TO ORD INFORMATION
w;LL H I hereby affirm that 1 am exempt From the Contractor's License
u o¢ Law for the followin reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
- g PERMIT ISSUAN 4..fr„ ;sl rat, jV0 /�,oii
Code:Any city or county which requires a permit to construct,alter,
rt a Q o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH/. LIC.NO: ELEC. -
m u regnires the applicant for such permit to file a signet statement that .OY �7 -� TOTAL ��a PERMIT TO
n w he is licensed pursuant to the provisions of the Contractor's License
p z r
Law(Chnpler9(commencing with Suet ion 7000)of Division 3 of the Vlr f I
P 4 o Business and Professions Code)or that he is exempt therefrum,and OTY. PLUMBING PERMIT FEE fltGv�/l/ t.
¢ r o the basis for.the alleged exemption.Any violation of Section 7031.5 el llf STORIES TYPE CONSTR.
n by any applicant for a permit subjects the applicant loo civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($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 do the work,and the structure Is not
intended'or offered I'ur sale (Sec. 7044, Business and Professions t DRAINS-FLOOR,ROOF,AREA,COND. 5.00 '
Code:The Contractor's License Law does not apply to an owner of -
properlywho.builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself notthrough his oor wn employees.Provided that such improve-me re improv Ment is
within offeredfor
yearsale.o If,however,thebuildingoGAS-EA.SYSTEM-1 INC.4OUTLETS 6.00
or improvement isre b within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or in+. - BUILDING USE
prove for purpose of sale.). INDUSTRIALWASTEINTER. 3000 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with . 0 ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 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
contracts for such projects with ucontmct.00 licensed pursuant to SEWER=SANITARY-STORM EA.200ftI10.00
the Contractor's License Law. TRACT NO., ,PARCEL NO.
❑ lace exempt under Sea ,B.&P.C.for Ibis
on WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATINGIR1901D 5.00
I hereby efface that I have m certiticuW of consent ID self-insure,
- or a certificate of Workers'Compensation Insurance,or a certifiedn _ ZONING ENG.SITE NO.
copy thereof(Sce.3800,Lab.C.).
Policy No. 7�1 Company- • %/ib RG
O ❑ CertifiedcOp hereby mashed. FIRE SPRINK ENERGY T-24
Z Z -Q�Cerny�d I 1 h H city inspection division.
F 0 Applicantg,L � � I - MISC.- Qty JIREkgRl TO ORD. Y E] N[ Y [3 No
IL W CERTIFICA'FF Op EXEMI'1]0N FROMWORKERS' _ PERMIT ISSUANCE J. 10.00 FLOOD ZONE A.LU.C.
LU COMPENSATION INSURANCE PLG.CONTE, LIC.NO. PLG. +
CL a' (This section need not he completed if the pennil is for one TOTAL Y❑ N� V NEI
Z hundred dollars(5100)or less.)'
U 0 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I Shall not employ any person in any manner so as to
Q w become subject to the Workers'Compensation Laws of California. 'a
y Date • Applicant - - BUILDING
�- m N01 ICH TO APPLICANT: If,after making this Certificate of Es ALTER OR ADD TO MECH. 5.00 -
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE '�-•
U such provisions or,his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
'CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.FM.) 6.00 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 permit is issued(Sec. MICROFILM
3097,Civ CJ. �'. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -
Lender'sAddress-_ HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC -�
I certify that rove read Ihis application and stale that the above VENTILATION FAN (SINGLE) 4,00
information n cornet.1 agree to comply with all city and county PLUMBING
. ordinances and state laws relating to building construction, and BOILER-cUMP(3 H.P.Or100,000 B.T.U.( 6.00
hereby authorize ropertyfor insves of this city es enter upon ,he BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL hereby
property for inspection of
purposes.
(WeP agree to save, indemnify and keep harmless the City of MISC.-j - REFER TO ORD.
` uperHno against 1'' lities,judgments, costs and expenses which
yy� CONST.TAX
say in any way f rue ag•�� st said City in consequence of the PERMIT ISSUANCE 10.00
ran/t1��Iq)11([7 pe it. �/�4 p MECH.CONT. , .;," LIC.NO, MECH,
ISn' � r TOTAL
• S dt a of A ph�[(Contractor Date Y`- TOTAL �Y/f-/✓/r/
OFFICE COPY