17953 POST THIS CARD NEAR FRONT OF BUILDING
_ 'PERMIT NUMBER .
CITY OF CUPERTINO 17953
INSPECTION DIVISION
JOB INSPECTION RECORD
h PERMIT EXPIRATION
JOB,ADDRESS l 0 y_ ._ .�u+r��'E� IJ-� •UNIT# _LOT# PERMIT E%PIR ES'IF WORK
OWNER - •(Q C�•i..L CONTRACTOR 1(`( Za, c_Cr - IS,NOT' STARTED WITHIN
NS ION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- .
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
' LIFER - ALL GRADING'AND'ORAINAGE SHALL'BE•INSTALLED LASTCALLED INSPECTION:
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERMIT VALIDATION
CUPERTINO STANDARDS. "? „ t'
„�.
GARAGE SLABS" - - '`i == 2" ••K'�r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - '�.
PLUMBING
` ELECTRICAL City of cupwwo ISSUANCE DATE
MECHANICAL - - BLDG ELECT I PLG. MLCH
. ❑ .❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR '.INFORMATION
VALUATION
_ PLUMBING SIFT.
- ,
MECHANICAL
ELECTRICAL +' PERMIT TO
FRAMING • , :cC'
T INSULATION > STORIES TYPE.CONSTR.
1711.GH11P'- RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
t
- - ROOF NO FINAL INSP.SHALL BE MADE BEFORE SO IT,FLOORAREA TOTALACREAGf.
THE C
DIAPHRAGM - .� THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING ` , RES IND CON PB Go— .�
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE" INSP, 0 ❑ C] 1:1 ❑
ASSESSORS PARCEL NO
ROUGH SAN.9
PLUMBING - ELECT.ENERGY - -
TRACTNO. PARCELNO
TUBS 85HOWER PAN PLUMBING ENERGY
MECHANICAC " _ MECH.ENERGY '
ELECTRICAL. - s BUILDING ENERGY ACC.DATY ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO,
- INSULATION PLUMBING GAS TEST - GAS - -
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E] NY,E] NO
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUC.
INTERIOR SHEAR - FIRE DEPT. ' Y❑ N 1 ''° 4L,1 N❑
SHEETROCK GRADE" FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATHr ' ' •• TEMPO RARY APPROVALS BUILDING '
SCRATCH COATI - ELECTRIC - PLAN CHECK .
r , - GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE `
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR: MICROFILM ,•
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC` (�
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
' PLEASE,READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL' . U •!`b ,
OFFICE COPY.
1.
APPLICANT TP FILL IN IN FORMAT ION.WITHIN RED LINES = USE BALL POINT PEN.ONL'Y'.
BUILDING PROJECT IDENTIFICATION rr PERMITNUMBER
nDILDING �M dk*PPLICATION &PERMIT �„ (],[�
BUILUJ�G BUILDING -ELECTRICAL-PLUMBING-MECHANICAL sJ';.- 95
OWNER'S "" ' - - PLAN CHECK VALIDATION
"" E CITY. ELECTRIC PERMIT FEE + - fl
_ aNE; 3S/ orH
• '• • + 2
CONTRACTOR'S • r..
NAME UTLETS-SWITCHES=RECEP.- 10.00/1.00 9
f10.00/1.00
1"1201'e. -LC'C1 IC ' LIC No. 0094.. LIGHTING FIXTURES
CONTRACTORS
y fj - �HM1Y ' APPLIANCES,RESIDENTIAL 4.00
ADDRESS N E(�71r
'
PANELS .10.00 DATE OF APPLICATION
ARCHITECT - _ PLAN CHECK FEE. .P.C.NO.
OR
PANELS (OVER 200'AMP)" 2466
ENGINEER. LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG - - - q - - ' 66' ;{ :PERMIT VALIDATION '
ADDRESS X SPECIAL CIRCUIT • 5.
` '• ...21P EMP.METER-OR'POLE INS., • .20.00
APPLICANTS - - MOTORS SEE FEE SCH.
'
ADDRESS � ,
• SERVICE,CHANGE
w o o- LICENSED CONTRACTORS DECLARATION ••.+ -
J . ,��I,'
< o I hereby affirm`that l,am licensed under provisions of Chapter,9 a t •A✓ •� .ISSUANCE DATE
2: "' (commencing with Section 7000)of Division 3of the Business and - _ MAY �-Q��� BLDG.. ELECT],-PLG. MECH." °
wi Professions Code nd my license Is In full force and'effecl - JVJ _ ❑ ❑
z o rn- License Clas Lic,Number 450 092 -
' o z r Date S'.-rn/59_ Commctor�L-'(CLq
P: x E - - BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION - - -
¢ w u - INFORMATION
w3 n y 1 hereby affirm that I am exempt from the Contractor's License MISC. ORD •a .vgLUATION - $/FT.
HP. o< Lawfor thefollowingrCode:Any city or county which requires a permit tocason, ,cc 70315,Business and Professions PERMIT ISSUANCE • 10.00
onatinct,alter;
.a ¢¢ improve,demolish,or repair any structure,prior to its issuance also ;E LEC.CONTR. - " 'LIC.N0. ELEC. J�
u LL'Do requires the applicant for such permit to file a signed statement that TOTAL 3 6a' I D ,
w m he is licensed pursuant to the provisions of floc Contractor's License PERM TO
- - 1 ,
Hzi -
Law(Chapter 9,(cominencing with Section 7000)of Division 3 oflhe - -
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE If
¢ H p the basis for the alleged exemption.Any violation of Section 7031.5 _ .ST RIES- TYPE CONSTR.
u ; m bynny,applicant for a'permit subjects the applicantloa civil penalty gLTER-DRAIN.&VENT-WATER (EA.)' 5.00
of not more than five hundred dollars($500).): '
❑ 1,as owner of the property,or my employees with wages as . BACKFLOW PROTECT.DEVICE 4.00
their sole.compensalion,will do the work,and the structure is not - - OCC.GROUP. RES.UNITS.
intended or offered for sale(Sec. 7044, Business and Professions -DRAINS-FLOOR,ROOF,AREA,COND. '5.00 -
Code:The Contractors License Lew does not apply to an owner of - - -
property who builds or Improves thereon,and who doer such work FIXTURES-PER TRAP �• - 5.66 SO.PT,FLOOR AREA TOTAL ACREAGE
himself or through-his own employees,provided that'such improve-
l� GAS-„EA.SVSTEM-I-INC.40UTLET$ 6.00
mems a no not intended.,offered forsale.If,however,the building - ,
or improvement is sold within one year of completion,the owner- 'GAS-EA.SYSTEM-OVER 4 IEA.) 2,00
builder will have the burden of proving that he did not build or im- BUILDING USE-
prove for purposeofsale.). -' INDUSTRIAL,WASTE INTER: 30.00 RES .IND CON PB Other.'
❑,I;as owner of the property,am exclusively,contracting with ET ED El ❑ ❑
licereed'contractors to.construct the project(Sec. 7044,Business LAWN 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(if property who builds or improves thereon,and who LAWN SPRINKLERS-,OVER-5(EA.) .1.00
- contracts for such projects with o contructons)licensed pursuant to - SEWER-SAN EA:200ftI10.00
the Contractor's License Law' TRACT NO. PARCEL NO.
❑-.l am exempt under Sec ,BARC.for this WATER HEATER WIVE T, - 6.00
reason
Owner Dute - WATER SYSTEM - -5.00
ACC.DATE ACC.FILE NO.,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I'heruhyaffirm thit'I have acertificate of consent Lo sell-insure,. •' ZONING ENG.SITE NO
.r a'certificate'of Workers'Compensation hourance,ror a certified
crop,thereof(See.38 L .CJ. - {� > - - "
Policy Nb'f^5; 3 I I . /gMEP(fON S'rA tES INC -
U Certified copy is hereby furnished '., FIRE SPR INK ENERGY T 24
Z Z �(`Cerlify+d"�2cry is�`f� d t he n:pe fon division - - - -
O A phcantGcb-muK.l� I MISC - REFER TO ORD. 'y❑ N❑; v ❑ '^N❑
I- rn '__'� - 'PERMIT ISSUANCE - 10.00
-cc CERTIFICATh OF EXEMPTION FROM WORKERS'„ .. ` - FLOOD ZONE 'ALUC.,
LU ,COMPENSATION INSURANCE. PLG.CO NTR. LIC.NO. PLG. `
CLO (This section,'need not,be completed if the permit is for one, - TOTAL Y❑ N❑ 1 Y❑. N❑
DZ" hundred dollars($1170)or less,) - " .•
U O 1 certify that in the performance-of the work for whicti,lhhs per-'• CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mht,is IssucILL shall nal employanyperson in any manner so as to - -
U Q become subject to the Workers'Compensation Laws of California.
e d..• Date Applicant - - BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR'ADD TO MECH. 5.00 -
H Z cation,you should become subject to the Workers'Compensation APPLIANCE,' - 5.00 PLAN CHECK.
provisions of-the'Labor Code, you-must forthwith comply with t FEE,
U - such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY. AIR HANDLING UNIT(OVER 10PWC.EM.) 6.00 t SEISMIC FEE "
I hereby"affirm that there is a construction lending agency fon EXHAUST HOOD(WITH DUCT) 5.00 -
tire performance of,the work for which this permit is issued(Sea. - - - MICROFILM
3097,Civ.C.). - ' ' HEATING UNIT-(TO 100,000 B.T.U.) ' 8.00
Lender's Name -
Lender's Addresr HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC'.' D
( certify thatI'have read this applicziibn and state that the above VENTILATION'FAN (SINGLE) 4.00 1
Information is orrect.l agree to comply with all qty and'county PLUMBING .
ordinances and"state.laws relating to building construction, and, - BOILER-COMP(3-H.P.of 100,000 B.T.U.) 6.00
hereby,authorize representatives of this city.to..enter upon the BOILER-COMP (Over 100,000 BTU)B EE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes., • _
(We) agroe to save, indemnify.and keep harmless the City of MISC: REFER TO ORD.
upeitino against liabilities,judgments, costs and expenses which CONST.TAX
may.in-any:way accrue a• in id Ci in consequence of the •PERMIT ISSUANCE 10.00
,anti this permit MECH.CONT. 'LIC.NW - MECH. '
TOTAL TOTAL
'ft are of Applican Contractor 1, Uul ^ • 13
put,?'
. J.
a. OFFICE COPY