17592 I,
POST THIS CARD NEAR FRONT OF BUILDING
_ y PERMIT NUMBER
CITY. . OF CUPERTINO 17592
J1` . INSPECTION DIVISION
JOB'INSPECTION RECORD
p• , � I �n .,, � ERMEXPIRA�TI�ON
708 ADDRESS_/—` ' UNIT# _LOT#•
PERMIT EXPIRES IF WORK
' - OWNER,; Q' C-0 'CONTFACTOR befe--l7 Vt IS NOT STARTED WITHIN
INS E TION DATE -INSPECTOR INSPECTION RECORD 180 DAYS OF..PERMIT ISSU, :
FOUNDATION - • ANCE OR 180 DAYS FROM
-NOTE: ' LASTCALLED INSPECTION. '
UFER - ALL'GRADING AND DRAINAGE SHALL BE INSTALLED'
PREGUNITE' TO COMPLY,WITH THE APPROVED PLANS'AND CITY OF HERMIT VALIDATION
CUPERTINO STANDARDS. "
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
,-UNDERGROUND /SLAB AOR 11
PLUMBING . . :J .P?'lll��..✓' �•'<'C'I
ELECTRICAL
ISSUANCE DATE
MECHANICAL' - Bluu ELECr. .•PLG: MECR
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - y - BUILDING PERMIT
WOOD FLOORINFORMATION
PLUMBING
VALUATION S/FT,
- � � � _
MECHANICAL' '� -•OvD
ELECTRICAL- PERMIT TO
a . FRAMING - .. f ' q 1 `e-,,w iolw
- INSULATION Yl 1 11O _ STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
I� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SD 1r,FLOON AREA TOTAL ACETATE
ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
L DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
' ROOF SHEATHINGREs roo ILDINGCON USE'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED, FINALS6'ATE INSP. ❑ ❑ E] ❑ El
ASSESSORS PARCEL NO,
ROUGH SANA
(r PLUMBING EIECT.,ENERGY
EL
TRACT NO. ' PARCNO.
TUBS BSHOWER'PAN -':' �' � , PLUMBING ENERGY -
MECHANICAL MECH.ENERGY - y
ACC DATE - ACC.FILE NO
f
ELECTRICAL; ` BUILDING ENERGY I '
FRAMING ELECT.FINAL TEST-
I NSU LATI ON ' PLUMBING
EST-INSULATION' PLUMBING,: ZONING ENG.SITENO.-
GAS TEST y, - GAS -
FIRESPRINK ENERGY T2C
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "'❑ ❑ "❑
�/ D FLOODZONE A.L,U,C.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEARFIRE DEPT. Y 11 ED Y ❑ NEI
• ' SHEETROCK GRADE - - FEE SUMMARY
EXTERIOR LATH BUILDING - - 'a,,l.
INTERIOR'CATH - " TEMPORARY APPROVALS I BUILDING - V
SCRATCH COAT ` ELECTRIC '" P46N_CHEG
FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuvgNcv. SEISMIC FEE yt
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED,BY BUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICELI
. FONE WORKING DAY BEFORE .REQUIRED INSPECTION. PLUMBING
' O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z EMECHANICAL
+
SEE PERMIT FOR EXPIRATION DAT
— -
CONST.TAX'
•IMPORTANTI . ,I
.PLEASE READ REVERSE SIDE BEFORE "
CALLING FOR FINAL INSPECTION: TOTAL .
OFFICE COPY
APPLICANT TO F.ILL'IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
. BUILDING PROJECT IDENTIFICATIONPERMIT NUMBER
BUILDING . APPLICATION & PERMIT '
A� ES� 17592
BUILDING-,ELECTRICAL-PLUMBING-MECHANICAL
l) O NER'S PLAN•CHECK VALIDATION
E ///� DTV. ELECTRIC PERMIT FEE '
• Olt
PHONE_` 1 . .•
I:DNT A O 'S 1 3,rte
N E ` ' ryI� 2 OUTLETS-SWITCHES-RECEP 10.00/1.00 \Nl U rlVl
V I ,uC.No. J LIGHTING FIXTURES 10.00/1.00
rrONTRACTORs
APPCIANCES-RESIDENTIAL 4.00 -
PHONE - PANELS 10.00 DATE OF APPLICATION
ARCHfTECPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEE
• LIC.No. SIGNS TRANS. 3.00
ARCH.OR G. - PERMIT VALIDATION-
AooR s SPECIAL CIRCUIT 5.00
5 zIP [U EMP.METER OR POLE INS. 20.00
APPLICANTS - I
AODRE s II ( � MOTORS SEE FEE SCH. _
Mali
SERVICE CHANGE - 20.00
F O o LICENSED CONTRACTORS DECLARATION
a v I hereby affirm that I am licensed under provisions of Chapter 9 -
y a n (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
i Prafeasio s Cod n y license is in full forcet' N BLDG. ELECT. PLG. MECH.
i m C Lirens��'as Lie.Number p �p p ❑
O H w Duro.1 I --Contractor V1tv yL L mft
❑ ❑
Q y E
COnS'E'• �
Q OWNER-Ii UILDER DECLARATION BUILDING PERMIT -4
o i U INFORMATION
w ; I- I hereby collo that I am exempt from the Contractor's License MISC.- REFER TO ORD
u O a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
r -w PERMIT ISSUANCE 10.00
Code:Any city or county which requirtxB permit to canslrueL alter,
rt ¢ Q p improve,demolish,of repair any structure,prior to its issuance,also ELEC.DDNTH, 'LIC.NO. ELEC. O D ,s
0 Be requires the applicant for such permit to file a signed statement that
TOTAL
e w m he is licensed pursuant to the provisions of ilia Contractor's License PERMIT.TO
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
i D Business and Professions Code)or that he'is exempt therefrom and QTY. PLUMBING PERMIT FEE - Cw.DNAIR C
I-$ the basis for the alleged exemption.Any violation of-Section 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjects the 0).)i ant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more thanwoe five hundred dollars(my employees
'❑ Las owner of the property,or my employees with wages as BACK FLOW PROTECT.-DEVICE 4.00 OCC.GROUP RES.UNITS i
their sole compensation,peation,will do the work,and the structure is not ,
intended I or,offered for sale(Sec. 7044, Business and Professions Code:The Contractor's License Law does not apply to an owner of DRAINS-FLOOR,ROOF,AREA,COND. 5.00
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 - SO.FT.FLOORAREA TOTAL ACREAGE
s 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-111NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or fill- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
i prove for purpose of side.). RES IND CON PB ' Other'
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project(Sec. 7044,BusinevLAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and.Professions Code;'flue 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 Confucians)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCEL NO.
❑ lam exempt under Sec.-,B.&p.C,for this
reason WATER HEATER W/VENT 6.00 .
Owner Data WATER SYSTEM _ 5.00 ACC.DnTE ACC.FILE NO.
WORKE RS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 '
herehy'affmn that l have'a eerlificate of consent In salt-insure,
or a certificate of Workers'Compensation Insurance,or a ceftil'ied ZONING ENG.SITE NO,.
copy there dipoy .. 4�1Cy
colic No. t py(fy
Q ❑ Certl red copy is hereby Irdshed.
FIRE SPRINK ENERGY T-24
Z Z O Certi •I 'o 'x I e with I� 1xtty faction division.
Cz Q Applicant MISC.- REFER TO ORD. Y❑, NEI ,' ry C] NC
'CC y CERTIFICATE 01'EXEMPPION FROM WORKERS'. PERMIT ISSUANCE 10.00 FLOOD ZONE . A.L.u.C.
LU > COMPENSATION INSURANCEPLG.CONTR. LIC.NO. - PLG.
CL O (This section need not be completed if the permit is for one TOTAL V❑ N[J] V ❑ No
Z hundred dollms(SWIDO,lcssJ -
U O I certify tllm indhe perfonnwme of are work for which this per QTV MECHANICAL PERMIT FEE ,.FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Comperisat ion Laws of California.
0 y Date - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 1 �'�
} N N YI Cl' TO APPLICAN'❑ If,after making this Certificate of Us-
F Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5 P
provisions of the Labor Code, you must fo-thwilh comply with FEE'
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4. (o
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 -
the performance of the work for which this permit is issued(Sec. MICROFILM
3o97;Civ.CJ, , I� - HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
Lend, 9anx
Lendn:'s Nam :en - HEATING UNIT(OVER 100,000 B.T.U.)9.50 'ELECTRIC
I certify that F have read this application and state that the above VENTILATION FAN (SINGLE) '4.00
and un.nees is correct I agree to comply with all city ucti county BOILER H.P.Or 100,000 B.T.U.) 6.00 .PLUMBING
ordinances and state representatives
to-building construction. and -
hereby entiaudoriee representatives ec This city to enter upon the BOILER-COMP Over Ioo,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. '
(Wap agree to save, indemnify and keep hornless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in con seyue e o the PERMIT ISSUANCE 10.00 ,
grpuiing,of this phrppit. MECH.CONT. LIC.NO. MECH.
.�/lppfiC TOTAL ' TOTAL
SI� re o(Apphcanl/Contfactor �] Da V
�� 11� OFFICE COPY 2