18758 POST THIS CARD.NEAR FRONT OF BUILDING
.. - PERMIT NUMBER
CITY OF: CUPERTINO. .1.8758
INSPECTION DIVISION PALS
JOB INSPECTION RECORD OCTQR
• I�/•L G� n • '" ' �.wM9 + _ 'PERMIT-EXPIRA710Np '
JOB ADDR ESS '` C7/ / �/��r✓J �IJ� UNIT# I)T'# PERMIT EXPIRES'IF WORK .
A ofi .e.A
• OWNER (^, - coNrR.croR S h 'IS NOT STARTED WITHIN
INSPECTION DATE' INSPECTOR INSPECTION RECORD flea Dnvs oF'rEaMI7'Issu �
FOUNDATION - :ANCE OR 180'DAYS FROM '
NOTE: LAST CALLED INSPECTION.
+
LIFER ALL GRADING AND DRAINAGE,SHALL'BE,INSTALLED,
• ' PREGUNITE ' - - - TO COMPLY WITH THE APPROVED PLANS AND CITY OF . - -PERN11T VALIDATION
CUPERTINO STANDARDS. - /;�,.
GARAGE SLABS - VUJ C.N
.POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- -.
UNDERGROUND /SLAB' 41
I PLUMBING - -.�, p
ELECTRICAL 'ISSUANCE DATE. `
MECHANICAL ', - - + _ Loc ELECT PLG. MECH.
L
❑ .. ❑ : ❑
DO NOT-POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED „• n: - .- >< BUILDING PERMIT
INFORMATION
WOOD FLOOR
,vnw.uoN sler..., .
PLUMBING" - - ,
MECHANICAL
P
ELECTRICAL (RIA I TO -
FRAMING' �r .
INSULATION - - .STORI. TYPE CONSTH.
GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE NAS BEEN SIGNED ~
r - SO I'I,FLOOR AHE. TOTAL ACREAGE. +
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '
DIAPHRAGM THE,CONSTRUCTION TAX IS PAID
ROOF SHEATHING`' - Hes INOUILOCNOIC,USEPB O
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS,: DATE 'INSP: .'' ❑ ❑ ❑ ❑
ASSESSORS YAHC
ROUGH SAN.a ,EL NO,
PLUMBING ELECT.ENERGY
TRACT NO. PARCELING
- TUBS 8 SHOWER PAN PLUMBING ENERGY - - r '
MECHANICAL MECH, ENERGY
'
ELECTRICAL - � -BUILDING ENERGY+J DATE ACC FILE No.ACC.�
.FRAMING 10 IL AjC ELECT.FINAL TEST
INSULATION PLUMBING - - ,ZONING. ENG.SITE NO:
GAS TEST - GAS.
MECHANICAL FIRE SPHINK„ -ENERGY T@4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
❑ o ❑
.
EXTERIOR SHEAR � ELECTRICAL RELEASE � � F L000� ZONE A.L U C.
` INTERIOR SHEAR FIRE DEPT. �.a v❑ rr❑. ' .v ❑ N❑'
SHEETROCK , r A GRADE FEE SUMMARY -
EXTERIOR LATH BUILDING BUILDING
INTERIOR.LATH - TEMPORARY'APP.ROVALS '
SCRATCHCOAT' ELECTRIC ,r PL'AN'CHECK ^�•;
GAS - FEE;' i'
NO TAPE OR PLASTER UNTIL ABOVE HAS'BEEN SIGNED OCCUPANCY SEISMIC FEE `_
OCCUPANCYrOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, -MICROFILM
ARRANGE FOR INSPECTION.BY PHONING 252-4505, ELECTRIC -
LUONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING
0 �-
Z PLEASE.GIVE JOB.,ADDRESS WHEN PHONING:.. ' .
— SEE PERMIT FOR EXPIRATION DATE MECHANICAL
' IMPORTANTI ". CONST.TAX --.
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR.FINAL-INSPECTION. TOTAL ,' S —
.,
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL-POINT PEN ONLY.
PERMIT NUMBER
BU LDING PROJECT IDENTIFICATION
aDILpING ,APP.LICATION & PERMIT '
AGpREas -
18758
�� ��646� BUILDING ELECTRICAL-PLUMBING-'MECHANICAL `
' OWNER'S - • Y PLAN CHECKMALIOATION
NAME QTY. ELECTRIC PERMIT - - FEE
• .; L+K �„//✓ PHONE ',
CONTRACTOR'S
NAME S�Gy�,� Qy-T'�' UTLETS-SWITCHES-R ECEP 10.00/1.00
SV LIGHTING FIXTURES r.. 10.00/1.00 `
a CONTRACTOR S - PPLIANCES-RESIDENTIAL 4.00
PHONF. J"C, & PANELS._,. ; >10.00
DATE OF APPLICATION ^
ARCHITECT - PLAN CHECK FEE P.C.NO.
oR PANELS (OVER 200 AMP) 20.00 i
ENGINEER • -
uc.NO SIGNS TRANS. 3.00
• - AARCHOR DDRESS ENG. - SPECIAL CIRCUIT 5.00 . PERMIT VALIDATION
"zIP' EMP:METER OR POLE INS. 20.00 's
A • MOTORS 'SEE FEE SCH.
ADDRESSDDRESS '
- SERVICE CHANGE - '. ,20.00 ®.�� •� '
-a o LICENSED CONTRACTORS DECLARATION `
a i w -I-hereby aClimt That I um-licensed under provisions of Clapler 9 _ ISSUANCE DATE
(commencing with$eatlon.7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F N z Professions Co�I` .i�ld •use is in full fort `J fact. 686F 6 Me
z o m _ License Clusa Y� Lic.Number 1 - ED _E - � a'
9 r S.D Dale�_Contractor-t�Cd
H N " / '/ � ' ``, -BUILDING PERMIT'
ma,w a OWNER-Il UILUER DECLARATION
MISC. REFER'TO ORD a -INFORMATION,
w ;A G I hereby affirm that I mn exempt from the Contractor's License -
u O¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT..
H - PERMIT,ISSUANCE • 10.00 -
Code:Any city or county which sequiturpermit to Construct,,Iter, 1. fA�
S ¢ ¢ 0 haprove, moil r repair anystructure,Prior I I its issuance,also ELEC.CONTR.,
-I.LIC.NO. ELEC. '/�_ Q ' QV
n w m u m lu a the applicant for such permit to file a signed statement that Tcyr 1c p gMIT TO
hpursuant is licensed pursunt to the provisions ifContractor's theLicense _
H z r
Law(ChAter9(commencing with Section 7000) fDivision 3 of the b �( '
2 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE l' YYY Y's
W.H 0 the basis far the alleged exemption.Any violation of Section 7031.5 . I . j STORI TYPE CONSTR.-
A. by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN 5.00 •a;
of
not than five hundred dollars(8500),): -
❑ 1,as owner of the property,or my employees with wages as BAOK'F LOW PROTECT.DEVICE - _4.00 OCC.GROUP RES.UNITS
(heir sole compensation,will do the work,and the structure is not
iulended or offered for sale (See. 7044, Business and Prod'easianr' DRAINS-FLOOR,ROOF,AREA,CON D. 600 .,
Cade:The Contract.,',License Law docs not apply to an owner of
properly who builds or improves thereon,and who docs such work FIXTURES-PER'TRAP 5.00 sG.'FT.FLOOR AREA TOTAL ACREAGE
himself re through hid own emend or sale.provided Ihut rush imprrvo- _
menuarcntent to sold or withinrone yearoIf,mpletion the theo nee- GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement rs sold within one year of completion,the owner- GAS-EA-.SYSTEM-OVER 4 (EA.) . 2.00
builder will have the of burden of proving that he did not build or ins ' BUILDING USE
prove for 1,as owner
of the.l. - ". i INDUSTRIAL WASTE INTER. 30.00 BES',' tNp ' CON PB Omer
❑ d as owner rs the property,am exclusively contracting with - ❑ 11 • � 11 ' 1
licensed contractors m 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 docs not apply
to an owner of properly who builds or improves(Iicrecn,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;200tt/10:00 TRACT NO. PARCEL No.
❑ I:un exempt under Sec. ,B.&P.C.for mix-
reason WATER HEATER VV/VENT 6.00
Owner Date WATER SYSTEM I' 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'I ION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that 1 have a certificate ofconsent to self-insure„ -
or a certlGcale o I Workers Co tel 'oration insuel me or a mortified - ` ZONING ENG.SITE NO.
copy thereof( 3800,Laby /NN�' 2 � -
Ss
O Poly, Company,(. 1 1... `rte.. - ,.
erl10ud'Cloy.is hcruby turn shcA. +
CeHdied co FIRE SPRINK ENERGY T-24
Z 2, yY is fled i c .pec tion division.
O Applicant-/�{Lf�Xf � MISC- REFER TO ORD, YQ N� :. y NQ
~ rte • I-rn/ . ' PERMIT ISSUANCE 10.00
- .Clilt'I'IF fF E SATION INS PROM WORAIiRS' -FLOOD ZONE ",A.L.u.C.
W > COMPENSATION INSURANCE - PLG.CONTR. LIC.NO.
0. 2• (This section lived not be completed if the permil isdor one - TOTAL '_ Y❑ v N� -'V ❑ N[3
0 hundred dollms($100)or less.) - -
I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY j
LL U mil is issued.I shall not employ any person in any manner so as to
O W become subject to The Workers'Compenudion Laws of Culilbrnia.
Date Applicant BUILDING
} tai! NOl'ICIi 70 API'LICAN'1': If,alter making this Cert ificme of I.x- ALTER OR ADD TO MECH. : 5.00
.F2 caption,you should beContcsubjccl to the Worked Compensmion APPLIANCE. 5.00 PLAN CHECK`,
provisions of the Lubar Code, you most forthwith Comply will FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.). 4.00
' CONSTRUCTION LENDING AGENCY p AIR HANDLING UNIT(OVER 10=r-F.M.) 6.00 SEISMIC FEE '0
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 - -
the perfor lance of the work-for which this permit is issued(Sec. MICROFILM yr--T��+
3097,Cie CA HEATING UNIT(TO 100,000 B.T:U.) 8.00
Lender's Name .HEATING UNIT(OVER 100,000 B.T.U.)9.50
•- Lender's AAdress � ELECTRIC
I certify.hist I have read Ibis application and state•.that the above VENTILATION FAN (SINGLE) .4.00
information is correct. Fagree to comply with all city and county BOILER-CUMP(3 H.P.Of 100,000 B.T.U.) 6.00 PLUMBING
ordinances and-slide laws relating 10 building construction;and
here by,mnhoniu,representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL _
Sir - (We) agree to save, indemnify -• -
y and keep hind experts City of MISC.- - REFER TO ORD.�upCONST.TAX
ay inn, agUimatay acct hies,judgments, casts and expenses which PERMIT ISSUANCE 10.00
may in any way accrue against said City in consequence of the
Sol f tis null' MECH.CONT. . LIC.NO. MECH.�.
TOTAL
TOTAL
Signature, p cant
1 OFFICE COPY
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