17065a
T�
- POST THIS CARD NEAR FRONT OF BUILDING
'
- A -CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
/1 1I A 1,�
JOB ADDRESS Z.. Sp.. �E'��l 7Y� UNIT# _ _LOT#,. _
J
OWNER V 0, CONTRACTOR d L '- D D
PERMIT NUMBER j
17066
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK 1�'
'IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU- •'
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
-
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
OUPERTINO STANDARDS.
LIFER
PREGUNITE
PERMIT VALIDATION
•,� -, �.�iL I,YT4 "
11'1V`'j
ISSUANCE DATE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
q
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL _
MECHANICAL
BLDG ELECT
PLG. MECH'" j
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
-
WOOD FLOOR-
qR•• VALUATION
I OD 0,
SIFT.
PLUMBING
MECHANICAL
ELECTRICAL,
PERMIT TOf�••��''
SIE' L
STORIES T PE CONSTR.
FRAMING -
INSULATION
OCC. GROUP
,HES. UNITS
"
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOFNOTE:
NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
" sn. Fr. FLooR AREA
'
TOTAL ACREAGE.
DIAPHRAGM.
ROOF SHE ATHING
BUILDING USE -
RES INO CON PB au...
❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SAN.#
ASSEssORS PARCEL NO
'
PLUMBING
ELECT. ENERGY
TUBS &SHOWER PAN
PLUMBING ENERGY
TRACT NO.
PARCEL NO
" 1
MECHANICAL
MECH ENERGY
ELECTRICAL
BUILDING ENERGY
ACC DATE
ACC FILE NO.
,
FRAMING
ELECT. FINAL TEST
INSULATION
PLUMBING "
ZONING
ENG. SITE NO.
GAS TEST -
GAS
'
MECHANICAL
FIRE SPRINK
Y NF]
o
ENERGY T.79
Y "�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
FLOOOZONE .
Yo. NE)'
AL U. C.
L N❑
INTERIOR SHEAR
FIRE DEPT,
SHEETROCK
GRADE •
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
INTERIOR LATH -
TEMPORARY APPROVALS
SCRATCH COATELECTRIC
PLAN CHECK
FEE
•
GAS _
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC'FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,ELECTRIC
ONE WORKINGDAY BEFORE REQUIRED INSPECTION.
z �. PLEASE GIVE JOB ADDRESS WHEN PHONING..
-SEE PERMIT'FOR EXPIRATION DATE -
MICROFILMLu
"
PLUMBING
MECHANICAL'.IMPORTANT!
CONST. TAX
'
PLEASE READ REVERSE SIDE BEFORE .
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
_-BUILDING PROJECT I DENTI FJCATION
APPLICATION & PERMIT'
PERMIT NUMBER
A7
BUILDING - -,
AooRess
BUILDING --ELECTRICAL— PLUMBING—MECHANICAL
1706
�?" I 0 6
OWNER'S
NAME
G PNONE
DTV. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
NAMERACTORs
UTLETS-SWITCHES -RECEP 10.00/1.00
Oo LIC. No,
LIGHTING FIXTURES 10.00/1.00
AONOREs9 oRs"
APPLIANCES - RESIDENTIAL - 4.00'
M Giv PHONE �$
PANELS 10.00
DATE OF APPLICATION -'
ORcrsrt i
ENGINEER
'�' LIC. No.
PANELS(OVER200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
-
,
SIGNS TRANS. 3.00ARCH.
OR
ADDRESS ENG
SPECIALCIRCUIT 5.60
PERMIT VALIDATION
ZIP
EMP. METER OR POLE INS. 20,00
4
ADDRESSTs -
MOTORS SEE FEE SCH.
SERVICE CHANGE - - 20.00
LICENSED CONTRACTORS DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and,
Professions Code and my license is in full forge and effect.
License Class. -0_1 Lie. Number OV 5 6 -.4
Datelr�i/-a a ContmctGr Rs*,,�-
OWNER -BUILDER DECLARATIONT oF' `V
I hereby affirm that 1 son exempt from the Contractor's License
Professions
Low: the city or counlHit ason.(h require a perminess t to
Code: Any city or county which Structure permit to consuanc alter,
improve, demolish, or for sR any permit
requires the d Pursues for such revisit to file a sContl statement that
to Structure, PADS n IIS Iatement talsohat
he is licensed pursuant to the provisions of Contractor's License
AN 1 1989
ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
® ❑ ❑ ❑
,
City. of Cupertino
BUILDING PERMIT
INFORMATION
MISC. — REFER TO ORD
PERMIT ISSUANCE - - 10.00
-
VALUATION
I (/�/(_)
$/FT.
ELEC. CONTR. LIC. N0.
..
ELEC.
TOTAL
PERMIT TO
00 tlic
Law(ChapterP,oco,i.n, Codeng with Section is exempt
Business mW Professions and
or that he is exempt therefrom and
DTV. PLUMBING PERMIT FEE
L_4yLl L)
:IE I i 1
exemption,
the basis for the alleged exemption. Any applicant
ofonclinn malty
by any applicant fora permit subjects S500).licam toacivil penahY
:
oC not mom than five hundred dollars (my
STORIES
TYPE CONSTR.
'
ALTER-DRAIN&VENT-WATER(EA.) 5.00
❑ I, as owner at the property, or my m
employees
their sole compensation, will and t e S with wages as
the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
,
intended or offered for sale (Sec. 7044, Business and Professions
(S
Code: The Contractor's License Law does not apply to an owner of
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00
GAS-EA.SVSTEM-l1NCAOUTLETS 6.00
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
ments are not intended or offered fur sale. If, however, the building
SQ FT. FLOOR AREA
TOTALACREAGE
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im.
GAS - EA. SYSTEM - OVER 4 IEA.2.00
1 -
BUILDING USE•
prove for puipow of sale.). "
❑ I, as owner of the property, am exclusively contracting with
RES .OND CON PB Other
0 ❑ ❑ ❑ 0
INDUSTRIAL WASTE INTER3000
. .
licensed contractors to construct the project (Sec, 7044, Business
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- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
contracts for such projects with a contmctoms) licensed pursuant to
the Contractor's License' Law.
❑ lam exempt under Sec.., B.&P.C. for this
reason
SEWER -SANITARY -STORM EA. 20011/10.00
TRACT NO,
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ADC. FILE No.
WORKF.RS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to sell' -insure,
ZONING
ENG. SITE NO.
or a certificate of Workers' Compensation Insurance; or a certified
copy thereof(See. 3800, Lab.C.).
Policy No. . Company
-
❑ Certified copy is hereby furnished. '•
❑ Certified copy is filed with the city inspection division.
Applicant
MISC.- REFER TO ORD.
FIRE SPRINK
Y N
[3E]�
ENERGY T2a
V N ❑
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
PERMIT ISSUANCE 10.00
FLOOD ZONE -
Y E] N ❑
A.L.u.c.
V ❑ N
PLG. CONTR. LIC. NO.
PLG, '
TOTAL
hundred dollars IS 100) or less.)
-
I certify that in the performance of the work for which this per-
Hit is issued, I shall not employ any person in any Hunner so as to
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
-
BUILDING
/1G ��
J
become subject to the Workers' Compensation Laws of California.
Date Applicant
ALTER OR ADD TO MECH. 5.00
NO [CF. TO APPLICANT': If, after making this Certificate of six-
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
PLAN CHECK
FEE
h
t`, h
emption, you should become subject to the Workere ComPtnsatlon
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (OVER 10,000C.F.M.) 6.00
SEISMIC FEE
50
CONSTRUCTION LENDING AGENCY
1 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.
3097, CN.C.).
HEATING UNIT (TO 100,000 B.T.U.) 8.00
MICROFILM
Lender's Name
Lender's Address
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
I certify that l have read this application and stale that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER-COMP(3 H.P. Of 100,000 B.T.U.1 6.00
hereby authorize representatives of this city to enter, upon the
above mentioned property for inspection purposes.
20'IER Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
(We) agree. to save, indemnify and keep harmless the City of
MISC. - REFER TO ORD.
upertinust liabilities, judgments, costs and expenses' which
ay i any ay ace a most sail ty in consequence of the
m ng his pe
-PERMIT ISSUANCE 10,00
CONST. TAX
MECH. CONT. - LIC. NO.
MECH.
TOTAL
TOTAL
r75
Si ture of App ice /Contract r Ddb,
OFFICE COPY
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APPROVED
IN ACCORDANCE WITH THE CITY 1415, L.1 L/1
CUPERTINO CODES AND ORDINANCES
DATE_ r—{/-�—
$IGNE [�1 z
i t o tt cAi I� as<. _n,) .;;r c ... cati ns PAUST m
be ; '; a a I ti:r:-s nd it s un•
lawful to m•:ae r;l, mzogcs o. vcfatiuns
on same with p s, . -u'pe m:ssi^n irom
(lie bui Cepa, ocp•., GJ) .tf 't:pe t'no.
The siampS,t; it n W pcuaLaiions
SHALL NL. iz ..c.6 t I,.. mA , r t , oe an
approval .of tats m_tati_n .,j any prcvisian• .
if any City 0 d,nance :.r S!a'e. Law. _
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OFFICE
COPY
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BLDG. INSPECTION DEPARTMERT,,
CITY OF CUPERTINO,
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Atop MFtm'
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OFFICE
COPY
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BLDG. INSPECTION DEPARTMERT,,
CITY OF CUPERTINO,