18249 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY- OF CUPERTINO gZg
INSPECTION DIVISION
JOB INSPECTION RECORD
` - PERMIT EXPIRATION
JOB ADDRESS - 1 A Z-e� —��L�LJ N 'P /�/ UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER a III S L CONTRACTOR IS NOT STARTED WITHIN
INSPE ION DATE fRSPECTOR 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 PERMIT VALIDATION ,
GARAGE SLABS - CUPERTINO STANDARDS., PA�D
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED sJ r7Y 4Y s,`ry
UNDERGROUND /SLAB JUL I U 190. 1fn'� /
PLUMBING - fN�F.w�{L^,,^',� .., ,r7n �' lA
ELECTRICAL. . City W Yumyno
ISSUANCE UAiE.
MECHANICAL - BLOC, I ELECT. PLG. MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING eA
VVAALUAT� Q $IFIT
MECHANICAL
ELECTRICAL vER I TD
FRAMING �I 1 ' ` I
INSULATION ST.IRIErry coNsrR.
OCC GROUP, RES UNITS
' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. SO,FT FLOGR PREP TOTAL ACREPGE.
ROOF . NOTE:NO FINAL INSP.SHALL BE MADE BEFCfRE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOFSHEATHING RES IND uu`�ON US penwl �
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS P ARCEL NO.
- ROUGH SAN.N ,
PLUMBING - ELECT.ENERGY'
TRACT NO. PARCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY I
MECHANICAL MECH.ENERGY - '
ELECTRICAL BUILDING ENERGY ACC DATE - ACC.FILE No
FRAMING - �� ELECT.FINAL TE ST
ZONING ENG,SITE NO
INSULATION PLUMBING
GAS TEST - GAS
MECHANICAL - FIRE SPR INK ENERGYT24F
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ° "
❑
EXTERIOR SHEAR - ELECTRICAL RELEASE FLoou ZONE A.L UC.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ YL ,N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - -
INTERIOR LATH TEMPORARY APPROVA S suILDINc -tea
SCRATCH COAT ELECTRIC PLANCHECK
C GAS 'FEE,. LQ
NO`TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I I SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ,
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
o�ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
— SEE PERMIT FOR EXPIRATION DATE — ' 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
•13UI LDA NG PROJECT I DENTI FICATI ON PERMIT NUMBER
I amLOING APPLICATION & PERMIT
07 S 8
nuoREss p BUILDING — ELECTRICAL—PLUMBING—MECHANICAL G `'I'J
BCA C -Q 2 A n
OWNER'S - PLAN CHECK VALIDATION
NAME ^ OTY- ELECTRIC PERMIT FEE
°inure ACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 '
LIC.NO, LIGHTING FIXTURES 10.00/1.00
CONTRA TORS APPLIANCES-RESIDENTIAL 4.00
DREPNONE PANELS 10.00 DATE OF APPLICATION
OORRCnri ECT PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER,
' tic.NO, SIGNS TRANS. 3.00
ADDRESS ENG. 5.00 CIRCUIT S,QQ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20:00
APPLICANT rs MOTORS SEE FEE SCH. 7--/
AD RCA ,/ nn //� /� [ 11
07T3 S. 8tao 4 SERVICE CHANGE 20.00
°0 i
ce°° LICIiNSEU CONTRACTORS UL LARA'fION PAD J. 4w7p V V.u/--
a is U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w< e- (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r °z Professions Code,and my license is in full force and effect ❑ ❑ ❑
0 too License Class Lie,Number
Z
Date Contractor
Q y f p� .L�
OWNER-BUILDER DECLARATION Yl Vl Wft
BUILDING PERMIT
° A° MISC.— REFER TO ORD INFORMATION
X 3 w 1 hereby mfmm that I am exempt from the Contractor's License VALUATION $/FT.
LL o a Law fur the following reason,(See.7031.5,Business and Professmms 10.00 Nprll
r - PERMIT ISSUANCE 3-/r� �� YD
F P Code:An y city Or coo my Whiny structurep riot t toconstruct,issuance.
also -7 Vy ,
Ii K¢° improve,demolish,at repair any structure,prior m its issuance,also ELEC.CONTR, LIC.NO. ELEC.
u w ° ec requires the applicant lot such permit to file a signed statement that TOTAL
$w he is licensed pursuant m the provisions of the Contractor's License PER T TQr5 N
Hi > Law(Chapter 9(commencing with Section 7000)a IDivition 3 ofthe If
E 4 4 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Skv
w h-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 - by any applicant for a permit subjects the applicant to a civil penalty
ofALTER-DRAIN -WATER (EA.) 5.00
got more than five hundred Jollurs(8500)J:
R 1,as owner of the property,or my employees With wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their we compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,01) SO.FTFFLOOR AREA TOTAL ACREAGE
himself to through his own offered
for provided that such im116IDe-
mmselfonot intended hhisor empldfus,provided
that suhebmldphg - GAS-EA.SVSTEM-11NC.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 inn- GAS-EA.SYSTEM-OVER 4(EA.) 200 BUILDING USE
RES IND CON PB Other
0 1,as o
prove of sole.). El ❑ El 1:1 1:1I,as owneerr of the property,our exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
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 a contractots)licensed pursuant to SEWER-SANITARY-STORM EA.200ft
the Cminaawr's License Law. /10.00 TRACT NO. PARCEL NO.
❑ I ane exempt under Sec. ,R.&P.C.for this WATER HEATER W/VENT 6.00
rexso
Owner Dat, - WATER SYSTEM 5,00 " ACC.DATE ACC.FILE NO.
WORK;RS'CONIPI:NSATION DECLARATION WATER TREATING EQUIP- 5.00
1 hereby affirm that I have acendicate ofconsent toself-insure,
Or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
Q ❑ Certified copy shereby furnished. - FIRE SPRINK ENERGYT-24
Z Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
~ w+ PERMIT ISSUANCE
Cr — CIiR1'IPICATEOFgAXTIOIDT ION FROM WORKERS' 1000 FLOOD ZONE A.L.u.C.
Lid COMPENSATION INSURANCE PLG.coNTR.CL LIC.NO. PLG
Z (This section need not be completed if the permit is for one TOTAL Y E] N❑ Y[1] N❑
hundred dollars IS 100)or IesO
U O 1 cenity that iu the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
IL U, mit is issued,1 shall not employ any person in a manner sn as w
Ow subject to the porkers'compensation Laws of California.
CL D1),te ate Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 400
} m NOTICE TO should eco IL after making lois Certificate sa ion
F-. ? em
Provisions
you should become subject to the Workers'Compensation with APPLIANCE 5.00 PLAN CHECK _
provisions io the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT ITO 10,000GF.M.1 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.EM.) 6.00 SEISMIC FEE E flD
• 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. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
HEATI NG UN IT[OV ER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is estateI agree to comply with all city and county PLUMBING
ordinances and stateaws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.1 6.0(1
hereby authorize representatives
laws
of this city eo enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over loO,Goo BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, casts anJ expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay in any way accrue against said City in consequence of the
ranting OI this peFmlt MECH.CONT. LIC.NO. MECH.
f-�r� (// dLT. -7/oma/y TOTAL TOTAL y�f�
Signature ofpipplmant/Contmm
cr De a /
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION 18249
JOB INSPECTION RECORD
• '''}}} ��` h PERMIT EXPIRATION
JOB ADDRESS �1`� IIIP Y UNIT# LOT# PERMIT EXPIRES IF WORK
OWNERAm CONTRACTOR IS NOT STARTED WITHIN
lmzPFTnON — " DATE PECTOR --INSPECTION RECORD_ --- 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPRO ,eIS AND CIN OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS. l''r►V,��,,��11 �
POUR NO CONCRETE UNTIL ABOVE HAS'BEEN SIGNED JUL 10 19B9
UNDERGROUND /SLAB np
PLUMBING city Of/4,..,,i;w
ELECTRICAL �L �'hfUW ISSUANCE DATE
MECHANICALLLDG ELECT. PLG. MECR.
S 1(J1 I�D L n41v-
❑ ❑ ❑
DO NOT POUR-FLOOR UNTIL`ABOVE HAS BEEN SIGNED c� —RUICDwG.PERMIr
INFORMATION
WOOD FLOOR
vALunnoN SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL � ,
FRAMING k
INSULATION STORIWS I TYPE C TR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT.FLOORAREA TOTALACREAGE
��.• DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING RES INouILOCON USE
Omer
APPLY NO ROOFING'UNTIL ABOVE HAS 8 EN SIGNED FINALS DATE' INSP:, ❑ ❑ ❑ ❑ El-
ASSESSORS
ASSESSORS PARCEL NO
ROUGH SAN.0
PLUMBING ELECT.ENERGY
TUBS 8SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE.NO
INSULATION PLUMBING -�� .
GAS TEST GAS
FIRE SPRWK ENERGY T.24
MECHANICAL Y ❑ No I ❑ N❑
'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A UC.
INTERIOR SHEAR FIRE DEPT. Y❑ N L Y ❑ N❑
SHEETROCK GRADEFEE SUMMARY
EXTERIOR LATH BUILDINo
INTERIOR LATH TEMPORARY AP R 'VAS BUILDING , w
SCRATCH COAT ELECTRIC PLAN CHECK
GAS
FEE !tp
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ,
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
•
o�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 TOTAL
CALLING FOR FINAL INSPECTION.
APPLICANTS POSTING COPY