18789 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF, CUPERTINO
. . 18789
INSPECTION DIVISION
JOB INSPECTION RECORD
U PERMIT.EXPIRATION
I'!+-• � JOB ADDRESS�/ / �2 / ` -�"' / • v UNIT# _LOT# * "
' L - PERMIT EXPIRES IF WORK•
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - 'ANCE OR 180 DAYS FROM
NOTE: ',.p LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITETO COMP,I.,T`711,-HI APPROVED PLANS AND CITY OF ^,SPERM1T VALIDATION
GARAGE SLABS +J _ '-T'I— •T
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,_I
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL • _ i ISSUANC ATE
LDGMECHANICAL �- _ _ _^ R0 ELECr PLG. MECH.
11
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- INFORMATION
WOOD FLOOR City Of tpn#in� VALUATION S/FT.
PLUMBING
MECHANICAL _ ` 1 d
PERMIT TO
ELECTRICAL
FRAMING
' F
INSULATION STORIES TYPE CONSTH.
` -
OCC.GROUP RES UNITS
i^
.,4 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED so,FT.FLOOR AREA • ?orAL ACREAc,F
°��' �'• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
a - THE CONSTRUCTION TAX IS PAID
DIAPHRAGM - euaolNc USE-
RES IND CON FT OP•r
t 1,�.•;,a! ROOF SHEATHING
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El El 11
ASSESSORS PARCEL NO,
ROUGH SAN.M
' PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL NO
F MECHANICAL MECH.ENERGY _ ACC DATE ACC.FELE No.
ELECTRICAL- BUILDING ENERGY � - _'-,..��-- "'
FRAMING ELECT.FINALTEST C��-;•'• _�r'"i r I�--I,S_,�, I"`
• - ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST - GAS -
I, - - - MECHANICAL FIRE SPRINK - ENERGY 124
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y 11 " 1 '• r El NQ
.
. EXTERIOR SHEARFLOOR ZONE AL.U.C.
- - ELECTRICAL RELEASE _
FIRE DEPT, r Y❑, N❑ YL N❑
• INTERIOR SHEAR -• ;*s,
4 GRADE :�
SH EETROCK '1: _. Y f { FEE SUMMARY
I •,.^ . .� •n ,
EXTERIOR LATH BUILDING „ T t k•G T, _:'_'C/� -` BUILDING
INTERIOR LATH - TEMPORAi,.1 APPROVALS- – z•1'
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANcv SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BYBUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC. K /_
I 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 ',,00
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED'L,INES = USE BALLPOINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .PERMITNUMBER „
BUILDING APPLICATION,& PERMIT `18789 8 7 89
ADDRESS - I f
- IOyZL" . c/7ST/NE vim•
BUILDING -ELECTRICAL-PLUMBING-MECHANICALiI
AME
R
`�� N 'a 9;aj y•7 PLAN CHECK VALIDATION.
Name OTV. ELECTRIC PERMIT FEE "
. _ �OOG.6` PHONEz.sf-Q3 "!
NAME A, I OUTLETS-SWITCHES,-RECEP 10.00/1.00
LIC.NO. f LIGHTINGFIXTURES 10:00/1'.00
CONTRACTOR'S - -
ADDRESS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS '10.00 DATE OF APPLICATION `-
ARCHITECT PLAN CHECK FEE P.C.NO.
OR. PANELS (OVER 200 AMP)'- 20.00 ,I
ENGINEER , LIC,NO SIGNS TRANS. 3.00 - -
APCH.OR ENG, PERMIT VALIDATION _
ADDRESS SPECIAL CIRCUIT, - 5.00
ZIP TEMP.METER OR POLE INS. .20.00 ,qI• A
APPLICANT'S
aooREss - � MOTORS .- SEE FEE SCH.
/ SERVICE CHANGE 20.00
h' •SQ' _
H o O� 'LICENSED CONTRACTORS DECLARATION S _
an u I-hereby affirm that ham licensed under'provisions of Chapter 9 -
w ' ISSUANC ATE-
Gn Professions ode, Section rayl 700e is
Divfull
3 o theect. ss end' BLDG. ELECT PLG. MECH.
H o Z Professions Code,and my license Is In full force and effect ❑ ❑ ❑
o z D License Class Lic.Number �" q Q
w w Dale Contractor OCT 16 1989,
inKa w a OWNER-BUILDER DECLARATION BUILDING PERMIT
o d ca• INFORMATION
X 3 y 1 hereby affirm that 1-am exempt from the Contractor's License MISC.-• Ofl D'
H g'O j Law for the following reason.(Sec.703 1.5Business and Professions -� ^ O VALUATION s $/FT.
Code:Any city or county which requires a permit to construct,alter,
PERMIT ISSUANCE "' U
< improve,demolish,Dr repair any structure,prior t0 its issuance,also ELEC.DDNTR, LIT
C.NO. ELEC.- 'q'lQ
y m ec requires the applicant for such permit to file a signed statement that OTAL PERMIT TO
ll//
w Q he is licensed pursuant m the provisions of the Contractor's License _
HiBusiness
(Chapter ndProfessions
Codeng )or Section is 00)exempt therefo andtbe
in i c Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
H o the basis for the alleged ezwnption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e_ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).): -
❑, I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00 OCC.GROUP RES.UNITS,..
their sole compensation,will do the work,and the structure.is net - -
intended or offered far sale(Sec. 7044, Business and Professions . DRAINS-FLOOfl,ROOF,AR EA,CON D. 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 S.00 50.FT.FLOOR AREA TOTAL ACREAGE;
himself or through his own employees,provided that such improve-
huntsurenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within'one year of completion,the owner. -
builder w'I have the burden of proving that he did not build or em- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove purpose of sale.). RES
I,as owner of the pINDUSTRIAL WASTE.INTER. 30.00 RE :E1 ON _PB O ,G❑r
ropery,am contracting with
licensed 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 of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.)- 1.00
contracts foractor' Lprojectswithocontractorfs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
ilia nI a.Contractor's License Law. TRACT NO. PARCEL NO.
❑ Inm exempt under Sea ,e.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dat�� WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO.
WORK ERS'COMPfi 5 70N DECLARATION WATER TREATING EQUIP. 5.00 ,E
-I hereby affirm that I have a certificateof consent m self-insure, -
or a certificate of Workers''Compensation Insurance,or a certified '?ONING ENG.SITE NO.
copy thereof(See.3800,Lab.CJ.
Policy No.-Company-
0
o. Company 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city Inspection division: -
I'- O Applicant MISC.- REFER TO ORD! Y Q• N❑ v❑ �O
� y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE, 10,00 FLOOD ZONE 1!A.L.U.c.-
W > COMPENSATION INSURANCE - PLG.CON I'R. - LIC.NO. -
CL o (This section need not he completed if the permit is for one PLG.- 's TOTAL Y O IN Y❑ NO
�:I Z hundred'dollars IS IDB)or less.)
U O 1 certify that in the performance of(hgwork for which this per- Q7•V 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'Compensation Laws of California. "
i Datc Applicarii ALTER OR ADD TO MECH. - 500 BUILDING
W NOTICE TO APPLICANT: If,after this Certif¢me of Ex-
. .
emptimn,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK- p
provisions of the Labor Code, you must forthwith comply with FEE
U_ such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10,000QF.M.)- 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.EM.) 6.00 `.' w SEISMIC FEE .
I hereby affirm that there issa construction lending agency for EXHAUST HOOP(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L - 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 Q'0
I certify that I have read this application and state that the aboveVENTILATION FAN (SINGLE) 4.00 -
Information is correct. I agree to comply with all city and county BOILER H.P.or 100,000 B.T.U.) 6.00 PLUMBING.
ordinances and state lues relating to building construction. and _
hereby authorize representatives forms of this city to enter upon the BOILER-COMP IOvnr 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of - MISC.- REFER TO ORD. _ -
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
maY in any way accrue against said City In consequence of tPERMIT ISSUANCE he - 10.00
ranting of this permit - ,• ' MECH.CONT. 'LIC.NO.
IO IG TOTAL TOTAL
Signature Of Applicant/C rftv&rDate
OFFICE COPY