17861 POST-'THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY. OF CUPERTINO 17861
INSPECTION DIVISION
JOB INSPECTION RECORD
7 .PERMIT EXPIRATION
JOB ADDRESS /yi-,L 5 d ^�L�7 UNIT# '_LOT# PERMIT EXPIRES.IF WORK
OWNER CONTE CTOR/-/j_61/ % ',IS NOT STARTED WITHIN -
INSPECTION DATE INSPECTOR INSPEC ION RECORD 1BO DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR-180 DAYS FROM
.NOTE: - LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAID
UNDERGROUND /SLAB
PLUMBING 8 989
ELECTRICAL O vJ ' ISSUANCE LATE
MECHANICAL C*Of n'.wsy, e4Dc ELEcr. vLc. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING /= j/, / � _ /ti9�L ii •4./ � '
MECHANICAL 7
ELECTRICAL PERMIT TO
FRAMING'
INSULATION' _ _
STORIES TYPECONSTH,
OCC.GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
\ - SD.FL GLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID. ,
pie ROOF SHEATHING HEs IND ILoCON USE
EB 0",.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCF.4 NO
ROUGH SAN.k ,
PLUMBING ELECT,ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO.- ' PARCEL NO
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 SPRINT( ENERGYT24 -
COVER NO WORK.UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ 'N❑
A.L.
EXTERIOR SHEAR � ELECTRICAL RELEASE FLOOD ZONE LIZ
-
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ v oL IND
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING - BUILDING
INTERIOR LATH - - TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY MIGFEE
- OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Ui ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING '
PLEASE GIVE JOB ADDRESS WHEN PHONING.
2 MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
_
IMPORTANT! * ' CONST.TAX
PLEASE READ REVERSE.SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .
APERMIT NUMBER
BUILDING UI LDING PROJECT IDENTIFICATION APPLICATION $l PERMIT
ATORESS �,
17861
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER' PHPLAN CHECK VALIDATION
. NAME DTV. ELECTRIC PERMIT FEE
ONE
NANTRAMOR It ME _ is+��Q UTLETS-SWITCHES-RECEP 10.00/1.00 „f'
F Lie NO. S LIGHTING FIXTURES 10.00/1.00
C TRACTO 'aA( vAPPLIANCES-RESIDENTIAL 4.00ADp�s PHONE
'
PANELS 10.00 DATE OF APPLICATION'
ARCHITECT PLAN CHECK FEE P.C.NO.
oR PANELS (OVER 200 AMP) 20.00 - .-
ENGINEER
ua NO SIGNS TRANS. 3.00 '
mooeOR ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
SS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADGR Cas
SERVICE CHANGE 20.00
o O D LICENSED CONTRACTORS DECLARATION -
<u 1 hereby affirm that I am licensed tinder provisions of Chapter 9 ISSUANCE GATE
r (commencing with Section 7000)of Division 3 of the Busmen aad
w ¢ BLDG. ELECT. PLG. MECH.
r w Professions Code,and my license is in lull for •'Rd feet. s 8 i989
❑ ❑ ❑
9 D y License Clas Liu.Number_ u �
9 m H j UaleU-CoNmctor� .P
� G BUILDING PERMIT
¢ p0 u U WNER-BUILDER DIiCLARATION INFORMATION
X ;LL N I hereby affirm that I am exempt from the Contractor's License
MISC.- R TO ORD
FUOQ Law forlhe following mason,(Sec,7031.5.Business and Professions VALUATION $/FT.
1
Code:Any city or county which requires a permit to construct,alter, pERMIT ISSUANCE- 10.00
Q6¢2 Improve,demolish,Or repair any structure,prior to Its Issuance,also ELEC,CONTR. LIC.NO. ELEC.
La O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w $ he is licensed pursuant to the provisions of the Contractor's License
aLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe !1 LyLG�
4 o Business and Professions Code)or that he is exempt therclimn and QTY. PLUMBING PERMIT FEE !�
re r the basis for the alleged exemption.Any applica t ofSection malty STORIES TYPE CONSTR.
u ; by any applicant fora u permit subjects the applicant too civil penally
.1 not more than five hundred dollars($500t): - ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of the properly,or my employees with wages as - BACK FLOW PROTECT.DEVICE 4.00 DCC,GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to in owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare lot intended orofferedfor sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE.
RES IND CON PB OUR,
prove 1,aso nee of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the properly,he exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors: construct the project La 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and nProfessionswneof Code:The Can tractor's License Law does not apply
to contracts
owner of property who builds or improves Ihercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the Cont for such projects with u ronlmutor(sl license(]pursuont to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for(his ATER HEATER W/VENT . 6.00 '
reason
• Owner Date WATER SYSTEM - 5.00
ACC.GATE ACC.FILE N0.
WORKP-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
.I hereby affirm tlral I have a certifieulc of consent to self-insure„ ZONING x or a certificate of Workers'Campensat n I uranc ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.)./r .
Policy No. Company )Y- _
' .❑ Curried Copy is hereby fltmshed. FIRESPRINK ENERGY T-24
Z Z ❑ Certified copy is riled with the city inspection division. MISC.- REFER TO ORD.
0 Applicant Y❑ IN y ❑ No
I- rn PERMIT ISSUANCE - 10,00
CCCER'fIPICA'pl>OP EXEMPT ION PROM WORKERS' FLOOD ZONE A.L.U.C.
11J COMPENSATION INSURANCE. PLG.CONTR, LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is I'or one TOTAL Y❑ N❑ Y❑ IN
0 Z hundred dollars IS 100)or less)
U O I certify that in the performance of the work for which this per OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner in as to
Ow become subject to the Workers'C'ompensal ion Laws of California.
C_ (late Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ to NO ICE.TO APPLICANT; If,after making this Certificate of Ex-
F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
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=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 C G
Lender's Name ELECTRIC
I certify tial I have read This application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and Mate laws relating to building construction, and BOILER-COMP(3 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes,
(We) agree to save, indemnify and kcup harmless the City of MISC.- REFER TO ORD.
uperC o again liabilities, 'udgmerts, costs and expenus which PERMIT ISSUANCE 10.00 CONST.TAX
ay ny ay' cru• ss said City in conseyu ace of the
ran fth p• iL MECH.CONT. LIC.NO. - MECH.
TOTAL TOTAL /
Sign tore of pplicant/ ontraclu ale
OFFICE COPY Q ,