17454 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO17454
INSPECTION DIVISION
�\ JOB INSPECTION RECORD 4
,. .PERMIT EXPIRATION ..
JOB AD DRESS_19 9 � d ✓e' \A 2 d UNIT# _LOT# (( 1. L `/ ; L �
�q VE'RMIT EXPIRES,IF WORK
OWNER L ' Vl� t-(/ CONTRACTOR Davi .51 j LL-4 CD IL-C-1 IS NOT STARTED WITHIN"
I INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
'.FOUNDATION _ ANCE OR 180 DAYS FROM
NOTE:
UFER � _ ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
C ERTINO STANDARDS.
GARAGE SLABS A 6.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
QK. S-'JO�I WAU.
UNDERGROUND /SLAB 1 p [�'
PLUMBING `J�" - V �l 7�1RTULI veCJ .
ELECTRICA ISSUANCE Dare-
MECHANICAL - B}fL�D7G1'' ELECT PLG, MEC.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED (,•Q-�`/ INA el
40 BUILDING PERMIT
WINFORMATION
WOOD FLOOR
VALUATION $IIT.
PLUMBING —�q ` fi
.-iC,7 _ -7?ust I ')00 .C"d
MECHANICAL '
� 1
ELECTRICAL - . PERMIT r ��
FRAMING '��
INSULATION \\ (\C K - sroRlEs TV PE CON rn.
fL G�w3 clG ti OCC GRouP RES UNITS
?P,OACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED S'vc` 7- 9--?—
ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE so�rr IPL(oo/a a.ea TOTAL nceEAce
DIAPHRAGM THE CONSTRUCTION TAX IS PAID =) F
BUILDING ISE
` ROOF SHEATHING - HES MO❑ ❑ c ❑ R"
o APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 11,
FINALS DATE INSP. Assessos PARCEL No
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN - PLUMBING ENERGY r.acT No, PARCEL No.
MECHANICAL MECH.ENERGY ncc Dare acc PLLE No
ELECTRICAL BUILDING ENERGY
FRAMING - ELECT.FINAL TEST ZONING ENc,SITE No.
INSULATION PLUMBING -
GAS TEST GAS �. _ .
MECHANICAL - FIRE SPRINK ENERcvTz-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED —HEATING ` ❑ "[ ❑
EXTERIOR SHEAR ELECTRICAL RELEASE _ FLOOD ZONE - nyu c, ;.
INTERIOR SHEAR FIRE DEPT. _ gffq v❑ NE v Lam• "1:1
SHEETROCK �• ,Q, GRADE FEE SUMMARY
EXTERIOR LATH' BUILDING
BUILDING
TEMPORARY c•T-L/1
INTERIOR LATH APPROVALS .J E/
SCRATCH COAT ,O , ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHON=INSPECTII ' N.
ELECTRIC . r .
F ONE WORKING DAY BEFORE REQUIRPLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PH
Z.,' MECHANICAL
- SEE PERMIT FOR EXPIRATIO
IMPORTANWe
T! CONST.rnx
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL Q�F,
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
` -BUI LDING PROJECT I DENTIFICATI ON .PERMIT NUMBER
EUR_mNG APPLICATION & PERMIT
ADDRESS 17454 ,
. O _ S /� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL -
OWNER's - ✓ PLAN CHECK VALIDATION
NAME
X11'- OTY. ELECTRIC PERMIT FEE
Cali
PHO E
CONTRACTOR
EUTLETS-SWITCHES-RECEP 10.00/1.00 (� �(
Db+JSrMONS Coa ry 7 LIGHTING FIXTURES 10.00/1.00 PJ - 6 qS% Z"'
roNTRACTGR's7/O VNrysi A,� APPLIANCES-RESIDENTIAL 4.00
ADDRESS' 77 -
ss �f(^PHONFJY�� Pof PANELS 10.00 DATE OF APPLICATION
ARCHITE `e- PLAN CHECK FEE P.Cy NO.
on e 'fp PANELS (OVER 200 AMP) 20.00 _
ENGINEE
uc.NO �6� SIGNS TRANS. 3.00
ARCH.OR ENG/ 1ME.V I/ 604 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Tes E4AZfyu EMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS 20 Seo srEvFN 64 Sit)D MOTORS 'SEE.FEE SCH. ^Z3
V 0 SERVICE CHANGE 20.00
Er O o LICENSED CONI ACTORS DECLARATION _ D� A,_TL
a u I hereby affirm that I um licensed under provisions of Cl to 9 ISSUANCE DATE
H z w (commencing with Section 7000)of Division 3 of the Elesti and
a y t l SLOG.. ELECT. PLG. MECH.
E N z Professions Code,anti my license is in full force and elle L ❑ ❑ ❑
o z n o License Class Lia Numher
IS Lf
u, �
Uute Contractor
BUILDING PERMIT
¢ a, w a . OWNER-BUILDER DECLARATION
O e. U INFORMATION
X ;LLE I hereby affirm that I am exempt from the Contractor's Lic - MISC.- FE TO D
LL O a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
E _ ISSUANCE 10.0 • -
f >E Code:Any city or County which requires a permit toconstruct,alter, 000.
ac w aa ¢O improve,demolish,or repair any stnreture.prior to its issuance,also ELEC.CONTR. LIC.NO. TOTAL ELEC. p� OOH
or
o¢ requirethe applicant for such permit to file a signed statement that -
w s$ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Eii Law(Chapter 9(commencing with Section 7000)of Division 3 cflhe 2,�Tbl � `
s 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ E$ the basis for the alleged exemption.Any violation of Section 7031.5 _ STORIES TYPE CONSTR.
a ' by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN III (EA.) 5.00
.I'not monition five hundred dollars(5500).): V 1.
❑ 1,as owner of the properly,or my employes with wages as BACK F LOW PROTECT.DEVICE 4.00 Dec.GROUP RES.UNITS
their sole compensation,will do the work,and Ilse 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 docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SD.FT,FLOOR AREA TOTAL ACREAGE
menta m through his own employees,provided that such improve- �� O
mems are not intended w thinoffered
one y Sale.o If,however,the building GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00
or improvement is held within one year of Completion,tire owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Mbuilder r purpos the burden of proving that he did not build or im- RES IND CON PB OrM1e,
prove f,as owner of sale.).p INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,am exclusively contracting with ❑ ❑ ® ❑ ❑
licensed contractors: construct fire project(Sec, does not
LAWN SPRINKLERS- 1,INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cole:The Contractor's License Law does not apply
n an contracts
for
of h projects
who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
MtheCotsctorIxhceneLwihacomrucmrts)licensedpursuant SEWER-SANITARY-STORM EA.the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,tl.&P.C.for this WATER HEATER W/VENT - 6.00 ,
reason
V Owner Dale WATER SYSTEM 5.00 ACG.DATE ACC.FILE NO.
WORKERS'COMPIiNSAI'ION UIiCLA RA'T'ION WATER TREATING EQUIP. 5.00
I hereby affir s IhoI I have u certificate ofcon.tat to self-insure,
�Ts or a certifical Workers'Co}}���pppppppensal ion Insurance,or a cert it led ZONING ENG.SITE NO.
Y tt,pyYhereof .e .3800,Pah.q y'./
V Polio No. Com amr�fl (J
Q ❑ Certi ed p Rumb for ishe FIRE SPRINK ENERGY T 24
z 2 ❑ Cert'ie Ile IRI re city inspection division. MISC.- REFER TO ORD.
O Appllcu, _ Y❑ N❑' Y N❑
W CERTIFICATE OF EX IiMPTION FROM W KERS' PERMIT ISSUANCE - - '10.00 FLOOD ZONE A.LU,C.
L COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLC..
CL
Z (This uclion need not he completed if the "coil is far one TOTAL Y❑ N❑ Y❑ NF]
hundred dollars(S)00)or less)
U O 'I certify that in the performance of the work for which this per. QTY. 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. ^
Is. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING `'
} to NOTICE '10 APPLICANT' If,after making this Certificate of Cx
F ?
coup tion,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions oI' the Labor Code, you must forthwith comply with FEE '
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10pMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLINGUNIT(OVER 10=C.F.M.1 6.00 SEISMIC FEE 3 O, 06
I 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 HEAT!N G UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lenders Address
I certify that 1 have read this application and Rate that the above VENTILATION FAN (SINGLE) 4.00
information is correct I agree to comply withall oily and county PLUMBING
ordinances and slate laws relating to building construction, and ' BOILER-COMP(3 H.P.Or 100,0008.T.U.) 6.00
her- authorize representatives of this city to enter upon the BOILER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL
a ve. •ntioned property for inspection purposes.
(We) greeto save, indenm' and keep harmless the City oI' MISC.- REFER TO ORD.
u n agui t li i ties j I cuts,costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
V ay n y a 'r s aid City in consequence of the
rant g f ermif MECH.CONT. LIC.NO. MECH.
xF IF TDTA} TOTAL
nature Applican/Con ractor Data
OFFICE COPY