17579 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO ' 17579
INSPECTION.DIVISION " .
JOB INSPECTION RECORD
,PERMIT EXPIRATION
JOB ADDRESS' p-:C 4-v,, -7- _LOT#
-
/ PERMIT EXPIRES IF WORK
OWNER O �. �- .h CONTRACTOR l ec IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 18o DAYS OF PERMIT ISSU.
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CALLEDINSPECTION.
UFER . ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF, PERMfI VALIDATION
CUPERTINO STANDARDS.
- GARAGE SLABS � � I .SI "-� �("' ',
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r�
UNDERGROUND"/SLAB APR 1 b 1989 �lfl � i,l ��'
PLUMBING -� vi
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG E}L}E-CST, PLG. MECH.�
7FI'Xj-,I LJ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
V Ab{lAtl N_-�� SIFT.
PLUMBING .
MECHANICAL
ELECTRICALPERMIT TO
" `
FRAMING 5a�
INSULATION STORIES TYPECONSTR,
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O,Gi ILOOR AREA TOTALACREAG!
ROOF' NOTE:NO C SHALL BE MADE BEFORE
DIAPHRAGM � THE CONSTRUCTION
TAX IS PAID
BUILDING USE.
ROOF SHEATHING - - RES 9ND CON PB 0"",
.APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS . DATE . INSP. L L L ED
ASSES5UR5PARCELNO
ROUGH SAN.M --
PLUMBING ELECT.ENERGY
TRACT NO, I PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY "
MECHANICAL,- MECH.ENERGY
. . .
ELECTRICAL - BUILDING ENERGY � •'ACCDATE.
ACCFILE NO
FRAMING - ELECT.FINAL TEST.
INSULATION PLUMBING ZONING ENG.STTE NO,
GAS TEST
MECHANICAL FIRRSPRINK ENEFGY.T@G
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y "�`
EXTERIOR SHEAR ELECTRICAL RELEASE " . FLOOOZONE A.Luc.
INTERIOR SHEAR* FIRE DEPT. vo NL YL NL,
SHEETROCK GRADE . , FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY'APPROVALS - - Bu1LDI 7,60
SCRATCH COAT ELECTRIC
. - - GAS FEE 4 h`f p.^
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC EE 1 ,91l
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING IN SP T�R:^ICROFI M '
ARRANGE FOR INSPECTION BY PHONING 252-4505, E sC C xvl
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PL MBING
• a PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z AMEHANCAL
SEE PERMIT'FOR EXPIRATION DATEIMPORTANT! TAX
PLEASE READ REVERSE SIDE BEFORE TOT
•CALLING FOR FINAL INSPECTION.
OFFICE COPY.
APPLICANT TO FILL-IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
';'9UILDING PROJECT IDENTIFICATION 'APPLICATION PERMIT
ADDRESS - - 1 ,7579
AooREs/O 9,91 /VTv vC BUILDING-ELECTRICAL-PLUMBING-MECHANICAL „✓4as
OWNER'S ,./F PLAN CHECK VALIDATION
NAME QTY. ELECTRIC'PERMIT FEE
PRONE '
CONTRACTOR'S
NAME 1 UTLETS-SWITCHES-RECEP 10.00/1.00
�� &:4 Llc.rvo. rO r/ LIGHTING FIXTURES 10.00/1.00 -
CONTR CTOms - PPLIANCES-RESIDENTIAL 4.00
ADryD1RESS
es'� 1T GL% � � PHDNE PANELS 10.00 PATE OF APPLICATION
ARCHITECT
OR - - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. r SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION,' -
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS T
Ar$ MOTORS SEE FEE SCH. T -
ADDRESS �
;;O /- t. . �6s -7 G'J SERVICE CHANGE 20.00 �1y'f
o o i1 LICEN CONTRACT RS DECLARATION t4�
< u v 1 hereby affirm that lam licensed under provisions of Chapter9 ABY ISSUANCE DATE
Z w (commencing with Section 7000)of Division 3 of ifie Business and BLDG. ELECT. PLG. MECH.
Ni Professions Code and t license is in full fore f t � ❑ ❑
Z, o�,- License Cass 1 Lie.Number p� �(p
E r ll
Dale C'ontraclor UI� YI �UpQI'11t1U
P L f BUILDING PERMIT
2 w¢ OWNER-BUILDER DECLARATION INFORMATION
DAca MISC.- REFER TO ORD
X ;u uHi I hereby affirm that I am exempt from the Contractor's License VAI.UATIO S/FT.
H LL04 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 sop s70
Code:Any city or county which requires a permit to construct,alter,
¢ 2 Q Q improve,demolish,or repair any structure,prior 10 its issuance,also ELEC.CONTR. LIC N0. LEC. Ib�Iy
LL requires the applicant for such permit to file a signed statement Chet T TAL I �• O PERMIT TO
w$ he is licensed pursuant to lire provisions of the Contractor's License I SI�-j N
Fii Law(Chapter 9(commencing with Section 70000of0ivislon3of the
- ¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING ERMIT FEE
re=$ the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as Owner of the property,or my employees with wages as - BACK FLOW PROTECT. DEVICE 4.00 DEC.GROUP REB.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to air owner of
property who builds or improves thereon,and who dues such work FIXTURES-PER TRAP 5.00 S6 FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-l 6,00
menus are'not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS,EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.). I INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB 'Omer
❑ 1,as owner of the properly,am exclusively contracting with 13. ❑ ❑ ❑ J❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO"
and Professions Code:The Contractor's license Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
Contra•ts m for such projects with a contractors)licensed pursuant
I
e actor's Licensgtaw. SEWER-SANITARY-STORM EA.200ft/10.00 . TRACT NO. PARCEL NO,
l am exempt under Sec. ,tl&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Bate WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WRIiRS'COMPENS'ATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I havc�cerI li IIf IreOnsent l0 self-insure, ZONING ENG.SITE NO.
or a certificate Of Workers'Co Pon I mac,or' certified
copy thereof(Sec 3800,Lfsb�y ��
Policy No, mp
JJJIIa��I
. O ❑iCertilied , «l bpfuinished. FIRE SPRINK ENERGY T@<
Z 2 •QI Certifie - �y'$"'f11ell with the cityinsp clime division.
' MISC.- REFER TO ORD.
O
Applicant Y ❑ N❑ V ❑ N❑
LU 1' � E
stn PERMIT ISSUANCE , 10.00 FLOOD ZONE A.L.U.C.
F IC' . -
W 7 � OMPENSATION ON ION FROM WORKERS'NSURANCE PLG.CONTR. LIC.NO. PLG.
CL O "lion need not be conquered if tiro permit is for one TOTAL Y❑ N❑ Y❑ N❑
0 hundred dollars($100)or less.) -
U / I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
mit is issued,I shall not employ any person in any Rmnner so as to
OW become suhjectto the Workers'Compensation Laws of California. BUILDIN •� •� (16
Date Applicant ALTER OR ADD TO MECH. 5.00 /¢
} N NOTICE TO APPLICAN"r: If,after making this Cerlificule of Fx-
? emption,you should become subject t0 the Workeri Compensation APPLIANCE 5.00 PLAN HECK
provisions of the Labor Code, you must forthwith comply with FEE 12,/s
U such provisions or this Penult shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 �•-�
CONSTRUCTION LIiNDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE FJ 0
1 hereby affirm that there is.'construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFI M
3097,Civ.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.5 E CTRIC U0
Lender's Addresss
'
I cerlily Ihul 1 have read this application and ,are that the above VENTILATION FAN (SINGLE) 4.0
information is correct. 1 agree to Co ly with all city and County PL MBING
S J'PT BOILER-CON?(3 H.P.or 100,000 B.T.U.) 6.00
ordinances and state laws realm building construction, and
hereby authorize represeplat`-ev p this - m enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. ME HANICAL
above-mentioned grope y n pec purposes. '
(We) agree to, ,ri a and keep harmless the City of MISC.• r REFER TO ORD.
upether,ago �I'K tin udgmenls, costs and expenses which CON T
T.TAX
Xay ir,i iw against said City in consequence of the PERMIT ISSUANCE10.00 -
ranll�. "& MECH.CONT. LIG NO. MECH.
TOTAL TO
out Factor Date
OFFICE COPY