17940u
r�
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION,RECORD'.
-
JOB ADDRESS -be %4'14_Z^�_ -�V UNIT# =LOT#
•
OWNER p—, CONTRACTORIS
PERMir NUMBER
17940
PERMIT EXPIRATION
PERMITEXPIRESIF WORK
NOT STARTED WITHIN `
16o DAYS OF PERMIT ISSU-
ANCE,OR 180 DAYS FROM
-LASTCALLED INSPECTION.,
INSPECTION DATE INSPECTOR
INSPECT -RECORD
IO
FOUNDATION.-
-
NOTE:
ALL GRADING AND DRAINAGE•SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
y" _�.D
LIFER'
PREGUNITE- '
PERMIT VAuoATION
;1
t�,ccf:
`
_fA����
ISSUANCE DATE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
Y 2.51989pp
UNDERGROUND/SLAB
PLUMBING
,�,..
Giij ot I uRd we�� w
ELECTRICAL
MECHANICAL
-
BL c ELECT.,
El .
PLO.MECR.
t ❑.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- -
-
BUILDING PERMIT
INFORMATION
•" -' WOOD FLOOR -
VALUATION
S/FT,
PLUMBING
MECHANICAL
ELECTRICAL -
PERI I TOO
' `
FRAMING
INSULATION
STORIED
TYPE CONSTR.
- OCC GROUP
-
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SO.11 rLDOR ARIA
L
Ta TAL ACREAGE
DIAPHRAGM
ROOF SHEATHING
BUILDING USE
RES IND CON• PB Other
❑ ❑ 0 ❑ ❑ '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.,
ROUGH
SANA
' ASSESSORS PARCEL NO
PLUMBING -
ELECT. ENERGY,
TUBS & SHOWER PAN
PLUMBING ENERGY
TRACT NO,
PARCEL NO.
MECHANICAL
MECH,ENERGY
ELECTRICAL
BUILDING ENERGY
- ACC. DATE
Acc. FILE No
FRAMING - S
ELECT. FINAL TEST
INSULATION'
PLUMBING
IZONINc
r
ENG. SITE No.
GAS TEST - - -
GAS
FRE SPRINK
Y I] N❑
ENERGY T 24
v ❑ N❑
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
FmOD ZONE
N[]
-A.L uC:
Y L NE]
INTERIOR SHEAR
FIRE DEPT. -
SHEETROCK S c
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING '— —g
BUILDING
4 (fi—oo
7(
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT -
ELECTRIC
PLAN CHECK
FEE '
-
GAS
,NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY .
SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252 4505;
ONE WORKING DAY BEFORE REQUIRED•INSPECTION.
zo � PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE-
MICROFILM
ELECTRIC 1.)b
PLUMBING
MECHANICAL
CONST. TAX' '
IMPORTANT! `"
PLEASE -READ REVERSE SIDE BEFORE,
CALLING FOR FINAL INSPECTION.
TOTAL
.�
OFFICECOPY
•
•
O
Z Z
PN
CC Lo
LU -
0. 0
7)z
00
u
110
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
. BUILDING PROJECT IDENTIFICATION
APPLICATION &PERMITnRs
UILDING-ELECTRICAL-PLUMBING-MECHANICAL
PERMIT NUMBER _
A
,-
O
ol+i�Lss-�
IVA C/
OWNER'S
NAM ,d `-
/J���� e PHONE��(�
QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATIONr
'
DATE OF APPLICATION
CONTRACTOR
(.lnl,Q4✓C/L't/ddgKeC �/
OUTLETS- SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
ADDTRACrofls DRESS
7.-Y "1 PHONEri VWO
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCRrtECT /�C ��
OR C'.5
ENGINEER
ilc. No.
PANELS(OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ADDRESS ENG
ZIP
SPECIALCIRCUIT 5,00
PERMIT VALIDATION
/
\ y�
V CC i
EMP. METER OR POLE INS. 20.00
ADDfl E55
21DRESIS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
2-40
I hereby affirm that I am licensed under provisionsof Chapferl)
ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business and
Professions Cp� m .§cCn,C is in full foypay)1 �jeCI.
License Class Sl7 Lie. Number✓
- JI -
BLDG. ELECT.
W M
PLG.' MECH.,
❑. ❑ .
Dale Contracto
MAY 2 519,$
BUILDING PERMIT
WNER-BUILDER DECLARATION
I hereby affirm that I so exempt from IAC Contractors License
Law fornycit ll or wuntason.(hrequi3Lres a permit ess and Professions
it to construct, Alan alter,
Any city or coo my whiny structure,
improCodeve. toFC, pd sign its statement also
prior
ImprOVs, he applic. Or repay h permit
requires the applicant for Such permit m file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that be is exempt therefrom and
the basis for the alleged exemption. Any violation of SccuoR7031S
INFORMATION
MISC.- REFER TO ORD
VALUATION SIFT.
O D 0
PERMIT ISSUANCECit
U.
ELEC. CONTR. LIC. NO.
ELEC. �
TOTAL I� I V V
.. PER IT O
'
11--
rl
OTY. PLUMBING PERMIT FEE
I STORIES
TYPE CONSTR.
by any applicant for a Demur subjects the applicant to a civil penalty
of not more than five hundred dollars 135001.):
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
,
DRAINS -FLOOR, ROOF, AR EA, CON D. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that Such improve-
menu are not intended or offered for sale. If, however, the building
-
..
FIXTURES - PER TRAP 5.00
50. FT. FLOOR AREA
TOTAL ACREAGE
GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of Completion, tse owner-
builder will have the burden of proving that h e did not build or im-
prove for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with
. ..
GAS - EASYSTEM -OVER 4 (EA.) 200
BUILDING USE
RES IND CON PB Other
El ❑ ❑' ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
_
LAWN SPRINKLERS -OVER 5 (EA.) - 1.00
ASSESSORS PARCELNO.
- -
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
contracts Icor such projects with a contractors) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
__YR ACT _NO.
PARCEL NO.
❑ I am exempt under Sec.-, BAP.C. for this
reason
WATER HEATER W/VENT 6.00'
Owner Date
- WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO,
WORKERS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insuro,
or a certificate of Workers' Compensation Insurunce, or a eerlificd
ZONING
ENG. SITE N0.
Copy Ihereo(lS5 3800. Lab.CJ. / I
Poll Company_`
Certified copy is h creby furnished.
Certif d co y_is EI w h the city aspect'
Applicant
FIRE SPRINK
Y ❑ N ❑
ENERGY T-74
Y ❑ ry❑
MISC. - REFER TO ORD.
CIiRTIFICATIi OF EXEMPTION FR WO ; S'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.UC.
PLG. CONTR. LIC. NO.
PLG.
TOTAL
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
Y ❑ N❑
I Y ❑ IN C]
OTY. MECHANICAL PERMIT FEE
-
FEE SUMMARY
hundred dollars IS 100) or less,)
I certify that in the performance of the work for which this per.
mit is issued, I shall not employ any person in any manner so as to
BUILDING
f +
becomesubjecttodieWorkers'Compensation Laws of Calil'onam.
Dale Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex.
eruption, you should become subject to the Workers'Compensation
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
provisions of the Labor Code, you most forthwith comply with
such provisions or this permit shall be deemed revoked.
FEE
AIR HANDLING UNIT (TO I0=C.F.IV0 4.00
'AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE
,
CONSTRUCTION L17NDING AGENCY
1 hereby affirm that there is a construction lending agency for
the 3097, Cw C.j"ce of the work for which this permit is issued (See.
EXHAUST HOOD (WITH DUCT) 5.00
' MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 6.00
HEATING UN IT (OVER 100,000 B.T.U.)9.50
ELECTRIC
a* �O
Lender's Name N
Lender's Name SS
1 certify filar I have read this application and Slate that the above
information is correct. 1 agree to comply with all city and county
ordinances Slid state laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
,
BOILER -cGMP (3 H.P. or 100,0008.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
MISC. - REFER TO ORD.
-
(we) agree to Save, indemnify and keep harmless the City of
uperdno against liabilities, judgments, costs and expenses which
my in any way accrue agail t sai .C' y tG`of-the
' ranting this permit. -
u
CONST. TAX
-
-
PERMIT ISSUANCE 10.00
MECH.CONT. LIC. NO. MECH.
TOTAL
-
TOTAL
00
Si ureofA m nl/Co actor Date
OFFICE COPY