17416 POSTTHISCARD NEAR FRONTOF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17416
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS o� J UNIT4.' _LOT#
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: LAST CALLED INSPECTION.
LIFER . ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERnIn vnuon noN
CUPERTINO STANDARDS. "
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - . 'S. A r
UNDERGROUND /SLAB
PLUMBING .5L..,�.•1
ELECTRICAL MAR .I ISSUANCE DATE
MECHANICAL a . ELEc r. PLC. NIECR
at cl
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING -
MECHANICAL
ELECTRICAL PLR&IIT TO
FRAMING
INSULATION STORIES TYPE CONSTA
- OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 IT I'IOON nRI:A TViAL ACNlA4E
ROOF -• NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID - -
auauwN use
' ROOF SHEATHING � RLs wo CON PB D.I,..,
APPLY NO ROOFING UNTIL.ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ 0
ASSESSORS PARCEI.NO
ROUGH SAN.# '
PLUMBING - - I ELECT.ENERGY - '
TUBS&SHOWER PAN PLUMBINGENERGY 7 TRACTNO. PARCELNO
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL . ' BUILDING ENERGY "
FRAMING ELECT'FINAL TEST
ZONING. ENG.SITE NO.
INSULATION PLUMBING
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T}<
3 . Yo No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y � N,
� � '
EXTERIOR SHEAR, ELECTRICAL RELEASE FLOOD ZONE A L.0 C.
INTERIOR SHEAR. FIRE DEPT. YE] "❑ ` L. "❑
SHEETROCK - - GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
• GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR•INSPECTION BY PHONING 252-4505, ELECTRIC"
LU
- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING..
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! ,.NST.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
BUI LDI NG PROJECT 1 DENTI FICATION -PERMIT NUMBER
BUILDING APPLICATION & PERMIT ` 17416
ADDRESS I�
a/3$3 D?Ixie -- I)r- BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
r, LiI^� te�e� PNDNEQ9�- lgs'I
v NAMLRACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
A,Ak A LIG.ND Y(D Salo<f LIGHTING FIXTURES 10.00/1.00
CONTRACTORS - PPLIANCES-RESIDENTIAL
ADDRESS 4.00
/-
S��O�YHC/Gi�& J` PHONE lJ�-ALT/`( P ELS 10.00 DATE OF APPLICATION .
ARCHITECT PLAN CHECK FEE P.C.-NO.
°R PUBLIC WORKS PANS (OVER 200 AMP) 20.00 _
EN , LIC.NO. SIGNS NS- 3.00
9 ARCHE REND �� SPECIAL C CU IT 5.00 - PERMIT VALIDATION
IP EMP.METER R POLE INS. 20.00
1 a
ADDRESS vvuCANTS ^ MOTORS SEE FEE SCH. - �r AO
0
Y /4S ,,11 LSERVM Q
3l�NIO� .
z � i
/-f ICE CHANGE 20.00
0
Foo LICENSED CON'1'RACfORS DECLARKf10R Q '
v u I hereby uftlrm 'flat I am licensed under provisions of Chapter 9 ISSUANCE DATE
z w (commencing with Section 7000)of Division 3 of the Bnsiness send
rri ¢ y BLDG. ELECT. PLG. MECH.
F y z Professions Code,anA my license is in lull forc�e��an�d y'flee; ❑ ❑
o m - License Clyss f-Je_ LiaNu:nber& Y.�•� 56
o o )atc..3 1 Contractor_k t
a Y BUILDING PERMIT
o i D OWNER-BUILUFR DECLARATION INFORMATION
w ; y I hereby ithrm that I am exempt from the Contractor's License MISC.- REFER TO ORD
.. o a Law ror the following reason.(Scc.7031.5,Bmuners and Professions PERMIT ISSUANCE 10.00 VALUATION 5/FT.
- 0 Code.Any city or county which requires permit to construct,alter,
¢ 2 Q 20 Improve,demolish.Or repose any structure,poor to IIS issuance,also ELEC.CONTR. LIF NO. ELEC.
¢ r ims the applicant fpr such permit In ft,a signed statement that TOTAL PERMIT TO
n w m he is licensed pursu.tll to the provisions of(lie Contractor's License I(cCA1r„I '
F z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the IIJYJ'.ILI,
- ¢ Business and Profession%Code)or that he is exempt therefrom andOTV. PLUMBING PERMIT FEE
IS F o I11e basis for the ullc,ed cxUmplin 1.Any violation nt Section 7031.5 STORIES TYPE CONSTR.
A. - by any applicant fora permit subjects the applicant toxcivil penalty
ofmd more than fivehtmdred dollarOS500).)'. ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages m BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the zImcwoc is not OCC.GROUP RFS.UNITS
intended or offered for sal,(Sue. 7044, Ilunine, and Profession, AINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Convector's License Law docs not apply to an owner of
property who builds or improves thereon,and who docs such work RINDUSTRI
-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL n�REACE
himself or through his own angloyecs-provided that such improve- a
menlsare not intended or offered forsale.lf.however,thebuilding YSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- SYSTEM-OVER 4 MA.) 2.00
builder will have the burden of proving that he did not build or ins- BUILDING USE
prove]or purpose ofsale.). WASTEINTER. 30.00HES IND cOry PB 'Omar
❑ I,as owner of the property,am exclusively contacting with � ❑ ❑licensed contract., toe hSro,1 the project(Scc. 7044,Busine, IN ERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Protssioro Code:The Comrctor's License Law does no'applyto an owner of property who builds or improves thereon,and who IN KL -OVER 5 (EA.) 1.00
c.ntraC,for such projects with a contracbds)liemscd purnuanl mthe Contractor's License Law. NITARY- RM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sea ,B.&P.C.for this WATER HEATER W/VE6.00
leasnn
Owner Dole WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORKERS'COMPEN's AT1ON DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that 1 have a certificate of consent to self msure.
or a certificate of Workers'Compensation Insurance,sera cerlifinl ZONING ENG.SITE NO.
copythereof Iscc.3800,1 IEC.L�
Policy N¢zl St3l=Company-P -
O ❑ Certilledcopyishcrbbyfurnislle1l' RE BPRINK ENERGY T"z4
Z_ Z A- Certified 1�y.��r file w 1 the city inspection division.
~ onppllc;tnt_J�/'k1 MISC.- REFER TO ORD. - Y ❑ N� Y ❑ N�
PERMIT ISSUANCE 10.00
L CERI'IPIG1'I'Ii OP EXIih1 N INS FROM W'URKCRS' FLOOD ZONE A.L.u.c.
W need hot
cam INSURANCE KANCE PLG.CONTH. LIC.NO. PLG. ❑ ❑ ❑ N❑
d hundred
dollar,IS
not be completed it the permit is l.r nI TOTAL Y N V
0 Z hu nd,,Iify that lS l 001 por elees.l
U O I is issued,
that fl the t employ an of me work for which this put- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
0 U It is issued,I shall not ,keo,' any person in saw monster.r as to
O w become subject to the Workers'Compnlsalion Laws of California.
Dulc Appli...I ALTER OR ADD TO MECH. 5.00 BUILDING
>_ ai NO1'ICI' TU APPLICAN"I': It,after milking this Certificate of E..
? emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of Om Labor Code, you must forthwith C U m,ly will+
U such provisions or this permH «
it all be dmed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)"C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work lot which this permit is issued(Sec. MICROFILM
3097,CI,C.), HEATING UNIT(TO 100,000 B.T.U.)
Lender's rddHEATING UNIT(OVER 100,000 B.T.U.)Lender's AAddress ELECTRIC
I eerlily that I have read this application and state that Bm above VENTILATION FAN (SINGLE) 4.00
. information is Correct I agree to comply with all oily aIJ ccmnty PLUMBING
.Nin:mces and state laws rhlnting m builJing nmxtnmtion, uml BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives ins of this city es Cater upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL Q Q
hereby authorize
property forinsp of ion purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,costs and expenzes which PERMIT ISSUANCE Zg�p �00 CONST.TAX
may any wayyeeerrraccrue against said City in consequence of the
fan;y�t(this nv ���, 1�-( MECH.CONT. LIC.NO. MECH.
Cl/a\V)h / /� �14 S L TOTAL^, d TOTAL
Signatme_pf Applicant/Cmt,acor Date A q s `�' '-T / U`�
OFFICE COPY