18254 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 18254 -
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESSI �(Y�'T+���1LV AVe UNIT# _LOT# PN L/", ' t' rJ
PERMIT EXPIRES IF WORK
OWNER CONTE ACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. __
GARAGE SLABS A � `�� 4r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
—Or
UNDERGROUND /SLAB - _ :, +1: � E�` �+ `
PLUMBING , i I t-P.
ELECTRICAL ISSUANCE DATEu
MECHANICAL 11_11EqqL[--E7�C��T ��IP�ppEjyG��. M eco.
no 1
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
PLUMBING WOOD FLOOR VVpALUAT.IONN�� SIFT.
MECHANICAL �// 'VV
MIT To
ELECTRICAL PER
FRAMING
INSULATION STORIES TYPE CONST
OCC GROUP RES UNITS +
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL MSP.SHALL BE MADE BEFORE so ET.aooR ARIA TOTAL ACREAGE
." DIAPHRAGM THE CONSTRUCTION TAX IS PAID "
ROOF SHEATHING RBS IND LUCOON usEF6, ou
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.H
ASSE55UHS PARCEL NO
'
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG,SITE NO.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FI RE 111111 ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ No ° ❑ NO
EXTERIOR SHEAR ELECTRICAL RELEASE PwoD ONE AL Uc.
INTERIOR SHEAR FIRE DEPT. Y❑ "❑ ° ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS a L BUILDING /0
SCRATCH COAT ]ELECTRIC PLAN CHECK _
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC s sO
z� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING D
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. M
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY J/
�-:
,
BUILDING PROJECT I DENTIFICATION PERMIT NUMBERAPPLICATION & PERMIT 18254
BUILDING x
ADDRESS BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S J/�l/ /)c
CITY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
PRON-2196-3-509
-.
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 a �0 h)
Q(„ Llc.No LIGHTING FIXTURES 10,00/1.00 l�F rtG� Tv ' 9
CONTRACTORS s ' 6aw MUDti APPLIANCES-RESIDENTIAL 4.00
3e.,,i11Ah-L1A Lt_ PHONE PANELS 10.00 DATE OF APPLICATION
RRCHIiECi PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE PD,N_O,
O
ENGINEER
uc,No ISIGNS TRANS. 3.00
0o ESS
SS SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS Ts goo � il?iJpA G; MOTORS SEE FEE SCH. 7
ht, SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS D17CLARATION
a v Hj I hereby affirm that I am licensed under provisions of Chapter 9
y a d (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
F m 2 Professions Code, td I license is in full force un i .) JI BLDG. ELECT. PLG. MECH.
oz m W License ass_ Lic.Number �T1
w H Datey�.Cnnlmc[or_��.. �_-.7�^
rc a w a OWNER-BUILDER DECLARATION - BUILDING PERMIT
A. o A. O INFORMATION
w g H I hereby affirm that I am exempt front the Contractor's License MISC.- REFER TO ORD
Huoa Law for the following mason.(See.7031.5.Busioesaand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
Code:Anyery orcounty which rnryires a permit to construct,alter, �St Dp �
FO improve,demolish,or repair any stfuclm e.prior tons issuance,also ELEC.CONTR. LIC.NO. ELEC. �r�� •
re O BE requires the applicant for such permit to file a signed statement that TOTAL
a w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthc �nj
s 2 o Business and Prokrrnfessions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE i 'z 19,111
BE I-m the basis for the alleged exemption.Any violation of Section 7031.$ J STORIES TYPE CONSTR7.
03 _ by any applicant for a permit subjects the applicant to a civil penally J ALTER-DRAIN -WATER (EA.) 5.00
of not more than live hundred dollars 155001.):
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC GROUP RES.UNITS
their sole compensation,will do the work,End the structure is not
intended or offered for sale (Sea 7044, Business and Professions pfl AINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's LiccnsC Law docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 J �u SO.FT.FLOOR AREA TOTALACREAGE
himself or through hisown employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
ments 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
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose ofsale.). - INDUSTRIAL WASTE INTER, 30.00 RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ El
licensed contractors to construct 0m Project(Sea. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
end Professions Code:Tim Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such Protects with a contractors)hcensed pursuant In
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00T'RACNO. PARCEL NO.
❑ lain exempt under Sec. ,N.AP.C.for❑tis'rcason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO,
WORKERS'COMPENSA'rloN DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have o certificate o1'consenl to solbinnuru,
ca certificate of Workers'Compensation Insurance,or certified ZONING ENG.SITE NO.
opy a meregyI ISec.3800.Lab.C.).�YA-'1Z" UVb
1'olicY M10 FL�-'yEomp py F
O ❑ CCrCCd''i'm�jj'"'cupy is hereby furnished. FIRE SPRINK ENERGY TY4
Z Z �Ccrtired-ty'ypy z lingl w'tla t thg spection division.
F O Applicant_ /.r_/J�'.ce MISC.- REFER TO ORD. Y N Y N�
CC y CERT IFICATE 01:EXEMPT ION PROM WORKERS' PERMIT ISSUANCE 10.00 .ZL 19 FL oO E!E A.L.ILIG
LU � C&ilrleNSA7ION INSURANCE PLG.CONTR. LIC NO. PLG.
CL Z (This section need Cut be cmaidetiol if the Permit is bar one TOTAL '�� v N[] Y E] N[]
hundred dollars(S 100)nr less.)
L) O I certify that in the per&mnancC ol'the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,1 shall Rot employ any Person in any nnanner so as to
O L) become subject to the Workers Compensation Laws of California.
UJ Date Applicant BUILDING
} GO NOl'ICE 1'0 APPLICANT': If,alter making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 ,®17 ( Y -�
F" z emption.you should become aubjeel to the Worker.'Compensation APPLIANCE 5.00 PLAN CHECK _
provisions o1' 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 6 3
1 hereby alfirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 J
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
Lcndcr i NaAddress U.)HEATING UNIT 100,000B.T. 9.50 ELECTRIC 'r r0
I certify that 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 late laws elating to building construction, and BOILER-CDMP(3 H.P.or 100,000 B.T.U.) 6.00 . OV
hereby enthoriio representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH, MECHANICAL 0 D
hereby
autioncd property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgments, Costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 1 OD
ranting of III is per MECH,CONT. LIC.NO. MECH.
o/✓ /0J,:// /-9 TOT TOTAL /
Signa ore of App icon ontmetor Date I.
OFFICE COPY