18665 POST.THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER ,
CITY OF CUPERTINO 866
INSPECTION DIVISION
JOB INSPECTION RECORD
/ •�. ,. ,. JPERMIT-EXPI '1'•ION
JOB ADDRESS to�o o- �- �—cS I�L�C S UNIT# _LOT# r _� -r , p�
T PERMIT EXPIRES IF WORK
O"ER C. l �1�.✓G+, l.( - CONTRACroa Q Ve L...Q, I_01�d { • ' IS NOT STARTED WITHIN'
IN PECT10N DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE:
'
ANCE OR 180 DAYS FROM
�"� '
LIFER 6 _y°1 _ ALL GRADING AND DRAINAGE SHALL BE INSTALLED. .LAST CALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - - MID
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB SEP 2 v 1989 f ./1 :£' ',,� V `
. PLUMBING - ' "-•1
ELECTRICAL cl#v of Cup"" '
ISSUANCE DATE
MECHANICAL .. 87 ELEcr. PLG MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR - _ INFORMATION
PLUMBING
VALUATION SAF T.
' � �
MECHANICAL
vERMIT r
ELECTRICAL
FRAMING 7 •—.91-S3 �/�}'
INSULATION �1-�•— "�,�' ,,, - STORIES TYPE CONSTR
DCC.,ROUP RES UNITS
(1 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sn. r.`Loo `a TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ,\
DIAPHRAGM THE CONSTRUCTION TAX IS PAID cyi�
ROOF SHEATHING , BUILDING USE
HES IND CON PB Otlm,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS. DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.M
PLUMBING IELECT.ENERGY
iH ACT N0. PANCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
. - MECHANICAL MECH.EN ERGY
ELECTRICAL BUILDING ENERGY - ACC.RATE ACC.FILE NO
FRAMING - ELECT.FINAL TEST
INSULATION - PLUMBING ENG'.SITE NO.
GAS TEST' GAS
MECHANICAL -`IRE SPR wrc ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - L - ✓� Y ❑ N❑ °'❑f`N❑
EXTERIOR SHEAR - ELECTRICAL RELEASE -`1010 ZONE A.LU.C.
INTERIOR SHEAR ,�� � FIRE DEPT. Y N❑ ❑ N
SHEETROCK - 0 GRADEFEE SUMMARY
EXTERIOR LATH - BUILDING'
INTERIORLATH ,TEMPORARY.APPROVALS . eulLDlniG ,�`p,'D
SCRATCH COAT ELECTRIC - PLAN CHECK
.. GAS . FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUI LDING ISNOTP.ERMITTED UNTILBUILDI NG FINAL IS SI GNED BY BUILDING INSPECTOR. MICROFILM '1__ _
uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, M
ELECTRIC
H-� ONE WORKING BEFORE REQUIRED INSPECTION. 1
' z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING -.
' —'SEE PERMIT FOR EXPIRATION DATE— MECHANICAL �,(}�
IMPORTANT! CONST:TAX ._ .'=
PLEASE READ REVERSE SIDE BEFORE`",
CALLING FOR FINAL INSPECTION: TOTAL3-
OFFICE COPY ' ,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT ` 1 8665
��BAIL 1r
ADDRESS _- w
O3�o BUILDING -ELECTRICAL-PLUMBING-MECHANICAL il.•
OWNER'S PLAN CHECK VALIDATION
NAME
n ^ w CITY- ELECTRIC PERMIT FEE
/( (� ONE
CONTRACTORS
Nnm CC'' n�r �y- •-�/�j� UTLETS-SWITCHES-RECEP 70.00!7.00
LIC.No. (ti CJv� LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS //•�/��/�Ey ./ ////II'' [_ 9 APPLIANCES-RESIDENTIAL 4.00
Q (//(I'I/A/O V�� HONE Ztf 1/� 4 PANELS 10.00 DATE OF APPLICATION
ARCHITECT' PLAN CHECK FEEP.C.N0.
OR PANELS (OVER 200 AMP) 20.00 u -
ENGINEER C�yryLs
, c:No. SIGNS TRANS. 3.00
ARCH.OR ENG' SPECIALCIRCUIT S.QQ PERMIT VALIDATION
ZIP - MOTORSEMP.METER OR POLE INS. 20.00
APPLICANT$
AODR Ess SEE FEE SCH. /
SERVICE CHANGE 20.00
'02 LICIiNSIiU CONTRACTORS DECLARATION
<u o I hereby.Httrm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
z w (commencing with Section 7000)of Division 3 ol'tire Business and '
BLO6. ELECT. PLG. MECH.
H N i Professions Code,' my license is in full force •1'c _- t-,,
o rtn
z w o LiecnsCf,Ipsx Lia Number f2 /�I aLjA.. OL D
DateContractpr City YL W f-�
Q y f J
¢ ¢w a OWNIiR-,RDECLARATION BUILDING PERMIT
F. OAe' MISC.- REFER TO ORD INFORMATION
w 0 y I hereby allin»that I am exempt from the Contractors License VALUATION S/FT.
ca ¢o j Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00
m� Code:Any city orcounty which raluiresa permit toconstroo,alter, oo
pQ a 0 improve,dL'mUll\II,or repair any SUlletnre,prior to Its issuance,aISU ELEC.CONTR. LIC.NO. ELEC. �i
wO LL requires the applicant for such permit to file a signed statement that TOTAL VX PERMIT TO
re he is licensed pursuant to the provisions of the Contractors License
z a
Law(Chapter 9(cmmmencingwi0l Section 7000)of Division 3 pith, (y-'J I
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE / 1 L^ lsl OL'@
¢rpm the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
uby any applicant fora permit subjects the applicant fair civil penalty LTER-DRAIN&VENT-WATER (EA.) 5.00
Of not mom than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as g K F LOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure Is not OCC.GROUP RES.UNITS
intended or offered for Sale (Sec. 7044, Business and Prolessions DRA S-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to in owner of
property who builds or improves thereon,and who docs such work FIXTUR -PER TRAP 5.00 So,ET FLOOR A A TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsare notintended or offered for sale.If,however,the building GAS-EA.S TEM-11 NC.4 OUTLETS 6.00 j^
or improvement is sold within one year of completion,the owner- GAS-EA.SVS M-OVER 4 IEA.) 2.00
builder will leave the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WA EINTER. 30.00 RES IND CON PB other
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codi The Contractors License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-O R 5(EA.) 1.00 - 2 /-n D f7• ^ ^
contracts for such projects with a cootmctor(s)licensed pursuant to ✓
the Contmctnr's License Law. SEWER-SANITARY-STOR A.2001t/10.00 TRACT NO, PARCEL NO.
❑ 1 am txempt under Sec. ,B.&I'.C.tier this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK E RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insum,
or a certificufe of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ tlified copy is hereby fumislied. FIRE SPRINK ENERGY T-ZO
Z Z Cerlifie op ¢ tied with th< city 'nspection division.
F O A licani_�� � _ MISC.- REFER TO ORD. Y 0 N❑ Y ❑ N�
Ir CERTIFICATEOFEXRMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC.
W > COMPENSATION INSURANCE PLG.C;ALTER
;ADDTO
. PLG
CL 0 (This section need not be completed if the permit is for one TOTAL -Y N� Y N�
0 Z hundred dollars(S 100)or Icss.)
U O 1 certify that in the performance of the work for which this per- CITY PERMIT FEEI
SUMMARY
W F- mit is issued.I shall not employ any person in any manner so as to
O w become subject to lire Workers'Compensation Laws of California.
a Date-Applicant 72: CH. 5.00 O�} to . NOTICE TO APPLICANT: If,uttermaking this Certificate of Ex- • 00emptiml,you Should become subject to Dle Workers'Com 5.00 Kprovisions of toe Labor Code, you must forthwith comly withsuh provisionsor thispermit shall he daenmd revoked. 10,000GF.M.) 4.00 -�CONSTRUCTIONLENDING AGENCY AIR HANDLING UNIT(OVER 10SWC.F.M.) 6.00 E (, 33Ihereby affirm that there '' a conetruciionlending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued tSec.3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00Lender's Name - HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 /Lender's AJJrcss f D�fI ceHity that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county
ordinances and state laws relating to building Sonstrucfion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby aLHhOrl/c representatives of this city to tuner-upon the `
9 above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL 1 �D
(we) agree to save, indemnify,and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which Z 11 CONST.TAX
ay in any, way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
m W of thi pcnniL MECH.CONT. LIC.NO. - MECH,
orAi
ignamre of Dli � t/Contractor ate '. O O TOTAL
OFFICE COPY