18185 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY- OF CUPERTINO 1 g1 85
INSPECTION DIVISION
i JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS (1 1° U �' [L Ly_7�(�12 UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER S v . CONTRACTOR, @ G` IS NOT STARTED WITHIN
INSPECTION I DATE INSPECTOR INSPECTION RECORDGayt.( 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
m:AIRY. 1"•j 1��- �..� ..
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED --
UNDERGROUND.
/SLAB Icz
PLUMBING
ELECTRICAL . '
i LE .CE DA
TE
MECHANICAL BLDG EICT. PLG. MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR _ INFORMATION
PLUMBING
VALUATION $/FT.
- _
MECHANICAL
ELECTRICALy T, ER"'IT r
FRAMING
)t Z' / , 6•'
INSULATION - - STORIES TYVECOlfSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED G- -
,
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5O FTFLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING ITS IND -CON PB DPL,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO,
ROUGH SAN.4
PLUMBING ELECT.ENERGY
TFACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO.
FRAMING _ ash �6 ELECT.FINAL TEST'
ZONING ENG.SITE NO.
INSULATION - PLUMBING
GAS TEST GAS"
FIRE PRINK ENERGY T 2
'-4'-LMECHANICAL
ER WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y ❑ N❑ Y ❑ N❑
EXTERIOR SHEARFLOOD TONE A,L.uc,
ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. "❑ N❑ ` ❑ N❑
SHEETROCK GRADE .. -
FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATHTEMPORARYAPPROVALS BUILDING
SCRATCH COAT ELECTRICPLAN CHECK
GAS ' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDB Y BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING aO_o1
Z PLEASE GIVE JOB ADDRESS WHEN'PHONING.
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL' 6_�
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
. CALLING FOR FINAL INSPECTION. TOTALS 6�
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION PERMIT NUMBERemu olNc APPLICATION & PERMIT r, 18185
ADDRESS
_ BUILDING - ELECTRICAL-PLUMBING--MECHANICAL G�:
ER'9 PLAN CHECK VALIDATION
NAME 'TY. ELECTRIC PERMIT FEE '
PHON�S�_ U r
C NTRACTCR"5
NAE // OUTLETS-SWITCHES-RECEP. 10.00/1.00 , pd
M" !'! B"i1 -,CN LIGHTING FIXTURES 10.00/1.00
DDRESOR'S
ADDRESS
APPLIANCES RESIDENTIAL 4.00
ONTRAS
490 O A � � PHONEZ�- PANELS
10.00 DATE OF APPLICATION -
OgclartecT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE, P,C.fNO.
ENGINEER
Lie.NO, SIGNS TRANS. 3:00 -
ADDRESs ENc. SPECIAL CIRCUIT 6.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 / �(
APPLICANTS MOTORS SEE FEE SCH.
ADDREu
cicciSERVICE CHANGE 20,00 ^
r o o LICENSE[)CONTRACTORS DECLARATION r4 l
a G i u I hereby affiml that I ,m licensed under provisions of Chapter 9 ISSUANCE DATE '
(commencing with Section 7000)of Division 3 of the Business,arta G 9 BLDG. ELECT. PLG. MECH.
F a Professions Co .9d my license is N full fo t� ®• _
z O - Littny C� e Lie.Nein, )'J
9 y F Lc'" /� on CIO
p��s� wf
sac as ,, OWNER-BUILDER DECLARATION civ at BUILDING PERMIT
- o d .INFORMATION
E:
g LL H I hereby of Brm that 1 am exempt from the Cuntmctur's License MISC.- REFER�TO ORD'
u o c Law for the following reason.(Sec.7031.5,Business and Professions VALUATION 5/FT.
_ PERMIT ISSUANCE 10.00 z,
Cole:Any colish mon tywh icy structurep riort oconsuanc ,her. `�
R Q 0 improve,demolish,or repair any structure,prior l0 its issuance,also ELEC.CONTE.. LIC.NO. ELEC (�/r + J DOP
d wD M rail Wres the applicant for such permit 10 IIIe a signed Statement that TOTAL PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License PER. e I l
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe e
a Business and I'rofussions CuJcl or tlwl nc is cwmPt therefrom and OTY. PLUMBING PERMIT FEE
0 the bads for the alleged exemption.Any violation of Section 7031.5 1 STORIES E L STR.
by any applicant fora permit subjects the applieam loacivil penalty ALTER-DRAIN&VENT-WATER (EA:) 5.00
of not more then five hundred dollars(5500).): W
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 DEC.GROUP "RES.UNITS
1 their sole compensation,will do the work,and the structure is not
intended or offered for salt IScc. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Codd:The Conhacmr's Liecnse Law docs not apply to an owner of
property who builds or improve thereon,and who does such work FIXTURES-PER TRAP5.00 $0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such improve-
mentsarenotintendedormferedforsale.If,however,the building GAS-EA.SYSTEM-I INCA OUTLETS 6.00
or improvement is sold within one year of completion,theowner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or if.- BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the property,an+ exclusively'contracting with ❑ ❑ ❑ ❑ ❑
limnxd contramors to construct the Project(Scc. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.06 ASSESSORS PARCEL NO.
and Professions Codc: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
contracts fur such projects wish a contractorls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iamexemptunder Sec. ,B.&P.C-fond, WATER HEATER W/VENT 6.00
reason
Owner Ddic WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
W'ORKERS'CO,MPIiNSATION DECL,\RATION WATER TREATING EQUIP. 5.00
I hereby infirm 11hu I have a h,,ffc.c ofclmsenl to self-insure,
or a eerlilicute of Workers'Compensation Insurance,or u refilled ZONING -ENG.SITE NO.
copy thereof(Sec.3800,Lab C.).
Policy No. Company -
U ❑ Ccrtilicd c.Py i,hcrchy furnished, FIRE SPRINK ENERGY T 24
z Z ❑ Certified copy is Tiled with the city inspection division. MISC.- REFER TO ORD.
Q Applies.( _ Y ❑ , N❑ Y ❑ N❑
CER'If FICA'FF Oh EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 1 AV FLOOD ZONE - A.L.U.C.
LLI > COMPENSA'T'ION INSURANCE PLO.CONTE. LIC.No. PLGCL a . D_DD
CL Z (Phis section need not be completed if the Permil is for n TOTAL Y E] N❑ Y[:] NE]
mmdeed doll o,1 S 100)or Ic,sJ
U O 1 certify that in the performance of the work for which this Per QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manrtc es to
V becoryc Workers'Compcnsariyn yM'C f r lu.
U n DafcO Tc Applicant kds+r,.aL rrJ' ALTER OR ADD TO MECH. 5.00 BUILDING D�QII
} m NO]IE CANT: If,after making this Certificate oT Ex-
emption.you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you must forthwith comply with FEE
U such provisions or this permit sIm11 be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE a 63
1 hereby aflimr that there is a construction Icnding agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit u issued(Sec. MICROFILM
3097,Cis,C.). HEATING UNIT(TO 100,000 B.T.0-) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
Icertify'that l haveread this application andslate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
loconstruction, . D
.Ehnun,rs and slate ws ecluting m
building and
hereby authorise roven,for
oriins of on city to enter upon the BOILER-COMP(he,100,000 BTU)SEE FEE SCH. /I , f-D
f above-mentioned propescnlalice of
purposes. MECHANICAL 1 D J
(We) agree to save, indemnify and keep handL.s the City salmisc.- REFER TO ORD.
Cupertino against Eal ilitics,judgments, costs and expenses which PERMIT ISSUANCE 1000 CONST.TAX
ay,in y way accrue against City' in consequence of the 6
aril fthispermiL MECH.CONT. LIC.NO, MECH.
G 'Y TOTAL' I S-d TOTAL
Signature of Applicant Contractor Vidi,
OFFICE COPY
i