18349 POST-THIS CARD.NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
18349
INSPECTION DIVISION
JOB INSPECTION RECORD
7 1,�,�1 / PERMIT EXPIRATION
JOB ADDRESS_ o ` �O �Y Zy `D�`� UNIT# LOT# '
' -
ownER tPERMIT EXPIRES IF WORK'
/f e L CONTRACTOR I IS NOT STARTED WITHIN
INSPECTION I DATE rINSPECTOR INSPECTION RECORD leo DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ,ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS." F' '
GARAGE SLABS
PAW
. . - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
PLUMBING
UNDERGROUND/SLAB -To!IA
- - - � �.VI
ELECTRICALISSUANCE DATE .
MECHANICAL - - cvawBLDG ELECT, I PLG. NIECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT INFORMATION
' WOOD FLOOR VALUATION /FT.
PLUMBING - � �
MECHANICAL u i` ✓v
ELECTRICAL .. • PERMIT iC 7!
FRAMING
INSULATION IS CRIES ,�.,.. TIPIrCONSTIR,
flu
AA flu
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR'UNTIL ABOVE HAS BEEN SIGNED
5(l FT.FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BEADE BEFORE,
DIAPHRAGM THE CONSTRUCTION TAX IS PAI ,
" R
ROOF SHEATHING ' RES IBUILDING USE,
NO . CON
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. D ❑ El
ASSESSORS PARCEL NO.
_ ROUGH SAN.# _
PLUMBING ELECT.ENERGY '
"
TUBS BSHOWER PAN - PLUMBING ENERGY TRACI NO. PARCELNO
-
MECHANICAL MECH.ENERGY
ACC DATE IACC FILE NO.
ELECTRICAL- _Z/- BUILDING ENERGY
FRAMING ELECT.FINAL TEST '
ZONING ENG.SITE NO.
INSULATION PLUMBING '
GAS TEST - GAS
FIRE SPgINK ENERGY T-]a
' MECHANICAL '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v "'� -` A[]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L U.C.
INTERIOR SHEAR' FIRE DEPT. Y. 1 ❑ IN
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING 17,oO
SCRATCH.COAT ' ELECTRIC PLAN CHECK
„F GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ,
.i . 00CUPANCY OF BUILDINGIS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC �1
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
r - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 3 ,
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON PERMITNUMBER
aD,LO,„G APPLICATION & PERMIT - O (�
AD<O35o m LLD E O J
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL �j,
OWNER'S PLAN CHECK VALIDATION
NA G/j� P/,a/�(''/' 2557-382
��.r _ OTY- ELECTRIC PERMIT FEE
oBC../C.-/ •`^V' ' T PHONE 255 I38Z
NAAMERAcioRs UTLETS-SWITCHES-RECEP 10.00/1.00 C
LIC.NO. LIGHTING FIXTURES 10.00/1.00
FDOORESSTOR's PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION '..
ARCHITECT PLAN CHECK FEE P.C,NO,
OR PANELS (OVER 200 AMPI 20,00
ENGINEER ,
LIC,NO. SIGNS TRANS. 3.00
ADDRESS ENc' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'Sif
MOTORS SEE FEE SCH. (']�2
ADDRESS
0 ad Z. SERVICE CHANGE 20.00
PMD
'09 LICIiNSBD CON'1'RACI'OR$DECLARATION
F0 uI hereby aftiml that I am licensed under IF...Won,of Chapter 9 ISSUANCE DATE-
(commencing with Section 7000)of Division 3 of the Business and pia,arso BLDG. ELECT. I PLG. MECH.
r D i Professions Coda,and my licenser is in full force and effect.
z o 'v{' - License ClassLie.Number 171
m w Date Contractor /1��E�� �� �r/� Lf'f
¢ y S J ra Of vinoyw
¢ a: ¢ OWNER-BUILDER DECLARATION --f��- BUILDING PERMIT
A o A " MISC.- REFER TO ORD 'INFORMATION
w ;LL I- I hereby affirm that I am exempt from the Contractor's License
u- 0A I.aw for the fonllUwldgoeS i,.(See.7031.5,Businessand Profo,mes VALUATION /FT.
- PERMIT ISSUANCE 10.00 2
f re s Code:Any mulish Good pair any reyulresuurs Permit prior
t o constructis iSSUadee,also (,
tc rt ¢o improve,demolish,or repair any structure,prior n its issuance,also ELEC.CONTR. LIG NO. ELEC. o
0 u rcy uucs the applicant for such pemtil to file u signed statement that .TOTAL �3,
o. w w he is licensed pursuant to the provisions of the Contractors License A Ll PERMIT TO
Fi > Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe I D���
s 4 o Busing and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ', l
SE r 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; by any applicant fora hundred
dollars(he00.): am loacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
o' not more than five hundred dollars(my crag:
�tl,Sc owner of tire property,or my,anduye s with re is not
BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure rs not
intended or offered for sale (Seo 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 sa Pr.FLOOR AREA TOTAL ACREAGE
himself or through h6 own employees,provided that such improve' .
ments are not intended or offered for sale.If,however.the huilding GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00
or unprovemunt is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
prove for purpose of sale.). RES IND CON Pe Other
❑ I,as owner of the property,dill exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to conditioner the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B, 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License law dna not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 -
contracts for such projects with a contractor(sl licensed pursuant to -
theCo"tmetori License Law. SEWER-SANITARY-STORM EA.'200ft/10.00 .TRACT NO. PARCEL NO.
❑ I an,exempt under Sec. ,B.&P,C.far flo,
reason WATER HEATER W/VENT 6.00
Ow"`r RS' WATER SYSTEM 5.00
ACC.DATE ACC.PILE No.
w )RKECOMPEN'SA ION Of CI-ARAT10N WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING - ENG.SITE NO.
copy lhereof(Sec.3800,LIb.C.).
Policy No. Company -
O ❑ Certilied copy a hereby furnished.
Z 2 ❑ Curt Wed copy is filed with the city inspection division. FIRESPRINK 'ENERGY T 24
F O Applicant MISC.- REFER TO ORD. Y❑ N❑ I Y ❑ �N❑
m CERTIFICATE 01'EXEMEfION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.u.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CLZ( This scGon need not be completed if the nortil is for one TOTAL Y[:] N❑ Y ❑ N❑
U O hundred dollars IS 100)or less,I
1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall net employ'any person in any manner so as m
Q w become subject to lire Workers'Compensation Imws of Culifomia. -
C. Uatc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING C y
} N NOTICE:'f0 APPLICANT: If,after making this Certificate of Ex-
f.. ? caption,you should become subject to the Workers C"mpe"salion APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you most forthwith comply Willi FEE
U' such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 109WC.F.M-) 6.00 SEISMIC FEE (�U
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -
* the performance of the work for which this pernot is Issued(Sea MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name HEATI NG UNIT ER 100,000 B.T.U.)9.50 jv w'
Lender's Address ELECTRIC
I certify that I 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 co ddly PLUMBING
ordinances and slate laws relating to building construction, and BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00
hereby au h..,e repre,cmun ves of this city In enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Ova 100,00DBTU)SEE FEE SCH. MECHANICAL
(We) agree to give, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 1000 CONST.TAX
ay in any way acerae against sad Cit 'in consequence of the
nC ft peon if. MECH.CONT. LIC.NO. MECH. '
G- -V ((TOTAL TOTAL 31, D�
ignature fAppllcantlContractor Date
OFFICE COPY
c POST THIS CARD NEAR FRONT OF BUILDING
<`f
PERMIT NUMBER_ CITY OF CUPERTINO 17982
INSPECTION DIVISION . ,
_ JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB AD ESS I(-J I w CJ �(� 1� UNIT# _LOT# '
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR�(J '""L! IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 1B0 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EG UNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAIADAnoN
CUPERTINO STANDARDS.
GARAGE SLABS *.:�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED i{ � \
UNDERGROUND /SLAB „ Q,II.I8q
PLUMBING _ ,J Illy
ELECTRICAL
6SUANCE DATE
MECHANICAL ,- .RLOc ELECT PLG M+ECR.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED . COW Of Cupe-*"Q
- � - - BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL11q 'EEll I TO
FRAMING - VI� •VI !
INSULATION - STORIES .1 PE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
• ROOF NOTE:NO FINAL INSP. MADE BEFORE SO FT�FLCOR AREA TOTAL ACREFGE
DIAPHRAGM THE CONSTRUCTION TAXAX ISIS P PAID
BUILDING USE
ROOF SHEATHINGEs IND CON PB 0......
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE ,INSP. ❑ ,❑ ❑ ❑
ROUGH sAN.p
ASS ESSOR SPARCE L NO
' � -
PLUMBING ELECT.ENERGY '+
iHACINO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL - ACC.DATE ACC.FILE NO
BUILDING ENERGY"
FRAMING ELECT.FINALTEST
ZONING ENG.SITE NO.
' INSULATION ` � PLUMBING -GAS TEST GAS '
FIRE SPRINK ENERGY L]<
_ MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING- ❑ N❑ ` ❑ No
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALuc.
INTERIOR SHEAR FIRE DEPT. ❑ N❑ ❑ N❑
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
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• H ONE WORKING DAY BEFORE REQUIRED INSPECTION.
1 0- PLUMBING Co)-
Z YYY PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR'EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST. rax
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION'. TOTAL
OFFICE.COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
$UI LDING PROJECT I DENTI FICATI ON PERMIT NUMBER
•RUIL.ING - //'' APPLICATION & PERMIT
IACIDNESS� �D f-A21�).1 mye o�, 17982
/1 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNERS W� U61' Y PLAN CHECK VALIDATION -
NAME V6 r-
J STV. ELECTRIC PERMIT FEE
L W H PHONE HI V _/ '
NACONTRACTORS OUTLETS-SWITCHES;RECEP 10.00/1.00
iJ /r o FY vMB/N�c.uo2 2y3 LIGHTING FIXTURES 10.00/1.00
r-ONT ACTORS'r/ If �,
ADDRESS T6 /}r6,L/n/fF �R. PPLIANCES-RESIDENTIAL 4.00
J qNI 1TOSC PHOnE2' raj PANELS 10.00 DATE OF APPLICATION
ORcsslTecr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. .
ENGINEER
- sac.No. ISIGNS TRANS. 3.00
ARCHADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS.T20.00 �LyC1/��
APPLICANT - MOTORS SEE FEE SCH.
ADDRESS �
SERVICE CHANGE 20,00 ) I r_I ferry
o a i
F o o LICENSED CONIRACTORS IIECLARA'f10N
a u 0 1 hereby ffinm that I am licensed under provisions of Chapter 9 ISSUANCE DATE -
y a i (commencing with Section 7000)of Diu'ision 3 of the Business and BLDG. ELECT. PLG. MECH.
H m y Professions Code,and my license is in full force and effect ❑ ❑ El -
License Clus Lie.Number �� -
O R D Date CnntmJ
rac
r '
a w a OWNER-BUILDER DECLARATION �) BUILDING PVRMIT
ION
MISC.- - EFER To
D INFORMATION
X a m I hereby atfurn that I am exempt from the Contractors Licanew VALUATION
.. o J Law for the following reason.(Sec.7031.5.Ifuxincssand Professions S/FT.
H - 'PERMIT ISSUANCE _ 0.00
Codr Any city or county which retinues permit to construct,alter,
¢ 2 ¢0 improve,demolish.or repair any structure,prior to its issuance,also FLED.CONTR. LIC.NO. Lff
A
- DLL requires the applicant for such permit to the a signed.statement that TOTAL w $ he is licensed pursuant to the provisions of tirePERMIT TO Contractor's License _ s
HiQLaw(Chapter 9(commencingwith Section 7000)of Division 3 ofthe -� �ombi
f 4 o Bubitsess and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT - FEE 111
m I- thghasis for the alleged exemption.Any violation(it Section 7031.5 STORIES 'TYPE CONSTR.
A , by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than Five hundred dollars(S500)J:
❑ I,as owner of the properly;or my employees with wages as BACK FLOW PROTECT:DEVICE 4.00 OCC.GROUP RES.UNITS
their sol,compensation,will do the work,and the svucture is not
intended or offered for sale(Sec. 7144. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves(hereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.Fr.FLOOR AREA TOTAL ACREAGE-
himself or through his own employees,provided that such improve. .
mems are not intended or offered for sok.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement Is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or iso- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ES IND CON PB onto
❑ I,as owner of the property,am exclusively contracting withEl 11 El 1-1
licensed contractors In construct the project(Sec 7044,Business LAWN SPRINKLERS- 1 INC 6 V,B. 6.00ASSESSORSPARCEL No.
and Professions Code: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
controc is for such projects with a contractuds)licensed punuant to
n - .-
theContraor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO.f
C) Ism exempt under Sec.-.BAP,C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby All Unit I have a r,rtiFicate of consent to self-hourr.
certificate of Workers Compensation li mance,or a certified ZONING ENG.SITE NO.
copy
thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Ccrtilied copy is hereby famished.
Z Z V Certified o y 01• with the oily inspection division. FIRE SPRINK ENERGY TY4
O APPllcant IS - O _ MISC.- REFER TO ORD. - v N E] NF
� N CERT]F]CA'1'B OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE- 1-2-112"'C FLOOD ZONE AL.u.C.
W� O CO}1PENSATION INSURANCE: PLG.CONTR. LIC.NO. TOTAL (J,/�U Y� N� Y � N�
2 ('Firs section need not be completed if it,, permit is for one -
hunred doll...IS 100)or Icss.l
U O I certify that in the performance of the work for which thu per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
0 U Income subject to the Workers'Compensation Laws of Califomia.
G. Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOl'ICF TO APPLICANT: If,after making this Certificate of Ex-
� 2 emplion,you should become subject to the Worked Compensation APPLIANCE 5.00 PLAN CHECK
UE
provisions
ioln the [Labor Code, you must I..ihwiOt comply with - FEE
such p e l[ permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)"r-F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1O=C.F.M.) 6.00 SEISMIC FEE
a I hereby affirm tial there is a construction lending agency for EXHAUST HOOD(WITH DUCT)' 5.00
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 Nan
Address
HEATING UNIT(OVER 106,000 B.T.U.)9.50
Lender's AAddress ELECTRIC
I certify'that I have read Ahis application and stale Unit the above VENTILATION FAN (SINGLE) 4.00 ����y.rr��
. infooration u correct. I agree to comply with all city and county PLUMBING '?n.co
ordinances and state laws relating w building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) fi.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned property for inspection purposes. '
(We) agreeto Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. '
I--
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way 'c sac against said City in consequence of the
ranting of this period- MECH.CONT. LIC.NO. MECH.
�� _ �_g,_ TOTAL TOTALCV
S .tare oI A�Icmn/Contractor Dain
OFFICE COPY