17680 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER .
CITY OF CUPERTINO 17680
INSPECTION DIVISION
JOB INSPECTION RECORD
/, •PERMIT EXPIRATION
JOB ADDRESS �rsT� Ud / //\— UNIT# LOT#
• PERMIT EXPIRES IF WORK
OWNER- � CONTE CTOR Q� -p,(_ IS NOT STARTED�WITHIN
INSPECTIONDATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS.FROM
NOTE: LAST CALLED INSPECTION. '
UFER' ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNI TE• - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERNUT V.L DATION
CUPERT IND STANDARDS. PAID
GARAGE SLABS 2— 7 ..�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Hrf< A 71989
-UNDERGROUND /SLAB of
�.. -
PLUMBING '- /yy �,Y_,.� ,J. 4 � 11 ��AX I,A;.i-4
ELECTRICAL wV 4U�1;1 ISSUANCe DATE '
MECHANICAL BLDGELICI PLO. NEC.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR
INFORMATION
-
PLUMBING VALUATION S/FT.
- - -
MECHANICAL
ELECTRICAL PERMIT TO S
FRAMING C,
STORIES TYPE CONSTR.
INSULATION ' � � � � '
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .
So.Ir r11bR AREA TOTAL ACREAGE
- ROOF - NOTE.NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM ' THE CONSTRUCTION TAX IS PAID
_ BUILDING USE
ROOF SHEATHING - - REs IND CDN PB ou,.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.q
A$$ESSUHS'PARCEL NO
-
PLUMBING - - ELECT.ENERGY-.
TUBS BSHOWER PAN .PLUMBING ENERGY TRACI NO. PARCEL NO'
MECHANICAL MECH.ENERGY
rACCIDATE - ACC.FILE NO:
ELECTRICAL - BUILDING ENERGY -
FRAMING ELECT.FINAL TEST -
ZONING ENG SITE NO.
INSULATION . . PLUMBING "
GAS TEST - GAS '
"FIRE SPRINK ENERGY T 2
MECHANICAL /O'tsl v ❑ N❑ Y ❑ N❑
" COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING.
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U C
INTERIOR SHEAR - FIRE DEPT. 'Y ❑ -N❑ Y'❑ 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 occuPANcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED,BY BUILDING INSPECTOR. MICROFILM' .
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — ' MECHANICAL
IMPORTANT! 1 coNST.Tnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE,COPY
APPJ�ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER -
BUILDING APPLICATION &-PERMIT I17680
ADDRESS- n
dL t,3'lvA1. AL CL7,�"11 BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
OWnE 3 PLAN CHECK VALIDATION
NPM zS3'6 fJ0 DTV. ELECTRIC PERMIT FEE
ONE
NOM ACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
OAf. X&C.NO. 67//5/ LIGHTING FIXTURES 10.00/1.00
ADDRESS
ADDREss PPLIANCES-RESIDENTIAL 4.00
FHOUE b PANELS - 10.00 DATE OF APPLICATION
OR ;EPANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG.
SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDREZIP EMP.METER OR POLE INS. 20.00 E �Z� �7
AFvuc"NT9 MOTORS SEE FE SCH. -d
ADDRE s
SERVICE CHANGE PAID 20.00y(`'
woo LICENSLD CON'I'RACfORS DECLARA'f10N ,. ��/`� kXIA V CLI
Q u v I hereby affirm er that 1 am licensed andprovisions of Chapter 9 MIy ISSUANCE DATE
zr ¢ e, (,muncncing with Section 7100)of Divisiml 3 of the Business and -
i. m BLOC. ELECT' PLG. MECH.
H O z Professions Code and my license is in lull(urea and elled. ❑ ❑ ❑
0 o v- - Litems Clan Lie.Number - ^.L- of ^..�n0
�'Z � Date Contrucmr VI{y W!
a x s BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION
E o a O INFORMATION
w ;LL y 1 hereby affirm that I am exempt from 0m Contractor's License MISC.- REFER TO ORD
F .. 04 Lawforthefollowingreasa Seo 703 1.5,Business and Professions PERMIT ISSUANCE 1000 VALUATION 5/FT.
Coda:Any city or comnty which req uimsa punnit to umslvmL,allcq
aU, ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
re C requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E
$m he is licensed Pentium to the provisions of the Contractor's License
Hi > Law(Chapter 9(commencing with Section 7100)of Division 3 ofthe
z o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE et,
IS f p the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
o ; by any applicant for a permit subjects the applicant loo civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than Five hundred dollars(5500).1:
.❑ I,as owner of the property,or my employ cs with wages asgACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS
their thesole compensation,will do the work,and the structure a not
intended or offered for sale (Sec. 7044, Business and Pfofessam, DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP .5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
cents are not intended or offered for soh?.If,however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 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 be did not build or int- BUILDING USE
prove for purpose ofsalc,). - RES IND CON PB Other
INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ L as owner of the progeny,he exclusively contracting wit I
licensed convectors m construct the project(Sec. does.Bminev LAWN SPRINKLERS- 1 INC 5 V.B. - 6.00 AsseSsoRS PARCEL NO.
and Professionsowner
of Codeprops The Contractor's License s w docs not apply
to an owner of property who builds rr improvesensed p.and who LAWN SPRINKLERS-OVER 5(EA.( 1.00 -
contruefs for such projects with a contrudorfq licensed pursuant m
N the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 -TRACT NO: PARCEL NO.
❑ I am exempt under Sec. ,B.BP.C.for this WATER HEATER W/VENT 6.00
reason
Q Owner )ate WATER SYSTEM 5.00
ACC.GATE ACG FILE NO,
WORK ERS'COMpENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 1 hereby atfirnt that I have a certificate of mnstot to wif-insum. ZONING
V or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
1t, copy thereat(Sce,3800.Lub.C.I
Policy No. Company
O Certified copy shereby furnished. FIRE SPRINK ENERGY T 24
�i
Z 2 Certifiedcop n fled rlr city inspection divisors. ❑
.F O Applicant .�o//✓ sa1�` MISC.- REFER TO ORD. Y ❑ [-]
N V N❑
Q: N CFR'fIP[CA'F1i 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
IL 0 COMIPEN'SATION INSURANCE PLG.CONTR. LIG N0. PLG. '
C ❑ (This'whilm need not be completed it [lie permit b for one TOTAL [:] N❑ v E] N❑
Z hundred dollars(S I ORD or Is..)
U O 1 certify mal in the vei-orrunce of the walk fur which this pis- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
EL I- mit is issued, 1 shall not nnploy any pawn in any mdmner so as to
O L) become subject to the Workers'Compensation Laws of California.
O_ Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
}
to NOTICE TO APPLICANT: If,after nicking Ibis Certificate of Ex-
F.. emption,you should become subject to the WorkersCompensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 , (I d
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a mmtructhm 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.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
NH EATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Name ELECTRIC
I certify that I have read this application and state that tine above VENTILATION FAN (SINGLE) 4.00 ;
O information is correct, 1 agree to comply with all city and county PLUMBING
ordinances and stile laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP ti (Over 100,0009TU)SEE FEE SCH. MECHANICAL d0
above-menoned property for inspection purposes.
(We) agr c to save: indemnity and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against laididies judgments, costs and expenses which PERMIT ISSUANCE 1000 Z�✓J CONST.TAX
an
may in y way ccrue msl said City in consequence of the
grantin f this IN MECH.CONT.• MECH.
y''^� ` 9t,/ TOTAL ^7 / 0/ TOTAL 0 0
ort of Applicant/Contractor atm .X4
OFFICE COPY