17628Ob!
POST THIS CAR D.NEAR FRONT OF BUILDING
�
DIVISION
CITY OF CUPERTINOYLO'T
1,JOB INSPECTION RECORDpPERMIT
JOB ADDRESS��( ��V\d V`UN IT## -
OWNER oOv-&I CONTRACTOR . SSC>WiP
PEPM1IIT NUMBER
�j%INSPECTION
17628
EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
_'180DAYS OFPERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION' DATE INSPECTOR
INSPECTION RECORD -
FOUNDATION
-
NOTE:.
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
-0UPERTINO STANDARDS.
UFER
PREGUNITE _
PERMI T' VALIDA ON
II
` , ``
! _r
►iL1.;:.�.
ISSUANCE DATE'
�
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1
n 14
'APR 14. 90.
UNDERGROUND/ SLAB
PLUMBING � -.
Cly OF cupelow
ELECTRICAL - -
MECHANICAL -
.,
BLDG. ELECT I
PLG. MECH
DO NOT POUR FLOOR UNTILABOVEHAS BEEN SIGNED
'' -
..
BUILDING PERMIT
INFORMATION
_ WOOD FLOOR+
VALUATION
S/ET.
PLUMBING p ,(�•-
� �
MECHANICAL
ELECTRICAL
d1eV Q
FRAMING
INSULATION
STORIES
'
IYP,ECONSTR.
-
`
OCCGROUP
'RES -UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SOfFr. FLOOR AREA
TOTAL ACREAGE
DIAPHRAGM
ROOF SHEATHING
BUILDING USE
IN
Res D 'cory PB O..,
n
❑ El 1 ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SAN.#
ASSESSORS PARCEL NO.
PLUMBING p _ - f, -
ELECT. ENERGY
TUBS ROWER - -
PLUMBING ENERGY -
TRACT NO.
PARCEL NO
,
MECHA
MECH.ENERGY -
ELECTRICAL
BUILDING ENERGY
ACC.OATE'
: .
ACCFILENO.
FRAMING., -
ELECT. FINAL TEST -
INSULATIONtog
PLUMBING
ZONING
ENG, SITE NO.
GAS TEST :S -
GAS - - -
MECHANICAL' -
FINE SPRINK
� N�
ENERGY T-74
v
� NEI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
FLooD zorvE
'
°.❑ N❑
A. L. -
u C.
❑ N❑
INTERIOR SHEAR
FIRE DEPT.
SHEETROCKGRADE
-.
FEE SUMMARY
EXTERIOR LATH -
'BUILDING'
BUILDING
,,U
INTERIOR -LATH _
TEMPORARY APPROVALS
SCRATCH COAT,
ELECTRIC
PLAN CHECK-
FEE
'
NO•TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY '- 1 -
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERM ITTED UNTIL BUI LDING FINAL IS SIGNED BVBUI LDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, `
DO! ONE WORKING DAY BEFORE REQUIRED INSPECTION-.
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-.SEE PERMIT FOR EXPIRATION DATE'-'
ELECTRIC
PLUMBING
'MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION:
TOTAL
OFFICE COPY
D a i
r• o0
QUU
N2w
H 'n zo
ion
4„I -w
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IS
af,
w3 Ic a Pq
u 0 a:
fN > 0
a,
A wLL
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as I
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as i o
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C-1
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION -
1,a
APPLICATION & PERMIT ,
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
I PERMIT NUMBER
A
I G
BUILDING
ADDRESS
10 /.¢
A. i/6 A
7 !/
DMNER'S
PLAN CHECK VALIDATION
NA
PRONE /i e�lT1
Y ✓� 2-/b4
QTY. ELECTRIC PERMIT FEE -,
�
DATE OF APPLICATION
CNAME
ONTRACTORS �7 -1 r� /
L Uc.ND, 7 I L Ip
OUTLETS =SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
AooREss �( , I�, �(� Q
(� `( Ikl, M0J 4 IrONE S �
PPLIANCES- RESIDENTIAL 4.00
PANELS 10,00
ogcwTEcr
ENGINEER
(: UC. NO.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. No..
SIGNSTRANS. 3.00
AARCH. OR
DDRESS ENG.
SPECIAL CIRCUIT • 5.00
PERMIT VALIDATION
ZIP
TEMP. METER OR POLE INS. 20.00
I
(] /L„TOx Uc(,�
�T�L, 1
APPLICANTS
ADORES$
✓/r i�iL
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSIiD CONTRACTORS DECLARATION
APR 41,i- „„
1 hereby affiRr [Hill I tint Ilccnsed Under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Businessand
Professions C1. y license is in full forQ 3
License CI I� Lic. Number.11976
Date
ISSUANCE DATE `
BLDG.
❑ .
ELECT.
❑
PLG. MECH.
❑ ❑
- -
BUILDING PERMIT
INFORMATION
-Conlremor.//
OWNER -BUILDER DECLARA N -
1 hereby affirm that I am exempt from the Cc Tactor s License
Law lot the following macro (Sec. 7031.5. Businessand ProfessionsPERMIT
Cale: Any city or county whichrequiresa permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
reclaims the applicant for such permit to file a signed collocent that
he is licensed pursuant to the provisions of the Contractor's License
MISC. - REFER TO ORD
ISSUANCE 10.00
VALUATION D
D
$/FT.
'
'
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL
PERMITTO a
OTY. PLUMBING PERMIT FEE
iheO(�
Law (Charter 9(commencing with Seelion 7000) of Division 3o fill,-POA
Business and Professions Code) or that he is exempt therefrom and
\,
Pe �O ✓\
the basis for the alleged exemption. Any violation of Section 7031.5
STORIES
TYPE CONSTR.
by any applicant for a permit subjects the applicant to a Civil penalty
of not mom than five hundred dollars (5500).):
'
gLTER-DRAIN-WATER (EA.) 5.00
❑ 1, as owner of the property, or my employers with wages as
it,c it rile compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
-
intended or offered for sale (Sec. 7044. Business and Proomions
Code The Contractor's License Law does not applyto an owner of
'
FIXTURES - PER TRAP - 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
property who builds or impro,c, thereon, .,,it It. dols -such work
himi or through his own employees, provided that such improv,-
mentsarenotintendedoroffered for Sale. If, however, lire building
GAS- EA. SYSTEM: I I NC. 4 OUTLETS 6.00
or intproverent is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
provcfor porposeofsale.). - -
❑ I, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Other
❑ 0 ❑ 0 0
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to mmtmct the project (Sec 7044, Business
and Richtoions Calc:'I'he Convacmr's License Law docs not apply
to an owner of property who builds or improves thereon: and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
-
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO. r
-
contracts for well projects with a contractors) licensed pursuant to
the Contractor's Liccma Law.
SEWER -SAN V -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ lam exempt under Sec. , BAP.C. for this
WATER HEATER W/VENT 6.00
reason
Owner Dat,
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP, 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby IF. that I hive a certitieale of commGt m self-insum.
or a ce 1 F', - he o ? Compensation Insu^�yce, ora rifled
Popy W,rLllrac�; Compal c.7, C
Policy No. Company_5
❑ C,rift d cop, u h eIb furnish
D Ce a file with the I
��}}..�� �4_ copy is y{ - yi jp inspc d///i��Ivisi n
Applican`v ALV+-(' KN :�l.n-
ZONING -
ENG. SITE NO.
/
FIRE SPRINK
'
YE:] N
ENERGY T -Z4
V N
MISC. - REFER TO ORD.
CHR'I' INCA'(' COP EXEMPT IONF RUN WDRKI S
9
PERMIT ISSUANCE 10.00
FLOOOZONE
A.LO.C.
COMPIiNSATIONI NSURANCE
I fhi-s section need nod be complctcd if the penlut is for ore
Y ❑ NE)
Y ❑ NO
PLG. CONTR. LIC. NO.
PLG.
TOTAL
hundred dsollars IS 1004 or les.)
1 certify that in the performance of the work for which this per-
hilt is issued, I shall not employ any person in y "nota" so as to
an
-
OTV MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING'
, D
become subject to the Workers' Compensation Laws of California.
Date ApplicantALTER
ALTEROR ADD TO MECH. 5.00 • •
NO]T: IC� TO APPLICANIf, oder making Ilia Ccrificme of Es
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=QF.M.) 4.00
PLAN CHECK
FEE
_
-
m you should become subject to the Workers' Compensation
provisions of the later Code, you must forthwith comply with
such provision or this permit shall be deemed revoked.
AIR HANDLING UNIT (OVER 10A0011F.M.) 6.00
SEISMIC FEE
•IT -0
CONsfRUCHON LENDING AGENCY
1 hereby affirm that 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.
3097, CIv.C.L
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
HEATI NG UNIT ER 100,000 B.T.U.) 9.50
ELECTRIC -
-
I certify that 1 have read this application and state that the aboveA
TILATION FAN (SINGLE) 4.00
information n correct, I agree to comply with all city and county
ordinances hod state laws miming to building construction, andER-
PLUMBING
CONP(3 H.P. or 100,000 B.T.U.) 6.00
(Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorise representatives ec this city es enter upon theER-COMP
above-mentioned property efor inspection purposes, to.
ON agree to save, indemnify and keep harmless `the City of,
- REFER TO ORD.
aper ino apei t U. ilio , j gments, costs and expenses which
fay n any ru a I s iA City in conscq uencb of ll¢
res in of lhrs r 1.
!
CONST. TAX
PERMIT ISSUANCE 10,00
MECH. CONT. LIC. NO MECH.
TOTAL
TOTAL
ign are A li ant/'o ractor D.
s
II
OFFICE COPY