18333 POST THIS CARD NEAR FRONT OF BUILDING
R"111uMBER
8333
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD !�
1 (� PF�r7M1T.EXi11RAT10N_�
JOB ADDRESS ` OD ` -��cb�e� C 'UNIT# _LOT# ` �//
_ PERMIT EXPIRES IF WORK
ow NER \' \1�, p•V'(S �, conrRnCroR����� J�� IS NOT -STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
. UFER' ALL GRADING AND DRAINAGE SHALLBE INSTALLED _
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION 4
GARAGE SLABS CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'yI PAID . `�
UNDERGROUND /SLAB NOV 1 d ]98,Q
PLUMBING
ELECTRICAL .'�lal.h"C lL aa.+i��A,
ISSUANCE 1 Ai
MECHANICAL .. ., BWGc ELECT,I PLG. mECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN:SIGNED _ - BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $IFT.�
MECHANICAL
ELECTRICAL - PERMIT TO
50CLir ;; 1✓,.
• FRAMING'
:INSULATION '- _ STORIES TYPECONSTR,
_ OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO IT.FLOVR AREA t.l ALACREAGL
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE`
�• DIAPHRAGM - THE CONSTRUCTION TAX IS PAID; -•
.. ROOF SHEATHING R-s BUILDING USE
� � � IND con PB •om.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED . FINALS DATE INSP. ❑ ❑ ❑ ❑-
ROUGH SAN.#'� n5SE55U"PA RCEL NO.
PLUMBING - ELECT.ENERGY '
TRACT NO. PARCEL No.
TUBS&SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY T ACC.DATE ACC.FILE NO.
t FRAMING ELECT.FINAL TEST -
ZONING ENG.SITE NO
INSULATION � PLUMBING
GAS TEST - GAS .
MECHANICAL FIRE SPRINK 'ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING •t 01 "❑ ` ❑ "❑
2
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD ZONE A L UC.
INTERIOR SHEAR - FIRE DEPT.
❑ "❑ L N❑
SHEETROCK ADE FEE SUMMARY
EXTERIOR LATH BUILDING UILDING -a. f 0INTERIOR LATH - - �.__T•EMPO_RARY APPROVAL _ ''j'',
i
SCRATCH COAT ELE 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 j
' ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC �r UGi
o�. ONE WORKING DAY BEFORE REQUIRED.INSPECTION. PLUMBING _
PLEASE GIVE_ JOB ADDRESS WHEN PHONING.
z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! `
CONST. TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL.' ��f
CALLING FOR FINAL INSPECTION. 1
OFFICE COPY '
` C
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.� BUILDING PROJECT IDENTIFICATION i PERMIT NUMBER ,
BUILDING APPLICATION & PERMIT 18333 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 0
OWNERS PLAN CHECK VALIDATION
NAME
T r e DTV. ELECTRIC PERMIT FEE "
PHONE (�
NOMERACCTORS r� Q'"Tzk(�G UTLETS-SWITCHES-RECEP 10.00/1.00 �j (� ���• !''O'
"�s\GA LIC.NOS ACI LIGHTING FIXTURES 10.00/1.00
CONTRACTOR S q�-gs3� PPLIANCES-RESIDENTIAL 4.00
ADORE95
9qEW s PHONE $ '� PANELS 10.00 GATE OF APPLICATION '.
ARCHITECT ' PLAN CHECK FEE - C.NO.
ON
ciNEER Fev2SEEl�ot-\ v PANELS (OVER 200 AMP) 20.00
tic.NO.�.\�O.q SIGNS TRANS. 3.00 _
ARCH,OR EN SPECIAL CIRCUIT 5,60 PBRARTLVAL'IDO.TION
GLIAN \,J
.So• �Cj\\Z . EMP. METER OR POLE INS. 20.00 NovA 1989
APPLICANT - MOTORS SEE FEE SCH. If 't OJ
I
ADDRESS -
SV SERVICE CHANGE 20.00
Cltr
woo LICENSED CONTRACTORS DECLARATION
a u w I hereby affimn thm 1 om liccnxd under provisions ofChaptc19 15$UAN\CE x,
n G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H H z Professions Cod nd my license is in full f� d effec_ t._ p ❑ ❑
z o m - License ClassNumber,�....++]] ]$4r �,
9 a w Date Contra".111 a-N \ 4
a m x J BUILDING PERMIT
¢ ono OWNER-BUILDER DECLARATION , INFORMATION
.K ; u I hereby infirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LLO ¢ Law for the f ollowingreason.ISec.7031,5,Businessmd Professions PERMIT ISSUANCE t� 0 VALUATION S'FT.
- Cafe:Any city or county which requires,permit to constmcl,allcr.
QQ ¢ O Improve,demolish,or repair any structure.prior to Its ixuanR,also ELEC.CONTE. LIC.NO. ELEC ...�JOO.
w - O
LL inquires the applicant for such permit to the a ligned statement that TOTAL I(J./ PERMIT TO
d w Ca he is licensed pursuant to the provisions of the Contractors License C O 'C_ ,
s-f h� m
Hii law(Chapter 9(commencing with Section 70000o'Division 3 ofthe s.7
-¢ Business and Professions Code)or that be is exempt therefrom and CITY. PLUMBING PERMIT- FEE
¢ = S the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
p ; by any applicant far a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of 0).
not more than five hundred'dollars($501:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC,GROUP: RES.UNITS
their sol,colnpcnsalion,will do the work,and the structure Is not
intended or offered for mis,'(Sec. 704E Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does 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 TOTALACREAGE
himself or throughhis own employees,provided that welt improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
nicety are not intended or offered for sale:If,however,the building
or improvenxnt.is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) - 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for pugmvenl'snE.T 1
INDUSTRIAL WASTE INTER. 30.00 INO 'CON PB Omer
❑ I,as owner of the property,am exclusively contracting with !R
E ❑ ❑ ❑ ,❑
liccnxd contractor to construct the projeel (Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professiotu Code:The Contractor's License Law does not apply
to an owner of property who builds ur,improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) -1.00
contracts for such projects with 3 contractoos)licensed pursuant to
the Contractor's License law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
Cl Ianlexernplumder Sec. ,B.&P.C.Ion Illi, WATER HEATER W/VENT 6.00 '
reason
Owner - r - Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO.
W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cerlillcam of comsat to wlbimvrm.
I or a cenificale of Workers'Compensation Insurance,or a certified ZONING - ENG.SITE NO.
copy thereof'(Sce.3800,W b.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished FIRE SPRINK- ENERGY T44'
Z Z ❑ Certified copy u fled with the city inspection division.
MISC.- REFER TO ORD.
C, Applicant _ v ❑ N❑ v ❑ IN
N CER'fIFICA'1'Ii101'EXEMPTION PRONI WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C. .
LLI >_ s •COMPENSATION NSURANCE PLG.CONTH. LIC.NO. FLc.
d O Tho vection cedrnot be rompleed if the permit is for one TOTAL Y❑ IN r V [:J NE]
D Z hundred dollars(S 100)or Ica.)
U O I certily that in the performance of the work for which this per- DTV MECHANICAL PERMIT FEE FEE SUMMARY
ll I- mit is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of Cnliforbia.' - �s
a Date Applicant ' ALTER OR ADD TO MECH. 5.00 . BUILDING So[a 6-�
} to NOTICE TO APPLICANT. If,after making this Cerlilicalu of lix-
Z enlption,you should bemm,'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'lhmn
is peil shall be deemed revukud. AIR HANDLING UNIT(TO 10SMC.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNT iOVER 10,000C.EM) 6.06 SEISMIC FEE
I hereby affirm lhal there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is ixsued(Sec. MICROFILM.
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 -
LendersNdme HEATING UN IT OVER 100,000 B.T.U.)9.50 / vU
Lender's Address ELECTRIC /
•I� I certify that I have read this application and slate that the above' VENTILATION FAN (SINGLE) 4.00
rr
information is coect 1'agree to comply with it city and county PLUMBING /
ordinances and state 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 IGwr 100,000 BTU)GEE FEE SC%. MECHANICAL
above-mentioned properly far inspection purposes. '
(We) agree to save, indemnify and keep harmass the City of MISC.- - REFER TO ORD.
against liabilities,judgments,costs and expenses which CONST.TAX
[operlino
yin any way accrue against said City in ettmsequenLe of the PERMIT ISSUANCE 10.00rtng of this penult MECH.CONT. LIC.NO. MEC%.
OTA TOTAL
ignalure of Applicant/Contractor Date
OFFICE COPY
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No. 0219
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BLDG. INSPECTION DEPARTINEBID
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