17977 POST THIS CARD NEAR FRONT OF BUILDING
PE.RNIT NUMBEF
CITY OF CUPERTINO 17977
INSPECTION DIVISION
. JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS &QP g0" M6kA tNIT# _LOT# •PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUP TINO STANDARD p
GARAGE SLABS \A+G• '• o02_ !9/y�CVL.t�C,GG
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED : R 64q ,
UNDERGROUND /SLAB
PLUMBING ' I, i,. I LI '66
ELECTRICAL ISSUANCE UATE
MECHANICAL IN Of Ciluertint) -- BLDG. I ELECT, I PLG. I MECH.
'x ❑ ❑ ❑
DO NOT POUR FLOOR UNTIVABOVE HAS BEEN SIGNED ; •r7'EBUILDING PERMIT�x3xb"
Tv.•+xc'n'ZINFORMATION�
WOOD FLOOR Fr,"j-,•;r;
VALUATION SIFT.
PLUMBING c56 �- .r- /
MECHANICAL
ELECTRICAL vERMIT TO _
1_ 4
FRAMING -
INSULATION -'�` STORIES TYPE CONSTR.
1 v lV
_ OCC.GROUP RES,UNI TS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN,SIGNED:
5 iT G�GOKR 1RFg ' TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MAGE BEFORE _T, `.v
DIAPHRAGM THE CONSTRUCTION TAX IS PAID s,
L ��O + BU
ROOF SHEATHING ILDING USE
REi IND cory PB " ow.•.`
APPLY NO ROOFINGUNTILABOVE"HAS-BEENSGNED;, ' `,}'r4,FINALSt'w'a' :.: ,S.DATE'.i•.=':, '"''INSP.r,�} ❑ ❑ -�❑ ❑ "❑
ASSESSORS PARCEL NO.
ROUGH SANA U
PLUMBING ELECT.ENERGY �'I�^ 'L�7•'IJ_`J`
TRACT NO. PARCEL NO,
TUBS 8 SHOWER PAN PLUMBING ENERGY ,
MECHANICAL MECH.ENERGY
------------
ELECTRICALACC.DATE ACC.FILE NO.
BUILDING ENERGY
FRAMING � ' ,Gj; ELECT.FINAL TEST
ZONING ENG.SITE N0,
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T"Za '
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED " HEATING Y ❑ N❑ Y ❑ _'Al
EXTERIOR SHEAR ELECTRICAL RELEASE ,FLOOD ZONE - A.L.U.C.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ ..N❑
SHEETROCK GRADE " "'f'i`�FEESUMMARVo-`�iA.'E
EXTERIOR LATH BUILDING Mg
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COATELECTRIC FL CHECK 7„ • . '_
GAS .Z7 -'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE Z/TG�f
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! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL of
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
e e /�U I LDING PROJECT I DENTIFICATI ON PERMITNUMBER
uLplrvc
APPLICATION &-PERMIT 17977
AODREss
BUILDING =ELECTRICAL-PLUMBING-MECHANICAL if.
OWNER'S PLAN CHECK VALIDATION
1 NAME e
CITY. ELECTRIC PERMIT FEE
FN�rpPRONE
CONTRACTORS
NAME
OUTLETS-SWITCHES-RECEP 10.00/1.00 � . 2_3UA5'.
P(,Om�G ua NO aQQ'6 LIGHTING FIXTURES 10.00/1.00 (JO
CONTRACTORAODR FES SAdUo`ill Q PPLIANCES-RESIDENTIAL 4.00
VLIbM (yj r.�IDGA� PRONE S-J(o0� PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
ONG R L-� w.& PANELS (OVER 200 AMP) 20.00
l -6`u LIC.no, 1,14-0_5 SIGNS TRANS. 3.00
ARCH.OR ENG.
ADORES1 S p,/(� SPECIAL CIRCUIT 5.00 r PERMIT VALIDATION
/�'PC"/A, $U�F�^�C7�F r•'D` EMP.METER OR POLE INS. 20.00
APPLICANT smur daa� MOTORS SEE FEE SCH.
LV6Sr 5 6C4y2,L S- . SERVICE CHANGE 20.00
2 F
0
000 LICENSED CONTRACTORS DECLARATION ..
¢o u 1 hereby it] nn'that 1 am licensed under provisions of Chapter 9
wad (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
ti i Professions Code,and my license is in Cull force and affect. El ❑ El o m - License Class Lic.Number V ( u 989
o� - � Date Contractor -
F rnH
Q y E J
¢ ¢ u¢r a OWNER-BUILDER DECLARATION BUILDING PERMIT
a o d U INFORMATION
X g LL H I hereby allinn [hct I am exempt from the Contractor's License MISC.- U6 F TO ORD
u o J Law for the following reason.(Sec.7031.5,Business and Professions VALUATION p $/FT.
r - PERMIT ISSUANCE 10.00 C UDO
Cade:Any city Primarily which inquirese pcnnit toconstant,,also
Q Q Q, Improve,demolish.or Rpmf h p rmit teff prior IO its statement
Unit ELEC.CONTR. LIC.NO. TF LEC.
OTA
o¢ inquires the applicant for such permit m file a signed Smtentnm Dial TOTAL
n w Cr m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
zQ Law(Chapter 9(commencing with Suction 7000)of Division 3 of the
F 4 o Business and he alleged emp)or that he is exempt Sectio 70 and DTV. PLUMBING PERMIT FEE
¢ F o the basis for the alleged exemption.Any violation of Section]031.5
a 3 iO by any applicant fora permit subjects the applicant Ioacivil penalty STORI S TYPE CO ST
olnot more than five hundred dollars(550().): ALTER-DRAIN&VENT-WATER (EA.) 5.00 V N
❑ I,as owner of the property,Or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply Io an owner of 1312-
property who builds or improves thereon,and who does such work - FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
."Improvement is said within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
but will have the burden at proving that be did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
El I,as owner of the property,inn exclusively contmciing with El ❑ ❑
licensed contractor, to construct 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 does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 //'' //llx hh�Cs
contracts nonsuch projects with a contractorts)licensed pursuant to VL/ VJ�
the Contractors License Law. SEWER-SANITARYG
V-STORM EA.200tt/10.00
----- ❑ lam exempt under Sec._,BTRACT NO. PARCEL NO.
for Utis
on WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORK ERS'COMPENSA'IION DECLARATION 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 thereof(Sec.3800,Lab.0.-
Policy Na. Company
O ❑ Certifie ropyisher ylurnished.
z Z Cmc if, c y is fled !;y the city inspection division. FIRE SPRINK ENERGY T-24
F O Allan SAL' ' MISC.'- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
lr T CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.0 c.
Lu COhiPF.NSATION INSURANCE PLG.CONTH. LIC.NO. PLG
CL D (1[,is section need not be completed if the pent.it is on one TOTAL Y❑ N❑ Y❑ N❑
� Z hundmddollars($100)orlcss.)
U 0 1 certify that in the performance of Ilse work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any Berson in any manner ai as In
become subject to the Workers'Compensation Laws of California.
LEI Date. Anplicuni ALTER OR ADD TO MECH. 5.00 BUILDING �0
} to NO]ICE: '1'0 APPUCANI': IC alter making this Certifieme of lix-
� Z emptloO,you should become subject m lire Workers'CompensaUr.. APPLIANCE 5.00 PL CHECK
provisions of the Labor Code, you must forthwith comply with �-
U suds provisions or this pcnnit shall be decvnd revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 FE 2.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT FO=CF M.) 6.00 SEIS CFEE
-- I hereby affirm that Ihcrc is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
III, perfonmance of the work for which lhis'Pelort is issued(Sec. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
O Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct,I agree to comply with all city and county PLUMBING
'ordinanfes and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives of this city to enter upon Ile
above-mentioned property for inspection purposes. BOILER-COMP lover 100,000 BTU)SEE FEESCH. MECHANICAL
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judglnents, costs and expenses which
nay in any ay a$S, against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
'an fn o[Ihis�urir MECH.CONT. LIG NO. MECH.
PP////phre TOTAL TOTAL �6
etureof Ap wet ontmc[or 'Date
OFFICE COPY