18575 POST THIS CARD NEAR FRONT OF BUILDING1
PERMIT NUMBER
CITY1 �F CUPERTINO 18575
'rvSrPECTION DIVISION
JOB INSPECTION RECORD
I
Tl
\ Z� JINSTAULFn
PERMTT EXPIRATION
JOB ADDRESS_ UNIT# OT 3T `PERMIT EXPIRESIF WORK
OwNELI CONTRACTOR_ IS NOTST,4R�fEDIWITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOR1 00AYSOF PERMIT ISSU.
FOUNDATION A C R 100 DAYS FROM
NOTE: LA TALLED INSPECTION.
UFER . ALL GRADING AND DRAINAGE SHALL PREGUNPTE TO COMPLY WITH THE APPROVED PLANPLRMII VAIJ[)ADQN
CUPERTINO STANDARDS. `
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDy
UNDERGROUND /SLAB
PLUMBING .. 1
ELECTRICAL '
ISSUANCE DATE
MECHANICALaloe ELEcr PLc. MECH
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING - VALUATION SIFT.
MECHANICAL
ELECTRICAL 11. //PERMIT ro
FRAMING
INSULATION STORIES TYPE CONSTR,
UCC.GROUP HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _
. ROOF NOTE:NO FINAL INSP.SHALL-BE MADE BEFORE STI I T:FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING Res "BURACNNG USL ON PEI o,l,,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ - ❑ ❑
ROUGHSAN.q ASSESSURS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT N0. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACE.FILE No
FRAMING ELECT.FINAL TEST +
INSULATION PLUMBING zoNlmc ENc ITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - iY ❑ AT Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE ' FLOOD ZONE. A.L UC.,
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ N❑
SHEETROCK GRADE
EXTERIOR LATHBUILDING FEE SUMMARY
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 IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ,
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I �(j tib'
• Iw� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING -cam
z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST..TAX � --
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL Jt
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
EDILDING r APPLICATION & PERMIT 10CI�C
ADDRESS I Q J I J
p } BUILDING -ELECTRICAL-PLUMBING-MECHANICAL E�'
OWNER'S SPAua �OS PLAN CHECK VALIDATION
NAME �Jr QTY. ELECTRIC PERMIT FEE
CONTRACTORS -�•� -
NAME 10% OUTLETS-SWITCHES-RECEP 10.00!1.00
i
uc.rvo. LIGHTING FIXTURES 10.00/1.00 1
ym
ADDRESSNTRACDH's �( �L PPLIANCES-RESIDENTIAL 4.00 \\\�
ADDRESS .per -q VVV"`rrr
PHONE PANELS 10.00
r OT OF APPLICATION
OR
PL H FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDR.SENG. - SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ARCH EssS
ZIP TEMP.METER OR POLE INS. 20.00
nooaess Ts 3 MOTORS SEE FEE SCH. �fQt 00
Z
O SERVICE CHANGE 20.00
o¢ i `VV-lT
Foo LICENSED CONTRACTORS DECLARATION V
< Ly, 1 hereby Atinn Thal I -in licensed under provisions of Chapter?
H a a. (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
H H 2 Professions Code,)gcey license is in full torc�apjLefl(pMy BLDG. ELECT. PLG. MECH.
z o w - License Class_�%Iv Lic.Number 1✓,�7r}- ❑ ❑ ❑
9 y-w Datc- CotRmctm - C
R-Ib s4- -
< "rc J BUILDING PERMIT
F ¢ w OWNER-BUILDER DECLARATION INFORMATION
F
3 LL , I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u O st Law for the following reason.(Seo 7031.$,Business and ProfessionsPERMIT ISSUANCE VALUATION S/FT.
w� Code:Any city or county which requires permit to construct,alley, 00
10.
¢ ¢a cy improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL
a w m he is licensed pursuant to the provisions of the Canhacmr's License PERMIT TO
H z i Law(Chapter 9 professions
Cod )or Section is 00)Exempt
therefrom
o of Ow -
4 o Business and Professions Code)or that he is exempt therefrom and OTY- PLUMBING PERMIT FEE
¢ I- o the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
by any applicant, lora permit subjects lheapplicant macivil penalty ALTER- RAIN&VENT-WATER (EA.) 5.00
of not more than live hundred dollars(55 emp
❑ Las owner at the properly,or my employees will,wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do life work,and the structure is not OCC.GROUP RES.UNITS
intended nr Off yrcd for sale (Sec. 7044, Business and Pro •ssiu DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cody:The Contractor's License Law docs not app! ,
property who baths or wn employees,
thereon,and who. c r FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.el
mynL are not intended maftend tirr sale.ll',howeve t i�yrl AS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of compleli r
builder will have the burden of proving that he did n or int- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove For purpose of sale.!. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
O 1,as owner of the property,am exclusively controGl ❑ ❑ ❑ ❑
licensed contractors m construct the project(Sec. 7040. LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Cotte:The Contractor's License Law does not apply ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects will,a contmctor(sl licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
..,on am exempt under Sec. .B.&PC.for This WATER HEATER W/VENT
Owner 6.00
Date WATER SYSTEM 5.00
ACC.GATE ACC FILE NO.
wORKIiRs'COMPIiRS,vION uECURATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of conxm mself-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG SITE NO.
copy thereof(Sec.3800,Lab C.).
Policy N'o. Company
0yrtilied copy is hereby furnished
z Z Cyrlified copy is tiled with the city inspection division. FIRESPRINK- ENERGY T-24
FO p`fc, MISC.- REFER TO ORD. Y[J NE3 YE] .N[:]
Dc y CIi K'1'11'ICA'I'EOF I:XI:MPITON FROM WORKERS' PERMIT ISSUANCE 10.00
LU > COMPENSATION INSURANCE, PLG.CONTR. FLOOD ZONE e A.LU C.
C p LIC.NO. PLG.
Z (This dollars
need ,Of be completed if Lhy Permit is for aw TOTAL V N •Y � N
O hundreddaltity luny( in 1the perfOF ormance
l
I certify that in the to employ
of the wank for which this per. OTY MECHANICAL PERMIT FEE SUMMARY
0 U mit is issued, I sha11 not employ amp person in any manner i as to FEE
Ow becmne subject to the Workers'Compensation Laws of California.
in Dula Ap,lICANI: I ALTER OR ADD TO MECH. BUILDING �-
} N NOPtion,TO shout become
If,after making this Certificate sa fix- 5.00
eruption,you should bor Co subject to the Workers'Compensation APPLIANCE
provisions io the Labor Code, you must forthwith comply with 5.00 PLAN CHECK
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 1000C.F.M) 4.00 FEE
. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 r
30 performance of the work for which this permit is issued(Sec. MICROFILM
Loader97. 's .C.1. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC
- I cell ify flat I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
inlornmtion is correct. I agree to comply with all city and county PLUMBING
ordinances and Sime laws relating m 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
above-mentioned property for inspection purposes. BOILER-COMP (OVar 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, nominally odd keep harmless the City of Misc.- REFER TO ORD.
.Per firm against Iia 'liliys,judgments, costs and-expenses which
may in any way u m against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
r gar Ibis pen it MECH.CONT. LIC.NO. MECH.
✓C/ - 2- 9 TOTAL rorAL Ir
Sign re of AtlC
pp canontruelor - Date GGGNNN
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING L PERMIT NUMBER
CITY OF CUPERTINO 1�(� 18576INSPECTION DIVISION
JOB INSPECT IO RECORD
1
FV PERMfT EXPIRATION
• .1013 ADDRESS .�,lr��rl��_ _IVUJ [L _UNITt1 LO�.\/T# � PERMIT EXPIRES IF WORK
O,YNER coNTRncTOR IS NOT STAATEb WITHIN
INSPECTION DATE INSPECTOR AN PECTION RECORD',`" `1: "'::i 190 AYS OF PERMIT ISSU-
FOUNDATION A141C OR 180 DAYS FROM
NOTE: LATSTC(ALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLARS CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � �` ",kks
UNDERGROUND /SLAB
'1' 'D:iF1i.Yaftr-.
PLUMBING ew�
EL[C fRICAL _ - Y ISSUANCE DATE
MECHANICAL RLUU FLFCI PEG. FCR
SEP 121989 ❑ 8 ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED -`,.BUILDING PERMITrs^�,^;:.
WOOD FLOOR GtY D} Cap"m .INFORMA?ION?w6`F:;%
PLUMBINGvnuln MON $IF T.
MECHANICAL d. ,�L �Y,`,.\ �'Ef- �Z
ELECTRICAL -. PERmr. TO
FRAMING
INSULATION STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABVBEEN SIGNED
ROOF NOTE:NO FINAL INSPiSHALL BE MADE BEFORE So F T.FLOOR AREA TOTAL ACREAGE
•
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
I100F SHEA I I IIN(i BUILDING USE
RES IND CON PIT Olnn
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS %" `:': '•'I'=DATE`At i ' INSP:C!; ❑ ❑ ❑ ❑ ❑
ROUGH As SSDRSPAIET O
SAN.M -
PLUMBING ELECT.ENERGY
I UBS 8 SI IUWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY
F.LECTRICAL ACC DATE ACC FILENO
BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST
GAS
MECHANICAL FIRESPRINI( ENERGY T 74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L UC.
INTERIOR SHEAR FIRE DEPT. Y❑ No Y ❑ N❑
SHEE iROCK GRADE y,.
EXTERIOR LNH BUILDING
INTERIOR Lona TEMPORAR S BUILDING ....,..
. SCHAICH COAT ELECTRIC PLAN CHECK
_ GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE --w •-
OCCUPANC Y OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED By BUILDING INSPE CTOR. MICROFILM --
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
'• lw-� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O PLEASE GIVE JOB ADDRESS WHEN PHONING. . PLUMBING
z
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST. TAX
PLEASE READ FIEVERS� SIDE EIEFORE
CALLING FOR FINAL INSPECTION. TOTAL
APPLICANTS POST1 0 COPY