17130 POST THIS CARD NEAR FRONT OF BUILDING
' rEan7lr NuniBEa
CITY OF CUPERTINO
17130
INSPECTION'DIVISION
2y JOB INSPECTION RECORD'
��.�/ �^�9S-7 ;_ > PERMIT EXPIRATION
JOB ADDRESS ems- (/ i /L/ C ,��•�I UNIT# '_LOT#
_ - _�( �y�_ PERMIT'EXPIRES IF WORK
ORGV� • .
owN ER j4A14A/ mew—)CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - . . ANCE OR 180 DAYS FROM
NOTE:
LIFER - - ALL GRADING AND DRAINAGE SHALL BE.INSTALLEO LASTCALLED INSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED W"p� iti
i�rsy
UNDERGROUND /SLAB
PLUMBING _
ELECTRICAL
ISSUANCE LATE
MECHANICAL. eLoc ELEcr NF�LG. NIECH.
❑ ;Ee ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING - VALUATION $/FT.
MECHANICAL _ -
ELECTRICAL - PERMIT To
FRAMING '
INSULATION - STORIES TYPE CONSTR.
oca_caouP 111,11ITI
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - pN 2'31989
ROOF SO IT,I'I.0011 AIILA TRIAL ACRLAGE
Il NOTE:NO FINAL INSP.SHALL BE MA BEFp�,
DIAPHRAGM THE CONSTRUCTION TAX IS P j19� D7 up. t�
ROOF SHEATHING BUILDIG USE
RES IND CN
ON PB . om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. . ❑ ❑ ❑ � ❑ ❑
ROUGH SAN.N
ASSESSORS PARCEL NO
�
PLUMBING . Z — ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY - TRA,CI NO. PARCEL NO.
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
INSULATIONPLUMBING ZONING ENC SITE NO.
/-3i-
GASTEST GAS
MECHANICAL EIRE SPRINIK ENERGY T.2a
COVER NO WORK UNTIL ABOVE HAS BEENSIGNED
HEATING - Y ❑ •N❑ ° ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L.0 C.
INTERIOR SHEAR FIRE DEPT, - Y❑ N❑ Y ❑ N❑
SHEETROCK a 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 BOCCUPANCY I ISEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLEASE GIVE JOB ADDRESS WHEN PHONING. PLurvewG J�
Z
— SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL
IMPORTANT! coNsr. rax
PLEASE READ REVERSE SIDEBEFORE
TOTAL ,
CALLING FOR FINAL INSPECTION. I, ;,,
OFFICE COPY
'APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT.IDENTIFICATION PERMIT NUMBER
BUILDING 1
17130
ADDRESS
Q _ _ BUILDING -ELECTRICAL-PLUMBING -MECHANICAL •,
OWNER'Sp _ PLAN CHECK VALIDATION
NAME �! �,p f� DTV. ELECTRIC PERMIT FEE 1 '
40 aE.NE O
Race AC OR OUTLETS-SWITCHES-RECEP 10.00/1.00
D f" GIG No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR S - PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION +
ARCIOTECT - PLAN CHECK FEE PC.NO.
on PANELS (OVER 200 AMPI 20.00
ENGINEER -- "
1-C.NO, SIGNS TRANS. 3.00
ADDREOR SS ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION/
ZIP EMP.METER OR POLE INS. 20.00
ADDRESSTs MOTORS SEE FEE SCH. 666 1
.- D/"lb axi) - SERVICE CHANGE 20.00
e.0
Foo LICENSED CONTRACTORS DECLARATION CC
a v u 1 hereby at that I am licensed under provisions of Chapter 9
2 w ISSUANCE DATE
Iconusionsng with Section ]00e is
Division 3 of t he Business and i BLDG. ELECT. PLG. MECH.
0 w i License
ice se Cla Code,and my license is in full force uad effect.
2 o m - Date Class Con Number El
D y F w UaIC Contractor nnp' p/h KK--��
¢ c,w a OWNER-BUILDER DECLARATION ! M1� ^ 19�� BUILDING PERMIT
D a ° MISC.- REFER T RD INFORMATION
X g LL w I hereby affirm that I am exempt from the Contractor's License
LL O ¢ Law for the following reason.(Sec."1031.5,Busincs and To fessions VALUATION - $/FT.
- < PERMIT ISSUANCE ,
Code Any city or county which requires a permd to construct,alter. 1 .00 I
¢ re ¢ p improve,demolish,or repair any structure,prior 1.its issuance,also ELEC.CONTR. LIG NO. '��1`�`�
ELEC.
- Ca u requires the applicant for such permit 10 file a signed actor's Li that TOTAL
A a, m he is(Chapter
Pursuant to the provisions of the Conlrrvision License PERMIT TO
r ¢Q Law(Chapter 9(osions Codeng )OrAhath tiie 7s 00)of excui0iheiefromn 3 Slid
ce i o Business and ire alleged Code)on.tAn he is exempt ectionom and QTY. PLUMBING PERMIT FEE
s_ H m the buffs for the alleged exemption.Any violation Of Section malty STORIES TYPE CONSTR.
a3 � by any applicant fora permit subjects Ba applicant toocivil penalty ALTER-DRAIN -WATER IEA.) 5.00
ol'no c t hon five hundred dnlla rs(S 500)J:
1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 -
their Sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered fur sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contract.,',License Law docs not apply to an owner of
properly 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 im Prove
mems are mot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or unprovmnent is sold within one year of completion. the owner- GAS-EA.SYSTEM-OVER 4 MA.) 2.00
builder will have the burden of proving(hat he did not build or im- BUILDING USE
prove for purpose of sale.), - INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Om,,
❑ I;as owner of the property,am exclusively contracting with ❑ F-1 . El O ❑
licensed contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:The Commctor'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 with a contractors)l eensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
,ere tat exempl'u tdcr Sea ,B.&P.C.for cis WATER HEATER W/VENT 6.00
Own, Date/P=f' WATER SYSTEM 5.00
ACG DATE ACC.FILE NO.
RKERS'Co,,+IPEN8n77oN ohsc Ln RATION ad
5.00
1 hereby'affion that 1 have a certificate of consent to self insure.
or o certificate of Workers'Compensation Insuranee,,.r a Certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.L
Policy No. Company
Q Cl Certified Copy is hereby tarnished.
Z Z ❑ Certified copy i, filed will, the city inspection division. FIRESPRINK ENERGY T-Z4
Applicant ER TO ORD. v N� Y ❑ N[]
1- O
OL N CERTIFICATE UI'EXEMPTION FROM WORKERS' ' 190
C3 FLOOD ZONE A.L.U.C.
CL COb11'IiNSATION INSURANCE PLG.CLIC. PLG.
1 O ' section need not be completed if the permit is for oneTOTAL Y� N Y N
2 hundred dollars IS 1001 or less.)
U O ' I certify that in the performance of OIC work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL V mit is issued,I shall not employ any person in any manner m as to
O W become subject to the Workers Compensation Laws of California.
a Dan npph,ant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICI?TO API'LICAN'I' If,;,tier making this Certificate of Ex-
H ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall bo deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby aflirm that there is .'construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the Perlonerance of the work for which this permit is issued(Sec. MICROFILM
3097,Ci S Name I.
r'
Lend, HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC -
1 certify the I hove read this application and state that the ab6C VENTILATION FAN (SINGLE) 4.00
information is correct I agree to comply with all city and county PLUMBING I0 d
ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00
hereby ami orire roperty taliins inspection
this city to pllcr upon the
above-mentioned property for inspection purpous. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC,- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
rely in any way accrue against said City in Consequence of the PERMIT ISSUANCE 10.00
ranting of this permit.
MECH.CONT. LID,NO. MECH.
TOTAL TOTAL / �7
Signature of Applicant/Contractor Date II ,(DD
OFFICE COPY