17544 POST,THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
o- CITY OF CUPERTINO17544 .
INSPECTION DIVISION '
JOB INSPECTION RECORD
I2/! 4o I�.,� j� PERMIT EXPIRATION
/ /�- n vI r-� G_ 1� r
JOB ADDRESS_ V 'v UNIT# _LOT#
./n�{�• �I{^'/J - PERMIT EXPIRES IF WORK
OWNER O CONTRACTOR / , _r`�� 7j . I t� 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 SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF, PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ 1 Ir I
UNDERGROUND /SLAB - _ � (g1
PLUMBING - >•�' 'i III
ELECTRICAL -
ISSUANCE OA rE
MECHANICAL �^� U BLDG. ELECT vLG MECH,
H [1] ❑ E]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING
VALUATION 5/FT.
� _ � -
MECHANICAL
ELECTRICAL - - - P uMIT'TO
FRAMING 'p4I 1 µb
INSULATION STORIESr PE CONSTR.
OCC,GHOUP TIES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
. BUILDING USE
ROOF SHEATHING rIND CONPB ov,r
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
ROUGH - SAN.p ASSESSORS PgRCEL NO
PLUMBING ELECT ENERGY
TUBS 8 SHOWER PAN ' PLUMBING ENERGY - rFACT NO. PARCEL No
• MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY _ ACC.DATE ACC FILE NO.
-
FRAMING ELECT..FINAL TEST ' '
INSULATION - PLUMBING �o"I"G ENG.SITE No
GAS TEST GAS -
MECHANICAL FIRE SPRINK ENERGYT-2]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. ` ❑ "❑ ° ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD tome A.L u.C.
INTERIOR SHEAR FIRE DEPT. ❑ N❑ Y ❑ N❑
SHEETROCK 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 BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING - Gb
PLEASE GIVE JOB ADDRESS WHEN PHONING.
ZMECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
'IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
..BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDINGADDRESS APPLICATION & PERMIT 17544
AbOnsss. .91 u S I / BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S rJ 6 PLAN CHECK VALIDATION
NAME
v PHDNEy 6-s QTY. ELECTRIC PERMIT FEE
CONTRACTORS
NAM OUTLETS-SWITCHES-RECEP 10.00/1.00
'keW IC.No. LIGHTING FIXTURES 10.00/1.00
nooTess ORS APPLIANCES-RESIDENTIAL 4.00 '
PHON PANELS 10.00 DATE OF APPLICATION
oARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC,NO, SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlp EMP.METER OR POLE INS. 20.00 fTCjfl .{/LDH
APPLICANT'' MOTORS SEE FEE SCH. �IIgG
ADOREss
SERVICE CHANGE 20.00
'02 LICENSFD CONTRACTORS DECLARATION G
avI hereby affirm that 1 am licensed under provisions of Chapter 9
a n (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
BLDG, ELECT. PLG. MECH.
r m i Professions Codi•.un Inerue is in full for •:) I ey l
0 o w — License Class_/'i LL"">Lic tract., �7k - ❑
9 w�_ Date �" LV Conlraclor
Q y E J
m CM a OWNER-BUILDER DECLARATI BUILDING PERMIT
E o a U INFORMATION
K g I hereby aflinn that I am exempt from the Contractor's License MISC.— FERO
F u 0< Law for the following reason.(Sec.7031.5,Business and Professions —PERMIT"ISSUANCE VALUATION . S/FT.
Code:Any city or county which requires a permit to menstrua,alleq l O.OQ
ac rt a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
¢ requires the applicant for such pernit to file a signed statement that TOTAL
n w m u hu is licensed pursuant to the provisions of the Contractor's License PERMIT TO
HQZLaw(Chapter 9(commencing with Section 7000)ofbivision 3 of the �I
4 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
rc H a the basis for We alleged exemption.Any violation of Section 7031.$ STORIES T E CONSTR.
T by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER
of not more than five hundred dollars($500).): - (EA.) '5.00
❑ 1,as owner of the property,or my employers with wages as BACK FLOW PROTECT. DEVICE 4.00 oCC.GROUP REB.UNITS
their sole compensation,will do the work,and the structun re not
'(tended or offered for sale(Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 sa FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintended or offered for sale.If,however,the budding GAS-EA.SYSTEM-11NC.4OUTLET$ 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or re- BUILDING USE
prove mr.....cc ofsdc.). INDUSTRIAL WASTE INTER. 30.00 ES IND CON PB oder
❑ 1,as owner of the property,am exclusively contracting with1:1 .�
licensed contracmr' to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 VB. 600 ASSESSORS PARCEL NO.
and Professions Code: rite Contractor's License Law docs not apply . .
to an owner of property who huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forsuch projects with a contractor(s)licensed pursuant to
the Conlreelor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
on
❑ nm exempt under Sec. '- B.&P.C.for this WATER HEATER W/VENT �D
Owner Dine WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK fSRS'COS1PIiNSA'I70h DECLARATION WATER TREATING EQUIP. 5.00
I hereby untied that I huv•a certificate of consent to self-insure-
or acertificate of Workers' mpmtsali0" Insurance, r a certified ZONING ENG.SITE NO.
pyyy r /i800,Lab. '.1.
Po 4 Company -
O e0 is hereby l r filled.-
z Z ie up
is fled 'Ill the city inspection di,malL FIRE SPR INK ENERGY Ti4
FO .Beam _ MISC- REFER TO ORD. v � NO v ❑ N�
Q- w CIi RI'II%( iOP EXEMPTION ERON WORKERS' PERMIT ISSUANCE 1 .00
L MP17NSATION INSURANCE PLG.CONTR. FLOOD=0Y
LIC.NO. PLG.
Z
(This section need not be completed if the pen.it is for one TOTAL J 00 Y❑
hundred dollars(5100)or less.)
U O 1 certify that in the performance of tire work for which this per- Eii
HANICALgl=C.F.M.)
FEE FEE SUMMARY
LL mil is issued,I shall not employ any perum in any manner so as tobecome auhjca to te Workers'Compatsation Luws Of Calilomiu.d DaleICANI: I D TO MEj400
BUILDINGVa Date TO APPLICANT: If,after making this Certi(icme of lix-
emption,you should become subject to the Workers'Compensation PLAN CHECK
Provisions of the Labor Code, you muss forthwith comply withsuch provisions or this permit shall be deemed rvoked. UNIT(TO FEE
CONS'T'RUCTION LENDING AGENCY UNIT(OVE - SEISMIC FEE
I hereby affirm that there is a construction lending agency forOD(WITH
the performance of the work for which this permit is issued(Sec.
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lenderi Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 verify that I have read this application an,'rule that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.01100,000 B.T.U.) 6.00 .�
hereby authored representatives of this city to toter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned roperly for inspection purposes. MECHANICAL
(We) agree to s try, indemnify and keep harmless tire City Of MISC.- REFER TO ORD.
Cupertino against it ililies,judgments, costs and expenses which CONST.TAX
may n any way aC ue against said City in consequence of the PERMIT ISSUANCE ' 10.00
•coning 'lhi'pernll MECH.CONT. LIC.NO. MECH.
.�� TOTAL
TOTAL /
Signat a (Applicant/Contractor Date 2
OFFICE COPY