17985 POST'THIS CARD-NEAR 'FRONT OF'BUILDING
PERMIT NUMBER
GIT
•Y OF P
ERTINO
-, '
CU 1.7985
INSP.ECTION'DIVISI=ONr
I JOB INSPECTION RECOR,Q I J, ; .
E PIR 1 I-
G' _
JOB ADDRESS_L'�(_ �s� (mow UNIT#' _LOT#" 'I*�.
X,P�,ES IF WORK
.OWNER �(,� Q�—, - ;CONTRAGTOIi 'N/'Lt'' �.' IS' N T. STARTED WI RIN
U . _
INSPECTION DATE INSPECTOR INSPECTION RECORD 1BoDAYsOFPERMITISSU-
' FOUNDATION •' 'ANCE-OR 180 DAYS FROM
.NOTE: LAST CALLED INSPECTION,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - " TO'COMPLY WITH THE APPROVED PLANS AND CITY OF PER VALIDATION
I CUPERTINO STANDARDS.T �
GARAGE SLABS .; PAID
I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'L ;; ���q _
JJ
UNDERGROUND-/SLAB.
��N /^1 1•
PLUMBING
Clty,of CuDerUno
c.
ELECTRICAL - _ ISSUANCE DATE
MECHANICAL
r BLO 1. F.LEGT. PLG. MFCN
' - tr � � _ -;, - 0 .❑
Sa l
_DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
�` INFORMATION
WOOD FLOOR
•yA✓A RONJSIFT.
PLUMBING
•.., MECHANICAL
7 ELECTRICAL - �{i�J4,o�P^EaIMIrTo-
FRAMING �''Q4""c"(A�'TL'
INSULATION - - sroRlEs TYPE CONSTR
OtJ
,R[5(UNIT$
' • PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �13 , .
$O.FT FLOON`AR€A TOTAL ACREAGE
ROOF THE C N STRUC ION T HALLBE�MADE BEFORE �f .+/,n;W.
DIAPHRAGM THE CONSTRUCTION TAX L PAID 4 P !G. tc>Z'
BUILDING USE
ROOF SHEATHING , ' , -RES- IND CCN FB CII.,
"-APPLY NO'ROOFING.UNTILABOVE HAS BEEN SIGNED :ELECT.
INALS DATE' ' INSP� ' ❑ ❑ •.❑. ❑.
ROUGH' , ASS ESSDRSRARCELNO.
. PLUMBING' - ENERGYTUBS&SHOWER'PAN*, NG ENERGYTRncT No. RARCEL NoMECHANICAL - '' - ENERGY,G:ENERGY ACC,Dore. 'ACC.PILE NO
ELECTRICAL - - _ ..
FRAMING - - ELECT.FINAL TEST ZONING ENC.SITE No.
INSULATION PLUMBING. _
1 GAS TEST GAS
y MECHANICAL _ 'FIRE SPF41NK ENERGY T.24"
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING'" ❑' •"❑ ° ❑ NEI
E P
ELECTRICAL-RELEASE - - 'FLOOD ZONE A. ,U,C
INTERIOR SHEAR _ FIRE DEPT. - Y❑ ' NQ Y ❑ No
SHEETROCK _ - GRADE - - FEE SUMMAR
BUILDING'
EXTERIOR LATH - — �BUIL5ING
INTERIOR LATH' ' TEMPORARY APPROVAL :F r '+.
SCRATCH COAT - ELECTRIC a PLAN CHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SI'GNEO OCCUPANCY - SEISMIC FEE, `
OCCUPANCY&BUILDING IS NOT PERMITTED Ulm TI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. .M ICROFI LM
. ELECTRIC
w ARRANGE FOR INSPECTION BY PHONING 252-4505; I
F ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING
O�' PLEASE GIVE JOB ADDRESS WHEN'IP"AWNG,
z SEE'PERMIT FOR EXPIR AT IO NDA E - MECHAiWCAL: .
. IMPORTANT! CONST.TAX .
PLEASE READ REVERSE SIDE BEFORE r
CALLING FOR FINAL INSPECTION. TOTAL '
" . OF FICE'COPY
APPLICANT TO FILL IN INFORMATION MTHIN.RED LINES - USE BALL POINT.PEN ONLY '
,.
QUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT ADDIR j
� -' ./ 7Q�BS 1�. I- BUILDING -ELECTRICAL-PLUMBING-MECHANICAL f,[M1'. 1 985
OWNER PoLfTHEC�y9'CLDLITI
NAME `/"Y�1 ' E�-r1/`
/E DTV. ELECTRIC PERMIT FEE
I, VI C r ( .1 - PHONE
p" CONTRACTOR S. 'l`
N LL UTLETS-SWITCHES-RECEP 10,00/1.00
Rf LIGHTING FIXTURES 10.00/1.00 r ,pp 1 lA 1 ,t
CONTRACTOR S - PPLIANCES-RESIDENTIAL 4.00
ADDRESS
-, ail Cr
a aDI- PH 75-
(� ^0 4 PANELS � 't O.00 DATE OF APPLICATION
ARCHITECT { - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER400 AMP)
' 20.00 --
ENGINEER
,LIC.NO. ISIGNS TRANS. 3.00 -
ADDRESS. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION '
ZIP TEMP.METER OR POLE INS: 20.00
APPIJAG -
ADDRESS MOTORS SEE FEE SCH
-
p A )2 SERVICE CHANGE . 20.00 ' 1��11� POI,
ry1/'
w ¢O2 j LICENSED CONT'RACPORS DECLARATION - 'J' 1 1f',1 ~ `ct`r`l
Q U W I hercby,aff!R.Iflat I am licensed Under provisions of Chapter 9 4 n 1 69 ISSUANCE DATE
(colnmencing with Sed iota 7000)0l'Uivisiu t 3 of the Business nod
G ¢ BLD . ELECT. PLG. ECH,
r y i - Profesiions Code,.s�1IU��,((I my license is in full force nQQ,,e�le I -
z O,,n - License .loss LL Lic.Number_ - �„ ❑
2A F w Date = 9_Contractor.MQa,(416 -16MiF3M1 ciw�I �CBpB(��
a m s - V "- eo
BUILDING PERMIT -
¢ ¢ a OWNER-IIUILDER DECLARATION
Ea,
a U - INFORMATION
K ;LL y 1 hereby affirm that,1,am exempt from the Comrador's.License MIS`.- REFER TO ORD
_ L 0< Law for the following reason.(Sec.7031.5,Businessand professions -PERMIT ISSUANCE a;qqp. 1^� L��� S/FT.
:Ay Cdde:Any city or comlry which requires a Permit to construct,alter,
Qa ¢ 0 Improve,demolish,or repair any st Notate,'prior to Its issuance,also ELEC.CONTR. ' 'LIC.NO. ELEC. �' /. ! '
a w m u Kyuim'4 the applicant for such permit to lila a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
Hii Law(Chapter 9(commencing with Section 7000)of Division 3 of the
x o; Business and professions Code)or that hu ie'exempt therefrom and QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 _ STORIES+ TYPE CONSTR.
by any applicant forn permit subjects the applicant ma civil penalty ALTER-DRAIN&VENT-WATER (EA.) 500
of not more than five hundred dollars(5500).1:
O 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 Contractors License Law does not apply to an owner of.
properly who builds or improves thercon,:md who does such work , FIXTURES-PER TRAP - 5.00 s0 T.PLooRPaeA TDTAL ACREAGE
himself or through his own employees,provided that such iumrove- L�•f ,_
meats arc not intended or offered for sale.If,however,the building GAStEA.SVSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA ) 200
builder will have the'bunlen of proving that he did riot build or im- - . • . .
BUILDING USE
ES IND CON PE) Orher
prove for purpose.1 the
INDUSTRIAL WASTE INTER. 30.00 ❑ . ❑ ❑ ❑
O' 1.d as Owner al'(I) properly,he exclusively contracting with
licensed Contractors : Iconstruct the project(See.La. do4 not apps LAWN SPRINKLERS-1 INC 5`V.B. 6.00 gSSEs5oR5 PARCEL No.
to n owner of Coda Thu Contractor's improv s th onus not Applyto contracts
owner of propertyh Projects
who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA-.) 1.00 '
the Comforter's
o for such cruse L with a contrucmr(s)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00'
the Conlm exempt
License Law. TRACT NO. PARCEL NO.
O lam exemptunder Sec.-,B.&P.C.for this WATER HEATER VY/VENT 6.00
rCll4n11 - -
Owner Uure WATER SYSTEM .5.00 .ACC.DATE- ACC.FILE NO,
WORK ERS'COMPENSA'LION DECLA RAT ION WATER TREATING'EQUIP. 5.00
I hereby affirm that l have a certificate ofconsenl to self-insmov, - - TONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certifieJ
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-yr,
'Z 2 O Certified copy is filed will, Il," city inspection division.
O Applic:uri MIS`.- REFER TO ORD.
Y ❑ 'N❑ Y ❑ IN
� N CE RTI F ICAT F OF Ii XEM PTION 1:ROM WORK Ii RS' PERMIT ISSUANCE 10.00 - FLOOD ZONE A.L.U.C.
LOU COMPENSATION INSURANCE PLG.CONTR. LIC.N0. PLG. - ❑ ❑ ❑. ❑
Q. 0 ('ty Nv N
his section need not be.completed if the permit is for one _ TOTAL
hundred dollms IS 100)nr lass.) -
U O I certify that'in'Ihcperformuncc.of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE"SUMMAR
U_ I- mit is issued,I shall not employ any pe rsnn in an manner so as to
Ow becomelub t9 the Workers'Compens:dionL s 'aliforoia. t
Uae_{P-{^rY Applicanh•5., BUIL b
ED C1 A P -("-_ ALTER OR ADD TO MECH. 5.00
} rn NOTI TO P LICAN'f: If,a ler making Olis erl il'ic:le of F.x-
Z Cmption,you should become subject to the Workers'Compensation APPLIANCE - _ - 5.00 PLAN CHECK
provisions of the Labor Coda, you must forthwith comply with FEE
U such provisions or This permit shall he dermal revoked. AIR HANDLING UNIT ITB 10,000QF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,0MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm Ibu( there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the permrmance of the work tar which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
-- --- Lender's Name HEATING UNIT 100,000 B.T.U:)9.50 ' I,
Lender's Address - ELECTRIC ^
JI certify Thal I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
in(oinuumn is correct. I agree to comply with all city and county PLUMBING
r ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,600 B.T.U.)-6.00
herchy authorile representatives of this city To enter upon the - BOILER-COMP (Over 100,000,BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes. ..
(We),agree to save, indemnify and keep lormhos the City of MIS`.- REFER TO ORD. - -
Cupertino against liabilities,judgments, costs and expenses which' CONST.TAX
may in any way accrue a pinst said City in consequence of the PERMIT ISSUANCE 10.00
ranting ofthispermit. MECH.CO NT. LIC.NO. MECH.
TOTAL
TOTAL
' Signature of Applicant/Contractor Unto �
OFFICE COPY