17541 I POSTTHIS CARD'NEAR FRONT OF BUILDING PERMIT NUMBER
OF CUP,ERT,INO . ' 17541
INSPECTION DIVISION
JOB INSPECTION,RECORD '
PERMIT EXPIRATION
q)P
+ = JOB ADDRESS I'� `-
`�•—^� � UNIT#; ` . LOTS# PERMIT,EXPIRES IF WORK
OWNER t - Lam£-„ - CONTRACTOR�{^ I f' IS NOT' STARTED WITHIN
INSPECTION DATE INSPECTOR' - INSPECTION REC leo DAYS OF PERMIT.ISSU
FOUNDATION - - - ANCE OR 1BO DAYS FROM
:OCOMP:LY
LAST CALLED INSPECTION.
LIFER - I '' _ NG-AND DRAINAGE SHALL BE INSTALLED "
- 'PREGUNITE - WITH THE APPROVED PLANS AND CITY QpF PERMIT vAUDA nD
STANDARDS. ,}- �V') ,
GARAGE SLABS
• - _-' Y )
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' UNDERGROUND /SLAB
PLUMBING
"- ELECTRICAL 'issuAlvcE ogre.
MECHANICAL wQ FLOG. ELECT. PLG MECH.
El 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ;. - BUILDING PERMIT
INFORMATION
• WOOD FLOORvnwnnoN s,PT.
PLUMBING -
MECHANICAL
ELECTRICAL..•, PERM I TO
FRAMING . 'TI - •.4 .
INSULATION
STORIES, �PYPECON STN..
- �- � ,
OCC.GROUP- ; ARES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
5O.{T.FLOOR AREA TOTAL ACREAGE
ROOF - NOTE:.NO FINAL'INSP.SHALL BE MADE BEFORE -
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID •`",
4 BUILDING USE
ROOF SHEATHING HIE IND CON 'PR. G,I
APPLY NO ROOFING UNTIL ABOVE HAS SEEN SIGNED FINALS DATE INSP. ❑`' ❑ '❑ ' ❑
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING, - ELECT.'ENERGY '
_ TRACT NOP., PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY hil
MECHANICAL MECH.-ENERGYT-
ELECTRfCAL 'ACC.DATE
ACC FILE'NO
- BUILDING ENERGY .
FRAMING - ELECTr FINAL TEST "
ZONING ENG.SITE NO.
INSULATION �' PLUMBING _ � � -
GAST.EST, - GAS-
MECHANICAL - FIRE SPRINK EN E RGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ . "❑ ^ Y ❑ "❑
E L,ECTRICAL 7REL ' _
EXTERIOR SHEAR EASE
-ELooD ZONE A.L us.
INTERIOR SHEAR FIRE DEPT. - Y ❑ N❑ Y.� N❑-
SHEETROCK. - GRADE ' +' ••' - -
FEE SUMMARY
EXTERIOR LATH - BUILDING - y�• _
TEMPORARY APPROVAL& BUILDING
INTERIOR LATH _ -
SCRATCH'COAT ELECTRIC - PLAN CHECKV'
GAS - f:. �' FEE .
• NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN.SIGNED OCCUPANCY. SEISMIC'FEE', 1 '
OCCUPANCY OF BUILDING ISNOTPERMITTEDUNTILBUILI) NGFINALISSIGNEDBYBUILDING INSPECTOR: MICROFILM
ARRANGE'FOR INSPECTION BY PHONING 252-4505, ELECTRIC ,
ONE WORKING DAY BEFORE REQUIRED INSPECTION. '
F PLUMBIN1.G
� PLEAS,E,GIVE JOB'ADDRESS WHEN PHONFNG: . '•, ' s. '
.' z .
- SEE PERMITTOR EXPI'RATION.DATE MECHANICAL
.CONST.TAX".
' IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE'
-CALLING FOR FINAL,INSPECTION. TOTAL Lj
r OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEWONL:Y.'
• ., ', .BUILDING PROJECT IDENTIFICATION PERMIT NUMBERAPPLICATION & PERMIT
r.'
BUILDING I.'.
ADDRESS 17 [Aj 1
i - O BUILDING —ELECTRICAL—PLUMBING.-MECHANICAL •P'ai a! I' I �T
OWNER'5 PLAN CHECK VALIDATION
NAME J� py GTV. ELECTRIC PERMIT FEE
CONTRACTORS
N E J _ OUTLETS'-SWITCHES-"RECEP 10.0011.00
IU."E'_'_FT//l• LIC,N LIGHTING FIXTURES 10.00/1.00
(ANTRA TORS - APPLIANCES-RESIDENTIAL 4.00 '
A E S - [ ,E -
- ( 2J NE d PANELS 10.00 DATE OF APPLICATION' _
IRS
- PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMPI - 20.00
ENGINEER , � I - r
" LIC.NO. SIGNS TRANS. • '. , 3.00 _ " "e N,'1"'•
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS - - SPECIAL CIRCUIT - 5.00 -
zm EMP:METER OR POLE INS. 20.00 , kb- OCGk/LVH
APPLICANT'S MOTORS SEE FEE SCH_. i -
ADORESa - ,51 J�JI�q
SERVICE CHANGE - f' " _
w
02 LICENSED CONTRACTORS DECLARATION
a v w I hereby affirm that I am licensed under provisions of Chapter 9 ; , ISSUANCE DATE
I- N a vat (commencing with Section 7000)of Division 3 of the Business and „� BLDG. ELECT. PLG MECH,
H N z Professions Ce� license is in full fo J - cup.
�
o i v,o Liccnsc Class Con ract., � d,YMQ ❑
F w Uato ill...... - Lie.Number
Contract.,_ p Y�`r
a y ..y� BUILDING PERMIT
¢ ¢ a -ffOWNER-BUILDERDECLARATI N
¢ w u INFORMATION
wi
z ;a-te I hereby affirm that I am exempt from the Contractor's License MISC.— flEFER TO ORD
'n u O a Law for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - ",10.00 VALUATION $/FT.
Code:Any city or county which requiresa permit toconstrucl,alteq
¢ ¢ Qimprove,demolish,or repair any structure,prior,to its Issuance,also ELEC.CONTN. C.NO. ELEC.
wO LL requires the applicant for such permit to file;,.signed statement Ilial - f "- TOTAL . .z�. PERMITTO
.9 a he is licensed pursuant to Ore provisions of the Contractor's Liccnsc - "
r z r - Law(Chapter 9(commencing with Section 7000)of Division3ofthe Lllgmbin
a Business and Professions Code)or that he is exempt therefrom and QTY- PLUMBING PERMIT FEE
¢ Es- O the basis for lire alleged exemption.Any violation of Section 7031.5 STORIES ECONSTR.
nam by any applicant'for a permit subjects the applicant toa civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 " '
of not more than five hundred dollars(5500)-1'.
i ❑ 1,as sowner,of the property,or Itry employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their ole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, HLSIGUSS.and Professions DRAINS+FLOOR,ROOF,AREA,COND. 5.00 '
Coder 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 so.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended oroffered for salc.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvenienlis sold within one year of completion,0m own'
builder will have the burden of proving that he did not build or irer- GAS=EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE- - E .IND CON; PB Other�
prove,to,purpose ofs.ILJ.;., - INDUSTRIAL'WASTE INTER. '30.00
❑ I,as owner of lire properly,am exclusively contracting with ❑• ❑ ❑•" ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.Br " 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 SPR IN KLERS-OVER'5.(EA.)r 1.00 '
coulnctsfor such projects withcontmetorfsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
- ❑ I
our exempt undcrSec. ,B.&NC.forthls WATER HEATER W/VENT6,ell (f? -
reason
Owner - Date _ .. WATER SYSTEM 5100 ACC.DATE ACc.FILE NO,
WORKF.RS'COMPENSATION DECLARATION - WATER TREATING EQUIP. 5.00
I hereby affirm that l haven certificate of-consent to self-insore, - ZONING
or a certificate of W r e i Compensa r Ins'unnce,o a certified r ENG.SITE NO.
on,
Pn �/1"ul' 'y—
LOAM I—
O Certil copy is here! furnished - . FIRE SPRINK ENERGY T�24
Z 2 Certi a copy is'fib with the city .inspection di kion. s
Q t MISC.- REFER TO ORD. Y ❑. N❑ Y ❑ No
~ w PERMIT ISSUANCE FLOODZONE A.L.u.C.
CIi R'1' I CO1 OIi SATI Pf ION RAN WORKERS' .-
W - COMPISNSATION INSURANCE* PLG.CONTR. LIC.N0. PLG:
' EL Q ,'(This secti(in need tint be cirmplcted il'the permit Is for one - TOTAL' j-/,W Y❑- SN❑' Y ❑ -N❑
• Z hundred dollars IS 100)or,less.). +
U 0 -.I cerllfy that in the performance of the work for which(his per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,I'shall not employ any person in any manner so as to
UW become subject to the Workers'Compensation Laws of California.
W Date Applicant - BUILDING
} w NOTICE 'f0 APPLICANT: If,after making this Ce}lificam of Ek. ALTER OR.ADD TO MECH. 5.00
F. ? emption,you should become subject In the Workers'Compensation . APPLIANCE *.5.00 PLAN CHECK
provisions of the Labor Code, you roust forthwith comply with FEE -
-U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO IOf.I00QF.M.), 4.00 -
.CONS'I'RUCfIONLENDING AGENCY AIR HANDLING UNIT(OVER IQOOOGEM.) 6.00 e' SEISMIC FEE
:I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. - MICROFILM
- 3097,Civ,CJ., HEATING'UNIT(TO100,000B.T.U.) -•8.00 k
Lender's Name HEATING UNIT(OVER 100,000 B.T-.U.)R50 Y 'ELECTRIC
Lender's Address -
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
ordinances and state laws relating.to building construclion, and BOILER-OJMPI3 H.P.Of 100,000B.T.U.1 6.00 d�
hereby authorize representatives of this"city to enter upon the BOILER-COMP (Over.100,000 BTU)SEE FEE SCH. MECHANICAL
abova-mentioned-property for ir'Peclion purposes. .- el
(Wc)^egree t save„indemiuify and keep•hsFniless the,City of MISC- .; REFER TO ORD. _
Cupertino against iabililics,.judgmenls, costs and expenses which CONST:TAX
H n .any way rue against said City in consequence of the PERMIT ISSUANCE 10.00 ”
r tin of(his per MECH.CONT. LIC.NO. MECH. .-
TOTAL TOTAL / M
,- Sig meol'APPlicant/Conlracmr - Date -,j a r (00
j ' OFFICE CCPV'