17119 POST THIS CARD NEAR FRONT OF-BUILDING
PERMIT NUMBER
: CITY OF ,CUPERTINO 17119
INSPECTION DIVISION
JOB INSPECTION RECORD '
i� T'f���[..,P,I,� ,d` '�II- I " PERMIT EXPIRATION
JOB ADDRESS .I04Cb I• �JD1lIYwA 'AVL ' UNIT# _LOT# y „
. - - PERMIT EXPIRES IF WORK
OWNER:'• HA IL ' CONTRACTOR ' L � ' IS NOT STARTED WITHIN
INSPECTION DATE . INSPECTOR INSPECTION RECORD 1e0 DAYS OF PEAMIT.ISSU
FOUNDATION* " - - ANCE OR-180 DAYS FROM
NOTE: LASTCALLEDINSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE
_ TO COMPLY.WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION -
CUPERTINO STANDARDS'., '
• GARAGE SLABS - - ��• �� 4'1 s'
POURAG.CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'l/ • ry �''-jl""'� I „ >"i -
- UNDERGROUND/SLAB
PLUMBING - - - c „ .}.•.! ' C`: 3
ELECTRICAL u'
2j�• 1�U•I IssuANCE ua TE
MECHANICAL BLDG: ELECT. PLG. mECR,
. ._ i of Cupe in® ❑ ❑ 01111
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT '
WOOD FLOOR I ORMATION
VALUATIO'il {-SIFT.
PLUMBING' •
MECHANICAL - -
ELECTRICAL - PERM T.TO --
FRAMING
. INSULATION STORILS , TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF OTE:NO FINAL INSP�SHALL BE MADE BEFORE so.Fr.,FLooH arum - TOTAL.anu:AGE
'
N
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF,SHEATHING. " RES INoua D(ON US EPB T
-APPLY NO ROOFING UNTIL ABOVEMAS BEEN SIGNEDFINALS :DATE INSP: ❑ El ❑ . ❑ ❑
ROUGH SAN.# _ ASSEssoIIS PARCEL NO
• PLUMBING 'ELECT.ENERGY
TRACT NO, PAHCELNO.
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL_ I MECH.ENERGY -
Acc.DATE -ACC.FILE NO
,ELECTRICAL 'BUILDING ENERGY .
FRAMING ELECT.FINAL TEST -
INSULATION - PLUMBING - - zoNiNc ENG,SITE No.
- GAS TEST - -- GAS:' '
MECHANICAL ERGY
FIRE SPRINK ENT74
.COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, - I I
• ° in N❑ Y ❑ N❑
ELECTRICAL RELEASE FLOOD ZONE A,L.0 C.
EXTERIOR SHEAR - -
INTERIOR SHEAR - - FIRE DEPT. Y.❑ ' N❑ _ w ❑ N
- GRADE ?. -
SHEETROCK -
FEE SUMMARY
EXTERIOR LATH BUILDING .
.INTERIOR LATH.,,
• T.EMPORAR•Y APPROVALS BUILDING
SCRATCH COAT - ELECTRIC • PLAN CHECK -
GAS
HECK GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE „
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, . MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
� '• o�- - ONE WORKING DAY BEFORE'REQUIRED'INSPECTION. PLUMBING
PLEASE GIVE-JOB ADDRESS WHEN PHONING:
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL .
IMPORTANT! coNsr. TAX,, ,.
PLEASE READ:REVERSE SIDE BEFORE
CALLING FOR FINAL-INSPECTION. TOTAL ,I >'
OFFICE COPY. ;:
AP.PLIFANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
1. PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT - 1,
alto ESS I ^ _ 17119
71 1 A
ADDRESS L4O,I V..Cl�hS�� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL - s!+ia" I J
OWNER'S PLAN CHECK VALIDATION
NAME
.. 77 , - ' 7S- QTY. ELECTRIC PERMIT,' FEE -
PHONE
CONTRNCTOR'S,- r
' NAME _ [J `P OUTLETS- WITCHES-RECEP' -10.00/1.00 -
• ;G IJC.NO.7(Psa` LIGHTING'FIXTURES 10.00/1.00 •'
CONTRACTORS , APPLIANCES SIDENTIAL 4.00
ADDRESS -
SS M�W&t 4/ PHONE �J(�S(I� - PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE - P.C.NO.
'• OR _ PANELS (OVER 200 MP) 20,00
ENGINEER t
uc.ND.,, SIGNS TRANS. 3.00 ,
AARCH.OR
DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
'- ZIP TEMP.METER OR POLE I 20.00 y� TM
APPucarrs
ADDRESS - - MOTORS EE FEE SCH. �• /`�'v��C'1
.I SERVICE CHANGE 20.00 r : „ .� -azj 21 I$�
D o o LICENSED CON"f TACTORS DECLARATION I -
¢�u 1 hereby affirm that I amlicensedunder revisions of Chapter 9 1 ryry
¢ Y P P `1' ISSUANCE DATE
H z-w (commencing with Section 7000)of Division 3 of the Business and
m a w BLDG. ELECT. PLG: MECH.
v, Professions CO"* an m license is in f I I'o c• nd feel.
f y 41 r a
of= o License class �A-L(c.Nnmherh4-4 - 1 Of CBpB ❑ ❑
H y H 0 Oalc_.pLF/�'(� Conlraclor_ * y�
a se f _ BUILDING PERMIT
¢ a affirm
th't I am examDER DECLARATION
o a u INFORMATION
X ; w 1 hereby a(Prm Ihm 1 am exempt from the Contractor's License MISC.- REFER TO ORD
HLLOJ Law for the following reason.(Sec.703 L5,Businessand Professions' PERMIT ISSUANCE. - 10.00
VALUATION 5/FT.
f ,A>f
Code:Any city or county whichlequitesa permit loconst roel,alter, ELEC.CONTR. . LIC NO.
¢ ac Q O Improve.demolish,Or repair any slrueltue,prior to its issiallCC,also ELEC. 3
u wO LL requires the applicant for such permit to IIIc a signed'statement that TOTAL \P^Ep MIT TO
he is licensed pursuant to the provisions of the Contractor's License 1 '�
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
f x o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M H m the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
by any applicunt.for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.)' 5.00
of not more than five hundred dollars($500L): -
d ❑ I,ae owner of the property,or my employees with wages as B K FLOW PROTECT.DEVICE 4.00 "' Oce.GROUP RES.uwTs
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRA S-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does imt apply to an owner of
property who builds or improves thereon,and who docs such work F IXTUR S-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through h is own employees,provided that such improve- GAS-EA. STEM-11NC.40UTLETS 6.00
• meals are not intended or offered for sale II',however,the building
or improvement is'sold within one Year nl'completion, the own°ry GAS-EA.SY TEM OVER 4(EA.) � 2.00 .
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for Purpose of sale.). RES . IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL STE INTER. 30.00 ❑ . El. ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLE S-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor,License Law does'nol apply - -
I.
on owner of properly who builds or improves thereon,and who LAWN SPRINKLER OVER 5(EA.) 1.00
conEruct.,for such projects with a contrac(ons)licensed pursuant In - SEWER-SANITARY-S RM EA.200ft/10.00 '
the Contractor's Licco.Law.' TRACT NO. PARCEL NO.
I ❑ I an,exempt under Sec: ' ,B.&P.C.lou Ibis WATER HEATER W/VEN 6.00
reason
Owner _ Date WATER SYSTEM 5.00 ACC.DATE' ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
- I -I herchy affirm,tlwl I have a certificate of consent to sell=insure, - -
or"a certificate of Workers'Compensation Insurance,or a certified' ZONING ENG.SITE NO.:
copy theregqf(S 800,Lab.C.). r
Policy No.gL(I c. -Company 4,./ly';ssrA1s; -1 ,
0 ❑ Certified Copy is hereby furnished. FIRE BPRINK ENERGY TY4
Z 2 §/Certified cop is filed with the city inspection division.
O Applicant�Q- .� MISC.- REFER TO ORD, Y 'N❑ Y ❑ .N❑.
~ w PERMIT ISSUANCE 10.00
LU - .CIiRT'IFICCOI ENEAEI Vf ION RANGE WORKERS, FLOOD ZONE 'A.LLLCCL . .
W 1 COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0 (This section need not be'compteted if the permit is for one TOTAL Y❑ N❑ Y ❑ Is
hundred dollars IS 100)or less.)
U O I certify that in the perfomimx,of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL I. mit is issued, I shall not employ any person in any manner so as to
U W become subject to the Workers''Compensation Laws of California.
a Dalc�Applicant- ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE: '1'0 APPLICAN"r: If,after making this Certificate of Iix-
F ? emption,you should become subject to the Workers Compensation APPLIANCE' 5.00 PLAN CHECK
provisions of the Labor Code, you must 1'orihwi0s comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=0C.F.M.) 4.00
CONS'fRUC'PION LENDING AGENCY AIR HANDLING UNIT(OVER I0AOOC.EM.)•6.00 , SEISMIC FEE
I hereby affirm that there'is a construction lending agency far EXHAUST HOOD (WITH DUCT) 5.00
the pvirom mice of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) -00 -
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)0.50
Lender's Address ELECTRIC
I.certify that l have read this application and state lhatthcabove VENTILATION FAN (SINGLE) 4.00
int arnmlion is correct. I agree to comply with all city and county PLUMBING
40 ordinances and state laws relating-to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T:U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL ' 7cl)
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which' PERMIT ISSUANCE 'L• 124 CONST.TAX
may ut Gy
way accrue against said City in consequence of the -
uanlin rf his permit MECH.CONT: LIC.NO. MECH.
C3QJ5' 1 y5 ( TOTAL�/ TOTAL Signature of Applicant raclor - Date
OFFICE COPY . '