17860 POST THIS CARD NEAR FRONT OF BUILDING
A , _ - PERMIT NUMBER "
CITY OF CUPERTINO 17$ 0
INSPECTION DIVISION" f' -"
JOB INSPECTION RECORD
'�• - Q - - , _ , PERMIT EXPIRATION
JOB ADDRESS ° ST• UNIT# _LOT# -
��y - - PERMIT EXPIRES IF WORK,
OWNER - �Q[. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD' 180 DAYS'OF PERMIT,ISSU:
FOUNDATION ANCE OR, 180 DAYS FROM
'NOTE: LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE.INSTALLED,
TO COMPLY WITH THE APPROVED PLANS AND CITY OF •,PLRNIIT VALIDATION./
PREGUNITE'. CUPERTINO STANDARDS.
GARAGE SLABS F' -
:r
' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING • . �,
ELECTRICAL ISSUANCE DATE
MECHANICAL -, !' `• RLDG -ELECT,r. PLG, MecR .
^ PAID• CV 'C�]! C�' C�'
DO NOT,POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED MAY INFORMATION
BUILDING PERMIT
WOOD FLOOR 11 VALUATIO sIFT.
PLUMBING, "- � - •� -- '
MECHANICAL . City Of Cll .e
;r..;
ELECTRICAL
" yy r;PERraIr tlo
-
•. FRAMING P t 11L.'Iti 'I 11�.5. �'•
r
INSULATION - - - 'STORIES TYPE CONSTR.
'�✓� �JG' -, /�ONa' , DEC.GROUP, TIES UNITS
P ACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OK 7 /cr-gc ,y
' 50.IT.FLOOR AREA TOTAL ACREAGE
' 'ROOF NOTE:NO FINAL-INSP.SHALLBE MADE BEFORE '
THE CONSTRUCTION TAX IS PAID� _- DIAPHRAGM. - .. :fl ,- auaolNc use
ROOF SHEATHING - Res IND CON Pe Om,,,
APPLY NO ROOFING UNTILABOVEHASBEENISIGNED- FINALS':' DATE - INSP. ❑ -0 ' '❑ '❑ ' ❑
ROUGH SAN.N'". A$$E$$ORS PARSE LNO.
PLUMBING ELECT.ENERGY
TRACT N0. • PARCEL NO.
TUBS B SHOWER PAN• - PLUMBING ENERGY - ,
MECHANICAL - - .MECH.ENERGY-
ELECTRICAL BUILDING ENERGY - ACC DATE ncc,wLE NO
FRAMING ELECT.FINAL TEST - -
PLUMBING ZONING ' ENG.SITE NO.
r INSULATION- - -
GAS TEST - GASlof� _ '
• MECHANICAL EIRESPRINK -ENERGY T24
4 COVER NO WORK ONTIL ABOVE HAS BEEN SIGNEDHEATING. , Y ❑ NEI ` ❑ NE]
EXTERIOR.SHEAR I ELECTRICAL RELEASE ' LOZONE A.L.u,c.
INTERIOR SHEAR - FIRE DEPT. Yo` ,N❑ Y ❑ NEI
SHEETROCK GRADE- FEE SUMMARY
EXTERIOR LATH. - BUILDING �- -
INTERIOR LATH
1 TEMPORARY APPROVALS ' - BUILDING
INTERIOR I 4. _!D
SCRATCH COAT - ELECTRIC+ T' PLAN CHECK t
GAS .. t FEE I `
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE j `=
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR' "MICROFILM
-ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC "le
ONE'WORKING DAY BE FORE'REQUIRED INSPECTION It^y"? • '
0� ''PLEASE GIVE.JOB ADDRESS WHEN,PHONING. PwMewc,:
Z - MECHANICAL l.J
,, • — SEE PERMIT FOR EXPIRATION DATE �. It 1
IMPORTANTI•
CONST.TAX
PLEASE READ REVERE SIDE BEFORE I Y f
,.+ .
CALLING FOR F-INAL'INSPECTION. TOTAL Ut I't
OFFICE COPY
l.1 L
APPLICANT TO FILL IN INFORMATION WITHIN RED,LINES - USE BALL POINT PEN ONLY
UI DING PROJECT I DENTI FICATION ,PERMIT NUMBER _
G,NG APPLICATION & PERMIT-S 1 ^h
BUILDING = ELECTRICAL'- 7O V PLUMBING'-MECHANICAL 11 O
� OWNER'S - „ _ PLAN CHECK VALIDATION
,. NAME ` - CITY. ELECTRIC PERMIT FEE 1; - -
PHONE
CONTRACTOR'S
NAME KI ,/- OUTLETS-SWITCHES-RECEP 10.00/1.00 10), .
uC.ry 47 I LIGHTING FIXTURES 10.00/1.00 (D,
CONTRACTOR s
ADPPLIANCES-RESIDENTIAL 4.00
HONEa PANELS 10.00 DATEOF APPLICATION '♦•
ARCHITECT . PLAN CHECK FEE P.C.NO.
OR ' PANELS (OVER 200 AMP) 20.00
ENGINEER .
UC.NQ: SIGNS TRANS. 3.00
ARCH.OR ENG, PERMIT VALIDATION
ADDRESS -__ ' SPECIAL CIRCUIT 5.00
ZIP ITEMP.METER OR POLE INS. 20.00 A �\.Ty`A.,�.li�-rte`
ADDRESS MOTORS " - SEE FEE SCH. .L\ 1 IV'�2 .
ADDRESS
'. I `M - SERVICE CHANGE:`- 20.00 5111 /89
o O LICENSED CONTRACTORS DECLARATION
a U U Chereby affirm that I am licenser)under provisions Of Clsapter 9 - 'ISSUANCE DATE
n 4 w (commencing with Section 7000)of Division 3 of the Business and
¢ a g BLDG. ELECT. PLG. MECH.
H w Z Professions CosJ16 lind my license is in full fort a
z 0 w- License Class Lic.Number /�f( L-L��- -
m r ea Date •Contractor , -
H ' MAY 11 1989
a r f ., ._ BUILDING PERMIT
¢ ¢ a OWN:R-BUILDER DECLARATION -
- INFORMATION
I.1.erehy uIfinI tlml I am exempt 1'rmn the Cmumelor's License MISC.r I„ REEE T nn
u 0¢ Law for the following reason.(Sec.7031.5,Business and Professionx
PERMIT ISSUANCE,- - VALUATION
w>i Code:Any city or county which requiresa permit to construct,alter, -
¢ ¢ ¢0 improve,demolish,oLiepalf any structure,prior to its issuadce,also ELEC:CONTR. LIC.NO. ELEC. Q� '-'e�r.�
O u requires the applicant for such permit to file a signed statement that " 39A0 TOTAL i PERMIT TO
w $m he is licensed pursuant to the provisions of the Contractor's License ' I,'y , 1 ���,{fy�[�`
F z < Law(Chapter 9lcommencing with Section 7000)of Division 3 ofthe. WTCI-1E,ti-1 ('Z.\'IWL,)
q i 0 Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
at the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e , by any applicant for a permit subjects theapplicont to a civil penalty ALTER-DRAIN -WATERIER.) 5.00 -
of not more thin rive bandied dollars l 55001.1:
❑ I,as owner of the,property,or my,ermloyees with wages as BACK FLOW PROTECT. DEVICE 4,00 OCC.GROUP' RES.UNITS
their sole compensation,will do the work,:rad^the struc Rue is not
n intended or offered lb, sale(Sec. 7044, Busine"ss and Professions +pRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's Lii'en,c Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTALACREAGE
• himself or through his own employees,provided that such.improve-
ments are not intended proffered for sale.11,however.the budding GAS-EA.SYSTEM-I INC.4 OUTLETS '6.00
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- .- BUILDING USE
prove for pummic of sale). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ '1,as owner of the property,am exclusively contracling with ',Q 11.110 1-1 ,
licensed conlraclprs to construct the project)Sec. 7044,business LAWN SPRINKLERS'-1 INC 5 V.B. j 6,00 . ASSESSORS PARCEL NO.
and Professions Code:The Contract,),',License Law does not apply
to an owner oIproperty who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a controctod,)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. - TRACT NO: PARCEL NO.
❑ I am exempt under Sec. B.b.P.C.for this WATER HEATER W/VENT 6.00
reason
Owner _ Date WATER SYSTEM -5.00 - ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION . WATER TREATING EQUIP. 5.00
I herby affirm that I hn've a certificate ol'Icimwnt[o sclGinaurc,
or.a certificate of Workers'Compensation Insurance,or cLrtific L 1, ZONING, ENG.SITE NO.
copy thereof(See.3800,Lab.C�'..]]ppr.q�
Policy No, Cmnpanyl�&F__ _r -
0 Certified copy is hereby furnished. f FIRE SPRINK ENERGY T-24
_Z Z Certi ie copy is Fl i I Ie city inspection division.. MISC.- REFER TO ORD.
O Applicant - - - Y ry Y [] N�
Hy PERMIT ISSUANCE .10:f)0 FLOOD ZONE A.L.U.C.
CERTI FICATI:OF IiXF. 'PION FROM WORKERS' I q.W
' LU COMPENSATION INSURANCE PLG.CONTR. L PLG. '
CL ❑
(This section decd not he completed if Ilm permit is for one TOTAL �� �' V N Y C] N E]
Z hundred dollars IS 100)or less) I - -
U 0 1 certify that in the performance or the work for which this per- DTV.• MECHANICAL PERMIT FEE FEE SUMMARY,
LL 1- mit is.issued,I shall not employ any person in any nlarinerso as to
O W become suhject to the Workers'Compensation Laws of California.
0- Date ApplicantALTER OR ADD TO MECH ' 5.00 BUILDING 225q-
} N NOTICE TO APPLICANT: If,after making this Certificate of lix .
I. 2 einption,you should become subject to the Workers'Compensalion
APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwifh<comply with h �7
U such provisions or this permit shall.be deemed revoked. AIR HANDLING UNIT(TO 10=r-F.M.) 4.00 FEE - L)
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE ' I I
I hereby affirm that there is a,constructinn lending agency for EXHAUST HOOD(WITH DUCT) 5.00 (p,
the performance of the work for which this permit-is issued(Sec. MICROFILM
3097,CiVe.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00
' Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 r] 4O
Lender's Address - ELECTRIC _'
I "rtify that)have read this application and%(ote that the above VENTILATION FAN (SINGLE)' 4.00
information n correct 1 agree tog to b with all city and county
_ BOILER-CUMP,(3 H.P.of 100,000 B.T.U.) 6.00 PLUMBING f 8 _
ordinances and stole lows relating m building,construction, and -
hereby,authorize representatives of this city"to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property lot inspection purposes. I S 5
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE - 49:80 Iaz GLS CONST.TAX
may in any way ac-rue ag 'est Said City in consequence of the
Hing of this pe,tit MECH.CONT. LIC.NO. MECH.
V TOTAL
Sign IMF Ap ant ontmctor „ D'ate' �sl�t � . TOTAL
STI
„OFFICE COPY ,