17618 POST THIS CARDS NEARFRONT OF BUILDING
PERMIT NUMBER
CITY OF. CUPERTINO
• INSPECTION DIVISION ' 17618
J�OTB INSPECTION RECORD
AWk
Sdo 4J ot/ie"sm iJ MI EXPIRATION
�.� JOBADDR ESS _LOT# 4' i (m�j `S
6 PERMIT �P ES IFIWORK .
OWNER 1$� " L'0,!s 0 >] - 7 .cONTa ACTOR -•IS NOT(STARTED WITHIN ,
- INSPECTION' DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM.
,NOTE: LAST CALLED INSPECTION'.
UFER zy^�Q 'ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO C,,LI=WITH THE APPROVED PLANS AND CITY,OF PERMIT NALIUA ION;
PR EGUNITE CUPERTINO STANDARDS. `' `
GARAGE SLABS rx
_ -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING �� ,
ELECTRICAL ISSUANCE DATE
MECHANICAL - Gj ELECT 'PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING, ERMIT
INFOR TION
.WOOD FLOOR --VALUATION slFT..-
PLUMBING
MECHANICAL J
ELECT1 PERMITTOrr {
' RICAL
FRAMING -
III I_v6T
INSULATION I . STORIES TYPE CONSTR.
OCC.GROUP. RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT aooR AREA TorAi.ACR FACE
DIAPHRAGM - 'THE CONSTRUCTION TAX IS PAID - -
BUILDING USE
ROOF SHEATHING - RES IND 1:1 El ❑N •❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP, ASSESSORS PARCEL NO.
ROUGH . SAN.N
PLUMBING- ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY -
Acc.UnTz ACC,FILE No
ELECTRICAL Ir
BUILDING ENERGY
FRAMING ` ELECT.FINAL TEST zONwc ENG.SITE NO.,
P INSULATION PLUMBING . .
GAS TEST GAS
MECHANICAL FIRE 5PRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "❑ �' "�
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.Luc.
INTERIOR SHEAR - FIRE DEPT, E] No YL No
YE]
GRADE FEE SUMMARY
EXTERIOR LATH '� BUILDING rJ ,
INTERIOR LATH" `. - TEMPORARY APPROVALS BUILDING
t
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 ISSIGNED BY BUILDING INSPECTOR. MICROFILM
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
ONE.WORKING DAY»BEFORE REQUIRED INSPECTION. PLUMBING –r
z -PLEASE GIVE JOB ADDRESS WHEN PHONING
• /
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
TAX ----
PLEASE READ REVERSE SIDE BEFORE' TOTAL'
`CALLING FOR:FINAL INSPECTION IL LIL,
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
�• BDUDING
T 7PERMITNUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMI
ApOREMMECA , 1761"
Q
0187 Las Ondas. , va BUILDING -ELECTRICAL- -
PLAN CHECK VALIDATION
OWNER'S • IF '
NAME - y08•- 9d% OTY. ELECTRIC PERMIT FEE
SC04. HoCKe s 114PNDNE , yI �3I89
CONTRACTORSUTLETS-SWITCHES-RECEP 10.00/1.00 ,-
NAME
LIGHTING FIXTURES 10.00/1.00 JIB g
CONTRACTOR'S PPLIANCES-RESIDENTIAL .4.00
ADDRESS -_
PHONE PANELS 10.00 OF APPLICATION -
ARCHITECT r PLANDATECHECK.FEE
OR PANELS (OVER 200 AMPI 20.00
ENGINEER ISI LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. S.00 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
zip EMP.METER OR POLE INS. 20.00 -{j�'�
APPuc ANra - - ' C4 MOTORS SEE FEE SCH. J.ANIVNu--i]I
ADDRESS
p�Q�,Q L Ondn,r(1-� -Cu C/1/� SERVICE CHANGE 20.00 �A} QI
w p o LICENSED CONTRACTORS DECLARATION _ 989
a v -I hereby affirm that 1 can -of Chapter 9 ISSUANCE GATE -
N Q LDG a. (commencing with Section 7000)of Division 3 of the Business and BELECT. PLG. MECH.
licensed under provisions
H D z Professions Code,and my license is in full force and effect. ❑ . ' El
z o I/, - License Class Lic'Number ,
o w DateContractor
a x f J - BUILDING PERMIT
rc ¢ w
OWNER-BUILDER DECLARATION INFORMATION
Kett -
u m hereby affirm Thal 1 am exempt from the Contractor's License MISC.- .REFER TO ORD VALUATION SIFT.
u O Q Law Ibr the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 ^� OO� _
- Code:Any city or county which re9uiresa permit to construct,ante" C
Sta 6 Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONT R. LIC.N0. ELEC. -
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
Z
$w he is licensed pursuant to'the provisions of the Contractor's License /t_I 1 A.1;On J We
t/:I e„Rr
ri> Law(Chapter 9(Curonacingwith Section 7000)of Division 3ofthe FEE N('3(� T r(I[11
a Business and Professions Code)or[hal he is exempt In and OTY. PLUMBING PERMIT
r mthe basis for the alleged exemption.Any violation of Sectlon7p31.$ . STORIES TYPE CONSTR.
La ; - by any applicant for a permit subjects the applicant tea civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure Is not
intended 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 F IXTUR ES-PER TRAP S.UD 50.FT.FLOOR AREA TOTAL ACREAGE
i himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6,00
ments are not intended or offered for sale.If,however,the building
or improvement is sold'Within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BU LDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Other
li v for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
p�[q I,as owner of the property,am exclusively contracting with
IifenSad contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. -6.00 ASSESSORS-PARCEL ,
and Professions Code:The Contractor's License Law docs not apply
to an owner of Property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00
contracts for such projects with a contractOAs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO,
the Contractor's License Law.
❑ lam exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
ason
•Owner a '� ' WATER SYSTEM 5.00 qCC.DATE ACC.FILE NO.
WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-Insure, ZONING ENG,SITE NO.
or a certificate of Workers'Compensation Insurance,or a Certified ,
copy thereof(Sec,3800,Lab.CJ. '
Policy No. Company -
Q U Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. Y Q N Q Y ❑ N❑
Applicant
F'• U, PERMIT ISSUANCE 10.00 FLOODZONE A.L.u.C.
= - CERTIFICAMOFE-XEMPTION FROMWORKIi I RS'
LJ - COMPENSATION INSURANCE PLO,CONTfl. LIC.NO. PLG. Y M N Q Y N�
d ❑ (This section need not be completed if the permit is for one TOTAL
:D Z hundred dollars(8100)or IcsS.) FEE SUMMARY'
U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE
F mit is issued.I shall not employ any person in any manner so as to
LL U becom sn bj'ZuEt to the Wnrkersa{i�n Lfs's of California. BUILDING n �+
0 w Dat`- f 7 Applicant �*Pk�-== - -- ALTER OR ADD TO MECH. 5.00
} SO NOTICE TO APPLICANT: If,after making this Certificate of Ex- 5.00 PLAN CHECK
F. emplion,you should become subject to the'Workers'Compensation APPLIANCE
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked.- AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.F,M.) 6.00 SEISMIC FEE �?
I hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 .MICROFILM
the performance of the work for which this permit is issued(Sec. , HEATING UNIT(TO 100,000 B.T.U.) 8.00
3097,CN.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9_.50 ELECTRIC
Lender's Address
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 PLUMBING
information is correct. I agree to comply with all city and county BOILER-00111P(3 H.P.or 100,000 B.T.U.) 6.00
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL �^
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 10:00 CONST.TAX
may in any way accrue against said City in consequence of the . .
anew�of this MECH.CONT. - LIC.NO. MECH..
TOTAL TOTAL n
Signature of Applicant/Contractor Data _ - f•
OFFICE COPY-