18689 POST THIS CARD NEAR FRONT.OF BUILDING PEaMir,,NUMeEa
_..
.CITY 'OF- CUPERTINOu
186
INSPECTION DIVISION
`
JOB INSP,ECTIM RECORD' - SEP,2' 989 '
/O l,L s—'7 ./; C �v�/` I .city �damerfino PERMIT EXPIRATION
JOB ADDRESS F /. LVIi"7J. �'t/�'�C`1�NIT# `7 LOT#
:PERMIT EXPIRES I�,WORK
OWNER' - CONTRACTOR' ��, + vn 7 V1r , 1S NOT STARTED_WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD leo DAYS,OF PERMIT ISSLI-,
FOUNDATION - - ANCE OR 1.80,DAYS FROM
'NOTE: LAST CALLED INSPECTION. .
UFER ALL GRADING'AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH-THE APPROVED PLANS AND CITY OF . .PERMIT VALIDATION
' ' ' CUPERTINO STANDARDS: .'
GARAGE-SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ^�• "� f' �'�"'I
UNDERGROUND /SLAB ,
PLUMBING '
ELECTRICAL - - ISSOANCIE DATE
M
MECHANICAL - I :BLDc� ELECT. PLG. Ec
0 O1. ❑ `1 (31
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLODR vaLuaTIO N siFT.
PLUMBING - '
MECHANICAL
- PEHMIT TO r
I 'ELECTRICAL -
FRAMING'.. �e'214+1 c 1,3
STORIES TYPE CONSTR.
INSULATION . . . . - - .."
I'
OCC.GROUP, - RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT FLOOR AREA ,TOTAL ACREAGE
L ! - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM ; THE CONSTRUCTION'TAX IS PAID
Y_ BUILDING USE .1
ROOF SHEATHING - Res IND CON' -Pe o r,
-APPLY NO ROOFING UNTIL ABOVE-HAS BEEN SIGNED:• FINALS - : DATE INSP.
1❑ ❑'. ❑ ❑` ❑
. ASSESSORS PARCEL NO.
ROUGH SAN.#
PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN'• - PLUMBING ENERGY
MECHANICAL. MECH:ENERGY .
ACC DATE ACC.FILE NO.
.' ELECTRICAL � � _ � BUILDING ENERGY
FRAMING ELECT.FINAL TEST.,
INSULATIOW PLUMBING zoN;NG ENc.SITE No.
GAS TEST - GAS
MECHANICAL PwESPRINrc ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y❑ "❑ ° El "❑
ELECTRICAL RELEASE FLOOD¢OE. A UC.
EXTERIOR SHEAR '- - - - I '
. INTERIOR SHEAR " - 'FIRE DEPT. Y❑ q N❑ y N❑
4 .. SHEETROCK , GRADE • FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH ' TEMPORARY APPROVALS . , BUILDING
- SCRATCH COAT ELECTRIC _ ,PLAN CHECK
.. .
GAS .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN.SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR:;lMICROFILM'
...a`
ARRANGE FOR INSPECTION BY PHONING 252-4505, _ ELECTRIC,
w- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING' '
z PLEASE GIVE JOB-ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL_ {�- -
CONST.TAX �--'
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL.• r1''
CALLING FOR FINAL INSPECTION.''-
OFFICE COPY / 5A ro
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
QUI L:JIING PROJECT IDENTIFICATION PERMIT,NUMBER
APPLICATION & PERMIT ` I�x
A ..BUILDING 1l,COn
AOORE55 �j,S/v 0 Vry
_ af ae, - BUILDING-ELECTRICAL-PLUMBING-MECHANICAL t
OWNE 'S -
NAME PLAN CHECK VALIDATION
1 f E.rJPHONE,� 4 OTY. ELECTRIC PERMIT FEE
F dit'
CONTRACTORS
N ^ /�j�{ UTLETS-SWITCHES-RECEP 10.00/1.00
1J0DrU 11_0 ZLIc.NO. Ael&� LIGHTING FIXTURES 10,00/1.00
CONTRACTOR i 's PPLIANCES-RESIDENTIAL 4.00
iX /rpl�/r r�V PHONE PANELS 10.00 DATE OF APPLICATION I
ARCHITECT ,,E PLAN CHECK FEE - P.C.NO.
OR �y PANELS (OVER 200 AMP) 20.00
ENGINEER /7
_1C.NO - SIGNS TRANS. 3.00
AErvG. - PERMIT VALIDATION
i
ADDRESS SPECIAL CIRCUIT 5.00
. ZIP EMP.METER OR POLE INS. 20.00
ADDAESs Ts MOTORS SEE FEE SCH. A✓
SERVICE CHANGE - 20.00 --
O¢z ^
.02 LICENSED CONTRACTORS DECLARATION -.
rt u U I hereby of firm that I am licensed under provisions Of Chapter 9 ISSUANCE DATE
a i (commencing with Suction 7000)of Division 3 of the Business and -
o BLDG. ELECT. PLG. MCH.
r N i Professions Code,and my license is in full force and effect. p ❑ 1-1
❑O i m Licenm ass _ Lic.Number
2 m; J Dalu Contractor
a a w a OWNER-BUILDER DECLARATION BUILDING PERMIT
°p ° MISC.- REFER TO ORD INFORMATION
K
g a. N I hereby affirm that I am exempt from the Contractor's License
reason.(Sec.7031.5,Business and Professions VALUATION
F u O¢ Law for the following PERMIT I $/FT.
Code Any city or county which requiresa permit toconstruct,alter, 10.00
am� $LEC.CUNTH. L
2 ¢p improve,demolish,or repair any structure,prior to its issuance,also FLEL.
n E Oo¢ requires the applicant for such permit to file a signed statement that TOTAL + PERMIT TO L
m he Is licensed pursuant to the provisions of the Contractor's License
r z a
Law(Chapter 9(commencing with Section 7000)o f Division 3 oft he / es'
- INI-lt��
E i O Busin ^/�/fLGL
ess and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ,
¢ I- the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
aim by any applicant fnf a permit subjects the applicant toll civil penalty ALTER-DRAIN -WATER IEA.) 5.00 '
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 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,CONO. 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 FIXTURES-PER TRAP •5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
mentsarenotintendedorofferedforsale.If,however,lire holding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner -
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose ofmle.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
- ❑ 1,as owner o1'the property,ran exclusively Contracting with O
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS=1 INC 5 V.B. 800 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 SPRINKLERS-OVER 5(EA.) 1.00 '
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. - TRACT NO, PARCEL NO.
❑ lam exempt under See. ,B.&P.C.for this WATER HEATER W/VENT 6.00 -
re,som
Owner - Date WATER SYSTEM 5.00 ACL.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATERTREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to selfinsure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.-3800,Lab.C.). -
Policy No. Company -
O O Certlfle y is herehy furnished. R FIRE SPRINK ENERGY T2A
Z Z ❑ Cer" ed=ly is Ne p, the city ns ectian division.
MISC.- 'REFER TO ORD.
Q Apphcan _ Y [) NF] y [:] NE]
~ rn PERMIT ISSUANCE - 10.00
� CHR'1l FICCOMOESATIOTINS FROM WORKERS' FL00020NE A.LU.L.
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL CI (This section need not be completed if the permit is for one TOTAL - Y N� V NC3
hundred dollars(5100)or less.)
V O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL l- mit is issued.I shall not employ any person in any manner so as to
O Wbecome subject to the Workers;Compensation Laws of California.
y Dae APPlicantALTER OR ADD TO MECH. 5.00 BUILDING r�
>_ to NOTICE TO APPLICANT: If,after making this Certificate of Ex. -
f- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK _
provisions of the Labor Code, you must lorlhwith comply with 'FEE '
U 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
the performance of the work for which this permit is issued(See. MICROFILM
3097,Civ C.). EATING UNIT(TO 100,000 B.T.U.). 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9
Lender's Address - ELECTRIC
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 IO building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives Of this city to,enter upon the BOILER-COMP IOver,l00,IX1D BTUI SEE FEE SCE. MECHANIC Al_
above-mentioned property for inspection Purposes.
(We) agree to save, indemnify and kes}s harmlese the City of MISC. M I R TO ORD.
against IiabilitICS,'judgments, costs and expenses which - PERMIT ISSUANCE 0 CONST.TAX
ay y way accrue a 'nst suit City in consequence oGthe
ran" 4his permit. MECH.CONT. LIC.NO.
Signature of Appicant/Contractor Date
OFFICE COPY