17284 f POST THIS CARD NEAR FRONT'OF•BU'ILDING,, aFAm;T NUMBER
CITY :°0F `CUPERTINO 17284.
INSPECTION DIVISION
JOB INSPECTION RECORD ;, ,LI;
(PERMIT EXPIRATION_,
JOB_AD DRESS tl D / � �j'rF� GT ,UN IT4* LOT# 7
11��( I PERMIT EXPIRES IF WORK,14
OWNER ' 1177 VY*Q C u4ik�CONTRACroR - gP�Va � 2� IS NOT STARTED WITHIN.
IN PECTION DATE INSPECTOR INSPECTION RECORD .180 DAYS OF PERMIT,ISSU
'FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
., LASTCALLED INSPECTION.
`
LIFERZ ALL'GRADING'AND DRAINAGE SHALL,BE INSTALLED .
PREGUNITE.:, TO COMPLY WITH THE APPROVED PLANS AND CITY OF -PERMIT VALIDATION
- PERTINO STANDARDS. - n
GARAGE SLABS • - CU -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLABMAR
,
PLUMBING'
ELECTRICAL + -1 -
city of cup"No ISSUANCE DATF•-
MECHANICAL x . ^ - ,Loc. ELECT .PLc. MECH.
, lNE!�OoEPscv�VG>?)ic�:ck
lana ls4nr e�w1v •.
00 NOT POUR FLOOR UNTIL'ABOVE HAS BEEN SIGNED w ,MS. NS�L+ttlt6e'4�_¢4 i llL BUILDING INFORMATION
PERMIT
WOODFLOOR
VALUATION $+F T.
PLUMBING. � r.Qj. - _ . .
MECHANICAL;
- - ELECTRICAL .• PERMIT To
FRAMING
INSULATION - sroRIES TYPE CONSTR. .
,. 1•A - - _ OCC.GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTILABOVEMAS BEEN SIGNED
ROOF NOTE:NO FINAL(NSP
" - .- SHALL BE MADE BEFORE SO FT,FLOOR AREA TOTAL ACREAGE
' DIAPHRAGM - _ : THE CONSTRUCTION TAX IS PAID ' d} .
.
R, BUILDINGUSE
ROOF.SHEATHING _0 `l�'�' ARES IND .CONPR oma,
" APPLY NO.ROOFING UNTIL"ABOVE HAS BEEN SIGNED FINALS DATE - (NSP:,' El El El ❑^° ❑
ROUGH SAN.# ASSESSORS PARCEL NO
R ' '
PLUMBING .ELECT.ENERGY -
TUBS BSHOWER PAN TRACT NOt PARCEL NO..
.;-, PLUMBING ENERGY '�-
MECHANICAL - MECH.ENERGY
- 'ELECTRICAL . ACC.DATE Ace FILE NO.
°q'�• •. • BUILDING ENERGY
• FRAMING`:•°" JIII I ELECT:FINAL TEST , S-b'f. -
- INSULATION �,�' , PLUMBING zoNlNc ENc.sITE_No.
GAS TEST - ` GAS
<.., i ..
' MECHANICAL - FIRE SPaINrc ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING'" Y ❑ "❑ ❑ "❑'
.
• '" EXTERIOR SHEAR '. - ELECTRICAL RELEASE - FLOOD ZONE AE,U.C.-
INTERIOR SHEAR FIRE DEPT. Y ❑ N Y ❑ .N❑
•. SHEETROCK s ` — GRADE . FEE SUMMARY
EXTERIOR LATH -• '+ BUILDING
INTERIOR LATH - - TEMPORARY APPROVALS BUILDING.
SCRATCH COAT ELECTRIC PLAN CHECK
- GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OccUPANCv• SEisMIc,FEE I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL'BUIL'DING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR' INSPECTION BY:PHONING 252-4505, •', ELECTRICS, 0
w. (�
U" ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING Z PLEASE GIVE'JOB•'ADDRESS WHEN PHONING.,
--SEE PERMIT FOR EXPIRATION D -
,RATION ATE' M9cHANI'cAL )
- CONST.TAX
IMPORTANT!
` PLEASE READ REVERSE-SIDE BEFORE.
CALLING FOR FINAL INSPECTION TOTAL �y
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
S PERMIT NUMBER
IDIU.B�I�DING PROJECT IDENTIFICATION APPLICATION.& PERMIT ,
ADDRESS
G - . 1-7,284
apoREss- -
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL .�
NAMER$ &In "7�p/� PLAN CHECK VALIDA710N'
as . OJ QTY. ELECTRIC PERMIT 'FEE .q1 "I
cTDR's
NAME �Qj UTLETS-SWITCHES-RECEP 10.00/1.00
NAME q
L.C.No. 3 9 LIGHTING FIXTURES 10.00/1.00
TOR'S
ADDRESS, IR13 APPLIANCES-RESIDENTIAL 4.00 ..
�e 1 �rO 1 PANELS - 10.00 /.C. DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP( 20.06 - PLAN CHECK FEE C.N0.
GINE
c.N SIGNS TRANS. 3.00
ARCH OR ADDRESS ENG. SPECIAL CIRCUIT 5.66 PERMIT VALIDATION
V TEMP.METER OR POLE*INS. 20.00 �K T
APPLICANT'S U
ADDRESS M SEE FEE
SERVICE CHANGE 20.00 D� u,
w o O LICENSED CONTRACTORS DECLARATION
a i W I hereby affirm Thal 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with ection 7000)of Division 3 of the Business and
rn a ng 1J BLDG. ELECT: PLG. MECH,
H m i Professions Code, my license is in full fo MAR 0 V ❑ �..
O i w I] Licen" .lass hie.Numb
Date Contractor _
re r re BUILDING PERMIT
re a OWNER-BUILDER DECLARATION _
A ¢w" MISC.- REFER TO ORD. INFORMATION '
w a y I hereby affirm that I am exempt from the ComructorN License VALUATION $/FT.
F �.04 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 � �
Cade:Any city.,,.only which reyuiresa permit to cansmmq alter,
0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. 'LIC.NO. ELEC. --
O u requires the applicant for such permit to file a signed statement that - TOTAL W PERMIT TO
n K m he is licensed pursuant to the provisions of the Contractor's License
r z T
Law(Chapter 9(commencingwith Section 7000)of Division 3 oflhe
z o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ADD
m H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any aPplicam for a permit subjects the applicant toll civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE '4.00 DLL.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for.salc (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who build,m,hR, oc,(hereon,alld who does$ach work FIXTURES-PER TRAP . 5,00 SQ.Fr.F,LDDR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
•.,,
mems are not intended or offered for,ele,l G however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 ��
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2,00 BUILDING USE
builder will have the burden of proving that he did not build or lm-- - IND CON PB Omer
Prove for purpose of Sale.). INDUSTRIAL WASTEINTER. 30.00 _ RES ES
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN'SPRINKLERS-I INC 5 V.B. 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 SPRINKLERS-OVER 5(EA.) 1,00 2/_2� O/x 020Licen
the Contractor's se L
contracts for such License
Law.
projects will, contracmr(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. GV PARCEL NO.
0 Iamoxemplunder Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKF,RS'COMPENSATION D17CLARATION WATER TREATING EQUIP. 5.00 ,
I hereby affirm that 1 have a certificate a(comsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec 3800,LaRC.)y.�Q
Policy No. Company 1-..�-
rp-
O ❑ Certified copy is hereby(umisl a FIRE$PRINK ENERGY T 24
Z ZCertifi c y is filed t the -'ty.ipspection division.
F O Apt icanitxtk\ I MISC.- REFER TO ORD. YE] N Y � N�
= W CERT1171CATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. v ry V Q N�
CL Z (This Section need not be completed if the permit is for one TOTAL
hundred dollars IS 100)or less,)
00 I certify that in the perlbrmance of the work for which this per- FEE SUMMARY
U. I- mit is issued,1 shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE
O w become subject to the Workers'Compensation Laws of California.
d. Date ' Applicant _ j ALTER OR ADD TO MECH. 5.00 Q, OU BUILDING 252r�
} m. NOTICE TO APPLICANT: If,after making this Certificate of EL
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -�
provisions of the Labor Code, you most forthwith comply with FEE
f.)
s, such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r-F.M.) 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.EM.) 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(Sec. MICROFILM
3097,Civ.C.). M/ HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50Jr,nder's Address ELECTRIC �>•1
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 qS-O
information is correct.I agree to comply with all city and county PLUMBING
-� ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P,or 100,000 B.T.U.), 6.00
hereby authorize property forivesins inspection
This.city to enter upon the BOILER-COMP (Over 100,000BTUISEE FEESCH. 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 PERMITISSUANCE 10.00 r p CONST.TAX
may in any.way accrue a•ainst said City in consequence of[he Z P
mating . This permit. MECH.CONT. LIC,NO. MECH.
TOTAL' ' 1 TOTAL
5 tore o Applican/Contrac o D Date _
OFFICE COPY