17225POST THIS CARD NEAR FRONT OF BUILDING
,
��^ . CITY OF CUPERTINO .
PERMIT NUMBER
17225
INSPECTION DIVISION
JOB INSPECTION RECORD
(f��
PERMIT EfXPIRATI N
V�
JOB ADDRESS �i '[ N 1 �C1.Y.e _UNIT# LOT#
.E RMIT EXPIRES IF WORK
bwNER ,l� CONTRACTOR01�
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU- .
180 DAYS FROM
LAST CALLED INSPECTION.
NSP CTION DATE INSPECTOR
INSPECTION RE ORD
FOUNDATION
-ANCEOR
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
LIFER - - -
'PR EGUNITE -
PERMIT VALIDATION
C,UPERTINO,STANDARDS.
GARAGE SLABS
POUR NO CONCRETE BEEN SIGNED
UNTIL ABOVE HAS
5'ro7L � % o Ta
um, ,
'UNDERGROUND /SLAB -rz,,
PLUMBING
MAR
ELECTRICAL -
ISSUANCE DATE
MECHANICAL
-
city of cuuertino9
BLDG ELIOT
I PLG. MECH
9'o
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDO'
O (J , L C
BUILDING PERMIT
INFORMATION
' WOOD FLOOR
VALUATION $/FT.
.PLUMBING
'
MECHANICAL
ELECTRICAL
PERMIT TOy�/9��O
Tw( I • ^/
. FRAMING
INSULATION ..
STORIES
TYPE CONSTH,
DEC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOFNOTE:
NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID -
so Fr rLomr aREa
- roraL ncREAGE
DIAPHRAGM
ROOF SHEATHING
BUILDING USE
HES IND CON PB. 00—
❑ ❑ ❑ ` ❑ ❑ '
APPLY.NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
' ROUGH
SAN.#
ASSESSORS PARCEL NO.
PLUMBING
ELECT. ENERGY
TUBS 6 SHOWER PAN
PLUMBING ENERGY
TRACT NO
PARCEL NO
MECHANICAL -
MECH.ENERGY-
ELECTRICAL c
BUILDING ENERGY. '
ACC DATE
. I
ACCFLE NO
FRAMING - -
ELECT. FINAL TEST /.217-
INSULATION �
PLUMBING
ZONING -
ENG sITE Nb.`
'
TEST
GAS
GAS
+"
MECHANICAL`
FIRE SPRINK
Y'❑ N❑
.'ENERGY T. 20
E] N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
PLooD ZONE
Y ❑ No
A.L U.C.
Y ❑ N❑
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK -
GRADE
FEE SUMMARY
EXTERIOR LATH -
BUILDING
BUILDING �,uG
INTERIOR LATH
TEMPORARY APPROVAL
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
' . ',.
GAS
NO TAPE OR PLASTER UNTIL•ABOVE AEEN;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
ILL
ONE'WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
0 PLEASE GIVE JOB ADDRESSWHEN'PHONING. '�
'
— SEE PERMIT FOR EXPIRATION DATE — '
MECHANICAL ,...�
CONST. TAX . ;
IMPORTANT!
TOTAL ��.
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
I APPLICATION & PERMIT
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
PERMIT NUMBER
ry'
�: 17225
ADl RG
ADDRESS nZIHZ.O nfic LAa0 L,ENV
OWNER'S
rv.vEtXQyM(ZS C, Coex-104gse" 7Zp-a
' PNON OQ;
ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
'
1 q D�
1
DATE OF APPLICATIONARCnrtECi
CONTRACTOR'S
NAME
�.1F6•`I'ME �.�a-i''I.C.No. Pa03IGHTING
UTLETS-SWITCHES-RECEP 10.00/1.00
erADDRESS
FIXTURES 10.00/1.00
IANELS
�Rs44,_0 Ac.TO ciLt tea' C415)PPLIANCES-RESIDENTIAL
pJF{NQ D PHONE7bA�
4.60
ANELS 10.0012.
-
GR
ENGINEER ftUC'7(7ST's WqG 6>Gb1q NN
• ,LIC.NO, 6ga•s
(OVER 200 AMP) 20'.00
PLAN CHECK FEE P.C. IN
- .-.
SIGNSTRANS. - 3.00 '
ARCH. OR ENG.
ADDRESS Q , 0 . z o
q/O 5AN AHtTUN10- Y43re3
zip
SPECIAL CIRCUIT . 5.00
. PERMIT VALIDATION
J r�
a'
µq
J de, l 1 VLTO �v�L
EMP. METER OR POLE INS. 20.00
ADDRESS = '"'
110 ' 5aN /qI1V0t4f81" Az'(O
MOTORS'ZaT',-(6I,. a FEESCH. , eO
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
-
-
1
1 hereby al'I'irm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions COdI', rd fpiy license Is m fall force and effect.
License Class ['-73 Lic.Number '�20'L82-
ISSUANCE DATE
-
'
BLDG.
ELECT.
PLG. MECH.
- ❑
Dale V/ 169_CommeItor L1l`GTIA4° IODeLC
' OWNER -BUILDER DECLARATION'
I hereby affirm that I so exempt from the Contractors License
Law for the ity or 001mlmohichn. e.uincta permBusiness t Incand Professions
imprCodeoAny cityorcourepair my requirese permit ttsconstructalter,
improve, demolish, Or repair any structure, Prior m its issuance, that
requires the applicant for such permit to file a signed statement That
he is licensed pursuant to Ilse provisions of the Contractor's License
Law (Chapter 9(commencing with Section 7000) ofDivision 3 ofthe
Business and Professions Code) or that he is exempt therefrom and
cityat &W40(BUILLDD
.-
ING PERMIT
INFORMATION
MISC. - REFER TO ORD
VALUATION
r(0
D O '
S/FT.
-
PERMIT ISSUANCE - 10.00
ELEC. CONTR. LIC. N0.
ELEC. �- Op
IOTA: j_ L
PERMIT TO
p'•! /
N W tW `.I If V19.Q(
T •1
OTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penally
of not more than five hundred dollars (8500).):
ALTER -DRAIN -WATER IEA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00 OL, QO
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA, COND. 5,00
intendedor offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's 1-icense Law does not apply to an owner of
property who builds or improves thereon, and who does Such work
himself or through his own employees, provided that such improve.
mems are not intended or offered for sale. If, however, the building
F IXTUR ES - PER TRAP 5.00
50. FT. FLOOR AREA
TOTALACREAGE
I GAS - EA. SYSTEM -1INC. 4 OUTLETS 6.00 4V O
Or improvement is sold'within one year of completion, the owner-
builder will have the burden of proving that he dill not build or int
prove for purpose of sale.).
❑ I, as owner of the property, am exclusively contracting with
- . •..
GAS EASYSTEM OVER 4 IEA) 200
BUILDING USE
RES IND CON PB Omer
❑ ❑ -❑ ' ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
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 - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO,
'
contracts far such projects will, t confusions) licensed pursuant to
the Contractor's License Law. -
SEWER -SANITARY -STORM EA, 200ft/10.00
TRACT NO,
PARCEL NO.
❑ lam exempt under Sec. ,H.&P.C. for this
reason -
'
I WATER HEATER W/VENT 6.00 AolD
Owner Date-
WATER SYSTEM 5.00
ACC.DATE
ACC -FILE NO,
WORK ERS'COMPENSATION DECLARATION
WATER TREATING EQUIP. - 5,00 , B
'
I hereby affirm that I have a certificate of consent to self -insure,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copy themof(Sec. 3800, Lab.C.).
Policy No. Company
❑ Certified copy is hereby furnished.
Applicant- Certified copy is filed with the city inspection division.
FIRE SPRINK
yN
❑ ❑
ENERGY T-24
v ❑ N ❑
MISC.'- REFER TO ORD.
CERTIFICATE OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00 A( 400
FLOOD ZONE
` A.LU.C.
PLG. CONTR, LIC. NO.
PLG. I'
TOTAL�O.V I'
COMPENSATION INSURANCL
(This section need not be completed if the permit is for one
'
Y ❑ N❑
Y ❑ N❑
hundred dollars IS 100) or less.)
1 certify that in the performance ol'the work for which this per-
mit is issued, 1 shall not employ any person in any niannerso'as to
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
11 O
BUILDING t
become subje 9 to the Workers' Compensation Laws of California.
Date?/e jR7 Applicant /-(rTTr Mss
NOTICE' TO APPLICANT: It after making this Cer ificalc of Iis-
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10AMC.F.M.) 4.00
PLAN CHECK
FEE
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNITIOVER 10,000C.F.M.) 6,00
SEISMIC FEE
CONSTRUCT ION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 5.00
HEATING UNIT (TO 100,000 B.T.U.) .8.00
- I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM
HEATING UNIT 100,000 B.T.U.)9.50
ELECTRIC 3VO
Lender's Nome
Lender's Address
I certify that I have read this application and stale that the above
information is correct. I agree to comply with all city and county
ordinances 'mW state laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING O• (1 D
BOILER-COMP13 H,P:Of IOO,000 B.T:U.)' 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH..
MECHANICAL
authorize representatives Forgives of this city e, enter upon the
herby authorize
above-mentioned propertytarvesp of the purposes.
MISC. - REFER TO ORD.
(We) agree to Save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue„ against said City in consequence of file
t nisi tabes permit.
S
CONST. TAX
PERMIT ISSUANCE 10.00
MECH,CONT. - LIC. NO.
MECH. ,
rorAL
TOTAL 14
' nature of A Time
OFFICE -COPY