17048i o
-01
POST THIS CARD NEAR FRONT OF BUILDING „
CITY.OF CUPERTINODoT y•.
INSPECTION DIVISION -
JOB INSPECTION RECORD
^7 �
JOB ADDRESS._/QS/ 3 A LC4Li' •UNIT;# LOT#
' -
OWNER CONTRACTOR
PERMIT NUMBER I
17048
PERMIT •EXPIRATION '
1 �`
PERMIT EXPIRES IF, WORK
IS NOT STARTED, WITHIN
180 DAYS OF PERMIT ISS6. '
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
r
INSPECTION DATE INSPECTOR
INSPECTION RECORD'
FOUNDATION..
-
NOTE: JAN, r!:3 ',1 L I
ALL GRADING AND DRAINAGE SHALE BE'INSTALLED
WITH THE APPROVED PLANS AND CITY OF
'CUP ERTINO STANDARDS., CIfiT R,rq^b/tIRB•-���"
UFER -
PRE GUNITE'TO,COMPLY
PERNI T VALIDATION
0 0 FJiwTciLaicc,
.. ISSUANCE DATE. .
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'UNDERGROUND/SLAB
PLUMBING'
.�r'.: •' •,. ,I'
ELECTRICAL '.
MECHANICAL'
_
BLDG- ELEcr
I PLG MEC. .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
1 I,,A, A
F 1V /1
BUILDING PERMIT
INFORMATION
�I
' •', WOOD FLOOR -
VALUATION
1262 L &6� 0i
S/FT.
PLUMBING - '
Wit'
MECHANICAL.,
ELECTRICAL -
DATE
-
�P�ERNIIIITpTO
/� l/Kdd---� .•.�.. i
FRAMING -
-
INSULATION � � •
STORIES
TYPE. CONSTR, ;
-
"
OCC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- ROOF • -
,NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
-
SO FT FL PI11.4
�] 7
TOTALACRI:AGE
.
DIAPHRAGM
ROOF SHEATHING
BLDING USE
RES $NO CON PB DR..•.
❑ ❑ C] ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SAN.M U �
ASSESSORS PARCEL NO
'
PLUMBING -
ELECT.,ENERGY-
TUBS 6SHOWER PAN'•
PLUMBING ENERGY
TRACT NO
PARCEL NO
MECHANICAL • ,
MECH.ENERGY
ELECTRICAL
BUILDING ENERGY
ACC DATE
ACC. FILE NO
FRAMING, 'f• 'I
ELECT.`FINAL TEST
INSULATION .+ ,,
PLUMBING
ZONING
ENG SITE No.
GAS TEST 1,
GAS
-
MECHANICAL
FIRE SPRINK
Y0 01
ENERGY r 24
El N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED.
HEATING-:
EXTERIOR,SHEAR i"r' -
ELECTRICAL RELEASE .,
FLOOD ZONE
F No
A LU.C,v
"'v L N❑
INTERIOR SHEAR' -
FIRE DEPT. -
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR, LATH
BUILDING -
a iCoING
6 ; .,
INTERIOR CATH_ • -
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC', -
LAN CHECK'
EE
-
GAS.1
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY I+
1
EISMIC FEE
MAN
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE -'
MICROFILM
ELECTRIC
LAMBING
;
MECHANICAL
11,
CONST. TAX
^ _ ,
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI N
APPLICATION & PERMIT
BUILDING—ELECTRICAL-PLUMBING—MECHANICAL
.PERMIT NUMBER
17048
BUILDING h�'
AooRF^�37 t 1 1�II� A_ll�
�-`��� �1V
OWNER'SV ]
HOME !J�/ !
' tg� Zi7 -�
PTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIOATI ON
�y ,^�^ 4
c'[b W "I
stip
CONTRACTORS
NamE -
OUTLETS-SWITCHES-,RECEP 10,00/1.00
LIG HT.ING FIX TUR ES 10.00/1.00'
1IC.Nb,
CONTRA
ADDREScroRs
PPLIANCES- RESIDENTIAL 4.00
PANELS 1
_ PHONE
DATE OF APPLICATION
ARCHITECT
OR
ENGINEER
' u�c�.NOLSO j,� O
PANELS (OVER 200 AMP)
PLAN CHECK FEE P,C. NO.
..
'
SIGNS TRANS. .0 '
�/�
ADDRESS x,AN
ARCH. OR ENG. r—f/�Si er,(. llvc S/( --,,j'
9' /�
�jV(� l(/%/-J-1rc-0 644,1 TIP
SPECIAL CIRCUIT 8.00
PERMIT VALIDATION
y
�'CG
EMP. METER OR POLE INS.%0,4,ran
APPLICANTS _
ADORES
MOTORS $FEEISCH: `'-
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
e3
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3.nf the Bigness end
Professions Code, and my license is in full force and effect.
License Class Lic. Number -
ISSUANCE DATE
BLDG. ELECT. I PLG. MECH.
Date - Contractor
BUILDING PERMIT
INFORMATION
OWNER -BUILDER DE
I hereby affirm that I am exempt from tie Contractor's License
Law for the following reason. (Sec. 7031.5, Business and Professions
Code: Any city orcounty which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permil to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
MISC. — ., REFER TO ORD
PERMIT ISSUANCE10.00 Grp
VALUATION
��� L
$/FT.
ELEC. CONTR. LIC. NO. ELEC. �/
TOTAL 6
OTY. PLUMBING PERMIT FEE
PERMIT TO
5
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant IDB civil penally
of not more than five hundred dollars (8500).):
ALTER -DRAIN -WATER (EA.) 5.00
BACK FLOW PROTECT. DEVICE 4.00
❑ 1, as owner of the properly, or my employees with wages as
their sole compensation, will do the work, and the Structure is not
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA, COND. 5.00
_
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
FIXTURES - PER TRAP 5.00
SO. FT, FLOOR 6REA
�-7
TOTALACREAGE
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
ments are not intended or offered for sale. If, however, the building
GAS - EA. SYSTEM -1 INC. 4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have (h e burden of proving that he did not build or im-
prove for purpose of sale.).
121, as owner of tho property, ma exclusively contracting with
GAS EASYSTEM OVER 4 IEA) 200
- . -..
BIM DING USE
RES ]NO CON FB Omer
❑ ❑, El ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
-
licensed contractors to construct the project (Sec. 7044, Business
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 -I INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 IEA.) 1.00
ASSESSORS PARCEL NO.
contracts forsuch projects with a contractods) licensed Pursuant to
the Contractors License Law.
SEWER -SANITARY -STORM EA. 200ft/10,00
TRACT NO.
PARCEL NO.
❑ lumexemptunder See. ,B.&RC. for this
reason
WATER HEATER W/VENT 6.00
Owner Dutra
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORK ERS'COMPENSATION DECLARATION
1 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 fliumbf(Sec. 3800, Lab.C.).
Policy No. Company
❑ Certified copy is hereby furnished.
c y
❑ Certifiaae�ss is_1'mled Corti the city inspection division.
Applicant J! - 1 /• - - / - t
FIRE SPRINK
Y N�
ENERGY T-24
Y ❑ NO
MISC. - REFER TO ORD.
CERTIFICATE OF EXEMPTION 17ROM WORKERS' V
PERMIT ISSUANCE 10.00 1,oD
FLOOD ZONE
A.L.U.C.
- COMPENSATION INSURANCE
IT section need not be completed If the permit is for one
PLG. CONTR. LIC. NO.
PLG.
TOTAL 76E3.S�
Y ❑ .. ,N❑
YY� N[
hundred dollars (S 100) or less.)
I certify that in the performance of the work for which this per.
mit is issued, I shall not employ any person in any manner so as to
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
UI LDI NG
�7�0
become subject to the Workers' Compensation Laws of California.[]
Date r Applicant
ALTER OR ADD TO MECH. 5,00
NOTICE TO APPLICANT: If, after making this Certificate of Ex
_
emotion, you Should become subject to the Workers 'Compensation
Provisionsof the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
APPLIANCE' 5.00 -
AIR HANDLING UNIT (TO 10AWC.F.M.) 4.
PLAN CHECK
EE
AIR HANDLING UNIT (OVER IO,000QEM.)6.00
EISMIC FEE
coNs1'RUCf10N LENDING AGENCY
( 1 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.
3097, Civ.C.).
HEATING UNIT (TO 100,000 B.T.U.) 8.00
MICROFILM
Lender's Name
Lender's Address
Address
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
1 certify that 1 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
ordinances and state laws'relaring to holding construction, and
above- authorize ed representatives ec this city to enter upon the
above -mentioned property for inspection purposes.
PLUMB ING
6.35
" BOILER -COMP (3 H.P. or 100,000 B.T.U.) 6,60hereby
BOI LER-COMP (Over 100,000 BTU) SEE FEE BCH.
MECHANICAL
i
76.35 -
MISC. - REFER TO ORD.
(We) agree to save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
may m any way accrue against said City in Consequence of the
pERM1T ISSUANCE 10.00 O d
CONST. TAX
.
rant' o�his perml't.
V
MECH: CONT. LIC. NO, IMECIT
e
TOTAL
TOTAL 76.�
-
TOTAL
,i atureof�pplmant/Contractor Data
OFFICE COPY