17047 POST THIS CARD NEAR,.FRONT OF BUILDING 'S PERMIT NUMBER
CITY OF CUPERTINO 17047
INSPECTION DIVISION �b 7
JOB INSPECTION RECORD Cit'I n� r?mortjRp
PERMIT EXRATION
! 1 ,r�•
JOB ADDRESS A0-'a 1`1721G�__ —UNIT#, _LOT# PERMIT EXPIRES IF WORK '
OWNER - CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE-1 INSPECTOR INSPECTION RECORD 180'DAYS OF PERMIT ISSU--
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:, ' LASTCALLEDINSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY-OF PERMIT VALIDATION
CUPERTINO STANDARDS. +q�
GARAGESLABS C-x,.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
' PLUMBING
ELECTRICAL ISSUANCE DATE:
MECHANICAL BLDG• ELECT I PLG, MECH
IN
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED TER INFORMATION
BUILDING PERMIT
'
WOOD FLOOR
PLUMBING - � -- � �f /
,7 // /' n .
MECHANICAL ' - ��� !� EATION SIFT'.
6VALUow
ELECTRICAL �' PE(R�MITro
FRAMING .rI^'"�„".
STORIES TYPE CONSTR, ,
INSULATION � � '• " --
i •
OCC.GROUP• RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O FT F100O PEA TOTALACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE I
DIAPHRAGM I " THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING 'i ;'e.; RES IND CON PB 'OW11
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS s DATE INSP. '❑ ❑ 11 11
ROUGH" SAN.# \7 � /�9O ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY %'
' -
TUBS&SHOWER PAN,.' 'PLUMBING ENERGY TRACT NO PARCLL NO
MECHANICAL t MECH.ENERGY
ELECTRICAL ' 'BUILDING ENERGY ACC DATE ACC,FILE NO
FRAMING - ELECT.FINAL TEST
ZONING ENG.SITE NO.
'INSULATION PLUMBING_ '
GAS TEST, _ GASB
MECHANICAL FIRE SPRINK ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD?..UNE A UC..' '
EXTERIOR SHEAR' ELECTRICAL RELEASE
INTERIOR SHEARFIRE DEPT. YG NE:l Y ❑ N�
SHEETROCK - GRADE ' FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS eOwc ` /- . SO
SCRATCH COAT ELECTRIC A AN CHECK
GAS AE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN'SIGNEO OCCUPANCY SMIC FEE .
OCCUPAN CY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. CROFILM
ELECTRIC
LU ARRANGE FOR INSPECTION BY'PHONING 252-4505, 7�i+•56
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PwMewc
o�. • PLEASE GIVE JOB ADDRESS WHEN PHONING, 1
r Z MECHANICAL A
SEE PERMIT FOR EXPIRATION DATE—
IMPORTANT!• coNST.TgxSo
PLEASE READ REVERSE SIDE BEFORE TOTAL y
CALLING FOR FINAL INSPECTION. jS2C .
OFFICE COPY "'I
APPLICANT TO FILL IN INFORMATION WITHIN RE
♦D LINES - USE BALL POINT PEN ONLY
BUI LDING PROJECT I DENTIFICATI ON - yy PERMIT NUMBER
aGILDIryG APPLICATION & PERMIT y
aODA eSEt O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 -7047
OwNER's �) q V�i PLAN CHECK VALIDATION
NAME
'j�/S� /' 7 OTV, ELECTRIC PERMIT FEE QQ
NAMERacroRs OUTLETS-SWITCHES-RECEP 10,00/1.00 p�
'
LIC.No. LIGHTING FIXTURES 10.00(1.00
CONTRACTORS
ADDRESS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT ) PLAN CHECK FEE
OR L/,V6 �l y4ff�i• PANELS (OVER 200 AMP( 20.00
ENGINEER - -
LIC.NC IfO/_lt,70 . SIGNS TRANS. 3.00
ARCH.OR ENG. ) PERMIT VALIDATION
ADDRESS - i - J ZD SPECIAL CIRCUIT12A um
(FO EMP.METER OR POLE INS. 20.00 -e-
ZIP
APPLICANTS MOTORS F
aooREss �Y
SERVICE CHANGE 20.00 -
w o o LICENSED CONTRACTORS DECLARATIONAf flonp Abe.
< i)L, I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
m a y (commencing with Section 7000)of Division 3 of the Business andBLDG. ELECT. PLG. MECH.
H o i Professions Cade,and my license is in full force and effect. x
Z 0 2 D License Class Lie.Number /L'C�1,
Date Contractor
a x i d BUILDING PERMIT
•¢ ¢ a OWNER-BUILDER DECLARATION
p d v INFORMATION _
w ;LL I- 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
b VALUATION $/FT.
e. Low Law for the followingrenson:(Sec.703L5,BusinessundProfessions PERMIT ISSUANCE 10.00 .DO
i Code:Any city or county which requires a permit to construct,alter,
/����"
Q ¢ ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEL. .W1 I Ili C�l...`J'
n w m u requires the applicant for such permit m file a signed statement that TOTAL 7 `) PERMIT TO
he is licensed 9(copursuant to the previsions of the Contractor's License +r,.._�,
F z i Law(Cha and
Profession,
Codeng )or Shaine is exempt theref o and SF�1✓IIV)`71
a fhe
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE 1
s�G
¢s_$ the Basis for the alleged exemption.Any violation of Section malty STORIES TYPE CONSTR.
i ; - by any applicant fore permit dollarslhea0plicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred tlollers(5500).):
❑ 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'far sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP -5.00 So.FTC FLOOR AREA T°TALACREAGE
2�
himself or through his own employees,provided that such improve- q
meats are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, -the owner- GAS EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 E] ❑ ❑ 0
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not upply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forsuch projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ l am exempt underSec. ,B.&P.C.lin this WATER HEATER W/VENT 6.00
reason
Owner - Date WATER SYSTEM 5.00
ALC.DATE ACC FILE NO,
WORK ERS'COMPENSATION 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 cerlificJ •
copy thereof(Sec.3900,Late.C.).
Policy Na. Company
(' ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z 2 ❑ Cat d co is filed wjth the city inspection division. MISC.- REFER TO ORD. ❑ � III
O Applicant Y N Y N
~ in I PERMIT ISSUANCE 10.00
C RTIFI TE OP'EXEMPTION F ROMW RKERS' ,LYJ FLOOD ZONE A.L.U.C.
tL LU > COMPENSATION INSURANCE. PLG.coNTR. - LIC.NO. PLG. Y N Y NE]
(This section need not he'completed if the permit is for one TOTAL �1 V
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
y Dale Applicant ALTER OR ADD TO MECH. 5.00 (L15�DING 975-�
>_ N NOTICE TO APPLICANT: If,after making this Certificate of lix-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 LAN CHECK
provisions of the Labor Cdde, you must forthwith comply with
CO such provisions or,this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 E
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOGflM.) 6.00 ISMIC FEE I(3;7Z
(,hereby affirm that (lien is a construction]coding agency for EXHAUST HOOD(WITH DUCT) 5.00 _
the performance of the work for which this permit is issued(Sec, ICROFILM
3097,CN.G)..' HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lcndcr's Address ELECTRIC
1 certify that I have read Ihisapplication andstale thus the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply wish all city and c°ar ly BOILER I3 H.P.Of 100,000 B.T.U.1 6.00 PLUMBING
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, 27.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 • CONST.TAX
may in any way,accruc against said City in consequence of tilt �S.
rami •of this ermit. MECH.CONT. LIC.NO. 'MECH.
FS ��'" /-e14-90 TOTALr19 TOTAL
Slglitalure of Applicant/Contractor Date -
OFFICE COPY