18920POST THIS CARD NEAR FRONT OF BUILDIN
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD ^'/ W ' •' '
67
ADDRESS �e_
OWNER - ��u'/V. •'CONTaAcroa' �¢7C�f-S/v �,i
PERMIT NUMBER
18920
-
PERMIT EXPIRATION
.' IJOB
PERMIT EXPIRES IF WORK
IS* NOT STARTED WITHIN
180 DAYS OF PERMIT liSU. '
'-rANCE OR .180 DAYS FROM
'LAST.CALLED INSPECTION. .
INSPECTION DATE INSPECTOR
-_ INSPECTION RECORD_ 7
_FOUNDATION -
'• �
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED'-
TO,COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.,
,... 'i .( .'��
,&—
LIFER
PREGUNITE . -- , ,
PERNn vAl-IRA TION,
M. YA f ' r'
a.
ISSUANCE DATE '
GARAGE SLABS.- •;. -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
eq;!-ISsL:�C(C(
` UNDERGROUND/SLAB
PLUMBING
QI (�(/ q n
ELECTRICAL - .+-
MECHANICAL
- '' v v wuj
•^`
.BLDG.
..ECT
c. PLO. MBCH.
0
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED""'
I, " fflflQ
..'i
BUILDING PERMIT
INFORMATION
' WOOD FLOOR
va'y ION
"T� A
'� y
n.TD
SIFT.
PLUMBING � � �
� � '
MECHANICAL -
ELECTRICAL'-
FRAMING^.
INSULATION - - -
-
STORIES
rwecomsTR.
`
OCC. GROUP
HES:UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF'
NOTE: NO FINAL-INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
- .'' "- ''
so 4T; FLOOR AREA
roIAL aclancE
DIAPHRAGM -
BUILDING USE
RES IND , CON. PB 00—.
ED ' ❑ 0'_ _ 0'
ICF.
ROOF SHEATHING
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS - DATE' INSP.
- ASSESSORS PAH, 1. NO
1 1•
' ROUGH -
SAN.#. - .1
PLUMBING,
ELECT. ENERGY
TRACT NO,
PARCEL NO,
--
.TUBS &SHOWER PAN
PLUMBING ENERGY '
MECHANICAL
MECH.ENERGY.
-
ELECTRICAL '- � � �
_
BUILDING ENERGY
'ACC'DA TE
- ACC FILE NO:
FRAMING - -
ELECT. FINAL TEST -
zoNlNc
ENC. sI ;E No.
INSULATION - -
PLUMBING
GAS TEST _ _
GAS LO --
.FIRE SPHINK
v �', N�
ENERGY L)G
'• "o Nom'
" I
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING - •
FLOOD 'ZONE-
,.1
A1,U,C.
.1 -
L N❑-
EXTERIOR SHEAR
ELECTRICAL RELEASE - '
INTERIOR SHEAR ,
FIRE DEPT. " -.y „
SHEETROCK' -
GRADE'
FEE SUMMARY
EXTERIOR LATH' -..
BUILDING
BUILDING
90:
-INTERIOR. LATH - ••
TEMPO RARY+APPROV S-,
SCRATCH COAT
ELECTRIC.
PLAN CHECK
FEE
GAS
'SEISMIC FEE
V'0
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING IN R.
'MICROFILM
' -.\ '_
ARRANGE FOR INSPECTION-BY PHONING+252-4505,
F'. ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z —SEE PERMIT FOR EXPIRATION' DATE'—
•ELECTRIC'•; ,.
-"'_",.:...-"'
PLuMBINc
w -
MECHANICAL
CONST.'TAX, .
IMPORTANT! -
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINALINSPECTION.
TOTAL
��
1 - OFFICE COPY. ' „ .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
I.
APPL'ICATION"& PERMIT
UILDING- ELECTRICAL- PLUMBING'- MECHANICAL
PERMITNUMBER ..
,.. 18.920.
BUILDING/
Ao"Riss /fP0
OWNER'S
NAME •. /�� .1 RR//--
•' PA O &.im VHONE \a(s- PYc
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
_
.�s
o y 17:
I (/ ,v
DATE OF APPLICATION
CONTRACTORS -
NAME
2A1•S •Lic.N
- UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'
,0. 2 PHOrvE l�rp�`OF�
PPLIANCES-RESIDENTIAL 4.00
PANIO.00
RctlfracT -
O
OR '/
ENOIN r� /L TZ Z
H Y LIC,NO.
2000
PANELS (OVER 200 AMP) .
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. - 3.00
RH.
ACOR ENG.
AOOREss -
13 Pe, -IS A1S'e "•U("F 9"19
SPECIAL CIRCUIT - 5.00
P RMIT VALIDATION
/���'1'1�"�i�
.
,
EMP. METER OR POLE INS. 20.00
APPucArvr's -
"_6 Lm C� 2a.
MOTORS SEE FEE SCH.
SERVICE CHANGE A13 20.00
' LICENSED CONTRACTORS DECLARATION
r--..�+
itlnll A n 100E]
I Itcreby aldrin that I am licensed underprovisions al' Chapter
(commencing with Section 7000) of Division 3 of the Business and
I'ro fessions CoJe..'B�J m - 'cense is in full force and effect
Lieahu Claxs �-• ` Lie. Number_A.l=LS3
Date_/_'/r=�%S-6--Colnmcror
1 ANCEDA
.... .- r---
BLDG.
-ELECT-
❑
PLG. MECH.
•'
❑ ❑
h� '
^.:f�ll10,
BUILDING PERMIT
OWNHR-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason.(Sec. 7031.5. Rmoressmul PorIcAons
Code: Any city or county which requires a permit to construct, alter,
Improve, demolish, or repair any structure, prior to Its Issuance, also
requires the applicant for such permit to file a signet) statement that
he is licensed pursuant to the provisions of the Contractor License
Law ( Chapter 9 (co atneacing with Section 7000) o1' Division 3 of the
Buvi less and professions Code) or that he is exempt themfroul and
INFORMATION
'
MISC. - REFER TO ORD
VALUATION 0,9S/FT.
Q O'
N
l'
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO.,
ELEC.
TOTAL
PERMIT TO
,f
`111 -
,
OTY. PLUMBING PERMIT FEE
„ STORIES
TYPE CONSTR: ,
Ihe basis for the alleged exemption. Any violation ul'Section 7031.$'
by any applicant lin a permit subjects the applicant III a civil penalty
of not nusre thon live bandied dollars ($500).):
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of the pntperty, or myemployees with wages as
their sole canlpcnsation, will d0 the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
.00G GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044. Business and Professions
Code: 'file Contractors License 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-
mentsarenutin«nded or offered for sale. If, however, the building
,
FIXTURES - PER TRAP 5.00
50. FT. FLOOR AREA
,TOTAL ACREAGE
GAS-EA.SVSTEM-1 6.00
or improvement is sold within one year of completion, the owner-
uiN or u -
builder will have the burden of proving that he did not br
prove for purpose ol'sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044. Business
and Professions Code: The Contractor's License Law does out apply
to an owner of property who builds or improves thereon. and who
GAS - EA. SYSTEM -OVER 4 (EA.), 2.00
BUILDING USE
RES IND 'CON - P8 Other'
-. ❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPR IN KLE RS - 1'INC 5 V.B. 6.00
-
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO. '
,
-
contracts for such projects with a contractors) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑- I ant exempt under Sec.-, B.&P.C. for this
reason
WATER HEATER W/VENT 6.00
-
Owner Date
WATER SYSTEM 5.00
ACC: DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSAT'ION DECLARATION
hereby AfRo 11.1 1 have u certif'icatc of consent tonclf in.atre.
or a certificate of Workers' Compensation Insurance, or a certified
TO NG
ENG. SITE NO.
copy thereof (Sec. 3800. Lah.C.L
_
,
Policy No. Con''
-
FIRE SPR INK
v ❑ N❑
- .
ENERGY T29
t Y ❑ N❑
❑ Curt ificd Copy tereb lu nis'hed
Cerlil'icA/c J ith.thc cit 'pspcction division.
Am,batltt
MISC.- REFER TOORD.
- Cl: A: K ION FROM WORK FRS,
PERMIT ISSUANCE , 10.00
FLOOD ZONE
A.L.U.C.
PLG.CONTR. LIC. No.PLG.
- -
TOTAL
COMPENSATION INSURANCE .
(I his section need not be completed if the permit is for else
Y ❑ N ❑
Y ❑ N ❑
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY'
hundred dollars 151001 or less.)
I certify BUT in the Performance oI the work for which this per.
our is issued, 1 shall not employ any person in any manner so as to
BUILDING
Q OO
become subject to the Workeri Compensation Laws of California.
Datc' APPlicaut
NOT'ICI: "10 APPLICANT: If, after making this Certificate of fix-
emption, you should become subject to the Workeri Compensation
ALTER OR ADD TO MECH. 5.00
APPLIANCE - 5.0
PLAN CHECK
provisions of the Labor Code, you must forthwith comply withFEE
such provisions or this permit shall be deemedrevoked.'
AIR HANDLING UNIT (TO 10)DDOC.F.M.) 4.00
AIR HANDLING UNIT (OVER IQOOOC.F.M.) 6.00
SEISMIC FEE
CONSTROMION LENDINC,AGENCY
EXHAUST HOOD (WITH C 1
'
MICROFILM
I hereby allirm that there is a`construction lending agency ]or
the purinnn:mec of the work forwliich4his permit ie issued ISae.
3097, Civ.C.4
HEATING UNIT (TO 10 ,0 '
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC "
Lender's Name
Lender's Address
1 certify Ih'af have reed this application and state that tlw ubeve
VENTILATION FAN (SINGLE) +. 4.00
nfonnation correct' I agree to cmrPy, will all city and county
ordinances and state laws relating to building construction, all
PLUMBING
BOILER- COMP(3 H.P. or 100,000 B.T.U.) 6.00
BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authoriec representatives of this city to enter 'upon 'tire
above mentioned property for inspection purposes.
MISC. - -_ REFER TO ORD.
-
CONST. TAX
(We) agree to in reify and. keep harmless the City Of
Cupertino agar liabilities judgments, costs and expenses which
may in an ay acerb gainst aid City in comequence of Ibe
PERMIT ISSUANCE 10.00
ECH. CONT. LIC. NO.
MECH.
TOTAL '
TOTAL
1 �/ o O
,anti ,
/jam/J-B
I Applica a Date
v OFFICE COPY