17420POSTTHISCARD NEAR FRONTOF BUILDING
: CITY OF CUPERTINO
' INSPECTION DIVISION
JOB INSPECTION RECORD ,. ;
^yan��•,.•�1
JOB�ADDRESS '� '4i-TL/''C/ UNITIk PLOT#
•
OWNER CONTRACTOR
,PERMIT NUMB ER
•174`20
PERMIT EXPIRATION
'• PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN'
1180 DAYS OF PERMIT ISSU-
ANCE - OR 180 DAYS FROM
LASTCALLED. INSPECTION.,.
'
INSPECTION DATEINSPECTOR
INSPECTION RECORD
FOUNDATION
_NOTE: - ••
ALL GRADING AND DRAINAGE*SHALL BE INSTALLED
TO'COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
UFER
PREGUNITE "',. •
•PEUNIIT VAI IDAIION
y
f ' rL. ,Sl.t C.•. l
' Issu ANCE: DA 1E
GARAGE SLABS•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,'
PAY.-)
-
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL -
MECHANICAL ..
BLDG..
ELECT. I
Pia mea..
DONOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
•
BUILDING PERMIT
INFORMATION
• WOOD'FLOOR
IACunn Om
- S/FT.
PLUMBING.'fie
- -
MECHANICAL•
ELECTRICAL
� - ',
ERMIL TO
.
IT.I�1'+..Y
FRAMING
INSULATION
STORIES
tYPE CONSTR,
C/h%F—'
OCC GHOUP
RF. S:uN1T5 -
,,PLACENOSUBFLOORUNTIL ABOVE HAS'BEENSIGNED
ROOF
N TE: NO FINAL WSP. SHALL BE MADE BEFORE
CONSTRUCTION TAX IS PAID
;' . '
�,
so,FT.«oogARI:A
.J
To*A1_Acacncr
_
-
DIAPHRAGM' rTHE
USE
r+Es IND aulE CON coN PB' u,I, '
C]A
ROOF SHEATHING
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS , DATE INSP.
55[SS0RSPARC1LL NO.
.ROUGH
SAN.#
PLUMBING
ELECT. ENERGY
.RACY No.
'
PARCELNO.
_
TUBS & SHOWER PAN
PLUMBING ENERGY-
MECHANICAL, -
MECH.ENERGY'-
ACC. DATE
"
ALL. FILE NO.
ELECTRICAL'_ -
BUILDING' ENERGY
-FRAM' NG, :.'
ELECT. FINAL TEST
4, 20NING
ENG. SITE N0.
_
INSULATION ', - _
PLUMBING 9',. y, '•
GAS TEST''
GAS
FIRE SPRINK
ENERGY TIG'
`
MECHANICAL-
ECHANICALCOVER
COVERNO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING '
F�OODIONE
'Y❑'.N❑�
"n,�aC
.N❑ "N❑
EXTERIOR. SHEARELECTRICAL
RELEASE
INTERIOR SHEAR
FIRE DEPT.,.
FEE SUMMARY
SHEETROCK- -
GRADE -
EXTERIOR LATH-
BUILDING,•
,BUILDING
INTERIOR LATH . -
TEMPORARY.APPROVALS
SCRATCH COAT, 'ELECTRIC
PLAN CHECK.
FEE
GAS ' '
SEISMIC FEE • ..
- "
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
JOCCUPANCY
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR;INSPECTION,.BY PHONING 252;4505,',
�- ONE WORKING DAY BEFORE'REQUIRED INSPECTION..'_,
PLEASE.GIVE'JOB'ADDRESS WHEN PHONING.'-
HONING.'MECHANICAL-SEE PERMIT FOR EXPIRATION DATE —
SEE
ELECTRIC
PLUMBING
MECHANICAL-
ODNsT: rnx,
IMPORTANT!-
•v, PLEASE READ REVERSE SIDE BEFORE
" r CALLING FOR FINAL INSPECTION.
, TOTAL';';
.'OFFICE COPY`
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY :
,BUILDING PROJECT IDENTIFICATION
- -
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER r
1 7 A n/
1 1 TLr.
BUILDING
ADORES
�3a obSj.a6
OWNER'5
NAME`'
'-T. Ux/7L.L PRONEDS Y-- �
OTY. ELECTRIC PERMIT FEE r'
`
PLAN CHECK VALIDATION
'
DATE OF APPLICATION _-
CONTRACTORS
NAME1
}1 Q.S'HEl..�:� uc. rvO.
OUTLETS - SWITCHES -RECEP'•'10.00/1.00
aLIGHTING FIXTURES 10.00/1.00
Ess
CONTRACTOR'S/� ']
l 5 T•• PRONE �q /-���
APPLIANCES - RESIDENTIAL - 4.00POOR
PANELS f&QO I'•SU
ARCHITEC
OR
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C.NO.
ENGINEER
' ilc. rv0.
SIGNS TRANS. 3.00
ARCH. OR ENG.
ADDRESS
SPECIAL CIRCUIT 5,00
PERMIT VALIDATION
EMP. METER OR POLE,INS. 20.00,
Ia
`61 tYr I Q�
CJ
L _
APPLICANT 'Sa
ADDRESS e^
VL
MOTORS' SEE FEE SCH. -
•.
SERVICE CHANGE 20.00
LICRNSEDCONTRACIORS DECLARATION
P,4-
* -
I hereby affirm that I am licensed under provisions of ClmpW19'
ISSUANCE DATE
(ronunracing with Section 7000) of Division'3 of the Business antiSLOG.
Par fessi.ns Lode, a ... I y license Is In full lorC9 ypd cflAc(�
License CIV if �] Lic. Number-yY�{-LC�/r S' dd(�
Dat, s/r Co n tractor_.1 c_ ", I
OWNER -BUILDER DECLARATION
I hereby anion that I um excerpt from the Contr:mtoi s Lironsc
Law 1'or the following reason. (See. 7031.5. Businessund Professions
Code: Anycolishcounpair any requires, perminoconsuance. 1q
improve, demolish, or repair any rcauclure, prmit t its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (conmten6ngwilh Section 70001 of Division of the
Business and Professions Code) or that he is exempt lhcrel'rom and
the basis for the alleged exemption. Any violation of Section 703 LS
ELECT.
❑ `
PLG. ' MECH.
❑
•-
CHY of Cupertin
BUILDING PERMIT
INFORMATION
MISC.- - REFER TO ORD-
VALUATION
'
$/FT.
'
PERMIT ISSUANCE - ' h@'BO
a���
ELEC. CONTR, LIC. NO, _
ELEC. P^� S
TOTAL p�. 50
PERMIT TO
1 -IT •MCL
OTY. PLUMBING PERMIT FEE 'I
STORIES
TYPE CONSTR.
gLTER-DRAIN-WATER(EA.) 5.00
by any applicant for a permit subjects the applieml toes civil penalty
of not me than five hundred dollars (S5001J:
or
'
❑ I, as owner of tut property, or my employees with wages as
their Still' COmpersation, will do the work, and they structure is nal
inwndcd or offend ltor sale (Sec.'7044,-Business and Professions
BACK FLOW PROTECT. DEVICE 4.00 '
OCC. GROUP
`
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
Cod,: The ConGectirr's License Law does nor apply to an owner of
property who builds or improves thereon, and who docs such work
FIXTURES -PER TRAP 5.00
SO. FT, FLOOR AREA
TOTAL ACREAGE
himself or through his own employees, provided that such improve -
.tons are not intended or offered for sale. If, however, the budding
GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00
oriimprovemenl is sold within one year of completion, the owner.
builder will have the burden o proving that he did slot build'Or in.
Prove for purposcol sulc.l. -
❑ I, as ownof tire property, am exclusively contracting with
lowner .1
contractors to construct the project (Sec. 7044, Business
GAS -EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
RES'. IND CON PB Oce,
❑ ❑ C1 ❑ 11
INDUSTRIAL WASTE INTER. -30.00
LAWN SPRINKLERS -'1 INC 5 V.8. - 6.00
.. ASSESSORS PARCEL NO.
and Professions Code: The Contractor's License Law does not apply
to mI owner of property who builds or improves (hereon, and who
LAWN SPRINKLERS - OVER 5 (EA.) 1,00
contracts for such projects with a enntractoIis) licensed pursuant to
the C....tractor's License Law.
-SEWER-SANITARY-STORM EA, 200ft/10.00
TRACT NO,
PARCEL NO.
WATER•HEATER W/VENT 6.00
❑ I am exempt under Sea ,B.&P.C. lox l his
reason
'
Owner Date'
- WATER SYSTEM, 5.00
.ACC. DATE
ACC. FILE NO.
WORKIiRS-COMPENSNTION DI:CLARATION
,
WATER TREATING EQUIP.. 5.00
to f-imure,
I harehy affirm that I have a certificate )I ennsmv sel
or a c,rtifiwte o1' Workers' Compensation'Insurann:, or a Leflil'iM
` >a, r
ZONING
ENG. SITE NO.
copy theregff 300, Lab. C.)
Policy No.dlw-Company-s,ty""
❑ Cenifiedcopyisherebyfurnished.
'C -Certified opurs, It1c with lire city inspection division.
Applieaut_�t •�.\ _%
FIRESPRINK
rv❑
ENERGY T 24
I vo N[]
MISC.- REFER TO ORD.v[j
Cl?BTIFICAT Ii OF EXI'MP'I'[ON FROM WORKERS'
PERMIT ISSUANCE '• 10.00
- FLOOD ZONE
"A.L.U.C.
PLG. CONTR. LIC NO.
PLG.
TOTAL
COMPENSATION' INSURANCE
IIhis sactio. need not be completed if the Permit is for one
YQ IN
Y� N�
OTY. MECHANICAL PERMIT FEE
- .•
-
FEE SUMMARY
hundred dollars (SIGN) or len.) -y
I certify that in the performance of the work Ii r which this Per.
mil Is iexued, 1 sbudi nut employ wry Person in any manner m as to
BUILDING. •.
become subject to the Workers' Comp,... mirmi Laws of Cuhl'orniu.
Dme ' Aplilicant -
on'tuoi TO APPLICANT: If, after taking this rs' C.icme of rix-
oh. you become o me W
r -
'ALTER OR ADD TO MECH. - 5.00
APPLIANCE _ • 5.00
PLAN CHECK
•.
forthwith comply with
provisions of the labor Code, you mull forthwith comply with
provisions the L Code, you
such provisions or this permit shall he deemed revoked.
AIR HANDLING UNIT (TO 10,000GF.M.) 4.00
FEE
AIR HANDLING UNIT (OVER IO,000GF.M_.)6.00
SEISMIC FEE
' CONSTRUCTION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) ,.5.00 :
HEATING UNIT (TO 100,000 B.T.U.) 8.00
MICROFILM
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.L
HEATI NG UNIT( OVER 100,000 B.T:U.)9.50
ELECTRIC
a. `'I•S�%
. Lender, Name
Laorr's Address
E l certify that l have real this application and slate that the ahovc
VENTILATION FAN (SINGLE), 4.00
infornhation is correct. 1 agree to comply with all city and countyPLUMBING
ordinances and slate laws relating -to building construction, and
BOILER-COMPOH.P.or 100,000B.T.U.)-64 .00
BOILER-COM Plover 100,000 BTUI SEE FEE SCH.
MECHANICAL
a1•(�
hereby authorize representatives of this city to enter upon tire
above-mentioned Property for inspection purposes.
_
MISC. - REFER TO ORD.
CONST. TAX'
.
- (We) agree to Suva, indenmify and keep hanillase the City of
upertino against liabilities, judgments, costs and expenses which
myn Gy way accrue against said City in consequence of the
ranli of this permit - [[
'/w
PERMIT ISSUANCE ' J
MECH. CONT. LIC. NO.
R 1''�S
MECH.
TOTAL / VO
TOTAL
_
4 Sa
Sik'1a re of Appli,mA nntmetor Dale
OFFICE COPY