17869 POSTTHISCAR D NEAR FRONTOF BUILDING RM1fITNUN,RER
CITY. OF :CUPERTINO
INSPECTION DIV.ISION. 17869
-JOB INSPECTION RECORD
• _ / /� I /Q s PERMIT EXPIRATION
.JOB ADDRESS ''16'a `' - v �C�� rV� I—UNIT jt _^LOTW
11 N - ,.+ PERMIT EXPIRES IF WORK
WN .
•OER •jf C_K Ce �LI•LL CONTRA ' '�,� x "IS NOT STARTED WITHIN
INSPECTION DATE - INSPECTOR INSPECTION REI 180 DAYS OF PERMIT ISSU-
FOUNDATION. ANCE OR 180 DAYS FROM `
NOTE: `LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED . `
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. - r
GARAGE SLABS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ! -
UNDERGROUND /-SLAB MAY, 1 ,d,�9��I f „[� • y` U!
PLUMBING-
ELECTRICAL - - City of Cupertino IssuANCE UA TF� !!Y"
MECHANICAL - ELUG„ ELECT. PLG. MFCH.
'DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED. BUILDING PERMIT
J. INFORMATION
"T •.
WOOD-FLOOR LOOK .. - - t. VALUATI DN SIFT.
PLUMBING
MECHANICAL% - -
ELECTRICAL - _ _ - _ .PEOM I TO.
FRAMING -
srURles TYPE CUNSTn
INSULATION , .
OCC.GROUP, RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,T T.FLOON AREA TOTAL ACREAGE
ROOF _ NOTE:NO FINAL INSP.SHALL BE DE BEFORE
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID
• - - . BUILDING USE
ROOF SHEATHING � '- .' '`Rus' INO CON PR om.r
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 'FINALS DATE INSP. ❑ 0. ❑ ❑
ASSESSORS PARCEL'NO
ROUGH ' SAN.N '
PLUMBING ELECT.ENERGY " -
TRACTNO, PARCEL NO,
TUBS&SHOWER PAN' PLUMBING ENERGY
MECHANICAL - - MECH.ENERGY
ACC DATE ACL.FILE NO.
_ ELECTRICAL '. ' BUILDING ENERGY
FRAMING - ECECT.FINAL TEST- - - zoNiNc - ENG!SITE No.
INSULATION- PLUMBING -
GASTEST GAS +
' vFIRE SPRJNK ENERGY L'1A '
MECHANICAL - 5...23 -y o 'N❑ IN
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING CD
EXTERIOR SHEAR i " ELECTRICAL RELEASE FOOD ZONE A.L U.C.
INTERIOR SHEAR FIRE DEPT. - v❑ N� v ❑ -0
SHEETROCK: - GRADE _ • FEE SUMMARY
EXTERIOR LATH BUILDING I -
9NTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY,BUILDING INSPECTOR. MICROFILM
ARRANGE FORINSPECTION BY PHONING 252-4505,' ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTIONi PLUMBING'
0� .PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL: �1CJ O'
— SEE PERMIT FOR•,EXPIRATION DATE
IMPORTANT!: ' CONST.TAX'
PLEASE READ REVERSE SIDE BEFORE TOTAL I,rvi0
' - CALLING FOR FINAL INSPECTION.'
OFFICE COPY ,.
,APPJ.LI3ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,
BU LDING PROJECT I DENT]FICATION - PERMIT NUMBER
BUILDING APPLICATION & PERMIT q p (�
ADDRESS // 1 0 9
O G oqw L) fP /� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OPNEH'S // ��5,7 i PLAN CHECK VALIDATION
t S6 1C PHONE ¢ / QTY. ELECTRIC PERMIT FEE 1 ,
DrvE ) 5
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC. 17 LIGHTING FIXTURES, 10.00/1.00
CONTRACTORS - PPLIANCES-RESIDENTIAL r 4.00
ADDRESS � pp /^1� •�
Q NU4 /IZ' PHONE J645) PANELS 10.00 DATE OF APPLICATION
ARCHITECT - CW PANELS (OVER ZOO AMP( , 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC,NO ISIGNS TRANS. 3.00
AARCH,OR DDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
. 'IIP EMP.METER OR POLE INS. 20.00
noo¢ss TG MOTORS - SEE FEE SCH.
l SERVICE CHANGE - 20.00 J, /�V�'�vL� ,/ _
woo LICENSED CONTRACTORS DECLARATION t 10- TT \�nl''//
I hereby affirm it,., 1 am lic,d;ed under provisions of Chupicr 9 ta ISSUANCE DATE
vHi Q H (commenemg with Section 7000)of Division 3 of Unit Ilusincss and IJ BLDG. ELELT. 'DLG. MECH.
H N z Professions Codd and n license is in full 17' Raj rJfitp.. IJ 1��'1
z o w - License loss_[7= Lie.Number.? _/_4 7 -• :�. L/SJ
9 z - Datr `LD-.F� Contractor •
p peffilto ' BUILDING PERMIT
¢ ¢ w ¢ OWNER-BUILDER DECLARATION VVr-
oAU MISC.- REFER TO ORD INFORMATION
wS LL r- 1 hereby aIfinn thin 1 am exempt from the Conlmctor S License
LL 0 4 law for the following reason.(Sec.7031.5,Basinessand Professions - PERMIT ISSUANCE 10.00 VALUATION S/FT.
� - Codm Any city or county which relluiresaperrin to construct,alter, '
2SE Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEG CONTR.. LIC.NO. ELEC.
so
-O u requires the applicant for such permit to file a signed statement that TOTAL _ PERMIT TO
wm he is licensed pursuant to the provisions nfthe Contractor's License
Hzi
Law(Chapter 9(conimcncingwith Sccti(.n 70001ofDivi,i.R3 ofthe et,
a Iluainess and Professions Code)or That he is exmnpt therefrom and OTY. PLUMBING PERMIT FEE 14,
O' STORIES TYPE CONSTR.
¢'H a the basis for the alleged exemption.Any violation ioSection 7n and
u ;m by.any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 .
of not more than five hundred dollars($500).): •
❑ I,as owner.1 the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their Vote compensation,'will do the work,and the structure is notio -
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 s '
Code:The Contractor's License Law does not apply to an owner of
property who builds or immoves thertml,and who docs slab work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or of rote his own,mpc]coir,provided(nut au ch improve- .1 .
himself a through his oro employees,provided
tever,lhe building GAS-EA.SYSTEM-11INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner GAS,-EA.SYSTEM'OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving Inst he did not build ur inr
prove for purpose of sale.). INDUSTRIAL WASTE INTER. ,30.00 RES IND CON ve oma+
❑ 1,as owner of the property.am exclusively contracting with ❑ •❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and I'rotcssiona Code:The Con.mctor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) . 1.00
contracts for such projects with a contractor(s)licensed pursuant to '
the Contractors License Law. SEWER-SANITARY-STORMEA.200ft/10.00, TRACT NO. PARCEL NO.
• ❑ l um exempt under Sec. ;B.&PIC.for this WATER HEATER W/VENT - 6.00
Owner Dan' WATER SYSTEM - 5.00 .
ACC.DATE ACC.FILE NO.
_ WORKERS'COMPENSAT1ON DECLARATION WATER TREATING EQUIP. 5.00
I herchy affirm that I have a ce,ut'icate of consent to self-in...... ZONING
or a certificate of Workers'Connpcnsition Insurance-or a certified ENG.SITE NO.
copy thcrcoflSec.3800,Lah.C.L ,
Policy No.- ' Company
O V�Cerlilled copy Is hereby furnished. I FIRE SPRINKENERGY T 24
Z Z ❑ Certi699�1II 7)yyyy led w'h the city ,inspection division.
Q Applicant_(J�C{ �G{ MISC.- REFER TO ORD. Y❑ N❑ ' Y ❑ IN
~ va PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU CIiRI'IFIGCI'li OP EWIOI'INS PROM WORKfiRS'
LD COMPENSATION INSURANCE PLG.coNTR. LIC.No. PLG.
1 0 (Thi section need not be complc.nl if the permit is for one TOTAL a v❑ N❑ �Y E] ry[:J
Z hundred dodurs(SIO(lor less.)
U O 1 certify that in to,permimance of the work for which this pre- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL t- tint is issued,I Shall not employ any person in any manner so is to
Ow become subject to the Workcr C'ompensalion Laws of California. FELECTRIC
Date Applicant Q D
a ALTER OR ADD TO MECH. 5.00
} rn NOTion,TO shouldCAN'I':'11,alter to king Ibis Certificate of lis-
H Z provision you Ilio L bor Co e, You iii the Workers Co reply nth APPLIANCE _ 5.00
provisions io lm Labor nit h you must forthwith comply with
U such provisions or this pcnnit shall be Aeancd ravukeJ. � AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0)000C.F.M.) 6.00
I hereby affirm that there is u construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of.he work for which this permit is issued(Scc. HEATING UNIT(TO 100,000 B.T.U.) 'B.00
3097,Civ.C.l. -
Lender'sName HEATING UN IT(OVER 100,000 B.T.U.)9.50
Under's Address
I certify In,I have read this'application and sate that the above VENTILATION FAN (SINGLE) 4,00
Information is correct. I agree to comply with all city and county OILER H.P.or 100,000 B.T.U.1 6.00 PLUMBING
ordinances and slut, laws relating to building construction, and B
hereby amhnriee representatives of this city to enter upon the BOILER-COMP (Over,100,000 BTU)SEE FEE SCH. MECHANICAL tT D
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liahilities,judgtucots, Costs mm expenses which - - CONST.TAX
Duty in any way accme against said City in consequence of the PERMIT ISSUANCE- 10.00 ,1,^OD
mnliof lh' m' MECH.CONT. LIC.NO, MECH.
TOTAL DO TOTAL
Si
Urge f ppli ant/Conlmctor Date -
OFFICE COPY