18340 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF .CUPERTINOg4p
I INSPECTION DIVISION
JOB INSPECTION RECORD
• R-0
- PERMIT EXPIRATION'
JOB ADDRESS_14) D Xi 0 A UNIT# LOT#
`" T .PERMIT EXPIRES.IF WORK
OWNER �}�'C�(-'`�` `Pi\' CONTRACTOR C[„ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
_ NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. _
GARAGE SLABS PAIDr�wyr/,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /,SLAB '-JAN 1.2 }990 •� .
PLUMBING - �. �1 I'S ✓I `!"�'r
ELECTRICAL F fILmowmim, ft 9SULA'i4REDATE
MECHANICAL g V DG CT PLC MECR
- _ ❑ }LL{L
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDNFOR ATION IL IN PERMIT
WOOD'FLOOR 7 ^�j IATIDN $IFT.
PLUMBING -
,MECHANICAL
_ ELECTRICAL " ,' PEr+mur TO
FRAMING - �G
STORIES TYPE CONSTR
. INSULATION ,
DCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF' SO.FT,FLOOR AREA TOTAL ACREAGE
THE NO FINAL INSP.SHALL BE MADE BEFORE -
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res IND CON . PS 0"',
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED .FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSE55URS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS 7SHOWER PAN PLUMBING ENERGY
MECHANICAL' MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.PILe No
- FRAMING ELECT.FINAL TEST
INSULATION - PLUMBING zoNlNc ENc.srtE No.
- � GAS TEST ' - GAS
MECHANICAL FIRE SPRINN ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOOD ZONE A.L U,C.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ YC N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OccUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED13Y BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F " T ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
BUILDING APPLICATION & PERMIT r
AP0o Pha,, 16k 18340
p r. BUILDING- ELECTRICAL-PLUMBING-MECHANICAL 7„
DwNER'S PLAN CHECK VALIDATION
NAME y a5e-5a77 QT ELECTRIC PERMIT FEE
PHONE
Ngnrrv�E/RAc*aRs J/,, ,//C LETS-SWITCHES-RECEP 10.00/1.00
4�Q.S /'f'E-a- uc.No."�fR� � LIGH NO FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS PPLIA ES-RESIDENTIAL 4.00
ADDDL //�s„
PANELS 10.08 DATE OF APPLICATION
Q ARRCHITECT PANELS (OVE OO AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
-ZFO
moo ESS ENG' SPECIALCIRCUIT 5.0Q PERMIT VALIDATION
4 ZIP TEMP.METER OR.POLE S. 20.00 /
"'l APPLICANT (� (\�' MOTORS E FEE SCH. 1 l 2-- ' D
ADDRESS //''� fS'-�, V��aC�
,sr.7 (.U�"7 SERVICE CHANGE 20.00 ( �U
0
, 02 LICENSED CONTRACTORS DECLARATION
u U 1 hereby affirm (hat I am licensed under provisions of Chapter 9 ' 111 ISSUANCE DATE
a¢ i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r D i Professions Cod 9j"ens,is in full force aI�F 1Jfe',L fes'
Nk
z o T- License CI: s Lia Number aF"S z�� JAN
�JL ❑ ❑ LF{
9 m H Date Contractor r
BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION
¢ R w u r INFORMATION
W ;LL N I hereby alfirm that I am exempt from IIIc Camractols License MISC.- I EF R D VALUATION S/FT.
LL O ¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
� - 0 Code.Any city orcounty which requiresa permit to construct,alter,
¢ ¢ 0 improve,demolish,or repair any structure,prior(o its issuance,also ELEC.CONTR. LIC.N0. ELEC.
D LL rNuires the applicant for such Perritt to file a signed statement that TDTAL PERMIT TO
X. $ he is licensed pursuant to the provisions of the Contractor's License
riQ Law(Charter 9(commencing with Section 7000)of Division 3 fthe
f 4 o Business and Professions Code)or Om(he is exempt therefrom and Q Y. PLUMBING PERMIT FEE OA
Ie 1-$
tire basis for the alleged exemption.Any violation of Section 7031.5 STORIES TVP CONSTR,
c ; - by any applicant for a permit subjects the applicant too civil penalty LTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as N FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do tire work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions OR,ROOF,AREA,GOND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work PER TRAP 5.00 SEE IT,FLOOR AREA TOTAL ACREAGE
. himself or through his own employees,provided that such improve- STEM-1 INC.4 OUTLETS 6.00
ments are not intended or offered for Sale.If,however,the building
or improvement is sold within one year of completion,the owner TEM•OVER 4(EA.) 2,00
builder will have the burden of proving that he did not build or im, BUILDING USE
RES IND CON Pe Other
P
rove for purpose of sale), INDUSTRIAL STE INTER. . 30.00 ❑
❑ I,as owner of the properly,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLE -1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves tharcon,and who LAWN SPRINKLERS- VER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SAN V-STD EA.200ft/10.00
the Contractor's License law. TRACT NO. PARCEL NO.
❑ IamexempLunder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Hate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK Ii RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm,that I have a certificate of consent to self-insure.
or a certificate of Wo rkers'Col ,..lion Insurance or a certified ZONING ENG.SITE NO.
copy there,( 8p],Lab.CC„ A/� U
Policy N.IYYff Qompuny `s�sE*i✓s'v' y•
Q p❑( CertlBed Copy is hereby furnished FIRE SPRINK ENERGY T20
Z p A{s llca�rtiflc c p is filcA viw rn coy inspection division. MISC.- REFER TO ORD. yN V N
To
❑ ❑ ❑ ❑
~ vat PERMIT ISSUANCE 10,00
Lu CIiRTI FICA COMONSATIOTION NSU MWOItKIiRS' FLOOD ZONE A.L.U.C.
W � COMPENSATION INSURANCE PLG.CONTR, LIC.NO. - PLG.
Z (t
his Section need not be completed if the permit is ]or one TOTAL V E] N❑ V[:] N[_]N
hundred dollars IS 100),r less.)
U OI certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W F mit is issued,I shall not employ any person in any manner m as to
0U become subject to the Workers'Compensation Laws of California.
ED ED Dme ApplicantALTER OR ADD TO MECH. B4OB BUILDING
>_ to NO'FIC17 TO APPLICANT:Jf,offer making this Certil'i<ate oI'
F Z enlption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO lOPWC.F.M.) 4.00
.CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.RM.) 6.00 SEISMIC FEE
'I hereby ufrirn Olat 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. MICROFILM
3097,Cu.C.). HEATING UNIT(TO 100,000 B.T.U.) `94Q
Lender's Name HEATING UN IT ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and state that IIIc ah,ve VENTILATION FAN (SINGLE) 4.00
• information n istate 11 agree to comply with all city and county BOILER-CCMP(3 H.P.or 10O,DOOB.T.U.) Zi7B0 . Q]J PLUMBING '
ordinances and state relating to building construction, and
hereby LuLthOention d representatives ec this city es enter upon the 801 LER-COMP IOvur 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.
Cupertino against liabilities,judgments, costs and ex enses which PERMIT ISSUANCE 0 Z•OZS CONST.TAX
may i any way accrue against said City in corse enc of the
r Ent f this permit. MECH.CONT. LIC.NO. MECH.
S�9D A_!l _r k ///_jZ(� TOT�;o TOTAL e30-�'
Slina to re of A pplican(/Contractor Late IfT
OFFICE COPY