17464 POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER
CITY OF CUPERTINO 17464
INSPECTION DIVISION
JOB INSPECTION RECORD
(h• PERMIT EXPIRATION
JOB ADDRESS_� !`�Y I/�.�CIS�-�Q_V— UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER �B CONTRACTORzllhIS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR 'As ECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM j
NOTE: LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALRTATION
CUPERTINO STANDARDS.
GARAGE SLABS , •� _ [ E;.
• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED O
UNDERGROUND /SLAB MAR 31 iuci -1�
PLUMBING -'i) . A V\ I ` \Z t,-
ELECTRICAL
,`ELECTRICAL / Cox uI woft ISSUANCE'Da TE
MECHANICAL e0 ELECT' PLG. MwR.
_ E] ❑ Ej ,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING -�
MECHANICAL
ELECTRICAL I1N'PEERRMITTTO1p-
FRAMING
INSULATION STORIES TYPE CONSTH.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SD FTFLOORAREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB GO...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.N -
PLUMBING -S ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL _51 MECR ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 2
.COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ NE] ° E] "❑
. EXTERIOR SHEAR ELECTRICAL RELEASE -
FLOOD ZONE A L U C.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR .LATH TEMPORARY APPROVALS BUILDING,
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN 51[IN 1:0.1 OCCUPANCY I ISEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
UJ
ONE WORKING DAY BEFORE REQUIRED INSPECTION. 1,21 PLUMSING
o� 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 1 APPLICATION & PERMIT. 17 4 6 4
i AOOR ESS I I f l
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .-
OWNER'S PLAN CHECK VALIDATION
NAME H TY. ELECTRIC PERMIT FEE
• 1 PHONE
NpMERAcroRs UTLETS=SWITCHES-RECEP 10.00/1.00
-'r Lia NIDID LIGHTING FIXTURES 10.00/1.00
RAC amiCTORs
ADDRESS
O#CPPLIANCES-RESIDENTIAL 4.00
CON
11
026- PANELS 10.00 GATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
oR 5u N►.�`�'d AL£ PANELS (OVER 200 AMP) 20.00 -.
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ADDRESS Ervc' _ SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 i Z
APPucANT5 MOTORS .SEE FEE SCH. J
ADORE as
SERVICE CHANGE 20.00 �n
'02 LICENSED CONTRACTORS DECLARATION J D,'p- j-� 1'(�6 aLvc-A
a u v I hereby affirm that am licensed under provisions of Chapter 9MAR bi It,. ISSUANCE DATE
lu mmencin with Section 70001 of Division 3 ol'the Business and
a H g BLDG. ELECT. PLG. MECH.
H y z Professions CoJ• nd my license is in full fore ct 7
o i w o License Class .,_Lia Number city of"Cupe o •❑ ❑ ❑
Dote_��nn.�,..,n in, Contractor-
a y f v_O� lc V I .r .I- BUILDING PERMIT
¢.a
OWNER-BUILDER DECLARATION
a o d U INFORMATION
X g u I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
VALUATION -$/FT.
H LL O a Law for the following reason.(Sec.703 1.5,Businessxnd Prufessi°ns PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit o construct,alter,
Ec improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E
$w he is licensed pursuant to the provisions of the Contractor's License `/�
rz > Law(Chapter9(comniencing with Section 7000)of Division 3 ofthe 1f�
E 4 o Business and Professions Code)or Drat he is exempt therefrom and QTY• PLUMBING PERMIT FEE
cc 1-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d g ,- by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law'does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.IL however.the building GAS-EA.SYSTEM-1INC.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 int- BUILDING USE
prove for purpose otsaleJ' INDUSTRIAL WASTE INTER3000 RES IND CON PB • Olhm
❑ I,as owner of the property,am exclusively contracting with . .
11 E _El
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- I INC 5 V.B. 6.00 - ASSESSORS PARCEL NO,
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with it co nractorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iain exempt under Sac.-,Il&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure ,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thcreo((Sca 3800 Co p h y -
Policy No. Company
❑ �ertifieJ copy is hereby furnish FIRE SPRINK ENERGY T-24
Z 2 CYCer if n y is fled r tll city inspection n MISC.- REFER TO ORD.
O Applicant* _ - Y E] ry11
y ry�
CC PERMIT ISSUANCE 10.00
� v�- CIiR'I'll%GATE OP EXIiA1P I(1N FROM WORKERS' PERMIT ZONE A.L:u.C.
lL COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG.
IL 0 (This section need not be completed if the permit is 1'or one TOTAL Y❑ N Y Q N[
hundred dollars IS 10(Dor less.)
U O I certify that in the'performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
u. F mit is issued,I shall not employ any person in any manner so as to
OW become subject to the Workers'Compensation Laws of California.
d [)are ApplicantBUILDING
} N NOTICE'10 APPLICANT: 11,after making this Certificate Of Ex- ALTER OR ADD TO MECH. 5.00
F Z emption,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 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 6.00 SEISMIC-FEE
I hereby affirm that 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,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that 1 have icad this application and wale that the above VENTILATION FAN (SINGLE) 4.00
- information is correct I agree to comply with all city and county BOILERCOMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and orate laws relating m •
building construction, and /\
hereby authorize: representatives of this city to enter upon the BOILER-COMP(Over 10.000 BTU) FEE SCH. MECHANICAL I�1 �`J
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 expenses which PERMIT ISSUANCE .}gap CONST.TAX
may in any way accrue against said City in consequence of the
ranting Ul his petrol MECH.CONT. UC.N MECH.
•'' `T 4-73 TOTAL - TOTAL
Slgnol re of Applicanl/Cm mclor Dale yK/11K 1rJ11-.Kir Il(TiSC)
OFFICE COPY