17018 POST THIS CARD NEAR FRONT OF BUILDING ERmlr NumaeR 1
CITY OF CUPERTINO,% 17018
INSPECTION DIVISION
put
INSPECTION RECORD
JOB ADDRESS 6 3 3 p t ( C PERMIT EXPIRATION
/ ( UNIT# LOT# PERMIT EXPIRES,IF WORK
OWNER ��( �' 'CONTRACTOR p p 1"-- IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION REC RD 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 PEHeuT VAI.IDATIDN
CUPERTINO STANDARDS. ^
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING DEC
ELECTRICAL ISSUANCE DATE
MECHANICAL uty at awitim
DCELECT. `{PLIC. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATIDN SIFT.
PLUMBING I� - _'� (_��1 � U O �p
MECHANICAL - - �• V
ELECTRICAL - veanur To
FRAMING k`%,j
INSULATION STORIES TYPE CONSTR.
DCC GROUT' RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
` ROOF NOTE'NO FINAL INSP,SHALL BE MADE BEFORE SO 11 11.0011AREA TOTAL ACREAGE
S DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
I
BUILDING USE
ROOF SHEATHING I RES IND CON PB OI-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El El Q E
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING y- ELECT.ENERGY
TNACl NO. PARCEL NO
TUBS 8 SHOWER PA z PLUMBING ENERGY
MECHANICAL MECH.ENERGY '
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE.NO
FRAMING ELECT,FINAL TEST zoNlNc ENG.sere No.
INSULATION —� ,� PLUMBING -�/.
GAS TEST GAS
FIRE SPRINK ENERGY T 2
MECHANICAL-
- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - _ Y I] NE
EXTERIOR SHEAR ELECTRICAL RELEASE _ FLOOD ZONE A L U C
INTERIOR SHEAR FIRE DEPT. Y❑ N� Y L-1N�
SHEETROCK Im — GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING `31'00
SCRATCH COAT ELECTRIC FEE CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1 I ,
OCCUPANCYOF BUI LOING IS NOT PERMITTED UNTIL BUILDING FINA LISSIGNED BY BUILDING INSPECTOR. MICROFILM
I
. . ARRANGE FOR INSPECTION BY PHONING 252-4505, �,;.i ELECTRIC
LU LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. ?„ PLUMBING
°z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL --�-IMPORTANT! ' CONST.TAX
PLEASE.READ REVERSE SIDE BEFORE TOTAL 6
CALLING FOR FINAL INSPECTION.
OFFICE COPY
S
ELECTRIC SERVICE NOTICE P.G.6 E.COPT
BUILDING INSPECTOR'S NOTICE
CITY'OF CUPERTINO
Sr/,
To
You are hereby authorized to Connect electrical service for
I•, Owneror Tenaannr_ l7 �/1/() �iL/ i L�y — �G/L' �•/
1
At
�. No.of Wtres Size of Wires Size of Switch
Motor Load Voltage Phase
I
Heating Load K.W. Voltage
I
No.a1 Meters
Light a
110_New Serve Reconnect
,
Heat 120 Three Wve More Service
No.of Add.Meters Power Three Phou Move Meter
—•�—
J �" ftECTRICAI INSPECTOR
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'
BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
GILDING - APPLICATION &,PERMIT 17018
ADDRESS
X33 l„1 ��•
BUILDING-ELECTRICAL-•PLUMBING-MECHANICAL
P
OWNERS
NAME f- ^ I 752-(0•7S1 OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
Q1r� kHOeS CP110NE
CONTRACTORS - (� UTLETS-SWITCHES-RECEP 10.00/1.00 5;00
_%bQY17 e NE+-11r LIC.No.11612 7 LIGHTING FIXTURES 10.00/1.00 t
CONTRAC
ADDRESS TORS f•VOQt ' p PPLIANCES-RESIDENTIAL 4.00
115'6 Jkl RLGiffil 1RONF.7 y1, PANELS 10.00
DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C_NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ADDRESS ENO SPECIALCIRCUIT - 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS, 20.00
APPLICANT'S (f
ADDRESS MOTORS SEE FEE SCH.
t� r
$SG U4..L �lA.�p l 1.4e SERVICE FCHANGE -�• 20.00 ���LL,�U1(1A1L
0 0o LICENSED CONTRACTORS DECLARATION I ick ax- /O
a i w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y a (commencing with Sectio 7000)of Division 3 of the Business and DEC- BLDG. ELECT. PLG.. MECH.
r OR-
M Professions Cod A nViccn,c is in full furgMaltO� cZ`J I ❑
z O w- License Class Lie.Number_ / '
4 y F°w 1)ate ._t.J`VY Contnminr. vty Of Cupertino
¢ ¢ ¢ 4 OWNI:R--BU�I LDI:R DFCLA RAT ION BUILDING PERMIT
a O a o INFORMATION
u y affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
FLLO J Lawfort �following reason. 7031,5,Businessun ntfess;nns pERM1T ISSUANCE - 10.00 Zp� VALUATION $/FT.
Ew
Code:Any sYorcounty which requiresapemotto stmcpalteq �2- p0�
¢ ¢Q O improve,dem sh,or repair any slmct tire,prior I IS issuance,alw, ELEC.CONTR. LIC.NO. TEL /a (ter
o¢ requires the are Fant for such permit to file a ned statement that TOTAL i
A w m u he is licensed our. ant to the provisions of 1 Contractor's License �s PE MIT TO
H z a Law(Clmpour)(co mencingwith Sectio 0001of Division3ofthe �,DC�
z c Business and Profess) s Cole)or tha cis exempt therefrom and QTY. PLUMBING PERMIT FEE /w PVl �L IFNek
¢ r m the basis for file allege xC,nplion. y violmion sf Sccti.n 7031.5 STORIES TYPE CONSTR.
by any applicant for a pe of suhj is life applicant W a civil penalty ZALTER-DRAIN& VENT-WATER (EA.15.00 Oa
- of not snore than five hon ed far,($500).):
❑ 1,as owner of the pr ly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC,GROUP RES.UNITS
their sole compensation,wi o the work,and the structure is not
intended or offered for s''c ( •c. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. -5,00
Code:'rhe Contractor's ¢ease w does not apply to an owner of
property who builds or Improves t reon,and who does such work FIXTURES-PER TRAP 5.00 •Op SO.FT.FLOOR AREA TOTALACREAGE
himself or through hi own employe . provided that such improve-
mentsurenollnten dorofferedfors .ILbowever,thehuilding GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is old within one year oompletion,the owner- GAS•EA.SYSTEM•OVER 4 IEA.) 2.00
builder will have he burden of proving that -did ow build or int- BUILDING USE
proveforpurpo ofsele.). INDUSTRIAL WASTE INTER3000 RES IND CON PS Omer
❑ I,as aw er of th . .
e property,am contracting with ❑ ❑ ❑
licensed con actors to construct [be project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO,
and Profits' ns Code:The Contractor's License Law does not apply
to an ow r of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contrac for such projects with a eontractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
Om C[ tractor's License Law. TRACT NO. PARCEL NO.
❑ lain exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
re.sml
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DI: 'RATION WATER TREATING EQUIP. 5.00
I ho dfirm that I have a curoff of consent to self-insure.
or a ceriifma orkers'Comp lion Insurance,or a certified ZONING ENG.SITE NO.
copy lhereoffsc<.3 uh.
Policy No.
Q ❑ CCrtitold copy is cby fumishc ' FIRE SPRINK ENERGY T-24
Z Z ❑ Certified c is Eled with the city inspection Jivisinn.
p Aoplicani MISC.- REFER TO ORD. y [:] N� v ❑ N[-
CC
❑CN CERTI IICATE OF EXEM PTION FROM WORK ERS' PERMIT ISSUANCE 10.00 Zvi FLOOD ZONE A.L.U.C.
W 2: COMPENSATION INSURANCE PLG.CONTR. UC.NO. PLG. ')!' [78
CL Z it his section need not be completed if the permit is for one TOTAL ✓a/ Y❑ N[] V [3 N�
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for wlych this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
Iy F mit is issued,I shall not employ any crson in any nr ser sO as In
O d beco ub'e heWorke Cgp�lt i La s California. U
Date Applicant_ ALTEROR ADD TO MECH. 5.00 BUILDING
>_ re- NOTICE TO APPLICANT: IL after staking this Certificate of tis- I
Z emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must fotlhwilh comply with FEE
U D-7
Such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,O170C.F.M.) 6.00 SEISMIC FEE a
1 hereby affirm [list there is a Com radion lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which This permissued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 • fro
Lender's Address - ELECTRIC V
Icetlily that l have dthis plicationundstaiethattheabove VENTILATION FAN (SINGLE) 4.00
inl'ormalum is correct. I to comply with all city and county PLUMBING aVe G
ordinances and state tat re 'ng to building construction, and BOILER-CUMP(3H.P.or100,000B.T.U.) 6.00
herchy'nuthoriee rep entatives this city to enter upon the
bove-mentioned p erty for inspect, Too., BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
a
(We).agree toave, indemnify and kit harmless file City of Misc.- REFER TO ORD.
Cupertino against "abili's,judgments, C is and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
-nay in any.wu are a eimt said Ci in consequence Of the
franlin is it y// ECH.CONT. LIC.NO.Uy TOTAL TOTAL 3b•09
Signature of Applicant/Contractor Uate
OFFICE COPY