18373 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPE.RTINO PERM11013
INSPECTION DIVISION
JOB INSPECTION RECORD
jD �� 1 PERMIT EXPIRATION
JOB ADDRESS 3 Off"' UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER `e CONTRACTOR LO WIS NOT STARTED WITHIN
INSPEtjr0N DATE INSPECTOR INSPECT ON RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 'ANCE OR 180 DAYS FROM
NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
TO COMPLY WITH THE APPROV,BD1Al1NS AND CITY OF PERMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS. ■
GARAGE SLABS -y _
k
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED JUL 27 1989
UNDERGROUND /SLAB (�
PLUMBING �V .j.N
ELECTRICAL ISSUANCE DATE I
MECHANICAL ILOc ELECT . PLG. .11H
❑ I ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION 4/FT.
PLUMBING .
MECHANICAL
ELECTRICAL PERMIrT
FRAMING illy h6teL
STORIES YPE CONSTR
INSULATION
OCC GROUP RES UNITS
' C/h!7 rC2 />qrJ C
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED vn Ti o:Fr.rLonRARFA TOTAL'ACREAGE
ROOF ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING nes IND CON PR om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
.
TUBS&SHOWER PAN PLUMBING ENERGY THACT NOPARCEL NO.
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY Acc.UnrE ACC PILE No
FRAMING ELECT,FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS - -
FIRE SPRINK ENERGY r.24
MECHANICAL 2> /� Y ❑ N❑ Y ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.1-U C.
-
,
- INTERIOR SHEAR FIRE DEPT, V❑ N❑ Y 0 .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 JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ^ ELECTRIC pts
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION., PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL "I"A
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO,FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY if/
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING N APPLICATION & PERMIT' tJ l''�
ADDRESS16) ,5� � T . wa� { 73
12 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'Sy PLAN CHECK VALIDATION
NAME (,V /� I-Y
I//v^ KorvE 11+'9666OTY. ELECTRIC PERMIT FEE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
VOM LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
AD/O'R''E155 {,I Tel /� /•r I (� QI
1f 0 II��T J /.NJ FRONE�q VI(/k0l PANELS 10.00 DATE OF APPLICATION '
ORcI9TEcr - - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
E NGINEEP
uc.NO. SIGNS TRANS. 3.00
ADDREss eNa- SPECIAL CIRCUIT 5.00 .00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 7`��
ADDRESS MOTORS SEE FEE SCH. �+3 !/
ADDRESS .�y� A ^ 11
5-71 �. IJ% ?A• SERVICE CHANGE 20.00 JJ* /T
MO o LICENSED CONTRACTORS DECLARATION - EB y IT f 1 tk lO V
a a w I hereby affirm that I am licensed under provisions of Chapter 9 Tc�•7V ISSUANCE DATE
z (coenmencing with Section 7000)of Division 3 of The Business andJill 4
¢w ��11d - BLDG. ELECT. PLG. MECH.
F w z Professions Co 4✓4, y licenx is in full fnrcpgp}�off}•}tk ❑ ❑
ae z m o License Class 4✓4 /v Lic.Number (r_�
Date Contractor
F m f -�+ - BUILDING PERMIT
a a: a OWNER-BUILDER DECLARATION
o a u MISC.- REFER TO ORD INFORMATION
w ; u y I hereby affirm That 1 am exempt from the Contractor's License VALUATION $/FT.
H LL D ¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 ,Q
in Code:Any city or county which requires a permit to construct,alter,
BE S¢,O improve,demolish,or repair any structure,prior to ils issuance,also ELEC.CONTR. LIC.NO_ ELEC ^ 'D
W ��
a O u requires the applicant for such permit to file a signed statement that TOTAL t
w ve he is licensed pursuunt to the provisions of the Contractors License PERMIT T
HZ >
Law(Chapter 9(commencing with Section 7000)ofl)ivision 3 ofthe QQ
4 o Business and Professions Code)or,that he is exempt therefrom and GTY. PLUMBING PERMIT FEE `L PL
to s- m the hasis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant lir a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1;as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work.and the structure is not
intended or offered for sale (Sec. 7044,.Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License:Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES PER TRAP 5.00 50.FT.FLOOR AREA TDTALACREAGE
himself or though his own employees,provided that such improve-
mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6,00
or improvement is sold within one year of completion,the owner- GAS•EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he dill not build or ino- - RES ,IND CON PB Oman
for purpose Of sale.). INDUSTRIAL WASTE INTER - 3000
❑ I,as owner of the properly,ran exclusively contracting with . .
❑ ❑ ❑ ❑ ❑
licensed contractors to construct the poI(Sea 7044,Business LAWN SPRINKLERS•1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I anI exempt under See.-,BAP.C.for this WATER HEATER W/VENT 6.00
mason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAT'ION DIiCLARA'PON WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, TONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or'.e certified
copy thereof_J$y`_73 OQ Lab.C.). AbRpi��K
Policy No Company r
O ❑ Cerlified cop is hereby furnished' FIRE SPRINK ENERGY T.24
Z Certified Appy is G, with the city inspection division. MISC.- REFER TO ORD.
Z
A pliednl fN/Nn y ❑ N❑ v ❑ N❑
CC rn -�• PERMIT ISSUANCE 10.00
' � - CIiRTIFICA'fli OF EXIiMPTI ON PROM WORKIiRS' FLOOD ZONE A.L.U.C.
LLI > COMPENSATION INSURANCE' PLG.CONTH. LIC.NO. PLG. - y❑ N C] v 13N❑
EL Z (This section need nut be Completed if the permit is for one TOTAL
hundred dollars 1$1001 or less I
f,)'O 1 certify that in the performance of the work f..which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,1 shall not employ any person in any manner so us to
OW become subject to the Workers'Compensation Laws of California.
Q_ Dam Applicant BUILDING
} r4 NOTICE 1'0 APPLICANT': If,after making this Cerlificma of Ex- ALTER OR ADD TO MECH. 5.00
F ? emption,you should become subject to the Workers'Coropensution 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 10,000C.F.M.) 4.00 O
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.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,Cie.C.). pA/N� � � HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name H EATI NG LIN IT(OVER 100,000 B.T.U.)9.50 d✓
LcnJCr's Address ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
hibernation is correct. 1 agree to.comply with all Cily and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 Q
hemhy authorize representatives of this city to enter upon the �D
above-mentioned property for inspection purposes BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL F
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ranlfn o this per MECH.CONT. LIC.NO. MECH.
tariff
TOTAD S TOTAL
d
STgnat�cant/ Uudor Dateirudor Date �
OFFICE COPY