17005 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 17005
INSPECTION DIVISION
JOB-INSPECTION
RE ORD
yF/
l�� L PERMT EXFPI AT,ION,
I
JOB ADDRESS �ILILL�r •P UNIT# LOT#j CY
((( PERMIT EXPIRES IF WORK
owrvER CONTRACTOR •� IS NOT STARTED' WITHIN
I SPE CTI ON DATE I INSPECTOR INSP CTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONI ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED-
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEE T+vALID TION
CUPERTINO ST DARDS. A �` �y
GARAGE SLABS I •v
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED A
UNDERGROUND /SLAB V�Lt',V�,LIJ!•v- "L.
PLUMBING -
ELECTRICAL ISSUANCE DATE
MECHANICAL @rC _�c •p+« eu ELECT PEE. MecR
❑ ❑ ❑
DO NOT-POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
_ 6
MECHANICAL -� lnn
.n .P,ERMrt T
ELECTRICAL
FRAMING
INSULATION — STORIES - TYPE CrNSEEL
OCC. GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT FLOOR AREA TOTALACREAGE
-ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
o BUILDING USE
ROOF SHEATHING - RES IND CON PB Cmr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El 0 ❑ ❑ E]
ASSESSORS FARCE[.NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
I' TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No PARCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ' ACC DATE ACC FILE NO
FRAMING Il ELECT,FINAL TEST
ZONING ENG SITE NO
INSULATION � � CLIMBING
GAS TEST AS
FIR E,SPfl INK ENERGY i-24
MECHANICAL YE] NL Y L NL
• COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD mrve al
EXTERIOR SHEAR ELECTRICAL RELEASE I
.INTERIOR SHEAR FIRE DEPT. YE] N� Y rv�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING , Y,
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK'
GAS FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE b'�T
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDI NG FINAL ISSIGNED BY.BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
oPL'EASE GIVE.JOB ADDRESS WHEN PHONING.
Iw Z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! • CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
-CALLING FOR FINAL INSPECTION.
•
OFFICE COPY
t
00.S
od
J
- - .. .x,.11% :irf� P� ''i• ,if:. � - -
1 APPLICANT TO. FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
r ,
BUILDING PROJECT IDENTIFICATION . • 'r 'PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS
P 1700
19055 Pruneridge Ave. (p BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
F•
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
Hewlett Packard PHDNE447-0523
NOME ACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 YC� 02
uc.NO. LIGHTING FIXTURES 10.00/1.00
CRERADRESCTOR's
ADPPLIANCES-RESIDENTIAL 4.00
HONE PANELS 10.00 DATE OF APPLICATION e
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR . 727-- PANELS (OVER 200 AMP) 20.00
ENGINEEMiomir BNikir� C18 7 5
I .No SIGNS TRANS. 3.00
ARICK OR
ADDRESS ENG SPECIALCIRCUIT 5.00 PERMIT VALIDATION
al EMP.METER OR POLE INS. 20.00 7 ,X
APPLICANTS MOTORS SEE FEE SCH. v�
ADDRESS
10900 Wolfe Rd SERVICE CHANGE 20.00
2 F
0
0oo LICENSED CONTRACTORS DECLARATION
¢ i w I hereby affirm Ilett I am licensed Linder provisions of Chapter 9 ISSUANCE DATE
Han (commencing with Section 7000)of Division 3 or the Business and LDG. ELECT. PLG. MECH.
_r M z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
o i w O Date
Class Lin.Number ply,M
H m r j Date Contru nib !(u Of GUAMM
BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
c i u INFORMATION
w5 u. r I hereby affirm that I am exempt from the Centocor i License MISC.- REFER TO ORD
F .. O a Law for the following reason.(Sec.7031.5,lhearessund Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
,7)y Code:Anycity orcounty which requires a permit to Construct,alter,
¢ 2 a 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
u wm u requires the applicant far such permit to file a signed statement that TOTAL PERMIT TO
provisions is licensed pursuant to the provisioof the Contractor's License
r 2 i Luw)Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
W r the basis far the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n 3 - by any applicant for a permit subjects the applicant toa civil penally
or of more than five hundred dollars(S500).)! ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,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 Lir 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
properly who builds or Improves thereon,and who apes such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- i
Fla mems arc not intended or offered for sale.ll',however,the h till ing GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA ) 200 Baa DING uSE
builder will have the burden of proving that he slid not build or im . . .
RES IND CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000
❑ Las owner of the property,ran exclusively contracting with . .
❑ ❑ D ❑ 1
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cade:The Contractor's License Law does not apply i
to au owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a comractm(s)licensed pursuant to SEWER-SANITARYV-STORM EA.200ft/10.00
the Contractor's license Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec...IL&P.C.for this WATER HEATER W/VENT 6.00
i reason
Owne` Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORT:ERS'COMPF.NSAT ION D17CLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent or a certiued ZONING ENG.SITE NO. ;ll
co a certificate thereof
of Workers'ri Compensal ion Insurance,or u certified JII
copy thereof(Sec.3gCo Labkpang )..
Policy No. Company
Q ❑ Certified copy is hereby famished. FIRESPRINK ENERGY T-24
Z 2 ;W-Certified py is filed with the city inspection division.
O Applicant - MISC.- REFER TO ORD. Yo N[] Y ❑ N[]
Ln� CIiRTI PIC OP I N NRO ORKIRS'
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSA'6OINSURANCE
PLG.CONTR. LIC.No. PLG.
Z (This section need not be completed if the permit is for one TOTAL Y N� Y N�
hundred dollars(S 100)or less.)
U O ' 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W 1- mit is issued,1 shall not employ any person in any manner so us to
O W become subject to the Workers'Compensation Laws of California. !U
CL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �b Cs
} W NOTICE TO APPLICANT': If,after making this Certificate of Ex-
F ? cum!ion,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
Prov'
s ions of the Labor Code, you must forthwith comply with FEE
C.1 such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 _
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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.L 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'
1 certify that I have read this application;md stale thin the ahove VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply wish all city and cotmly PLUMBING
ordinances and state laws relating to boilJing construction, and BOILER-COMPI3H.P.or100,000B.T.U.) 6.00
hereby authorize represental fives of this city to emer upon the BOILER-COMP IOver 100,000 BTU)SEE FEESCH. 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 Lind expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
61lanting of his permit. MECH.CONT. LIC.N0. MECH.
TOTAL TOTAL e
Signa ure of Applicant/Contractor Date f
OFFICE COPY
L