17403-Lots A & B POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17403
INSPECTION DIVISION
JOB INSPECTION RECORD
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� ��� ,, � � PERMIT EXPIRATION
• JOB ADDRESS _4 ✓° ^'
��P UNIT# _LOT# !t.. .
OWNER 1,�' \ L ORK
IS NOPERMIT STAIRTED WRES IF IT HIIN
Ser LV' ONTRACTOR y � ��{( � SO
INSPECTION0 DATE i't NSPECTOR -` INSPECTION RECORD- 180 DAYS DF PERMIT ISSU.
FOUNDATIONANCE OR 180 DAYSFROMlwtAg NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMD VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS „ 7
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Zq 1eiat05 - ✓
L.4- (2E1�1.19� 41 L.� { -
PLUMBING UNDERGROUND /SLAB L' :�y+ '+ y7.: '.•—
ELECTRICAL
ISSUANCE DATE
LG.
MECHANICAL Q��y Of ou BLuc ELECT. Pc. -NECK.
3 �1 9Y Kw'FoQK5 0�
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I^3..Be 'Pim Ficl,-SVS cik BUILDING PERMIT;. .
WOOD FLOOR INFORMATION,'
VALUATION S/FT.
PLUMBING jI(/ 'p
MECHANICAL LTl.I,C (X><D "I �, v v D
ELECTRICALeenn"T iO /
FRAMING /t• 114
-
INSULATION STORIES TYPE CONSTR.
OCC:GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED,
ROOFNOTE:NO FINAL INSP,SHALL SO FT,FLOOD AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID MADE BEFORE D
BUILDIND USE
ROOF SHEATHING RES IND T. PB om.•
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED' ° : FINALS- r3.' '": DATE;-"r.: . INSP.-': L ❑ L L L
ASSESSORS PARCEL NO.
ROUGH SAN.a
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT N0, PARCEL NO.
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACCFILE NO,
FRAMING ELECT.FINAL TEST
INSULATION. ZONING ENc.SITE No.
PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENER] TIN
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y L NE ` E o
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOOD ZONE A.L.U.C.
INTERIOR SHEAR FIRE DEPT. vNL Y L "�
SHEETROCK GRADE FEE SUMMARY .?
EXTERIOR LATH BUILDING BUILDING D O
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occu PANcv SEISMIC FEE 'E
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
-* 0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
. z
— SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL
IMPORTANT! CONST, TAX
PLEASE READ REVERSE SIDE BEFORE I TOTAL Z6��
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.,qUl 1-nI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 17403
AD EBB e Ls9c/Q
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
(�G.�w.r/CH PHONE
O NANTRncroasRECEP 10.00/1.00
NAME � UTLETS-SWITCHES- rp �V
r D
LIC.NoILIGHTING FIXTURES 10.00/1.00
CONTRACTORS or � APPLIANCES-RESIDENTIAL 4.00
Do
Aness r/p
/ ZQ ,VA Z PHONE 3 y-7V6 r PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 20
ENGINEER 0 AMP) 20.00 PLANCHECK FEE P.C.NO.
OR
Loc.NO. ISIGNS TRANS. 3.00
Roo ESS ENc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH. 6
ADDRESS
SERVICE CHANGE - 20.00 'f
a o LICENSED CONTRACTORS DECLARATION Jin u u I hereby affirm that I am licensed under provisions of Chapter 1) al ISSUANCE DATE
h Q v6i (commencing with Section 7000)of Division 3 of the Business andEd ,J ,. BLO ELECT. PLG. MECH.
H m z Professions Code,and my license is in full force and effect El 1:1 ❑
z 0 w - License ClassLic.Number
q w H Date Contractor
a y s City Of CUped►uO BUILDING PERMIT
¢ ¢
in a OWNER-BUILDER DECLARATION INFORMATION
D A U REFER TO ORD
W H 1 hereby collo that I am exempt from the Contractor's License MISC.-
VALUATION'` $/FT.
FLLNj Lawforthefollowingreason.(Sec. uires a•ermit is and Professions PERMIT ISSUANCE 10.00 V
Code:Any city or county which requiresa permit construct,alter, (/ D U
ia¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. 1
-O¢ requires the applicant for such permit to file a signed statrmam that TOTAL fi TO
wm u- he is licensed pursuant to the provisions of the Contractor's License
H z
to LawCha ter 9(commencin with Section 7000)of Division 3 ofthe - I,
Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT - FEE"
in F o the basis for the alleged exemption.Any violation of Section7031.$ STORIES TYPE CONSTR.
au ate _ by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER IEA.) 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
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
me is are not intended or offered for MIC If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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 provins that he did not build or am.
BUILDING USE
Prove for purpose ofsida.). .RES IND CON PB Omer
INDUSTRIAL WASTE INTER. 30.00
❑ as owner of the property, exclusively contracting with ❑ El E) El
dd contractors to construct the
project(Sew 7044,lousiness LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and n owner of Cade:The Contractor'sbuildLicense Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.1 1.00
I. contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ 1 um exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-Imanre, ZONING ENG.SITE N0.
or a cenifiwte of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.CJ.
Policy ND. Company
p ❑ Cllnifie yla hereby fi msed. FIRE SPRINK ENERGY T 24
Z Z .T ;C ifl c y is fled ylwrthe ciry in, enion division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
0 APPlic:mt - _ V N V N
2 w CERT 'ICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
IL > - COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
(L 0Z IThis section need not be completed if the Penn it is for one TOTAL Y❑ N❑ Y[:] N[3N
Hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I shall Rol employ any person in any manner so as 1.
U
O become subject to the Workers'Compensation Laws of California.
w
6 Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Workers'
Comps of Ex
Z pr %isiemption,you should become Co subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK _
provisions io the labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be seemed revokes. AIR HANDLING UNIT(TO 10,000GF.NL) 4.00 �--�D
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE ( ' V
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance f the work or which this permit is Issue e. MICROFILM
3097,GIV,C.). I o 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 ry�� ELECTRIC
Icertify that l have read this application a0 it suite that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,0000.7.U.1 6.00
hereby authorize representatives ol' this city to enter upon the BOILER-COMP (Over 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.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
I
ay in any way accrue against Said City in consequence of the
ranting of this permit MECH.CONT. LIC.NO. MECH.
_
/J _! TOTAL TOTAL
Signature of Appdicjlpl mtramor Date - 1
OFFICE COPY