18598 POST THIS CARD NEAR FRONT OF BUILDING
' - PERMIT NUMp[H
' CITY OF CUPERTINO � g59g
INSPECTION DIVISION
JOB INS ECTIO RECORD
- - PERMIT EXPIRATION
JO B.ADDRESS -- U T# LOT PERMIT•EXPIRES IF WORK
OWNER - CONTRACTOR IS NOT..STARTED'WITHIN
INSPECTION DATE INSPECTOR W INSPECTION RECORD - 180 DAYS,OF PERMIT ISSU-
FOUNDATION - - ANCE OR.180 DAYS FROM
NOTE: -
UFER _ ALL GRADING'AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
P R EG U N I TE CUPERTINO STANDARD Ift
GARAGESLABS . • ', .. .,l "".+-- `, ;'}^'r,
POUR NO CONCRETE UNTIL ABOVE HAS.BEEN SIGNED - 1 -
UNDERGROUND /SLAB ��P 1"4 1000 J t t\ (1
PLUMBING CityDfFM
ELECTRICAL "�u,�/ ` ISSUANCE DATE
MECHANICAL , _ „ eLUr, ELECT PLC, MECH.
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - ''I' BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $/FT.
� - � � i -
MECHANICAL
ELECTRICAL
_ FR IT To
FRAMING
.A
INSULATION ST,PIES TYPE CONST H.
GChe..ar•
. - OCC GNODP fl[5 UNITS
PLACE Nd__SUBFF0_0if UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOIIAREA TOTALACREAGE
ROOF - - NOTE:NO FINALINSP.SHALL BE MADE BEFORE
40 DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING - - - - Iu;7;7wBUILDING USE
o aON .Pp - Dlnv,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
ROUGH SAN.q ASSE SSG HS PAR CC I.NO.
PLUMBING ELECT.ENERGY "
IHACTNO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE No.
FRAMING ELECT.FINAL TEST
Z
INSULATION PLUMBING
ZONING NC SITE NO.
'GAS TEST T GAS '
MECHANICAL FIRE SPRINK ENERGY T-14,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ "❑ ° ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC.
INTERIOR SHEAR FIRE DEPT. Y ❑ N v ❑ N�
SHEETROCK GRADE - ' FEE SUMMARY.
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS -BGII,DING SCRATCH COAT ELECTRIC PLAN CHECK
G
FEE
AS - .,—sm.>•"
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING'IS NOT PERMITTED UNTIL BUI LOING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTIONTBY PHONING 252-4505, ELECTRIC
F�' ONE WORKING DAY'BEFORE REQUIRED INSPECTION..PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMSINc
-
ZMECHANICAL
— SEE"PERMIT FOR EXPIRATION DATE ` S
IMPORTANTI CONST.TAX w.
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
0 BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
BUILDING APPLICATION & PERMIT 18598 Q C O
aDDflE55 ` U
R I`V\ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 18�J
O NER'a PLAN CHECK VALIDATION
TY. ELECTRIC PERMIT FEE
42-
NAMEflacroRs / UTLETS-SWITCHES-RECEP 10.00/1.00
j� No. 3S(VO LIGHTING FIXTURES 10.00/1.00
ADDRESS TORS APPLIANCES-RESIDENTIAL 4.00 ,
I�Al ` PRONE 3 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
oR PANELS (OVER 200 AMPI 20.00
ENGINEER
LIC NO. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 t
ZIP EMP.METER R,P INS. 20.00
APPLICANTS MOTORS EE SCH. \LJ
ADDREooflsss ^ 1
SERVICE CHA Gill 20.00
M.o LICENSED CONTRACTORS DECLARATION
av�, I hereby affirm that I am licensed under provisions of Chapter 9 l
¢ ISSUANCE DATE
(colnmencing with S,eflon 7000)of Division 3 of the Business and
w i Professions Codeynd license is in full ftirifteff c ❑ ❑ ❑
Z O w - License Class S= Lic.N, be, BLDG. ELECT. PLG. MECH.
Q- 0
"Q Y O
Date-Q___UTL_, Conlr:Ictor_ � _(11_Iyrp- p ,
¢ ¢ w a a 1"IOWNF.R.BUILDER DECLARATION 1"'•s9 BUILDING PERMIT
W0 a" - . INFORMATION
3: LL F 1 hereby affinn that I am exempt from Ilse Contractor's License MISC. REFER TO ORD
HLLO< Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION $/FT.
Code:Any city or County which requires a permit to construct,alteq 10.00
rtmT ELEC.CONTR. LIC.NO'
¢ ¢ improve,demolish,or repair any structure,are,prior LLI its issuance,also ELEC.
m¢ requires the applicant for such permit to file a signed statement that TOTAL
i
w he is Chap pursuaTo nt with Section the Co:IDivisi53 License
PER TTO
H i i Law(Chapter and 9(commencing or Section is exempt theiui 3 and
4 o Business and Professions Coder or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H - thebasis for the allegedernifsbje Any applicant
to a Civil penalty malty 6T0 IE6 TYPE CONSTR.
e. , by any applicant fora permirsuhllar'the Bpplicam toaeivil penally ALTER-DRAIN -WATERAEA.) 5.00'
of not more than five hundred dollar'($500].): I
❑ 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. ROUP RES.UwTS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5,00
Code:The Contractor's License Law does not apply to to owner of
properly who builds or improves Thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA. TOTAL ACREAGE
himself or Through his own employees,provided that such improve-
memsare not intended croffmcd forsale.l f;howcver,On,burning GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,The owner- GAS-EA.SYSTEM-OVER 4 1EA.) 2.00
builder will have The burden of proving that he did not build or im- BUILDING USE
prove for 1,aso neeose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES _ I❑ ❑N ❑ O❑
❑ d as owner of the property,ant exclusively contracting with125
licensed contractors to a C....tot the pmcenT(Sea. 7044,Business LAWN SPRINKLERS-1 IVC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code'.The Contractor's License s th docs opt apply _
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts t'ar'esor l License
widl a cnnlrugor(s)licensed pursuam m SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT N0. PARCEL NO.
❑ Pant exempt under Sec...B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.05 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'I'ION IMCLARA'MON WATER TREATING EQUIP. 5,00 I -
I hereby affirm that I have a cenilicew of consent to self-insure,
or a certifluste of Workers'Compensation Insurance,or it certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab C.).
Policy N Com ny
o ❑ err lie cop,is her 1 a niche .
z 2 Cert ie 'o ix t t ins m division. FIRESPRINK ,ENERGY T-24'
O Applicant--
P
pplicant_ MISC.- REFER TO ORD. v NO v N�
W CI!RTIh ATI'OP EXEMPTION FR WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.OL.
LU 7 C0.11PENSATION INSUR CI
PLG.CONTR. LIC.NO. PLG.
CL CI (Phis section need not be completed it the permit is (,it one TOTAL V N Y N
- 2 hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which ill's per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner seas to
O become subject to the Workers Compensation Laws of California.
LIE
Datc Applicant I BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate 61 Hx- ALTER OR ADD TO MECH. 5.00
H 2 emption,you should become subject to the Workers'Compeasat ion APPLIANCE 5.00 PLAN CHECK
provisions of 111c Lahr, Code, you must,hitthwilh comply with FEE
V such provisions or this permit shell be deemed revoked. AIR HANDLING UNIT ITO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY. AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE �.--
1 hereby affirm that there is a construction leading agency for EXHAUST HOOD (WITH DUCT) 5.00 _
the performance of Dm 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
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify Thal l have read this application and state that the above VENTILATION FAN (SINGLO 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
herebhereby authorise representatives of This city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
y
out
above-mentioned properly forinspe of
purposes.
(We) agree to save, indemnify and keep limitless the City of MISC.- REFER TO ORD.
Cupertino again9 IiaE lines,judgments, costs and expenses which CONST.TAX 1 `
my in any way accnm against smiA City in Consequunee of the PERMIT ISSUANCE 10.00
ming oLihis ern't MECH.CONT. LIC.NO. MECH. �V
TOTAL TOTAL
$i a re o(Applicanr/Contractor Uate . �
OFFICE COPY i'