18627 . POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 18627
INSPECTION DIVISION
JOB INSPECTION RECORD
�—•p PER/N1yyE XPIRATION
JOB ADDRESS UNIT# _,LOT#"
- / P RMIT EXPIRESAF WORK
OWNER Daae G10� CONTRACTOR - (, �Q�,•`.(.� , ,8• *OT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD180 DAYS OF PERMIT ISSU.
FOUNDATION .NOTE: ANCE ORLLED INSPECTION.DAYS FROM
' •
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
LAS A
• PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF Pe Rn+rt VALIDATION
_ CUPERTINO STANDARDS. �•G C
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p�� f"
UNDERGROUND /SLAB p.All� �,
PLUMBING '
ELECTRICAL T•D 01989 .
ISSUANCE DATE
MECHANICAL BUA: ELECT. , PLG. ER
a dao'. . , ❑ � ❑ ' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT,
MECHANICAL
ELECTRICAL (/ PERM T TO 1'•_—
FRAMING
'INSULATION - STORIES TYPE CONSTR,
- OCC GROUP RES UNITS
,,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
_
ROOF . NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO-iT rLoal Aln.A TOTAL ACREAnE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING IND CON Po Do—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDIMECHANIC
FINALS DATE INSP. - ❑ • ❑ ❑ ❑
.ASSESSORS PARCEL NO.
ROUGH
PLUMBING ENERGY'
TRACT NO. PARCEL NO
` TUBS&SHOWER PAN - ' ING ENERGY
MECHANICAL ENE -
ACC DATE ACC,FILE NO
. ELECTRICAL NG E -
FRAMING ' " FIN /
.ZONING ENG.SITE NO.
INSULATION NG
GAS TEST '
CFIRE SPRiNrc EN[RGV T-aa
COVER NO WORK UNTIL ABOVE HASBEEN SIGNED G v ❑ NNFLOOD ZONE AL UC.
EXTERIOR SHEAR RI AL R L E
INTERIOR SHEAR FIRE DEPT.' Y❑ D v ❑ No
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 OCCUPANCY' SEISMIC FEE ;)L..•1
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
,IE ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING --
�� PLEASE GIVE JOB ADDRESS WHEN'PHONING.
' - SEE PERMIT FOR EXPIRATION DATE'= MECHANICAL !, /
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL TOTAL INSPECTION.' 11U
OFFICE COPY
. ,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.BUILDING PR CT IDE TIFICATION APPLICATION & PERMIT
PERMIT NUMBER
18627
BmLm
ADDRESS NG y,� .;
'
C9 aS BUILDING -ELECTRICAL-PLUMBING-MECHANICAL +
OWNER'S PLAN CHECK VALIDATION
NAME
/� ^ p OTY. ELECTRIC PERMIT FEE 1 `� G GL^ I O D ONE '
CONTRACTORS
NAME l3 SOd ,. ' OUTLETS-SWITCHES-RECEP 10.0011.00 /
'(( L4.�'2 t..T� ♦ • o,%& Ilk We LIGHTING FIXTURES 10.00/1.00
ADDRESS TORS _ APPLIANCES-RESIDENTIAL 4.00 -
a�n•v I •� G 3G PANELS 10.00 -
DATE OF APPLICATION w
ARCHITECT - PLAN CHECK FIFE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 -�
ENGINEER
- UC,NG SIGNS TRANS. 3.00
noo Ess ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
IIP TEMP.METER OR POLE INS. 20.00
�IyGC s
APP IRCESS s
ADDflEA MOTORS SEE FEE SCH.
SERVICE CHAN E 20.00
o o LICENSED CONTRACTORS DECLARATION _ -
a u u 1 hereby affirm that 1 um licensed under provisions of Chapter 9
Z w ISSUANCE GATE
N 1$ (commencing with Section 7000).of Division 3 of the business and C
F 7 2 Professions Cotl I py license s in tui lure•and c(j� `' BLDG. ELECT. PLG. :MECH.
Z .00 ; Lice nse Cha V Lic.Numh ( QSEl El 11
F m r J
Date-CL Lu� ��Contmcto L-(_w(y, /y,'�
sc a w a I OWNER-BUILDFh)nCLAR� V �! ` ✓�R9� BUILDING PERMIT
d MISC.-' REFER TO ORD INFORMATION
t'xu g r 1 hereby affirm that I am exempt front lhu CoNruetor's License
m u o so Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION $/FT.
Code:An cit 10.00
Any city countywhich structure permit tots issuance.
also ELEC.CONTR. LtG.NO.
St
2 4 0 improve,Demolish,nr repair any structure,prior to its issuance,also ELEG.
n u
o LL requires the applicant for such permit to file a signed statement that TOTAL
w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
i Law(Chapter 9(commencing with Section 7000)o(Division 3 ofthe J
io Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
f o the basis for the alleged exemption.Any violation of Seel ion 7031.5 STORIES TYPE CONSTR.
e- '2 by any applicant for u purmit su bjects the applicant to a civil penalty -
ofnetmore'(Iran five hundred dollars(S500).): - ALTER-DRAIN&VENT-WATER (EA.) 5.00 '
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00
their sole compensation,will do tire .e work,and the structure is not OCC.GROUP- RES:UNITS
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00 '
Code:.The Contractor's License Law Joe,not apply to an owner of
property who builds or improves then om and who does such work FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTALACREAGE
ofeltrulf re of rote his own employees, le.If,cd thin such int building
-
mmselfenatintendeJorofferedforsalu.lf,ed that however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 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 proving that he did not build or am- BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 E IND ❑N 1PB:1 1:1❑ I,as owner of the properly,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.8. 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 contruutons)hecosed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
0 I um exempt und¢r Sec. ,B.&P.C.for 111 is anon WATER HEATER W/VENT 6.00
Owner Date - WATER SYSTEM, 5.00 ACC.DATE ACO.FILE NO.
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
or it certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab,C.). - -
Policy No. Company
Q ❑ Certified Eopy is herebyhed '• ' FIRE SPRINK ENERGY T-24
Z Z )[1` Cer- d Cop is fe ilh the c" L2ion s' n.
F O /CpllBcunt _ _ �- misc.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
Q: N CERTI FICATEOF EXIT ION IBOM WO IiRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W COMPENSWION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 O 'f'fbis section need not be contplcted if the permit is fur one TOTAL V❑ N❑ Y❑ N❑
Z) Z hundred dollars(S 100)or less.)
U O I Certify that in the pprfonnunce of the work for which this per- QTY MECHANICAL'PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any Person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Uuta Applicant ALTER OR ADD TO MECH. 5.00 BUILDING ►+�
} 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex.
2 emption,you should become subject to the Workers Cmupensalion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall he decmat revoked AIR HANDLING UNIT TO 1Q000C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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.isood(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT•(TO 100,000 B.T.U.)' SRO kU
Lender's Name
Lender's Address - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC �-
Icertifythatlhavereadthisepplicatlonandstxtethatfheabove VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER•COMP(3 H.P,or 100,000 B.T.U.) 6.00 PLUMBING
III . ordinances and.state laws relating to building construction. and
a5boveherelfmuutioned ,ropertyresefatives of this city to enter upon the BOILER-COMP(Over 100.000 BTU)SEE FEE SCH. MECHANICAL t 1 II
bove-men[ionetl property for inspection purposes. O( YLZ'
_(We) ail""16 save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX
may in any way accrue against a City in consequent of the 16:40 / /
rant'IP got lis Perini s
MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
signature of Applie Con[mmor Date el 1 �
�`I $� OFFICE COPY