14911 POST THIS CARD NEAR FRONT OF BUILDING
.. PERMIT NUMBER
CITY OF, CUPERTINO' 14911
INSPECTION DIVISION
JOB-INSPECTION RECORD ,
PERMIT EXPIRATION
*�°+^ JOB ADDRESS, 205 3 ;ROd71CJlleS Avenue UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER Jeff/Glad S .KWOk CONTRACTOR' IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR- INSPECTION RECORD 180 DAYS OF PERMIT ISSU..
FOUNDATION3 NOTE: - ANCE OR ED INSPECTION.
L 180 DAYS FROM. ,.
UFER� ALL.GRADING AND DRAINAGE SHALL BE INSTALLED -
LASTCAL
PREGUNITE - - - '• - TO COMPLY WITH THE APPROVED PLANS AND CITY'OF PERMIT VALIDATION
CUPERTINO STANDARDS. •,,,-y;,...
GARAGE SLABS nJ -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - Y
ELECTRICAL' '
ISSUANCE DATE:
MECHANICAL . . gLUC, .ELEC•1I PLc, MEC'L
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
_ -� INFORMATION
WOOD,FLOOR
PLUMBING' VALUATION $t ET.
� - - - � �•
MECHANICAL
ELECTRICAL
FRAMING
INSULATION srn RlEs TYPE CONSTR,
//2y� 0•t i%�ouT'"n .w�ry.yJuc✓ OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED p—i/
ROOF _ NOTE:NO FIN INSP.SHALL BE MADE BEFORE so IT.FLOOR AREA TOTAL ACRcact
DIAPHRAGM THE CONSTRUCTION TAX IS PAID USE
UILDING
B
ROOF SHEATHING ° Res IND CON PB 0,I.-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 4ifNALS DATE INSP. ❑ ❑ ❑ ❑ El
ASSESSORS PARCEL NO.
-ROUGH _ N.
PLUMBING 0 LEFT.ENERGY - -
' TUBSBSHOWER PAN - PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY -
ELECTRICAL id' BUILDING ENERGY ACC.DATE ACC,FILE NO.
FRAMING ELECT.FINAL TEST
_ ,ZONINGENG.SITE NO,
INSULATION PLUMBING
GASTEST - GAS
FIRE SPRINK ENF.RGV L24
MECHANICAL -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v "� ° "�.
y.^ I� vLDOD 2ON[ A L o.C.
- EXTERIOR SHEAR ELECTRICAL RELEASE `yam
INTERIOR SHEAR - FIRE DEPT, Y ❑ ., N❑ v ❑ N�],
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH _ BUILDING '
INTERIOR LATH TEMPORARY APPROVAL BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED'INSPECTION. . PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. '
OFFICE COPY
r �S
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
1§11JI LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING
ADDRESS OWNER'S CA-oDRIGU55 Ub., APPLICATION & PERMIT 1 Q 11
2,0573 R BUILDING —ELECTRICAL—PLUMBIN1491 SIG—, ;-x
uPcRT�n10 Sar¢
~Y1; NAME
JG! rj GS KwoK QTYELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
Cf}DYPRGrvEZSS'9ST'O
/ CONTRACTORS
�4 NAME JEF UTLETS-SWITCHES-RECEP 10.00/1.00 1
LIC.No. / LIGHTING FIXTURES 10.00/1.00 Ifo CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
'HONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
oR / PANELS (OVER 200 AMP) - 20.00
ENGINEER TIA-1161 r YU/�y
/ LIC.NO.RCE 2S-1_L3__SIGNS TRANS. 3.00
ARCH. ENc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR'POLE INS. 20.00 . p
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
o 5��/ep,
F o LICENSED CONTRACTORS DECLARATION UU
a U w1 hereby afOfm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(cummeneing with Section 7000)of Division 3 of the Business and
¢ B 5 ELECT.
y PLO. MECH.
H o z Professions Code,and my license is in full force and effect. 1 ❑. ❑
z o y_ — License Class Lic.Number -
o w w Dale CONfaCtor
< xrM11LDING PERMIT
¢ x w OWNIi R-BUILDER DECLARA'T'ION �s�"`11
w ;LL w I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD NFORMATION
r u.o J Law for the following reason.ISac.7031.5,Business and 1'rofessinns PERMIT ISSUANCE •.70.00 VALUATION $/FT.
Code:Any city orcounty which requires a permit to construct,alter,
¢ ¢ ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. Uy '
a w m¢ requires the applicant for such permit t0 File a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
Fii Live(Chapter 9(ecmme"cingwithSection 7000)ofDivision3ofthe �1ddiTc,ow '
4 ¢o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for x pelnhit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500j):
❑ 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 d"the work;and the structure is not
Intended or.offered for sale (Sea 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 TRAP5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.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 EASYSTEM OVER 4 (EA.) 200
builder will have the burden of proving that he did notbuild or in - . - . .
to BUILDING USE
RES
prove for purpose of sated. - INDUSTRIAL WASTE INTER. 30.00
IND CON PB Gol,
as owner of the properly,am exclusively contracting with 11 -❑ . 11 Ellicensedd contractors to construct the project La does,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License s therces not apply
to contracts
owner of property who builds or improves thereon,and won LAWN SPRINKLERS-OVER 5 (EA.) 1.00
[lie Contract suchLiceneLts witllawntmdorf sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. ,PARCEL NO.
❑ lam Cxemptunder See. ,B.&P.C.forthls WATER HEATER W/VENT - 6.00
\^ reason
N Owner Did WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS' MPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent In self-Insure,
or a certificate of Workers'Compensation Insurance,ora certified ZONING ENG.SITE NO.
copy thereof(Sec-3800,Lab.C.L
Policy No, Company "
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y. IN E] Y N❑
M m PERMIT ISSUANCE 10.00
� — CERTI EICCO1 IPE SATIOT'INS FROM WORKIiRS' FLOOD ZONE A.L.U.C.
W � COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG.
CL Z (This section need,not he completed if tile on
e permit is for e - TOTAL Y❑ N❑ Y F] N❑
hundred dollars(S 100)or leas.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
EL I. mit is issueA, I shall not employ any person in any manner so as to
O W become subject to the Workers'Conhpemsulion Laws of California.
y Datc Appl.cam ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Iix-
F Z caption,you should become subject to the Workers Compensation 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=C.F.M.) 4.00 //
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE S Y
I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00 -
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CivC.). 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 AJJress ELECTRIC f Sa
I certify that I have read tIli,application and slate Ihal the above VENTILATION FAN (SINGLE) .4.00
information is correct. I agree to comply with all city and County PLUMBING
ordinances and state laws relating In building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP IGVBr 100,000 BTU)SEE FEE SCH: MECHANICAL
(We) agree to save, indemnify unit keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which - CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE , 10_.00
ranting of lis pe nil. /A f / MECH.CONT. LIC.NO. MECH.
/L
' O1Y!-/ `s �ZFo_ TOTALTOTAL -,3 4 R:
Signature of Applic /Contractor - Date
OFFICE COPY