14419 POST THIS CARD NEAR FRONT OF BUILDING'
PERMIT NUMBER
` -CITY�ODIVISION
CUPERTINO 14419
INSPECTION
/y{19B I ISPECTION RECORD `
• wL!v�^ /�� --77'� / • 1f1 -1I/ I PERMIT,EXPIRATION
DRESS G'�LP�l . I:' �^'� _ S# _LOT# 11 .
/,1 J � 'PERMIT EXPIRES IF WORK
OWNER ILLTLIL, CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPIECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION
ANCE OR 180 DAYS FROM
- NOTE: LASTCALLEDINSPECTION.
UFER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. .
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL • IS�S� . M
UA{�NCE DA rE
MECHANICAL 'EYJO PLC. EmH
_ 1QYYyJ�{
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu1Lo PERMITI- r
it}F2MATION U`,:.,,
WOOD FLOOR'' ALUATIDN SIFT.
PLUMBIry
MF.CHANICA
ELECTRICAL `II {,- rBRMlr ro
FRAMING
INSULA T NE STORIES TYPE CONSTR.
DA's
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- 50 'T 1'LOOR AHEA TOTAL AGREA(W
• ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID .
BUILDING use
ROOF SHEATHING - - - . -- -1 as IND WN nB'- 0,1-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.M
ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY -
TRACT No PARCEL No
TUBS&SHOWER PAN PLUMBING ENERGY A
.
MECHANICAL d. MECH.ENERGY '
ELECTRICAL BUILDING ENERGY ACC DATE Acr..EILF NO
FRAMING ELECT.FINAL TEAT
ZONING ENG.SITE NO.
INSULATION \ PLUMBING
GAS TEST GAS
MECHANICAL ' FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] "Q ❑ "❑'
FLOOD ZONE AL LLC
EXTERIOR SHEAR ELECTRICAL RELEASE
/ ❑ N❑ L N❑
INTERIOR SHEAR FIRE DEPT.
SHEETROCK , - Z GRADE FEE SUMMARY
• EXTERIOR LATH 'LAO - - BUILDING '
INTERIOR LATH TEMPORARY APPROVALS BUDDING ,:
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. - SEISMIC FEE (�
OCCUPANCY OF BUILDING IS NOT FERMI TTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM '
LU ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC ?
F .ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
zo PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL,
IMPORTANT! coNsr.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL _• 3o ,1/(e
CALLING FOR FINALANSPECTION.
OFFICE COPY
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL-POINT PEN ONLY,
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 14419
ADDRESS
206SI LoaKIGUGS Alb BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
•OWNER'S PLAN CHECK VALIDATION
NAME (L'(.n'F yI DTV. ELECTRIC PERMIT FEE yt•7
CONTRACTOR
lCE LElul$ PHONE'04116-410R
NAM>ERacroas OUTLETS-SWITCHES-RECEP 10.00/1.00
LiC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ORCHITEcr PANELS (OVER 200 AMPI 20:0Q PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No ISIGNS TRANS. 3.00
ADDRESS ErvcSPECIAL CIRCUIT 5.00 PERMIT VALIDATION
. zm TEMP. METER OR POLE INS. 20.00 ^
77-ZZ-.79- MOTORS SEE FEE SCH.
ADORE SS
SS
SERVICE CHANGE 20.00 Q,y✓
O o LICENSED CONTRACTORS DECLARATION
¢ v�' I hereby affrm,thel I am licensed under provisions of Cha ter9
¢ Y p p SSUANCE DATE -
w (commencing with Section 7000)of Division 3 of the Business and
ra < HBL ELECT. PLG. MECH.
I-w z Professions Code,and my license is Nfull force and effect J
License Class u
Lic.Nmber IY/JN\
o T r w Dale - Contractor
st m E - - UILDING PERMIT
¢ ¢ w� OWNIi R-BUILDER DECLARATION _
w;u y - 1 hereby affirm Owl 1 ant exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
ec O j Law for the following reason.(Sec.7031.5,Business and Professions ! VALUATION S/FT.
_ PERMIT ISSUANCE .fB�O
Code:Any city or county which requires a permit to construct,alter'
rIS2¢ 2 improve, or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC. .� �<`� /
u requires the applicant for such permit to file a signed statement that TOTAL R )
6
se 0. he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
r;Zi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 7-,
the
i a Business unit Professions Code)or that lac is exempt therefrom and GTV. �,PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Seelion7031.5 STORIES TYPE CONSTR.
n ;^ by any applicant for u pe nnit subjects the applicant to a civil penalty
of not more than five hundred dollars(8500).1: 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 or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 0V
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered for sale.I G however.file building GAS-EA.SYSTEM-1INC.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 h . . .
u did not build or im- BUILDING USE
•
seIfor purpose of sale.). RES IND CON Pa Other
I,as owner of the property,am exclusively amtructng with INDUSTRIAL WASTE INTER. 30.00 11 ❑ 1] O Elli d contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply ,
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forsuch projects with a coutractor(s)licensed,pursuant ht
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 ! TRACT NO, PAHCEL NO,
ad tum exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner DateWATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. .5.00
I hereby affirm that 1 have a certificate of consent to sel Giusure,
ora certificate of Workers'Compensation Insurance,ora certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. _
Policy No. Company
O ❑ Certified copy is llerehy furnished. FIRE SPRINK ENERGY T-24
Z Z O Certified copy is filed with-the city inspection division.
O Applicant MISC.- REFER TO ORD, Y � N Y❑ NE]
D CERTIFICATEOF F-XEMMION FROM WORKERS' PERMIT ISSUANCE .iAr69 (02 FLOOD ZONE A.L.u.C.
UJ > COMPENSATION INSURANCE I PLG.CONTR. LIC.NO. I.G.PaO00 Y� N� Y� IN C]
CL Z This Section need tat be completed if the permit is for one TOTAL
• hundred dollars IS 100)00 less.) -
U 0 J certify that in one performance of the work for which this per GTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,1 Shall not employ any person in any manner so as In
Q w become subject to the Workers'Compensation Laws of California.
d Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING as e
} to NGlIC17 TO APPLICAN'C If,after making this Certiflaxim of 1ix-
♦- 2 empfion,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 1G=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE -
I hereby afluin 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,Civ.CJ. 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 e+
1 certify that I have read this applicaflon and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct. I agree to comply with all City and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 :.• PLUMBING aQ 0✓
ordinances and state laws relating to building construction, anJ
hereby authorize representatives of this city to enter upon ale BOILER-COMP Over 100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned properly for inspection purposes,
(We) agrw to save, indemnify and keep harmless the City of - MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,costs and expenses which PERMIT ISSUANCE ,1geog CONST.TAX
may in any way,uccraa against said City in wnsequenee of the
•ranli{tg of this permit.- MECN.CONT. LIC.NO. MECH.
�J`^l'/ -x.v-•. ty^+-s
lz-z
F y� TOTAL a�OBD TOTAL p
Signatureofr(Cijplicant/Contractor Ua[e •�
OFFICE COPY