17285 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17285
'INSPECTION DIVISION
JOB INSPECTION RECORD
^D�7 PERMIT EXPIRATION
JOB ADDRESS_ /� UNIT,'*--LOT#
' PERMIT EXPIRES IF WORK
OWNER C �e. CONTRACTOR a ( 0 �/1 , IS NOT .STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GOADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHrvT VAI.IDATTON
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
PLUMBINGI -MRK U .I t� NIL�N`JT'L�
ELECTRICAL ,� .�J
ISSUANCE DATE
MECHANICALCity SLUG ELECT PLG. MECH
VV •0 0 o a
°. . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �_'3_ �C 1.� i BUILDING PERMIT
WOOD FLOOR a l INFORMATION
VALUATION SIFT.
PLUMBING
MECHANICAL ,7
ELECTRICAL - PERMIT ro /�
FRAMING hO
W('UNw(t INSULATION STORIES vPECONsrR,
OCC.GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEDa ROOF Su.IT PLOGIIIAREA TOTAL ACHEAOL
NOTDE BEF4ORE•IAPHRAGM THE CONSTRUCTIO
BUILDING USE
T` ROOF SHEATHING RES IND CON PB
T APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ \❑ ❑ ED
ROUGHSAN.k AssessORS PARCEL No
PLUMBING ELECT.ENERGY
TUBS B SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST '}
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPR INn ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ "',❑ ` ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE PLDDD ZONE nLOC.
INTERIOR SHEAR FIRE DEPT. v❑ NE) i ❑ NO
SHEETROCK GRADE
FEE SUMMARY
EXTERIOR LATH. BUILDING 4-V bU P
INTERIOR LATHTEMPORARYAPPROVALS// / BUILDING ' �p
SCRATCH COAT ELECTRIC - PLAN CHECK ('+
GAS. FEE ,iOJ;
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
1 ^ o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING:
SEE PERMIT FOR EXPIRATION DATE - !CONST.
CHANICA'C -
IMPORTANT! TAX
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
14V LDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER
"� ` ' 17285
A DRESS
ZOg-7z �(Q STT BUILDING-ELECTRICAL-PLUMBING-MECHANICAL °+s
OWNER'$ PLAN CHECK VALIDATION
e NAME CC/I Eft� ` PHONE ZSZ-�1� QTY. ELECTRIC PERMIT FEE
,
CONTRACTOR'S
NAMEpp 2- OUTLETS-SWITCHES-RECEP 10.00/1.00
Poor1S LIC,N0,27Fi2SZ 7- LIGHTING FIXTURES 10.00/1.00 1,00
aooeessTORs APPLIANCES-RESIDENTIAL 4.00
Z2A5_yG,rll--•`4' f/e, • J. PHONE /- Q / PANELS _IZED DATE OF APPLICATION'
ARCHITECT
OR I „ q /���
I PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.0.NO.
ENGINEEV/1�//1 caA uc No. ISIGNS TRANS. 3.00
ADDRESS sear. SPECIAL CIRCUIT 5.60 PERMIT VALIDATION
22•S$�mlp,,(/.�,Tc cS,J• ZIPN11z`/ EMP.METER OR POLE INS. 20.00 / _ �9
APPLICANT'E V I
ADDRESS MOTORS Z dP SEE FEE SCH. xQb
ez,q amt4.lAJe, S:� • ?,Jri2 SERVICE CHANGE 20.00
w ¢= Joe 440hVC ,;
H o o LICENSED CON'T'RACTORS DECLARATION
au w I hereby Affirm that 1 am licensed under provisions of Chapter 9
H <N (commencing with Section 7000)of Division 3 of the Business and �-1�9 v ISSUANCE DATE
n a Professions Code and my license is in full force and effect. JR„n H BLDG. ELECT. PLG. MECH.
z o m- License Clas Q Lin.Number
o w r w
Date_ Contractor
¢ ¢ w a
OWNER-BUILDER DECLARATION --`e -` wY�IYN! BUILDING PERMIT
o a U INFORMATION
X 0 m 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL U. 4 law for the following reason.(Sec.703 t.5,Business and Professions fy, VALUATIONa $/FT.
L - PERMIT ISSUANCE 10.00 a. 'S V
m y Code:Any mulish coo ray whiny fequiresa prior to its issuance,
appy lw V
Q E ¢ 0 rmpfOVs,hefa applicant
Of repair any permstruit
to tum,
e a signed
ne statllaeeq nIW ELEC.CONTR. LIC.NO. ELEC.
a
o¢ requires the applicmt for such permit to file a signed statemotl that TOTAL
w m w he is licensed pursuant to the provisions of the Contractors License l PERMIT TO
HiQLaw(Chapter 9(commencingwith Section 7000)of Division 3 ofthe 1
i o tlusiness and I'rolessiuns Code)or that ho
e is exempt therefrm TV
and O . PLUMBING PERMIT FEE 5�(µKL �
Lam•
¢ H m Ibe basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i 3 - by any applicant for a perrnit subjects the applicant to a civil penalty
of not mor,than five hminred dollars(5500).1: ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees will wages is BACK F LOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Busioell and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: The Contractor's License Law does not apply to am owner of
}T• � property who builds or improves thereon,and who does such work F IXTUR E$-PER TRAP 5.00 Sa FT.FLO0.AREA ToTALACREAGE
s himself of through his own employees,provided that such improve-
inX
^ ,�
ents are not intended of offered for sale.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
v♦ builder will have the burden of proving that he did not build of inn- BUILDING USE
prove for purpose of sale.). . INDUSTRIAL WASTE INTER. 30.00 0 IN❑D coN I] OOf
cens❑ I,as owner of the property,um exclusively contracting with
lied contractors to construct the project(Sec. 7044,Business LAWN SPRINKLER$-1 INC 5 V.B. 6.00 gBBE5S0 SPARCE_L NO.
and Professions Code:'The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contruelods)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200tt/10.00 TRACT NO. PA CELNO.
❑ 1 am exempt under Sec. ,N.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC FILE N0.
wORKIi RS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm [hat 1 have a certificate of consent to self-insure,
or a certificate of Workers Compensation Insurance,or a Certified ZONING ENG.SITE NO.
copy thereof(Sce.3800,Lab.C.).
Policy No. Company
0 ❑ Certified ropy is herchy furnished.
Z 2 �Cers ified opy i?) fly w44lh the city inspection diviaion. FIRE SPRINK ENERGY T 24
F• O APplicum ,suit_ omf,i MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ IN
w CH RT'I f ICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 1' OD FL000 ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO.
PLG.
(This section need not be completed if Thr pcnttil is far one TOTAL I�1� v❑ N❑ V❑ N�
U b hundred dollars(4100)or less)
I artily that in the performance of the work for which this per- QTV
LL U mit is issued,I she))not employ any'person in any nhanner so as to MECHANICAL PERMIT FEE FEE SUMMARY
become subject to the Workers'Compensation Laws of California.
Dateu, NOT ICANI: I BUILDING r I f�
} to NOTICE 'f0 AI'1'LApplic': If,afire making this Ccrtificatu of Ex- ALTER OR ADD TO MECH. 5.00 l v t
♦- ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Libor Code, you must forthwith comply with FEE 1 p• �
U such provisions of this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 O
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEEP47 , r1'L6
1 hereby affirmthus there is v construction lending agency toy EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work par which this permit is issued(Sec.
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC PC' IS,ro
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
v ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.of 100,000 B.T.U.) 6.00 PLUMBING
hereby imhorieu representatives of this city to enter upon the BOILER-COMP Fy,
above-mentioned property for inspection purposes, (Over 100,000 BTUI SEE FEE SCH. r MECHANIC L , �g ',y
(We) agree to save, indemnify and keep hunnless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which ^ CONST.TAX
,may in any wry accrue vgoinst said City in consequence of the PERMIT ISSUANCE 10.00 U�
lingo his a n' MECH.CONT. LIC.NO. MEC,
.
L� TOTAL rN k
Signa reofA ' icant/Contractor at •�� TOTAL _:�SI
OFFICE COPY