17033 POST THIS CARD NEAR FRONT OF BUILDING PF RMIT NUM9ER
CITY OF CUPERTINO 17033'
INSPECTION DIVISION
JOB INSPECTION RECORD
� P, v/�� Af S7ge_4.i4JkT'# _LOT# PERMIT EXPIRATION i
JOB ADDRESS PERMIT EXPIRES'IF WORK
OWNER CONTRACTOR - IS NOT STARTED WITHIN )
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE:
ANCE OR-180 DAYS FROM
� '
UFER ALL'GRADING AND DRAINAGE SHALL BE INSTALLED, LASTCALLED INSPECTION.
PR EGUNI FE, TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALJDATUN -
CUPERTINO STANDARDS.
GARAGE SLABS 4
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r1 ^ vVIT VIT It -47
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL ,. ISSUANCE DATE
- MECHANICAL - eu)c ELECT. PLC. MccR
FEB 6 �9a� El El ❑
DO NOT POUR FLOOR UNTIL'ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR City Of CUpBI'tIR INFORMATION
PLUMBING- VALUATION., $SFT.
MECHANICAL -
ELECTRICAL PERMIT TO
FRAMING -
sTonleS TYPE CDNsnr,.
INSULATION
... UCC.GROUP RES,UNITS
PLACE NO SUBFLOOR.UNTIL ABOVE HAS BEEN SIGNED
' * - ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so,IT.aooR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING .. nes IND r,Ory PB ofl,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 El 0 ❑
ASSl550n5 PARCEL NO
ROUGH ' SAN.a
PLUMBING - ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL - AGO DATE ACC FILE NO
, BUILDING ENERGY I
FRAMING - ELECT.FINAL TEST d ZONING ENG SITE NO i
INSULATION PLUMBING -
GAS TEST GAS
MECHANICAL-
FIRESPnINK ENERGY T.24 I
r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑. IN E] El N❑- - -
FLooDzorvE ALuc.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR- - FIRE DEPT. Y N Y N[_
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH - - TEMPORARY APPROVALS'
SCRATCH COAT ' ' ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - - - SEISMIC FEE
OCCUPANCY OFBUI LDING ISNOT PERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM {
• ARRANGE FOR-INSPECTION BY PHONING 252-4505, ELECTRIC
�� ONE:WORKING DAY BEFORE REQUIRED INSPECTLON. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING..-' '
z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
.. C -
IMPORTANT! CONST.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
•' 471 LDI NG PROJECT 1 DE TI FI AT ON PERMIT NUMBER
emLO.,G F - APPLICATION & PERMIT r.. 17033
aooREss Io! p� , ^ � ` W
NII
BUILDG —ELECTRICAL—PLUMBING—MECHANICAL M
Tiour.5 PLAN CHECK VALIDATION
• " c /oFGiOeRrtn/o ff2A460 TV. ELECTRIC PERMIT FEE
HONE
co"N(�r}R,a1cro/Rt0i) 7 'q/ OUTLETS-SWITCHES-RECEP 10.00M. 0
CONTRACTOR
r✓V{1A Irv./ LIC.NO.�/SS r/ LIGHTING FIXTURES 10.00M. 0
ADrareacrons APPLIANCES-RESIDENTIAL 0
ADD APPLIANCES-'g� AV ,1'/�
:l1 16 �1.J.f Oak W'N1�dNE. •SS I PANELS 1 O DATE OF APPLICATION
—I ARCHITECT PLAN CHECK FEE P.C.NO.
v
OR PANELS (OVER 200 AMP) 0
ENGINEER `
Q ���'J EP-6 uc.No. SIGNS TRANS. 3.1 0 .
ARCH OR ENG. - PERMIT VALIDATION
AGOR/`�ss n . �7c - SPECIAL CIRCUIT 0
Q GO P,ag24 "" ' zip RSI ID EMP.METER OR POLE INS. 0
i APPuca"r's MOTORS • SEE FEE
AFTLIC$A15 ppn
L.LIS �LA �QIL(�AA/O eZ SERVICE CHANGE 2P.00 yZIc I
w
02 LICENSED CONTRACTORS DECLARATION
< u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE '
,HA a w (commencing with Section 70001 of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r N Z Professions Code n u license Is in full for g
o i m o License Class Lic.Number-�� �
r w Dote Contractor fr
< ft
x FE G BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION
¢ w v INFORMATION
I'xu ;n y I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
Imo ¢ - Law for the following reason. 703 1.5,Businessand Professions PERMIT ISSUANCE 1 InOVALUATION $/FT.
-I Code:Any city or county which requiresa penal toconstruct,aheq
¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also E C.CONTR. ��) /� LAI pqNO: �1 ELEC. /'
u w m u requires the applicant for such permit to file a signed statement that EANpP-•�W a•�Y 15 6 2 J TOTAL 1V6 PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License .�-4
F z t Law.(Chapter 9(commencing with Section 7000)of Division 3 of the r—•1 T
¢ tlusiness and Professions Code)or that he is exempt therefrom rout DTV. PLUMBING PERMIT FEE
sio
IE H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant too civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5000.).
❑ 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,ond the structure Is not
intended or offered for sale (Sec. 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 docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
menta dre not hrough
own empld forsle.if,ed ever,such improve- GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
mems arc not intended or emplo ee sale.If,however,the building
or improvement is sold within one year of completion,the owner- - GAS EASYSTEM OVER 4 IEA) 200
builder will have the burden of proving that h - . - . .
e did not build or im- BUILDING USE
prove for purpose ofsileJ' INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON Pe Other
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
- licensed 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 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft110.00
the Contractors License Law. _ TRACT NO. PARCEL NO.
- ❑ taro exempt under Sec ,B.&,P.C.for lLiS WATER HEATER W/VENT 6.00
• mason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
- WORKERS'COMPENsA'fION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a.serlificule of consent m self-insuue, ZONING ENG.SITE NO.
ora thereof( of Workers'b c)7V au—ne ,�uFetlil'icd
wry thereof(Sec Co pang ' en0 VL - -
Policy No. Company
O ❑ Certified copy shereby furnished. FIRESPRINK ENERGY T.24
p Ap❑plicunitil'ied copy is filed with the city inspection division. misc.- - REFER TO ORD. Y 'N v N
—Y � PERMIT ISSUANCE 10.00 ❑ ❑ ❑ ❑
CERTIFICATE OF EXEhl PITON PROM WORKERS' FLOOD'ZONE A.LU.C.
W COMPENSATION INSURANCE PLG.CONTR. LIQ.NO, PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y F] N[3
hundred dollars($100)or less.)
U O 1 certify that in the periurmanee of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers Compensation Laws of California.
ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- - -
F 2 cord ion,you should become subject to the Workers'Compansm ion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must I'orthwidh comply with FEE
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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 issued(Sec. MICROFILM
3097,Ce CA 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
I certify dhat I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00
' information n correct. 1 agree to comply with all city and toasty PLUMBING
ordinances and state laws relating to building construction,city
nd co and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby enthnritc representatives inspection
this city to enter upon the BOILER-COMP IOwo 100,0008TUI SEE FEESCH. MECHANICAL
above-mentioned property for representatives
of
purposes.
(We) agree to save, indemnify and keepharmless the City of MISC.- REFER TO ORD.
upertino against liabilities,funems, costs and Cxpenaes which PERMIT ISSUANCE 10.00 CONST.TAX
nay,i �urt1 way see be ag+ISs said by in consequence of the
rami Oft is ptrm MECH,CONT. LIC.NO. MECH.
N
Si o(Appli fiit 2-A;/8 TOTAL TOTAL
ns/Contra mr Date
OFFICE COPY