17987 POST THIS CARD NEAR FRONT OF BUILDING '.
PERMIT NUMBER_
.�;. CITY OF CUPERTINO r� 7987
INSPECTION�DIVISION.
JOB INSPECTION RECO'RD7-,, ZO'
'• / ''II �T'' : �.. PERMIT EXPIRATION
JOB ADDRESS �o(�( ' •S`1-e V' .C.�'\ �1.we-" .UNIT# _LOT# I '
PERMIT'EXPIRES IF WORK.'
.owNER- '-`� _ e.i coNrRncrOR D•, p'l�_
:IS NOT .STARTED WITHIN
INSPECTION DATE INSPECTOR - INSPECTION RECORD " 180 DAYS OF PERMIT ISSU-+
FOUNDATION _• - „ •,- ANCE OR 180'DAYS.,FROM
`NOTE' '..L•AST CALLED INSPECTION.-
, UFER . . ;, •" • ALL GRADING SAND DRAINAGE SHALL BE INSTALLED
- •TO'COMPLYMITH THE APPROVED PLANS AND CITY OF . -PERMIT VALIDATION
PREGUNITEt CUPERTINO STANDARDS. '
GARAGE SLABS
P _ ":''.
ff
{7.
G, ,
POUR NO CONCRETE UNTIL'ABOVE HAS BEEN SIGNED c•,' ' ' '
UL'AB JU -
. '
NDERGROUND /S . . +
N ,P
PLUMBING l _
' ELECTRICAL ` City.,Of cuii IssuarvcF DATE .-
MECHANICAL, •, 'BLDG xT ei EF,r . `LG I Meot. ,
R DO NOT POUR FLOOR UNTIL ABOVE-HAS BEEN SIGNED - • BUILDING PERMIT
F INFORMATION '
' WOOD FLOOR jrVALUATION $/F T.
L.Y.
PLUMBING—
MECHANICALh • tr
4 •' C n
ELECTRICAL - PERMn To
' FRAMING
STORIES T ECONSTR.
,
" "INSULATION
.A � r OCC.GROUP•. HES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN'ISIGNED
- $O ('T�GLOOR ARE ••i OTAL ACREAGE
"• ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID. "
BUILDING.USE
ROOF.SHEATHING ' ' - P` nes- No CON" PB
APPLY NO;ROOFING UNTIL ABOVE HAS BEEN SIGNED' ""'FINALS 'DATE' "-?INSP.'
ASSESSORS PARCEL NO:
ROUGH• c SAN.H'„'
PLUMBING t ELECT.ENERGY
-
' TUBS&SHOWER BAN - ” - PLUMBING ENERGY • - '"nci No, PARCEL No.
MECHANICAL - - MECH.ENERGY I'•'• Aca GATE, •Acc FILE No.-
ELECTRICAL,; . ',• BUILDING ENERGY.
.FRAMING ELECT.FINALTEST. '
• INSULATION PLUMBING - - ZONING, 'e"c.SITE NO.
.. - GAS.TEST ` - GAS ,
"• MECHANICAL FIRE SPRINK ENERGY T-29 "
'�•" COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED, HEATING a .:r, ` ` 0 ` El "ID
'EXTERIOR SHEAR. - ELECTRICAL'RELEASE "FLOOD
'ONE n.L,ua
V.O N� V L N�,
INTERIOR SHEAR FIRE DEPT.'"
SHEETROCK GRADE • FEE SUMMARY
EXTERIOR,LATH BUILDING -
, '• INTE RIOR'.LATH - TEMPORARY APPROVALS - BUILDING -
SCRATCH COAT ' ELECTRIC ' PLAN,CHECK .
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPER MITT ED UNTI L BUILDING FINAL IS SIGNED BY BU'LDINGINSPECTOR. MICROFILM ..
ARRANGE,FOR INSPECTION BY PHONING,2524505, 'ELECTRIC
'1• �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING D
O PL''EASEGIVE JOB ADDRESS WHEN PHONING.
Z • ' • MECHANICAL '
' '= SEE PERMIT FOR EXPIRATION DATE -' �'- ., :
. - CONST.TAX
]M�ORTAN T!
< PLEASE READ.REVERSE SIDE BEFORE
�., TOTAL � •®(6 ..y
CALLING FOR FIN'A6'INSPECTION. � .r .�
:, FFICE COPY
APPLICANT•TO FILL-IN INFORMATION WITHIN RED LINES ='USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION . •; / - - PERMIT NUMBER ..
( -APPLICATION:& PERMIT, r
apILDING... if . '. '17 9 8.7
ADGRE55.,. \.
O I is " BUILDING',-ELECTRICAL-PLUMBING-MECHANICAL , ' ;
OWNER'B PLAN CHECK VALIDATION
,. rvamE QTY. .ELECTRIC PERMIT' -` FEE^ J
PHONE -
NAME OUTLETS OUTLETS SWITCHES-RECEP 10.00/1.00
rLm.RD. Q LIGHTING FIXTURES 10.00/1.00 '
r, DRRAcrogs '-RESIDENTIAL 4,00. '
aooREss - APPLIANCES
VHONE O PANELS .'i., 10100 ,DATE OF APPLICATION _
AR Hrtecr PANELS (OVER 200 AMP),— " � 20.00 PLAN CHECK FEE P.C.,NO.
OH '
ENGINEER
' -
LIC.NO. ,, SIGNS TRANS. 3.00
ARCH OR ENG. PEPMIT VALIDATION
ADDRESS - 'SPECIAL CIRCUIT 5.00
i1P EMP.METER OR POLE INS. 20100 -
APPLICANT'S .MOTORS SEE FEE SCH:
ADDRESS. ,..
- H SERVICE CHA 20.00
oc
F O O LICENSED CON'TRACTORS.DECLARATION - -
a i w I hereby ufllrm ih.t I am licenxd under provisions"of Chupler 9ALIN 61989
- - - ISSUANCE DATE
¢ y (commencing with Seel ion 7000)of Dwisim 3 of the Business and - - BLpG: ELECT 'PLG MECH.
H D z Polfessmns Cody{...an�I,i hccnse isIn 11 II fore fe' �,� -
' 002 - License Classh=��Lic Number _ _ City of Cupertino - •' �
O z H w Date �rq�' Cnntr minr -
a m -�-° / •
OWNER BDILDhR .CS-ZION - - BUILDING PERMIT '
DI:CI. -
u - ;INFORMATION
a.w3 tl I hereby aon that I art ex'mpt from the C t a tors.License MISC , REFER TO ORD
o O¢ Law for the followmg reason.(Sec.7031.5,Business and Professions _ VALUATION $/FT.
m 0�� CodepAny-city .....ot -PERMIT ISSUANCE ` 10:00 -
y which requires a permit to construeL.lter,
p,p¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ECEC.CONTR.' LIC.NO ELEC. `
D ¢ requires fhC'applic.nt fur such permit to file d signed statement 111.1 w- +. TOTAL PERMIT TO
o. w m he is licensed pursuant to,the"provisions of the Contractor's License. _ \ '
H z i '
Law(Chapter 9(mnimencing with Section 7000)of Division 3 of the " ' ' ' ''
¢ Business mW I'rofuasions Code)ar that he is exempt therefrom ands DTV. .. ,PLUMBING*PERMIT FEE V
¢ r $ the basis for the alleged exemption.Any violationof Section 7031.5 :.'., •: '.11. STORIES - TY(E CONSTR.
n ;'_ by any aorethanf for permitdsubjects ihcapplicamton civil penalty' - ALTER-DRAIN&VENT-WATER (EA.)e5,00
.. of not more than five hundred dollars(5500).): . s O
❑ 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'sule(Sec. 7044, Business and Pr2ffessions DRAINS-FLOOR,ROOF,ARE_A,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 workFIXTURES-PER TRAP , 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
i himself or through his own employees,provided that such improve-
ments'are not intended or offered for salt.If;however,the building GAS-EA.SY,STEM-11NC.40UTLETS 6.00 _
or improvemtnl is sold within one year of completion,the..a, GAS--EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that c did not build or im- - - BUILDING USE
prove for purpose of sale.). 1 - INDUSTRIAL WASTE INTER. 30.00 RES IND CON ' PB One,
licensed
I,as owner of the property,and 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; rho Contractor's License Lawdoes not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.)- 1.00
contracts fat such projects with a eon raclous)licensed pursumlLtn SEWER-SAN EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.,
❑ Iain exempt under Sec. •,B.&I'.C.I'or this WATER HEATER W/VENT 6.00
mason
Owner' - Date WATER SYSTEM - - 5.00
ACC.DATE . ACC.FILE No.
WORKI:RS'COMPIiNSATION•DI?CI.ARATION WATER'TREATING EQUIP. '-5.00
hereby affirm that 1 have a certificate of consent to self=insure, - - -
or o certificate of Workers Compensation Insur.nce,or a certified ZONING ENG.SITE N0.
copy thereof(Sec.3800,Lab.CJ.
Policy No. Coni pony I
U ❑ Certified copy is her y(umis(cJ. FIRE SPgINK ENERGY T@4
Z_ 2` icJ";copy' s I • with iT msl •ct on division. MISC.- " ° REFER TO ORD. ❑ ❑ ❑ ❑
O App want _ V N V N
~ rn 1�' PERMIT ISSUANCE" 10.00 .UO FLOOD ZONE A.LuC.
t- C'Rllfl Th OI'PXI'M1fI?IONS MWORKERS'.
W D .,COh1PENSATION INSURA Ch PLO.CONTR. , LIC.NO. PLG.
d (This scdiiinnceJ nut be ttnnplcleJ if the Penni) iY (nr one TOTAL ' �0' V❑. N❑ V ❑ N❑
hundred Aoll ors(S 100)or less.) '
U'O I certity that in the.performance of the work for which this per- DTV. 'MECHANICAL PERMIT 'FEE FEE SUMMARY
LL H - mit is issued,1 shall not employ ony person in any manner so as In _ -
U L) become subject
to lbs Workers'Comptursalion Laws of Califnudw BUILDING
a O.le ICAN]:.If,
am ALTER OR ADD TO MECH. 5.00
},W N01 ICE TO Slbo.lI CAN'T':�I f,after making this Certificate of Ex-
F ?" ` em vision you she L become subject to the forthwith comply win APPLIANCE 5.00 _ PLAN CHECK
provisions io the Labor mit sh you muss forthwith comply with - FEE
U such provisions or this permit shall be deemed revoked. ' AIR.HANDLING UNIT(TO 10J30D C.F.M.) 4,00
'CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby art lon titu rl ,re is it construction Imlding apmey fiir EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued fSec, - MICROFILM
3097,Civ.C.). 'p HEATING UNIT(TO 100,000 B.T.U.) •8.00
" Lender's Nddr HEATING UNIT(OVER 100,000 B.T.U.)9.50
' Lender's Address` ELECTRIC
Icertilythatl have read Ibis uppliculion unA stulu shat the above VENTILATION FAN (SINGLE) 4.00
. infonnntion is correct. I agree to comply with all city and county - PLUMBING Q�
ordinances and state laws relating to building construction, and - BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby:,.uthorizc representatives of this city, to enter,upon the BOILER-COMP(Over.100,000 BTU)SEE FEE SCH. " - MECHANICAL
above-mentioned property.for inspection'purposes.•
'(We) agree.to save, indemnify and keep harmless the'City of MISC:- _ REFER TO ORD.
ri uportimo against liabilities,Judgments, costs andiexpenses which' CONST:TAX
may in any way.ac roc against said C' in consequence of the - PERMIT ISSUANCE •s '10.00 l
antm,!)f lh is li MECH.DONT. LIC.NO. MECH. - -
�. TOTAL TOTAL / 6
' Si a rc of App icant Contractor Date (�Q
,a, OFFICE COPY