17429 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
- .,CITY 'OF CUPERTINO 17429
INSPECTION DIVISION
l JOB INSPECTION RECORD `
r � PERMIT EXPIRATION
' JOB ADDR•�`q�•\�{-S �O`--' S4 • cy� "—tky UNIT# 2W LOT#
fJ 9 - PERMIT EXPIRES IF WORK
�,
OWNER ! I � CONTRACTOR Gln `�'�1G IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUN ITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF 77 • PERMFT VALIDATION
CUPERTINO STANDARDS. � ' T
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED •�, //— '"'
UNDERGROUND /SLAB
PLUMBING,
ELECTRICAL ISSUANCE DATE
h MECHANICAL - BLDu ELCCT, PLG, MECHID ,
- ❑ '❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 11-79-89 B INFORMATIONT
WOOD FLOOR
PLUMBING vALUAnuN SIFT,
MECHANICAL - UPB►f100
ELECTRICAL. - I, 1 PER�MMIT,ro
FRAMINGG.�
INSULATION sTDiaes TYPE CONSTH
-
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • '
50 PT FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
•. DIAPHRAGM - _ THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HES RND Co PB OTE"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El
ASSESS PAHCEL NO
ROUGH SAN.a
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL ` BUILDING ENERGY ,ACC.DATE. ACC FILE NO.
FRAMING ELECT.FINAL TEST
ZONING- ENG.SITE NO.
INSULATION PLUMBING
. GAS TEST GAS.
FIR F.SPRINK ENERGY T2
� MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y 0 NY 'N�
.
EXTERIOR SHEAR - � .. � ELECTRICAL RELEASE FLOOOZONE A.LU.C.
INTERIOR SHEAR . FIRE DEPT. Y❑ N❑ Y ❑ NQ
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH - TEMPORARY APPROVALS -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 BUILDIN G FINAL IS SIGNED BY BUILDING I NSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC '1
. 1-0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.rnx '
PLEASE READ REVERSE SIDE BEFORE TOTAL /1
CALLING FOR FINAL INSPECTION. „ /1
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' BJILDINGPROJECT IDENTIFICATION ZO PERMIT NUMBER APPLICATION
LOWS 17429
ADDRESS
20863 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
utUt �rr
OWNER'S PLAN CHECK VALIDATION
NAME � 1 QTY. ELECTRIC PERMIT FEE
'�• ,Q /r x..�IM1 !/IC� PHONE
NAMCON E AcroRs 245 OUTLETS-SWITCHES-RECEP 10.00/1.00
n/k C uc.NO. ( `[ 318 LIGHTING FIXTURES 10.00/1.00
•-
Anon
- APPLIANCES-RESIDENTIAL 4.00
CONT A
,J O' t `QI PHONE '� / PANELS 10.00 DATE OF APPLICATION 'v
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
uc,No' ISIGNS TRANS: 3.00
ARCH.OR ENG. SAII F'r4U.C'I1P0 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT - 5.00
160'5' SOnlSo s ZIP -TEMP.METER OR POLE INS. 20.00 1 /
APPLICANTSMOTORS SEE FEE SCH. J O
ADDRESS
a� D $ /L-(t • SERVICE CHANGE 20.00
t
o o LICENSED CON'T'RACTORS DECLARATION
LU¢i w I hereby affirm that I am licensed under Provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and eAM
BLDG. ELECT. PLG. MECH.
F i Professions Cosjje and my license is in full force and effect. ❑ ❑ ❑
z O 0 License Class f -10 Lie.Number-
C, N t Datc_(p=1.3=E9-Conto,cIor.F'rdAJ1C_ JUN 1 ,3 1989
a ae BUILDING PERMIT
¢ ¢ w
OWNER-BUILDER DECLARATION
X ;u I hereby aRlrm that I um exempt from the Contractor's License MISC.- Cf RD INFORMATION
FUN J Law forthe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE - O VALUATION SIFT..
Code:Any city or county which requires pennit to construct,alter,
¢ ¢ ¢0 improve,demolish.Or repair any structure,prior to its issuance,also ELEC.CO TR. LIC.NO. ELEC. �
DLL requires the applicant for such permit to file a signed statement that F /SZ I7S TOTA V/ PERMIT TO
a w m he is licensed pursuant to ine provisions of the Contractor's License _ ^w.
L, Law(Chapter 9(corn t to the with Provisions
Scelion the Co f Division 3 of the LYl
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
gi0
¢ I-m the basis for[he alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant]era permit subjects the applicant toacivilpenalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($5001):
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OCC.GROUP Res.UNITS
soft compensation,will do the work,and the structure is not
intended or offered for sale (Sea 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law does not apply to an owner of
property Mir,ImlldS or Improve,thereon,snit who doe, Ch woS
rk FIXTURE .PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
toSn
himself are net intended
ownemployees,for sale.
11,edtbmsuch improve- GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
menta are not intended w thin one y sale.II',however,the building
or improvement is solo within one year oft ion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the huNlie diden of proving that he did not builA or im- BUILDING USE
prrve for purpose of sale J. RES IND CO PB. Onner
El1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑. ❑
licensed cmrtractmS to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSo PARCEL NO.
LZ Professions Code:The Contractor's License Law does not apply
to an owner of pro perry who builds Or improves thereon...it wlm LAWN SPRINKLERS-OV ER 5(EA.) 1.00
contracts for such projects with n corttrxctoAs)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00
the Contractors License law. TRACT NO, PARCEL NO.
❑ lam exempt under Sec.-,BARC Tor this
reason WATER HEATER W/VENT 6.00 -
Owner Dare WATER SYSTEM 1 - 5.00 ACC.oATE ACC,FILE No.
WORKERS'COMPENSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby hIfnn that I have a cerlificateof consent to self-insure, ZONING ENG.SITE NO.
or a certif cane of Workers'Compensation Insurance,or a Certified
copy thercof(Sec.3800,Lab.C.lt /
Policy No. Company} CM
O ❑ Certified copy is hereby furnished. FIRE$PRINK ENERGY T-24
Z Z ft Cenil'ie t Is ledwi�h I - city ivsper'm division. MISC.- REFER TO ORD.
O Applicant Y( - y❑ N❑ y ❑ N❑
CC T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE 0.L.U,C.
LU COMPENSATION INSURANCE: PLG.CONTE. - LIC.NO. PLG.
d O 1'I'his section need not be completed if the permit is for One - TOTAL Y❑ IN Y❑ N❑
::3 Z hundred dollars($TOO)or less,)
U O 1 certify that in tine performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
a Date Applicant BUILDING
>_ to NOTICE '1'O APPLICANT: If,;liter making this Certificate of fix- ALTER OR ADD TO MECH. 5.00
F-. Z emption,you should become subject to the Workeri 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
I hereby uflinn 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(See. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's NamAddress
HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address - ELECTRIC
I certify th at l have mad this upplicat ion:md ,are that the above VENTILATION FAN ISINGLE) 4.00 -
information is cornet. I agree to comply with all city and county PLUMBING
ordinances unit state laws relating to building construction, and BUTLER-COMP(3 H.P.Ur 100,0008.T.U.) 6.00
hereby above-mentioned
representatives Of this city es enter upon the BOILER-COMP(Over 100,000 BTU)BE E FE E SCH. ' 'MECHANICAL
herebymentioned property far inspect ion purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- -REFER TO ORD.
Cupertino against liabilities,judgments, costs hod expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT'ISSUANCE 10.00
ranting of thi per it. MECH.CONT. LIC.NO. MECH.
� � 91 TOTAL TOTAL P (% /
Signa[ r4'� pplicant Contractor Uale Q'C' •�)
(f
OFFICE COPY