17802 I
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY .OF CUPERTINO7 n
INSPECTION DIVISION " �"�
JOB INSPECTION RECORf
�I '`c 20 O PERMIT EXPIRATION
JOB�ADDR ESS—�aa_p=.�_�ey LCI_�.�(_UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER CONTRACTOR GO k,( IS NOT STARTED WITHIN
INSPE ON DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
- UFER � ALL-GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
TO COMPLY WITH THE APPROVED'PLANS AND CIN OF PERMIT VAIJOAnoN
PREGUNI7E CUPERTINO STANDARDS.
GARAGE SLABS' PAID,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING • - V
ELECTRICALof ClopfflLm IssuaNce DarE
MECHANICAL oLDG ELECT. PLG. mecR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VAwaTION - SIFT.
�
MECHANICAL - - -
ELECTRICAL - v/EJ�mTn ro
�•�(L /o k 1 r t
FRAMING - -
INSULATION STORIES TYPE CONSTR.
-
cc GROUP HES.UNITS
f4P,L►ACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.IT noon AREA roraL acnEacE
� +ginDI'APHRAGM THE CONSTRUCTION TAX IS PAID'
BUILDING USE
ROOF SHEATHING RES IND CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS " DATE INSP. ❑' ❑ ElEl
ASSESSOR S PARCEL NO:
ROUGH _ SANA
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS 8 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 .
FIRE SPnINK 'ENERGY T@4 '
1 MECHANICAL Yo No .V N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A,L'U.C.
EXTERIOR SHEAR ELECTRICAL RELEASE .'
INTERIOR SHEAR - FIRE DEPT.
❑ N❑ Y ❑ N❑
SHEETROCK - GRADE - FEE SUMMARY
EXTERIOR LATHBUILDING
INTERIOR LATH - TEMPORARY APPROVALS. BUILDING' (Ja
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
� LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
� LEASE GIVE JOB'ADDRESS WHEN PHONING.
- SEE PERMIT.FOR EXPIRATION DATE-- MECHANICALIMPORTANT! CONST.TA
PLEASE READ REVERSE SIDE BEFORE -TOTAL •
CALLING FOR FINAL INSPECTION, ZS/
OFFICE COPY '
_ r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN_ONLY
BUItDING PROJECT IIDENTIFICATION-re ? D gppLICATION & PERMIT .PERMTNUMBER _
BUILDING ZOE
_ T
AODREss 17802
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
s,
- - OWNER'S J�LY�NJ f�lr PLAN CHECK VALIDATION
�
NAAk} PLC
1 y/ � � � OTV. ELECTRIC PERMIT FEE
'X4
AR '
CONTRACTOR
W ACTOR'S
NAME: ,^ OUTLETS-SWITCHES-RECEP 10.00/1.00
W� 4✓ry/1• ' uc.N0.7-1-1��OJ LIGHTING FIXTURES 10.00/1.00
. CONTRACTOR APPLIANCES-RESIDENTIAL 4.00
AODREss,^( L,y.•J 7
W7 � E r,V 8 PANELS 10.00 DATE OF APPLICATION
ARCHITECT -- - PLAN CHECK FEE PCNO.
o PANELS (OVER 200 AMP) 20.00 P.C._.
0 f}SfOG
Llc.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS �L ,I' y/yam, �/� SPECIAL CIRCUIT 5.00
�wJ 41J M. T �•"`�,�+ IP Ti 111 EMP..METER OR POLE INS. 20.00
APPPPPLLIC�ANTSS.. / ( MOTORS SEE FEE SCH:
AJJ✓ WJ (,(.G ! SERVICE CHANGE 20.00
O a LICENSED CONTRACTORS DECLARATION v 'r'f� •u
Fi w I hereby affirm That 1 mn licensed under prnosions ol'Chapter 9 - ISSUANCE DATE
a (commencingows�ith Section 7000)of Division 3 of the Business and
F H 2 Profusions CR+my license is in full fCsa(J®F'��. r 9-- BLDG. ELECT. PLG. - MECN,
o i m W Licel a 1 Lia maim rL__� �1G ❑ ❑ ❑
Uatc Cnntractor �
a y f BUILDING PERMIT
¢ ¢ a
OWNER-BUILDER DEC[-ARATION
¢o n o INFORMATION
z ; u 1 hereby affirm that I am exempt from the Contractor's License MISC.- RE ER TO RD
FLL0 J Law for the following mason.(Sec.7031.5,Bu.viness and Professions PERMIT ISSUANCE - 1000 VALUATION $/FT.
Cade:Any city orcoumty which requires a pennit to construct,alter, .
, ¢c 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO. ELEC. YJ ✓ O B
o n requires ilia applicant fur such pennit to file a signed statement that TOTAL - - E MIT,TO
e. w m he is licensed pursuant to the provisions of the Contractor's License
p
_ - /p , `1I
Fzi Law(Chapter 9(commencing with Section 7000)ofDivision3ofthe - ne�D./1�" N/ t
E 4 o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE IV t
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES" TYPE CONSTR.
by any applicant for a Permit subjects the applicant to.civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred did]...($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the Structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Bnriness and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 -
Codei The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own emPlnyors, le.if,co tern such improve-
m hoprov not intended old w thinoffered
one year
If,however,thebuildingowner. GAS-EA.SYSTEM-1 INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that hu did not build or LII. BUILDING USE
prove'1,aso nee of they INDUSTRIAL WASTE INTER. 30.00 RES IND CON' PB . Other
O d as owner of the property,he exclusively contracting with ❑
licensed contractors to ie Contractor's
the Project La 7044,of apply LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
an Professions Code:The who
o License Law does not apply i
to tr owner of property who builds to improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts ct such projects with u cmrlruutoNsl licensed punuam m
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B.&P,C.for this WATER HEATER W/VENT 6.00
reason
Owner
Data WATER SYSTEM 5.00ACC.DATE ACC.FILE NO.
WORK 1:RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5:00
1 hereby affirm that 1 have a certificate of consent loself-insure,
or a certificate of Workers'Compensation
-attiioonn Insurance.or a certified ZONING ENG.$ITE N0.
copy "rJy;yS�µp9 g00 C.mlbC
pany lllJ_�IWN
Policy No LJIQ�SL
O ❑ CeHihadcopyisherehyfumishod' FIRESPRINK ENERGY T-T4
Z Z C/CeRifieq��yp� ily inspectiuu division. -
O Applicant-sl�n^-BVI -�`e MISC.- REFER TO ORD. Y � IN Y ❑ N0
~ �+ PERMIT ISSUANCE 10.00
� - CEKTIEICATF-OPEEION IR(1MWORKERS' FLOOD ZONE A.L.U.C.
W 7 COMI'IiN$Al'ION INSURANCE PLG.CONTE. LIC.NO. PLG.
a ('I his rection Reed not be compla(ed if the Permit is Ion one TOTAL v N� V N❑
D Z hundred dollars IS 100)or less.)
V Q 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE _ FEE SUMMARY
LL F rile 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.
G. Date - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING +O d
} N NOl'ICE '1'0 APPI,ICAN'F'. If,after making this Cea'tificate of Ex.
F-. ? emption,you should become subject to the Worker,'Compensation APPLIANCE 5.00 'PLAN CHECK _
provisions of the Labor Code, you must forthwith comply with FEE
LJ such Provisions or this permit shall be deemed rcvokad. AIR HANDLING UNIT(TO 10/100C.F.M.) '4.00
CONSTRUCTION[.ENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE FyO
it 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(See. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG U N IT(OV ER 100,000 B.T.U.)9,50
Lender's Address ~ELECTRIC
I certify that l have read this application and state that ilio above VENTILATION FAN (SINGLE) 4,00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U,) 6.00
hereby)au0mrize representatives of[his city to anter upon ilia -
' above-m
entioned property for inspection purposes. BOILER-COMP (Overt000008TU15EE FEE SCH. MECHANICAL
(We) agree to save_indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,Judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST'.TAX'
yin wa accrue against said City in consequence of the
ingo t 'n11iL MECH.CONT. LIG NO, MECH. p
TOTAL TOTAL
ignalu plir /Contractor Data
OFFICE COPY