17022 POST THIS CARD'NEAR FRONT OF BUILDING
PERMIT NUMBER
,. ,. - .• C.ITY .OF CUPERTINO
INSPECTION DIVISION 7022
JOB INSPECTION RECORD
- x 'PERMIT EXPIRATION '
.f
JOB,ADDR ESS �'0 etc II� Y ).1_(-_LkUNIT# Y _LOT# �IIpERM1T-•EXPIRES IF WORK ;{
nn
OWNER '+/✓ CONTRACTOR _ - • IS:NOT STARTED WITHIN'_'•
1 INSPEC ION DATE' INSPECTOR INSPECTION RECORD 1e0 DAYS OF PERMIT ISSU- I
FOUNDATION - '1' '' 'ANCE' OR 180 DAYS FROM
.� - NOTE., '•n ! '.; LAST CALLED INSPECTION.
USER' ' _ - ALL GRADING AND DRAINAGE SHALL BE',INSTALLED
TO'COMPLY'WITH THE APPROVED PLANS AND CITY OF PERnui VALIDATION
PR EGUNITE - -` CUPERTINO STANDARDS. ' - p
GARAGE SLABS - " .x F l,+.r., Jam,( ,••.r,• '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED nn �+ -Q e - l ` ' '
.. - UNDERGROUND7SLAB p. LEC 2`J 1968 __
PLUMBING _ -."•"T7IN+ RC-G�..
ELECTRICAL, . - ''6ty of CUp01'fIDO iSSUANGE DATE
MECHANICAL' _ / - FLUID ELECT. - PLG.- MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS'BEEN SIGNED. yll _ - BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING. -VALUAnoN $/FT.
' MECHANICAL
ELECTRICAL
• - FRAMING -
r. INSULATION - .. _ , ;ro ES :,TYPEic,NSTR,
T '` OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ,' f • * F
• . . SO�FT FLOOR AREA TOTAL ACREAGE
ROOF:'- NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS,PAID _ -
'�,I 'RUILUI NC,USE
ROOF SHEATHING '' " ` I+ES 'IND CON rR OSI,..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - DATE INSP. ❑ El,- ❑ ❑ ❑
ASSESSOR S PARCECNO
•.. ROUGH , .. sAN.a ' 1
PLUMBING - .ELECT.ENERGY. _ y
TRACT NO, PARCEL NO
TUBS 8 SHOWER PAN qPLUMBING ENERGY
MECHANICAL.- � � � MECH.ENERGY
- ELECTRICAL' 'x. BUILDING ENERGY ' ACC.DATE:, - ACc..FILE rvo
FRAMING Cl , ELECT.FINAL TEST: 1
ZONING ENG,SITE NO.
INSULATION _ L F' PLUMBING - - -
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T-74
. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING.' I ❑ n� ` ❑ 'NO'
n. .
EXTERIOR SHEAR - - � - ELECTRICAL RELEASE ' FLRRDZDNE 1.11c;
INTERIOR SHEARe—1S FIRE DEPT: - 'Y❑ NE] Y 1_1 ._ N❑!
SHEETROCK '`, - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING "• BUILDING •Q/
INTERIOR LATHTEMPORARY APPROVALS:g - l
SCRATCH COAT, ELECTRIC 'PLAN CHECK
GAS • FEE -G•(;J.,! .
NO TAPE OR PLASTER UNTIL'ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE.
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED.BY BUILDING INSPECTOR. MICROFILM
ARRANGE,_F..OR INSPECTION BY PHONING 252-4505, ELECTRIC.LU
ONE WORKING DAY BEFORE REQU6RED'INSPECT:ION PLUMBING
z :: PLEASE GIVE JOB ADDRESS WHEN PHONING
— SEE PERMIT'FOR EXPIRATION DATEJ.- MEcNaNIDAL
IMPORTANT•. coNsT.TAX
PLEASE REAO.REV,ERSE SIDE BEFORE , TOTAL. 2�
CALLING FOR FINAL INSPECTION.
OFFICE'COPY
APPLICANT TO FILL IN INFORMATION WITHIN-RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON - PERMIT NUMBER
BUILDING APPLICATION & PERMIT 17 '//�///��� '//�///��
BUILDIN i{� DD - � 1 1 0-Y'Y
. 1QQ STON,�Qn,� DK .. d BUILDING-ELECTRICAL-PEUMBING-MECHANICAL
OWNER'$ - r / .• PLAN CHECK VALIDATION
N'MER-(CK734=71o1.s OTY. , ELECTRIC PERMIT FEE
CONTRACTOR'S, - .. -OUTLETS-SWITCHES'-RECEP 10.00/1.00
NAME
)acctsLIGHTING FIXTURES"" 10.0010.00/1.00. ;
n
- EONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS -
- PHONE , PANELS .10.00 - DATE OF APPLICATION
` ARCHITECT PLAN CHECK FEE . P.C.NO.
OR - t PANELS(OVER 200 AMP) 20.00 _
ENGINEER '- -
' �'uc.No � SIGNS TRANS. 3.00
ARCH.OR ENG. - "' PERMIT VALIDATION,
ADDRESS - - -• SPECIAL CIRCUIT - 5.00 ,
.. z,P TEMP.METER OR POLE INS. ', 20;00
APPLICANTS q MOTORS - ,SEE FEE SCH. ( �C
ADDRESS '
SERVICE CHANGE .20.00
�oo LICENSED CONTRACTORS DECLARATIONDEG
U U I hereby affirm that.)am licensed under provisions Of Chapter 9' - 'ISSUANCE DATE `
N< h (mmmameing with Seclion 7000)of Division 3 Of the Business and BLDG. ELECT. PLG. , MECH.
Professions Cove,and.my license is in full force and effect IBD ® .❑ 1:1 ❑,
•z O w-- ' Licensa Class - Lic.Number
Data Contractor ..
� H ' E " _ ' „'BUILDING PER
a m OWNER BUILDER DECLARATION '
5 , . "a u, t ` - ' .'INFORMATION
w ; n E' I hereby affirm that I am exempt from.the Contractor's License MISC,- REFER"TO ORD
Hu0 J ' Law for Dm following reason.(Sec 7031.5,ItuNnessaml Professions PERMIT ISSUANCE, - 10.00 VALUATION, O 5/FT.
as -I Code:Any city Orcounty which reyuiresa parmnloconsin¢I,alter, - �bo a
K Q O improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTE LIC.NO. , ELEC. t
n w m ac, requir s ili•applicant for such permit to file I 'its d statement That ' TOTAL .rf'PER IT TO
he Is heenad pr umant to the pro Isl m II the Cont lctor's License - _ f
HZQ Law(Chupfar 9(commencingwi)h Section 7000),0 f Division 3 of the
4 D Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ H $ the basis for the alleged exemption.Any viola)ion'of Section 7031.5 STOR S TYPE CONSTR.
T by any applicant for a permit subjects ilia applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00
.:I'- of not more than five hundred dollars(5500).):' -
.o ,I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00
Lien-sole compensation„will do the.work,and tire structure is not' OCC.GROUP "RES.UNITS
intended Or offered for sale (Sec. 7044,.Buslness.and Professions DRAINS-FLOOR,ROOF,AREA,COND.. 5.00 ' ','" _ P
Code's The'Contractor's License Law docs But apply to an owner of - _!
property who builds or improves thereon,and who'does such work.'. FIXTURES-PER TRAP 5.00 sD.Pr.FlooB AREA TOTAL ACREAGE
himself re of intended
own employees,provide)that such improve. - _ ,
mems are not mtendeJ or offered for sale If,'however,the budding GAS-.EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement Is sold within one year of completion theowner- GAS-EA.SYSTEM OVER 4 (EA.) 2.00 . BUILDING use
budder will have tireburden of proving that liedid not h 'Id r r nr RES IND , CON. ,E, Oruer
prove for purpose of I•.). INDUSTR IAL WASTE INTER. 30.00 - ❑ ❑ ' -❑ ❑, ❑
L( I,as owner of ilia property,am exclusively contracting with - - -
Ii wlseA contractors Io construct.tire.pniieet(See.7044,Business' • ' LAWN SPRINKLERS-1 INC 5�V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I lie Cr)ntractor's License Law does nal apply - -
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA-) 1.00 -
contracts for such projecl,with a contruclor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200fT/10.00
the Contractor's License Lew. TRACT NO., PARCEL NO.
❑ I our exam Lunde Sea. ,B.&F.C.for this WATER HEATER W/VENT 6.00
Owner Date f�2�-Fo WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WURRERS'COMPP ATION DECLARATION' ` - WATER.TREATING EQUIP. 5.00
hereby affirm that I have a can heo a of consent to self-insure, - y ZONING ENG.SITE N0.
or a tcolificvte of Workers'Compensation Insurance,or a certified
copy thereof(See.3800,Left C.):
Policy No:- - Company" - ..
O ❑ Cmtltied copy isharehy furnished. FIRE SPRINK ENERGY T-24
F'O. ❑ Certified copy I, filed with the city Inspection division. MISC.- - REFER . - ❑ ❑ ❑ N ❑
Applicant TO ORDY N V N
to 'PERMIT ISSUANCE • 10,00
LL CER'TIIICCOMOP EXEMPTION INS PROM WORKERS' -' FLOOD zorvE A.L.u.C.
r W � COMPISNSATION INSURANCE - PLG.CONTE. LIC.NO. PLG. '
e -
a- Z (finm
s seulion�Deml not he cop late,[ if' the Permr o
Perron,is fun ❑' ,_e TOTAL V❑ - N , K❑. N❑
Hundred dollars IS 1000G,less) r
U'O I certify that in ilia performance of tlic-work for which this per, QTY.' MECHANICAL PERMIT FEE . FEE SUMMARY_'
LL H 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. r
Q. ' 'Applicant ALTER OR.ADD TO MECH. 5.00 -Date BUILDING 00
t
} to NO'T'ICE'I'O APPLICANT` If,after making this Certificate of Ex
e ? empllon,ynli would bannw subject m the Workers'Compansutlon• I APPLIANCE - 5.00 PLAN CHECK
provisions of•the-Lahor Code, you'musl forthwithmIY with
coil - /
' U - such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(T6 10=C.F.M_) 4.00 FEE 6e t
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby,affirm that there is'a construction lending agency for - EXHAUST HOOD (WITH DUCT) - 5.00
the pedonnance of ilia work for which this permit is issued(Sec. MICROFILM
3097,Civ.0 L ,. , o HEATING UNIT(TO 100,000 B.T.U.) 8.00 -
Lendcr'sNnmc HEATING UNIT(OVER 100,000 B-.T.U.)9.50
Lender's Address - ELECTRIC
I c,rlil'y 1114,1 have real On,application and ,are that the above' VENTILATION'FAN (SINGLE) - 4.00
information is correct I area tan
comply with all city d county - PLUMBING' '
ordinances and state laws relating to building construction,, and BOILER-COMPO H.P.Or 100,000 B.T.U.) 6.00
hereby aulhonor, representatives of this city to enter upon the
above-mentioned property for inspection pu7pose., BOI LER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL,'
(We) agree to save, inrlonmify and keep hared... ilia City of MISC.- ',REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
` ISSUANCE 10.00
may in any way , true against said City in consequence of the PERMIT
ranting is pe 1. "- MECH.CONT. LIC.NO. MECH. -
& p TDTAL - .� .TOTAL i ZT ,
Signature of Applicant/Ci ractol/ /D e - I
OFFICE COPY