17080 POST'THIS�CARDNEAR'IFRONT OF BUILDING '- . -r: d �
- - PERMIT NUNIBER
. 7
CITY OF CUPERTINO .. x
. . . : ' ' 1 - 080
`INSPECTION DIVISION '
JOB INSPECTION RECORD
*Ir »
PERMIT EXPIRATION
JOB ADDRESS_ D�((_��L'IArT'>-�-�1 UNIT# 'LOTtk " :PERMIT EXPIRES IF WORK ]
P // f
OWNER ', 'CONTRACTOR' (_�+ v CI IS NOT STARTED WITHIN " v
INSPECTION DATE INSPECTOR INSPECTION R CORD tea onVs of PERMIT Issu
ANCE OR 180 DAYS FROM
FOUNDATION.,,. NOTE:', '..r, � LAST CALLED INSPECTION.
UFER - 'ALL GRADING AND DRAINAGE SHAEL BE `INSTALLED . -' + '
PR EGUNITE'"r' TO COMPLY WITH-THE APPROVEDPLANS AND'CITY OF. PERnn?VALm"n ON
CUPERTINO STANDARDS '
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUNDS/SLAB - `1989*4 . ,r •y--� ..,, ;,
. PLUMBING",. - '.1 '"tnt.GC K,4l1CLZ.:
' ELECTRICAL. - " '- - .0} CII ertino. 155„ANLE DATE `
MECHANICAL - II..JD'7G EBEc r.. PLG. Meat',
o
El
00 NOT POUR FLOOR UNTILABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR',. I - - vawanoN s,p r.
PLUMBING'
MECHANICAL .
ELECTRICAL c PERMn To
FRAMING
" ' srnracs - rvE coNsrrr
INSULATION . .,
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I -
' - ROOF NOTE NO FINAL INSP.SHALL BE MADE BEFORE 50 FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM - "' -"r rt.. - - THE CONSTRUCTION TAX IS PAID, • 's
ROOF SHEATHING - .,^ Buu.o N use
' •� � ` B ' HES IND COON' 'PB Olney
APPLY.NO ROOFING UNTIL ABOVEMAS BEEN SIGNED FINALS, . DATE - INSP.
ASSESSORS PARCEL NO:
ROUGH SAN.N
PLUMBING '+ ELECT.ENERGY
- PLUMBING ENERGY, ^- ,RACY No.. PARCEL No,
TUBS&SHOWER PAN i
MECHANICAL '_ - MECH.ENERGY '!
ELECTRICAL, _ ACC DATE - Acc.FILE NO
} ' BUILDIN&ENERGY _
' FRAMING —AP ELECT..FINALTEST -
INSULATION - PLUMBING tON1NC ENG,Si
GAS TEST GAS -
' - - MECHANICAL. ` FIRE.SPRINK ,- ENERGY T.2ao
-Y
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . 'HEATING Y ", N� Y 0 �:. N
l EXTERIOR SHEAR ELEQTRICAL RELEASE ' . FLOOD/ON A.L.u.c.
INTERIOR SHEAR • ,FIRE DEPT. " v N v L ry�
SHEETROCK . GRADE - .I FEE SUMMARY
EXTERIOR,.LATH " ' BUILDING
• - INTERIOR LATH TEMPORARY APPROVAL'S euILDINc
SCRATCH COAT ELECTRICPLAN CHECK"
GAS , . FEE 'Q
' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ,' SEISMIC FEE i 1
OCCUPANCY OF BUILDING,IS NOT PERMITTED UNTI L BUI LDI NO FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ' �'~�` 'P �•
ARRANGE F-OR INSPECTION,BY PHONING 252-4505, : ELECTRIC
ONE WORKING'DAYBEFORE REQUIRED INSPECTION. ,' - PLUMBING
OZ PLEASE.GIVE JQB:ADDRESS WHEN PHONING. Tom_
-'SEE PERMIT FOR EXPIRATION,DATE — MECHANICAL
IMPORTANT! CONST:TAX '
s'
PLEASE READ REVERSE'SIDE'BEFORE IT
-' TOTAL
CALLING FOR FINAL'INSPECTION. I
. OFFICE COPY: —
�r APPLI°ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL„POINT PEN ONLY
BUILDING PROJECT IDENTI FICATION .PERMIT NUMBER
eBUILDING •APPLICATION & PERMIT' , TVS
ADDRESS '
_ ''� BUILDING-ELECTRICAL-PLUMBING -MECHANICAL 17000
OWNER S ,PLAN CHECK VALIDATION "
NAME
I EMNE��Z' TY. ELECTRIC PERMIT.? FEE
13.05
CONTRACTORS
' ' •.
JOUTLETS-SWITCHES=RECEP 10.00/1.00 ,
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS 93—,3
PPLIANCES-RESIDENTIAL 4.00
NE d ✓ PANELS
,1 0.00 DATE OF APPLICATION .7s'
Amcm Zell - PANELS (OVER 200 AMP) -20.00 PLAN CHECK FEE P.C,NO.on .
ENGINEER •• r "
LIC.NO, SIGNS TRANS. 3.00
ADDDRRESS ENa •' SPECIAL CIRCUIT 5.00. PERMIT VALIDATION
ZIP EMP.-METER OR POLE INS. >r, 20.00
APPLICANT'S �1 /r
ADDRESS . MOTORS SEE FEE SCR.
.. SERVICE CHANGE. - 20.00 fL .
I]. i
0 - <
r o a LICIiNSIiD CONTRACTORS UECLARA'fION
a u U. I hereby affirm that I am licensed under provisions of Clepter 9 ISSUANCE DATE
w <a (commencing With Section 7000)of Division 3 of the Business and OG. ELECT. - PLG. MECH.
r N z Prol'cssions Cnd r my license is in full for e�y f �r� JAN 13
-1969
- -r
Ozom - Liceny/
seCl Lic.No... igC eJ '7
Zm=w ntra
Date _f Coctor .
a /// �( }� CITY.Of CIIaOfflfl0 •- - BUILDING PERMIT
M a / NCR-BUILD it DECLARATION /3 A-i
°w U MISC.- - ' REFER TO ORD INFORMATION „
K
3. n y 1 hereby'afGnn that 1 am exempt from the Contractor's License
u o¢ Lnw for the following reason.(Sec.703 L5.Rosiness and Professions VALUATION
I- - PERMIT ISSUANCE 10.00 ��
Code Any city owing my which req uiresa permit to construct.runs - -
¢ K a D improve,demolish,or mpuir any stmeture,prior to its issuance,also ELEC.CONTR. _ LIC.NO: ELEC.
u requires the applicant for such permit to file a signed statement that - TOTAL - -
' w`� he is licensed pursuant to the provisions f the Contractor's License PERMIT TO
F z a Law(Chapter 9(commeacing with Section 7000)of Diviam '-1,3 ofthe - '- r Sk ' 1 lj
s 4 e ,- Business and professions Codi.)or that he is exempt thercl non and DTV. PLUMBING PERMIT• FEE i I
Ie r c� the basis for the alleged exemption.Any violation of-Section 7031.5 +" p - +STORIES, TYPE C NSTR.
a ; by any applicant for a permit subjects the applicant lea civil penalty
Of net more than five lmndred Anllurs(S500L): IALTER-DRAIN&VENT-WATER (EA.),5.00 .
'1 ❑ .1,as owner of the properly,or my employees with wages asggCK F LOW PROTECTDEV ICE' 400 ' DCC.GROUP RES,UNITS
their sole compensation,will do the work,and the structure i . .
s not .
intended or offered for sale(Sec. 7044, Business and Professions DRAWS-FLOOR,HOOF,AREA,COND. 5.00 - -
Code:The Contractor's License Law does net apply to ria owner of
property who builds or improves there On,told who does shell work FIXTURES-PER TRAP 1 a ' 5,00 SQBT,FLOOR AREA. TOTALACREAGE
' himself or through his own employees,provided that such improve-
merits are not intended or offered for sale.If,however,the budding GAS-EA.SVSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS'-EA.SYSTEM-OVER 4'IEA.1 ' 2.00,
builder will have tire harderi'of proving that he did not build or air. BUILDING USE
prove for purpose of sale.).,- - ' INDUSTRIAL WASTE INTER. "30.00 - RES IND CON PB Other
❑ 1,as owner Of the property,am Cx Clusivdy contracting with' Q � ❑c ❑ 1
licensed contractors-lo.construcl the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code: ]'he Conlractor s License Low does not apply
to an owner OI properly who huilds or improves thereon.and who LAWN SPRINKLERS-OVER'5 (EA.) • 1.00
contracts for such projects with a contractor(s)licensed pursuant to -
tire Contractor'sLutto,c.Law. u ' - SEWER-SANITARY-STORM EA.200ft%10.00 ,TRACT NO. . PARCEL No. '
❑' I am exempt under Sec. ,B.&I'.C.for't hisWATER HEATER W/VENT ' 6100
reason
Owner Date WATER SYSTEM . 5.00
ACC.DATE ACC.FILE NO..
WORK FRS'COMPENSA'rION DECLARATION WATER TREATING EQUIP. 5.00
I hemby of Rrm that l have a certificam of consent to sell=insure, - -or a certificate of Workers'Compensation Insurunce.,Or a certified ZONING ENG.SITE NO.
copy thereofff Sec 00,Lub.C.l. r
Policy No. Company " �' +
0 ❑ Ce s hereby famished.
Z Z ertit a Ili the ci �ped[ion' n. FIRESPRINK- ENERGYT-24
p At plicia MISC.'- REFER TO ORD. Y ® , NEI .Y o "NE]F- y PERMIT ISSUANCE - 10.00
CERTIFICATE OP O
EXEMPTION PRO RKERS' FLOOD ZONE A.L.u.G.
W - COMI'CNSA'I'ION INSUR Cli. PLG.CONTR. LIC.NO.. PLc.
Z CI his section need not he completed if the perinit'is for one' TOTAL Y NO Y,� NQ
hundred dollars(S100)Or less.) "
U O 1 certify that in the performance of the work for which this per- CITY. •MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any manner so as to
U become subject to the Workers'Compensm ion Laws of California. - a
Dale Ap licant BUILDING'
O aw. p ALTER OR ADD TO ME CH. 5.00 _ 06
} N NOTICE TO APPLICANT: If,after making this Certificate of ion s
F ? pr isin,you shouldbecomee, you to the forthwit COngensm ith APPLIANCE, , 5.00 -PLAN CHECK '"
provisions of the Labor Code, yell moot forthwith comply with FEE
.0 such provisions or this permit shall be deemed revoked' a AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDIN6rACENCY AIR HANDLING UNIT(OVER 10DWC.F.M.) 6.00 SEISMIC FEE
I hereby afI'irm.thul there is a constriction lending agency ICE EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Add e HEATING UNIT(OV ER 100,000 B.T.U_.)9.50
Lender's Address ELECTRIC
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE)' 4.00 - -_
information is correct. I agree to comply with all city and county, PLUMBING
ordinances and state laws rending to building Construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to - er upon Lite
above-mentioned property for inspection purpoBOILER-COMP (Over 100,000 BTU)SEE FEE SCM. MECHANICAL -_
se
-(We) agr to.save, inefenmify ;ml keep .ri Css.thc City of MISC.- f - REFER TO ORD.
upertino gain St liabilities,judge Is, co expenses which - �CDNST.TAX --
ay in ny way accrue agail t aid C' consequence of the PERMIT ISSUANCE - 10.00
this perms' MECH:CONT. LIC,NO, MECH. f
LO
MECH. TOTAL
anti ontr or Date
OFFICE COPY- -