18694 i5
POSTT.HISCARDNEARIFR0NTOFBUILD'I'NG Rh�Ir;NUMeER
-18694
P -,CITY-,0F�CU,PERT:INOI--
INSPECTION •DIVISION.' a
JOB INSPECTION RECA RD
PERMIT EXPIRATION
!JOB ADDRv�UN1T# T# `
PERMIT EXPIRES IF WORK
'owNEa :i`'s - _ .•LONTsa'n"cTOR_ - 1,'. IS NOT 'STARTED WITHIN'
INSPECTION' :DATE (INSPECTOR INSPECTION RECORD' - 180 DAYS OF_,PERMIT;ISSU,,�•
4 FOUNDATION „ • .! i.• s._ -... r ANCE ORr18O DAYS FROM,• ';
rNOTE, LAST CALLED INSPECTION:
LEER ° - 'ALL.GRADING'AND DRAINAGESHALLINSTALLED!
PREGUNITE
TO COMPLY WITH THE PLANS AND CITY.OF - RfR6 T vAl,ID TION
i is - > - '� G _ F
- CUPERTINO STANDARDS
GARAGE'SLABSS
POUR-NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
4 UNDERGROUND,/SLAB
PLUMBING ' p ,19p
•NELECTRICAL 89 � l- s `
DA'E
MECHANICAL,. Bl-DG
cr. P,La• mECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
, BUILDING PERMIT '
•.�. '•WOOD"ELOO R' ,,'pi , T; - INFORMATION
• - VALUATIONr-: A
PLUMBING SIFT
q
I r.i MECHANICAL' - PECm IT,To
�_�• ELECTRICAL � .• i r
FRAMING j
INSULATION i, - •+ :«:�, *5,',,.• 5,, IPE comsT
- _ _ .• OCC.GFOUP .RES UNITSf+
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
50,FT FLOOR AREA TOTAL ACREACE
• a' `_ ROOF - NOTE!NO FINAL INSP SHALL'BE MADE BEFORE
DIAPHRNST
THE COW IS PAID
4 " ', BUILDING USE
ROOF SHEATHING• i •� RES 'INDCON '. PR olm:
APPLY NO:ROOFING UNTIL ABOVE'HAS•BEEN'SIGNED FINALS > '` :DATE : INSP. �" �'
1' ASSESSOR5PARCELNO. v
ROUGH—', ' SAN.qw.
PLUMBING `.'. - ELECT:ENERGY G ' 4
TUBS'&SHOWER PAN - PLUMBING ENERGY S iT�,^oT N° -PARCELNo
MECHANICAL MECH.ENERGY " '
ELECTRICAL- . 'BUILDING ENERGY r °?cc.DATE .Acc FILF NO_'
FRAMING:"'.. + , ELECT.,FINAL TEST.
INSULATION PLUMBING ZONING -,ENc.SITE No
GAS JEST GAS•I`' iY. �'
y 3•. ' ' .E IRE SPRINK ENERGY ,24
MECHANICAL
�: •< -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEDr• HEATING - - ,•N❑ El 'I N[D
•, FLOOD ZONE . A.L,U c:' - L
, .ELECTRICALRELEASE -
b EXTERIOR$HEAR n '� 'y v.� ru� •T. yL NQ•. .
INTERIOR SHEAR'- ' FIRE DEPT. -
~'�! SHEETROCK '' I •ry GRADE •'r; I,•.. FEE SUMMARY"
EXTERIOR LATH ,.,+- BUILDING , ,
,INTERIOR,LATH
TEMPORARY,°APPROVALS , , BUILDING rs
.1• SCRATCH COAT ,.• I* ELECTRIC. PLAN CHECK
'GAS FEE .....••—.•da-
_ '
., NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY "+ SEISMIC FEE
OCCUPANCYOF'BUILDING ISNOTPERMITTED'UNTICBUILDING'FINALISSIGNEDBY13UILDING INSPECTOR •''""."��
" .. ' .r:w, •. : t. . .r .MICROFILM ..
'e t•,
' ELECTRIC_
w. , n .ARRANGE.FORINSPECTIONIBYPHONINGd252-4505 ,
H ONE"WORKING DAY-BEFORE REQUIREDANSPECTION PLUMBING --'
0�: PLEASE'GIVE JOB ADDRESS WHEN PHONING i
Z: SEE PERMIT F•QR.EXPIRATION DATE — MECHANICAL '; -� '*
µ IMPQRTANTI co`ysTIt .rAz
� w
{ PLEASE READ REVERSE SIDE BEFORE r TOTAL'•
CALLING FOR FINAL'INSPECTIOW1,1
IL
°° OFFICE COPY' >
APPLICANT TO"FILL'IN INFORMATION WITHIN RED LINES * USE BALL POINT PEN ONLY, j
'� f /n/IA/ BUILDING AEPEC7RATAIONL&MB NRGM(MECHANICAL I PERMIT NumBER !
. SUI LDI NGPROJECT IDENTIHUI F ATION �+,
A ESS
NG �. 11// / 518694
_ G,
NAME S "- ! - i'�' E, a PLAN CHECK VALIDATION .,
OTY. a•::ELECTRIC PERMIT FEE
PHONE'. - n y •4 ��
CONTRACT-R'S�
• rvAME -
OUTLETS, -RECEP
� '10.00/100
:JRTYIr"No. - L'IGHTING'FIXTURES;f; ; " ' 10.00/1.00
r0
NTRAC70R'S
AooREss •APPLIANCES RESIDENTIAL 4.00.
.. . 10
,.PHONE,... PANELS`, - '4 H .. ¢
L q ", 00
'DATE OF APPLICATION
i ARCHrtECT =- PLAN CHECK FEE - PC,No.
OR. ////// r•.� PANELS (OYER§00 AMP) 2000 T -
` ENGINE,E "
x , •\; r tire:NO SIGNS TRANS. ''100
ARCH OR ENG = . . . +, ^' PERMITVALIOATION
-+ ' • ADORE ♦ [.n.� SPECIALCIRCUIT : 500
_ nl I 7 zip -.'r< .i EMP:M 20'.00 :.
noo s5_/ ;• `'•C�f}.�ySO'�J'- ' MOTORS: �, SEE FEE SCH.
,f-(,cZ ' - SERVICE 20.00 .�+ '• ' -
o o 'LICENSED CONTRACTORS DECLARATION' " a 'v .°•-' -r - - _Y
cur 'I hereby'dfOrm'that I am licensed under provisions of Chaplet 9 70 ! ISSUANCE GATE' t
< y (commencing with Se tion 7000)of Division 3-of the Business and
'BLDG. ELECT. PLG. MECH
v_N z Professions Code an my.bcense Is in•full for i e et. ❑ ❑ ❑
i cc w w Lcense CI as
'• Lu.Number e y
0 H Date Eontraclor ai '
��� � - ! `..r ; BUILDING PERMIT
. ¢'n: w,� -, OWNER:BUILDER DECLARATION INFORMATION
X oc ;a.H a 1 hereby affirm that I am exempt from the Contractor's'Li ense MISC.— `REFER'TO ORD VALUATIDN $/FT.,
u O¢ Law for the following reason:(Sec.7031,5,Business and Professions.
- PERMIT ISSUANCE- „ . - " 10.00 .. -
Code:Any city occountyra
whichregwresa permilloconshucLallcr - - I ,-
er�0 improve,demolish,or repair any structure prior to its issuance also ELEC.CONTR LIC.NO., ELEC
C G regmns the applicant for such permit to file a signed statement that '1• ' : �i ' _ _ - TOTAL
,'.w 2 he'is licensed pursuant to the provisions of the Contractors License - PERMIT TO
i• ' Law,(Chopter9(commencing with Section 7000)ol Division 3 oC the
2 o' Business and Professions Code)or thathe is exempt therefrom and. CITY. `PLUMBING PERMIT FEE
er H $ the basis for the alleged exemption Any-violation of Section 7031.5 - ' " , - ,. .STORIES I; TYPE CONSTR.I
by any applicant for a permit sublets the applicant to a civil penalty -
.r' ALTER-DRAIN&.VENT:WATER-IEA:) 5.00 "
of not more than five hundred dollars($500).)::
❑ I,as..net of the ro cit employees ' g A. , is
}' {t. p p• y,'or my em to ees with"wa wages , BACK FLOW PROT,ECT..'DEV,ICE '-,4'00 DCC.GROUP REs ,NITS'
their sole compensation,will do the work.'and the structure is not R - - .,` :�-
.1: intended or offered for sale'(Sec.7044;Business and Professions' DRAINS-FLOOR,ROOF,AREA,COND.+`500
- Code:The Contractor's License Law does not apply to an owner of - -
property.whr builds or improves thereon,and who does such work FIXTURES'-PER TRAP,_;:' :• x+4500 SM FT.FLOOR AREA TOTAL ACREAGE
® himself or through his own employees,'provided that such improve - k
ments are not Intended or offered for sale.IC;however,the building' ' GAS-EA:SYSTEM- 1)NCA OUTLETS"6.00
or improvement is sold within one year of completion,the.owner, -
builder will have the burdedof proving Out he did not build or im ;EA
GAS .BYSTEM.,OVER 4,(EA.1. 2.00 BUILDING USE
prove dor purpose of sale J. =IND .'CON' ',PB ' Other
❑ I,as.owaer of the,property, m
a "exclusively contracting with ; INDUSTRIAL WASTE'INTER - , 30 00 '� . , El
UO . El El.
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 VtB. 600 . H
ASSESSORS PARCEL NO
and Professions Code:The Contractor's License Law does ootapply - -
1.. to an owner of'property who builds or improves thereon,and who DAWN_SPRINKLERS-OVER.5(EA.) 1.00 -
.� contracts for such projects with d cau tractors)liciowd pursuant to
e the Contractor's License Law. ; 'p '- SEWER-SANITARY-STORMEA.200ft/10.00 ', '%TRACT NO PARCEL NO.
.❑ 'I am exempt under,Sec. B.&P.C.lorih's Wp.T;ER'HEATER WJVENT '+ 6.00
reason
'? Owner " Date WATER SYSTEM" 5.00 , ACC.DATE ACC FILE NO.
•I ,"i WORKF.RS'COMPENSATION DECLARATION ;V'' t WATER TREATING EQUIP.' f 5.00 -
.hereby affirm that I have a ceriificat,of consent to self-ins'- -
+
at certificate of Workers'Compensation Imam ce or a'cer60 J c 20NING ENG SITE NO.
k copy thereof( ec.3800,Lab.0)��^'� .�jj----�� 1, ?. , - H I T
Policy NoW-'�CompanY a,D�.(',� '- - tr N -
" '�- ❑f�edified copy Is hereby funnshcd t -:.
'Z 2- - 4l"ertifi• copy his filed with the •'ty inspect n division " - FIRE SPRINK "ENERGYT24
p Applicant misc. ri.' . REFER TO ORD s Y Q;, N❑; '"v NO.-
. CC L5 ` ' " PERMIT ISSUANCE •10.00
CERTIFICATE OF�EXEMPTION FROM RKf RS: FLOOD-zONE A.L.I.I.C.
W COMPENSATION INSURANCE; 9 PLG,CDNTR . LIC NO.. a ptG i• ! '
(This section need enol be completed'nf_the permit'IsS forDue ' TOTAL 1' v,� N�' V�. N
Z' hundred dolls s(5100)or less)a , F-
U O I certily that in the performance oftlie wok for wli ch this per QTY a MECHANICAL PERMIT FEE „pi. FEE SUMMARY
LL F mit is issued,1 shall riot employ any person in any inanner so as to ,
O W become"subje-t m the Workers Compensation Laws of California
y Date Applicant ALTER•OR;ADD'TO MECH. BUILDING
} N NOTICE-TO-APPLICANT..If„after.making'this Cefiificate oF,Es- - _ -'�-- '
cmplion,you'should become subject to the Workers C'mpensatton APPLIANCE:,',_-„i. : 5.00 PLAN CHECK' r
provisions of the Labor Code,;you must for0iwithrccimply with - `
U - such provisions or this permit shall be deemed revoked:,. AIR HANDLING UNIT(TO 1O= FL 4 00 • FEE
+/ - AIR HANDLING UNIT(OVER 10=C.F.M.) 600 SEISMIC FEE. '
CONSTRUCTION LENDING AGENCY R -
I hereby affirm ehaClhcle rs e c6nslruclion Iendmbiagency for EXHAUST HOOD (WITH DUCT)'
the performance of the work for which this permit is.issued(Sec �
3097,Cie.CJ. a� ''d . ' HEATING UNIT IT 100,000 B.T.U.1:"'8.00 MICROFILM '
Lender's Name �](PrwP
Lender's•Addmss HEATING UNITi(OVER'100,000 B.T.U.)9.50 `• .ELECTRIC
-
I certify,thai l have readphis application sad slate that the above - VENTILATION FAN,(SINGLE) ; .1,'4.0 )
information is wrr cl I,agree to comply with a1Luty and county - ;PLUMBING ' -7'^
ordinances and state laws relatmg'to building construction and ”BOILER-COMPI3 H.P.or 100000BT.U.1' 600 /”
hereby authorize representatives of this city lO enter. upon tale g01 LER-COMP'_IOvar 100,000 BTUfSEE FEE SCH 7/
above-memioned property,fonnspei.tion par pos s '� - 'MECHANICAL V
(We)�agree to save„indemnify and"keep harmless the Cltyrof - ' MISC. !REFER-TO ORD _
Cupertino against liabilities,judgments, costs and c pehses which pERMI ISSUANCE 4 10:00 CONST TAX
m any way accrue against said CI in cons quenc of the i
Jnl g of this per
mlf: q MECH.CONT .,'p: LIC NO. r MECH ��0
l -�lA-iu o Ig���i TorAL # i :TOTAL I/VI
Slgvamra cfApplsa t/Contractor Ual !+ . :y -
n OFFICE COPY '
COPv
CITY OF CUPERTINO
GAS-SERVICE NOTICE
. I .
To
Ver You ore hereby aurhor'aed to connect the GAS service for
r Owner or Tenant
- New Service
Jt Reconnect
i No. of Meters 1
Move Service
No. of Add.,Meters Move Meter
w
a PLUMBING INSPECTOR _