18092 r
POST.THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
1 INSPECTION DIVISION 8092
JOB INSPECTION"RECORD1"k C 1 "Z
. - Lj1,,�• /r p PER MIT EXPIRATION
JOB ADDRESS LD ul' [ �l _p_{��n�fT-# _LOT#
PERMIT.EXPIRES IF WORK
OWNER . 1/ CLb- .e.V1 .CONTRACToa v �'2 Ll(' 2V'I IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD TRUE) DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vnuunnory
CUPERTINO STANDARDS. P�D {-
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED July Z C 1989
UNDERGROUND /SLAB I �• -
PLUMBING City Of Cupertino
I I I rV r,
ELECTRICAL - ISSUANCE DATE
MECHANICAL FLOG aEcr P LG I MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION -$YET.
PLUMBING
MECHANICAL
ELECTRICALPERMIT To/E.�cf(
FRAMING -e ` QC-
INSULATION - STORIES TYPE CONSTR
UCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. L ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO"FT F I.°m+ARFA TOTAL ACREAGI
DIAPHRAGM -THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING ' RES IND CON PF GO-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.M It I
AssessoRs vAHCEL No.
PLUMBING ELECT.ENERGY,
TRACT NO PAR CEL NO
" TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY "
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING zoNlNc ENG sere No.
GAS TEST GAS
MECHANICAL -- FIHE SPRINK ENERGY T.2B
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED 'HEATING - ` E:1 "❑ ° E] N[]
`
EXTERIOR SHEAR � ELECTRICAL RELEASE FLOOD ZONEA,L UC.
INTERIOR SHEAR FIRE DEPT.- v❑ N❑ Y ❑ "❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH- BUILDING,
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COATELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' SEISMIC
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
'ARRANGEFOR INSPECTION BY PHONING 252-4505, ELECTRICd rJ
F ONE WORKING DAY-BEFORE REQUIRED INSPECTION.
Iio PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE'BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
((.
BIG ItgINGPERMIT NUMBER
euamrvG
PROJECT APPLICATION 18OJZ
ADDRESS•e y'� '
() W- �111 lux A It
I G —ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME �/• 1 ,�I� E
- OTY. ELECTRIC PERMIT FEE Y �
CONTRACTORS' OUTLETS-SWITCHES-RECEP 10.00/1.00
D/VfOc�lo -L LICNO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
5C,00 V NPHONE PANELS 10.00 - DATE OF APPLICATION
ARCHITECT PLAN CHR77 P.C.NO.
on PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.no, SIGNS TRANS. .3.00
ADDDRRESS Ervc. SPECIALCIRCUIT 5,00 - PERMIT VALIDATION
ZIPEMP.METER OR POLE INS. 20.00 dyeb—
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICECHANGE PAID 20.00 I ��1s 1,s Vl 1
�oo LICENSED CONTRACTORS DECLARATION `� ,, '-�Vz IV V�.-L�
a U U I hereby affirm that I am licensed under provisions of Chapter 9 x U11 ISSUANCE DATE
h w (commencing with Section 7000)of Division 3 of the Business and n BLDG. ELECT. PLG. MECH.
r N a Professions Code,and my license is in full force and effect. �s�
Z O - License Class Lia Nunilrer City Of CUpBitIUO
o w L w Date Contractor
a x E BUILDING PERMIT
a O a o OWNER-BUILDER DECLARATION INFORMATION
X ; r- I herby affirm that I am exempt from the COntrachn's License MISC.— REFER TO ORD
u o v, Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
_0 LI PERMIT ISSUANCE 10.00 Z.
,A0 Code:Any city or county which requires a permit to construct,alter.
IS Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC e1� �/
n wD IS W a requires the applicant for such permit file signed statement that TOTAL eft•• PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License
r z a Law(Chapter 9(commencing with Section 7000)of0ivision 3 ofthe .i ioc
4 D Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
M H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects lite applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the straCture,is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 -
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered corsnle,If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or inquovemmnt is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did nor build or im- BUILDING USE
RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively Contracting With ❑ 0 11
licensed contractors to Construct for project(Sec 7044,otlapply LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The who
o License s tit docs nal apply
to contracts
owner of property who ba co contractor(s)
improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the Cotsforsuchceneets Lwithacontractar(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam axenlpt under Scc. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00
ACC.DATE ACC FILE NO.
WORK E RS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sel Ginsum, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy Ihereof(Sec.3800,Lab.CJ.
Policy No. Company
l] ❑�ertirmul ropy is hereby furnished. FIRE$PRINK ENERGY T.14
~
Z /pli Certifie y i twHh tire city inspection Division. MISC.- REFER TO ORD.
O Applicant -♦ACdZ✓•C�t V N V N
iry CEKIT FICAI'li Ole li X EM PTION F ROM WO R K E RS' PERMITISSUANCE 10.00 FLOOD ZONE A.L.U,O.
LU > COMPI]NSATION INSURANC17 PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not he completed if the permit is for one TOTAL Y❑ N Y O NE]
Z) Z Rmcbed dollars IS 100)or less.)
U O 1 certify that in the pertornrance ul'the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any ntannerso as To
U become subject to the Workers'Compensation Laws of California.
Date Applicant BUILDING
CL ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT': If, Her making this Certificate of Iix-
F 2 emption,you Should become subject to the Workers Cr n acmettion APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUC-'I'ION LI?NDING AGENCY AIRHANDLING UNITIOVER 10MC.F.M.16.00 SEISMIC FEE
I 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 Sec. MICROFILM
3097,Civ.C.). I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 22, D
1 certify that I have read this application and state that It,above VENTILATION FAN (SINGLE) 4,00
•
information n correct I agree to comply wish all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
infirmitio and stateorrec laws re to to
comply
wiIflg construction,Hit a any
hereby authorise representatives of this city to enter upon rite BOILER-COMP(Over 100,000 BTU)SEE FEE SC H. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep lour less the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 10A0 CONST.TAX
may in any way, accrue against said City in consequence of the
ranting Of[his p rlllit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
[SilimlHoo of pp icant/Con actor Date
OFFICE COPY