18320 I
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION 1 8320
JOB INSPECTION RECORD
/ �,• 1 PERMIT EXPIRATION .
JOB ADDRESS_� ` fi.�-U-_UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER O L d _ 'V CONTRACTOR IS NOT STARTED WITHIN
INSPECTION I DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.,",
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
I PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEH%lIT VALIDATION
GARAGE SLABS CUPERTINO STANDARDS. - �j�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED-
UNDERGROUND /SLAB
IGNED , q �C�y
- UNDERGROUND /SLAB JUL + 9 1989
PLUMBING
_ ELECTRICAL of mwm ISSUANCE DATE
BLDGELECT, PLC. MECH
MECHANICAL 1 I,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR _ VALUA�TI�O)N $/F T, ..
PLUMBING •vLrL
MECHANICAL (Y'
ELECTRICAL - Q PE L
FRAMING '1J d'�"
INSULATION STOH IF. TYy(l CONSTR
UCC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,f T FLOOR AREA TOTAL ACREAGE
FINAL INSP.
DIAPHRAGM
' ROOF THOE CONOSTRUCTION TAX IS P PAID BEFORE .
BUILDING USE
ROOF SHEATHING RIs IND CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El c
A55E550R1PARCE L N0
ROUGH SAN.#
PLUMBING ELECT,ENERGY
TRACT NO PARCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ALC.DATE ACC:FILE NO
ELECTRICAL BUILDING ENERGY
- FRAMING - ELECT.FINAL TEST
ZONING ENG.SITE NO,
INSULATION PLUMBING �
GAS TEST GAS
MECHANICAL EIRE SPRINK ENeacvT.-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �
FLOOD]ONE A,LUC.
EXTERIOR'SHEAR _ ELECTRICAL RELEASE
N� v ❑
INTERIOR SHEAR, FIRE DEPT. L N
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - L BUILDING -�
INTERIOR LATH - TEMPORARY APPROVALSJs pD
SCRATCH COAT ELECTRIC" - - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I- 'ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
• PLUMBING
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! covsT.TAX
PLEASE CALLING F R FINALESIDi INSPECTIONRE TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY d
BUI LDI NG PROJECT I DENTI FICATION - - - .PERMIT NUMBER
BUILDING APPLICATION & PERMIT /� /] 0
ADDRESS I J
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OW R'S 9 - PLAN CHECK VALIDATION
NAME
QTY. ELECTRIC PERMIT FEE
Od ONE
CONTRACTOR'S
NAME / OUTLETS-SWITCHES-RECEP 10,00/1.00
IA_ It lc_ d{ti LIC.NU, O Z LIGHTING FIXTURES 10.00/1.00
Anon SST S APPLIANCES-RESIDENTIAL 4.00 QQ
9s
111014F.370-703 PANELS 10.00 ' DATE OF APPLICATION
ogcwrecT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO SIGNS TRANS. 3.00
AARCH,OR DDRESS ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICECHANGE P 20.00 1.
w o o LICENSIiD CONTRACTORS DECLARATION p J ��'Olk✓LLr
<U 0 1 hereby at that I am licensed under provisions of Chapter') JUL J ISSUANCE DATE
z (commencing with Section 7000)of Division 3 of the Business and
m ¢ A -1289
BLDG. ELECT. PLG. MECH.
o Professions Code, I m license is in full force.'y��ffeet ® ❑ ❑
O i y G License lass y Con Number Y71.
F m r J Datc 3(� Contractor_(,(Jr Kr_
¢ r f , BUILDING PERMIT
BE BE M Q ' OWNIER.BUILDER DRCLARATION
w U INFORMATION
E
;n H I hereby affirm that 1.1111 exempt from the Contractor's License MISC.- REFER TO ORD
u o j Law far the fullowin rcmon.(Sec.7031.5,Businessand Professions VALUATION $/f T.
E - g PERMIT ISSUANCE C. .fI O .D
BE , Code:Any mol or countypair any requiresstructure p prior
t o isconstruct,,alsoer, a 1
,Q Q Q O improve,he applic,nt repair h p structure,prior n its issuance,also ELEC.CONTR. LIC.NO. El EC./1 D
o¢ re4uires the applicant far such permit to file a signcA sLGemenl that T, 1 - PE
Er
,n he is licensed pursuant to the provisions of the Contractor's License I e
rZ >
Law(Chapter 9(commencing with Section 7000)of Division 3 oftho
E 4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE 8-
m
¢ I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPI CONSTR.
by any applicant for a permit subjects the applicant ton Civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or cry employers with wages us BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES,UNITS
their sole compensation,will do the work,and the Structure is not
intended or offered for sale (Sec. 7044, Ilusiness and ProfessionsDRAINS-FLOORROOF,AR EA,CON D.' 5.00
Code: The Contractors License Law docs not apply to an owner of ,
properly who builds ,,in.pmvex Ther......and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,Provided thus such Improve- .
ments are n0l intended oroffc,ed iia sale.ll',however.the building GAS-EA.SYSTEM-11NC:40UTLETS 6.00
or improvement is sold within one year of completion, r
the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have tiro harden of proving that he did not build or stet BUILDING USE
prove for purpose of sale.). RES IND CON PB Orbe,
O I,as owner of flee property,ten exclusively contracting with INDUSTRIAL WASTE INTER. 30,00 ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Coda:The Contractors Uw Urease Ladocs not imply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.).- 1.00
contracts for such projects with u conractooto licensed Pursuant ID
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sea ,B,&I'.C.our this
reason WATER HEATER W/VENT 6.00
Owner Irate WATER SYSTEM - 5.00 ACC.DATE ACC,FILE NO.
-WORKIERS'COMPFNSA'Id ON DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm Ilial I have a certificate of cons....to self-insure, - ZONING ENG.BITE NO.
of a certificate of Workers'Compens:Itiou Insurance,or a certified
copy thereof(Sec.3800,Lah.C.).
policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T44
Z Z Ell Certified copy is fled with .he city inspection division.
F-' O Applicant MISC.- REFER TO ORD. Y F-1 N❑ V E] NC]
CC LO CERTIFICATE OF EXEMPTION I7ROM WORKERS' PERMIT ISSUANCE 10.001 FLOOD ZONE A.L.U.C.
LU > I COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0. O (This section need not he completed if the permit is for one TOTAL V❑ N❑ ' V [:] N❑
ZiZ hundred dollars IS 100)nr less.)
) O I certify that in .he performance of the work Iia which this pro- FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE
O W becomes bjec7L�m,{ Workers Coo n11pensma n Law C. Ifo rim.
a Uate /7tdpplicmv.(,(,/.Idyry_�- df,�_ ALTER OR ADD TO MECH. 5.00 BUILDING DD
} m NOTICE:TO PPLICANT: If,after mAlkking this Certificate of fix
2 emption,you should become subject to the Workers'Compmisation APPLIANCE 5.00 -PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10=C F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER IQOOOC-F.M.) 6,00 SEISMIC FEE P r0
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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's NamAdds HEATING UNIT 100,000 B.T.U.)9.50 ( ii OD
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
•
information n entree. I agree to comply with all city and county BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and store paws relating to is building construction,Olin, and
hereby authorise representativesEd ections city es enter upon the BOILER-COMP over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-menlinneA property for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of Misc.-
Cupertino .REFER TO ORD.
against liabilities,judgments, costs and expenses which PERMIT ISSUANCE ORD CONST.TAX
may In tiny wa accrue against said City in consuglmnce of the
grant ofdho p Intl. �� MECH.CONT. - LIC.NO. MECH.
C..�'C . 7- rip - TOTAL TOTAL Y7
-D-f 1
Signature 0l'Applir 1 ontmanr DIIIC -
OFFICE COPY,