14559 . ' • POST-THISCARD.NEAR-FRONTOF.BUILD,ING
.i . - PETRAIT'NUMBER
CITY, OF CUPERTINO : 1 8559 • .
INSPECTIOWDIVISION
JOB^INSPECTION.RECORD {
•"PERMIT EXPIRATION
JOB ADDRESS �� UNIT•# LOT# _
. - ^ . •^PERMIT EXPIRES IF WORK I
. OWNER• - CONTRACTORV'(�'j,�j L'`—L �.� ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT Issu-
FOUNDATION ' < ANCE.OR 180 DAYS FROM -
_ ' NOTE_ ' LASTCALLEDINSPECTION.
-
UFER' _ • '� ALL GRADING AND DRAINAGE SHALL BE INSTALLED id
3 , PERMIT VALIUATIUN
PREGUNITE - TO COMPLY WITH-THE APPROVED PLANS AND CITY OF -
• CUPERTINO STANDARDS' ,i
'GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB
PLUMBING •` -
- «,
ELECTRICAL - issu CE.UATE
M ECHANICALf - - BLDG, ELECT-• PLG -MECH. .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED euILDwG PERMIT
F INFORMATION
WOOD FLOOR - ' k 1, VALUATION ' s/FT,
.PLUMBING.
MECHANICAL
' PERMIT.TO ,yI
ELECTRICAL' . >- • . ..
FRAMING sTBRI Es T vPE corvsTR.
r•
INSULATION,' •
'
OCC.GROUP RES UNITS
c G PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
''ROOF NOTE.NO FINAL'INSP SHALL BE-MADE BEFORE.-
SO `T,FLOOR.AREA TOTAL
0-", ACREAGE
THE CONSTRUCTION TAXIS PAID s - +
DIAPHRAGM BUILDING USE
POP, '. ROOF SHEATHING . � 14E5 IND • ON .PB om",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE' INSP.,,' 11 • ❑ 1:11 ❑ -❑ '` `
ASSESSORS PARCEL NO.
-. . -ROUGH SAN.# -
? PLUMBING ELECT.ENERGY , -
TRACT NO . PARCEL NO.
• TUBS&SHOWER PAN' - PLUMBING ENERGY -
MECHANICAL ._ MECH.ENERGY.
'ELECTRICAL" BUILDING ENERGY - ACC.U4TE ACC,FILE NO
.FRAMING ,-+ '' ELECT.FINAL TEST
',ZONI NO ENG.SITE NO.'
• INSULATION " PLUMBING" -
GAS TEST GAS . *,." •! .
, FIRE SPRINK •,ENERGYT24
MECHANICAL `
COVER NO WORK UNTIL ABOVEMAS BEEN SIGNED HEATING � ❑ Nom.
- FLOOD zoNB aL.0 c.,",,
EXTERIOR SHEAR, - _ _ ELECTRICAL RELEASE
L'
N N
I ' INTERIOR SFIEAR,. FIRE DEPT.
SHEETROCK" GRADE '- FEE SUMMARY
' EXTERIOR LATH 7- BUILDING„ BUILDING
" ,INTERIOR LATH ' - TEMPORARY APPROVALS' '
SCRATCH COAT - ELECTRIC "' PLAN CHECK .
GAS �, FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE +"
OCCUPANCVpF,BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDI NG INSPECTOR. MICROFILM ,. .
4
r.
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 60''
ONE WORKING DAY.BEFORE REQUIREDINSPECTION ,x; PLUMBING
f O PLEASE GIVE JOB ADDRESS WHEN PHONING "
Z ' '^ MECHANICAL :
TP
- SEE.'PERMIT FOR EXPLRATION DATE.-. ' '''
�IMP„ORTANT! .; c`ovsr Tax
PLEASE READ REVERSE SIDE BEFORE,.`` _ ' y • ^ b"� �.' TOTALr
CALLING FOR FINAL INSPECTION.
OFFICE COPY
T.,
APPI.ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATIN7N & P,ERMIT § 14[59
ADDRESS a�)J
O1 w1 -,- . BUILDING-ELECTRICAL-PLUMBING-MECHANICAL -
OWNER'S �V PLAN CHECK VA41DATION
NAME - OTY. ELECTRIC PERMIT FEE ,
PHONE
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME w C-lo
V idlc.N°. LIGHTING FIXTURES 10.00/1.00 '
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00 -
ADDRESS '
, 9 PHOrvE 8�/yy PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMP)-- 20.00 PLAN CHECK FEE
OR P.C.NO:
ENGINEER
_ LIC.NO ISIGNS TRANS. 3,00 .
ARCH.OR ENG. $PEDIAL CIRCUIT S,QQ PERMIT VALIDATION ,
ADDRESS
ZIPEMP.METER OR POLE INS. ,61ee
> APPLICANTS
ADORESS MOTORS- SEE FEE SCH.
S - tme SERVICE CHANGE 20.00
D o a LICENSED CONTRACTORS DECLARATION
a U u hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE '
Z, w (commencing with Section 70001 of Division 3 of the Business and
BLDG" ELECT. PLG. MECH.
D z Professions Code and my license ism fall force pd��j
z o u°i- License I qss �.�Lie.Number.3 _TJ.3 ❑ ❑
9 Date ((_GCOntractor.Y' _ BUILDING PERMIT
M a w u / OWNER-BUILDER DECLARATION INFORMATION
o A MISC.- REFER TO OR
X3 3 u y I hereby affirm that I am exempt from the Contractors License ION $/FT.i
F .. O a Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10. I
Code:Any city or county which requires a permit to construct,alter,
Q Q Q 0 Improve,demolish,or repair any structure,prior to Its issuance,also E EC.CONTR. L..'O. ELEV
i - °u requires the applicanl,for such permit to file a Signed statement that 1N TOTAL PERMIT TO ,
E
m he is licensed pursuant to the provisions of the Contractor's License
Fri
Law(Chapter 9(commencing wit h Section 70001 of Uivision3 of the 7� r� -o: t,�
a Business and Prolcssions Codel or that he is exanpt therefrom and QTY. PLUMBING PERMIT FEE -
¢_$ the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
w. by any applicant lora permit subjects the applicant to acivil penally ALTER-DRAIN&VENT-WATER (EA.)'5.00 '
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,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 structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF;AREA,COND. 5.00 -
Code:The Contractor's License Law docs not apply to an owner of
properly 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-
mGAS-EA.SVSTEM-11NC.40UTLETS 6.00
I ems are not intended or offered for sale.If,however,the building
or improvement is sold within onn,year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int' RES IND CON PB Ome.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construe the project(Sec.7044,Business' LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ,
contracts for such projects with a conlractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 I TRACT NO. PARCEL NO.
❑ lain exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner - Data WATER SYSTEM. '5.00 ACC.DATE ACC.FILE NO.
WORKERTCOMPF.NSATION DECLARATION. WATER TREATING EQUIP. 5.00
I herehy affirm that I have a certificate Ofconsent to Self-insure. - ZONING ENG.SITE NO.
Ora certificate of Workers'Compensation Insurance,or a certified
copy lherpq�l(Sec.38 Lab.C.lupint .^
Policy, ereby-untie . ..
. Q '❑ edified copy is hereby furnished. � FIRE SPRINK ENERGY T-ZA
Z_ 2 Cant y.is filed ith,lu�. ky inspection division. MISC.- REFER TO ORD. y,❑, ry y . No
O npphoamh. � _
FM PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
c CERTIFICATE 01'EXEMPTION 17ROM WORKERS' _
LD _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. - y N Y N[3C (This section need not,be completed if the permit is for amu TOTAL
D Z hundred dollars($100)of less.)
U O 1 certify,that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall'not employ tiny person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. '
Date Applicant ALTER OR ADD TO MECH. . 5001BUILDING
,�- Do NOTICE TO-APPLICANT: If,alter making this Certificate of fix. _ -
F ? emplion,you should become subject to the Workeri Compensation APPLIANCE' 5.00 PLAN CHECK
provisions oIF the Labor Code,you mast forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.N1.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
Clic'perl'orrmmce of the sm,kefm which this permit is issued(Seel MICROFILM
HEATING UNIT(TO 100,000 B.T.U.) 8.00
3097,Civ C.1.
Lender's Name HEATING UNIT I0 VER 100,000 B.T.U.)9.50 ELECTRIC ,
Lender's Address L, -
/certify that I have read this application and. a that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comp) ' 'fl city'and cowry PLUMBING
ordinances,and state laws relating ail ng construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authoriee representatives this Ily O enter upon the BOILER-COMP Over 100,000 BTUI$EE FEE SCH. MECHANICAL
above-mentioned property for pection or us.
(We) agree'to save, ind nify an k- harmlessthe City of MISC.- - REFER TO ORD.
upertino inst liabiliti ,judg Sts and expenses-which PERMIT ISSUANCE 10.00 CONST.TAXA
ay in aI y sec aged C'y in consequence of the
rantin Of - MECH.CONT. LIC.N0. MECH.
TOTAL TOTAL
$i8n r o APPIic tit/Cont Date - - -
OFFICE COPY
ELECTRIC SERVICE NOTICE OFFICE COPY
a BUILDING INSPECTOR'S NOTICE
-- CITY OF CUPERTINO
1LIh�� 21 . 19 88
i To
You are hereby-authorized
toConnectelectrical service for
Owner or Tenant
At—
No.
r No.of Wires Size of Wires Size of Switch
Phase
Motor Load Voltage
Voltage
Heating Load K.W.
'1 -TC(�11'
Light O.
New Service Reconnect
iNo of Meters Heot 120Three Wire More Service_'
No.of Add.Meters Power Three�PJhhose � Move Meter
� QQ •
ELECTRICAL INSPECTOR
f