14723 i POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 14723
. INSPECTION DIVISION
^� JOB INSPECTION RECORD
'v (v 2_3 /
T x 1. /• // PERMIT EXPIRATION
JOB ADDRESS /D I ZJ /�^ VV D 1 F. UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER (O (J
CONTRACTOR - •V a IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RE ORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - -NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED F E B
- . UNDERGROUND /SLAB
PLUMBING - QtY Of CUpe.rV 9U
ELECTRICAL hDO a eISSUANCE)ATE
MECHANICAL BLDG ELECT,I PLG. MECR
❑ ❑ L71
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
• INFORMATION
WOOD FLOOR VALUATION $TFT.
PLUMBING
I
MECHANICAL
ELECTRICAL - PERMIT To
FRAMING
INSULATION -
IORILS TYP ONSTR.
- OCC GROUP RES UNITS
I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
. ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO.FT FLOOR AREA TOTAL ACREAGE.
DIAPHRAGM- THE CONSTRUCTION TAX IS PAID
BUILDINGUSE
ROOF SHEATHING - Res INo cON oN PE 011-1 "
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ED ❑ ❑ ❑
ASSESSORS PARCEL NO,
ROUGH SAN.k
PLUMBING - ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ELECTRICAL ACC DATE AC
ELECTRICAL rv0
BUILDING ENERGY -
FRAMING ELECT.FINAL TEST
ZONING �NG.SITE NO.
INSULATION � - PLUMBING ,�GAS TEST GAS -
MECHANICAL FIRE SPRINK ENERGY Tea
COVER NO WORK UNTIL ABOVE HAS BEENSIGNED HEATING "�
FLOOU LONA.LUQ
EXTERIOR'SH EAR: ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y6 E N❑ vL- No,
SHEETROCK, GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING -
INTERIOR LATH. - TEMPORARY APPROVALS - BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION._ PLUMBING .DO
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR-EXPIRATION DATE -
IMPORTANT! CONST,TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL/"N FORMATION�TIVTTH 66�61INES - USE BALL POINT PEN ONLY
-9VILDlhhPROJECT IDENTIFICATION PERMIT NUMBER ^
O
mill-mam' -14723 APPLICATION & PERMIT
ADDRESS
BUILDING- ELECTRICAL-PLUMBING-MECHANICAL ,q rn
PLAN CHECK VALIDATION
NBME - l o f OTY. ELECTRIC PERMIT FEE
• W7:STFT.LQ I_JC�N.Nr253,CONTo0
NAAMERACTOvs UTLETS-SWITCHES-RECEP 10.00/1.00
R�::DWaoo =C!<'/Lp.No, 53Y3 1 . LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S J�OTAooREss i9COMV WA
PPLIANCES-RESIDENTIAL 4.00
RSQW00-0 7 o PANELS 10.00[3-
DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE PX.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
t,1 Z LIC,NO. SIGNS TRANS. 3.00
U ss ENG'
AooRESPECIAL CIRCUIT. 5.00 PERMIT VALIDATION
O tII
1
APPLICANT'S ZIP EMP.METER OR POLE INS. 20.00
1^
ADDRESS MOTORS SEE FEE SCH.
Rc^�WUO/� . SERVICE CHANGE 20.00
wo o LICENSED CONTRACTORS DECLARATIONr�//v
< 1 hereby affirm that 1 am licensed under provisions of Chaptei 9 il,v r I ✓L LL.. _
a o L s I ISSUANCE ATE
a (commencing with Section 7000)of Division 3 of the Business and r BLDG. ISSUANCE
ELECTPLG. MECH.
H w i P fpsZme,Code,unit m license is in tLill force: d -fee. . ❑ ❑
oZ FEB 1
y`T O "rl�9 pi U-r- Lic.Num
a Contracta
City of Cupertino
V1. f� BUILDING PERMIT
¢ ¢ a OWNGRH UILDIiR DIiCLARA'fION I IQ(� / ,
o a " INFORMATION
X ; LL H I hereby affirm that I um exempt from the Contractor' License MISC.- REFER TO ORD
F ALO j Law lorthe l'ollowingreason.(Sec.7031.5,Business and P,s fessionsVALUATION
Zi w Code:Any city oreounty which requires a permit to construct,alter, PERMIT ISSUANCE 10.00
R ¢¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. '
o
a LL requires the applicant for such permit to IIID a signed statement that TOTAL -
he is licensed pursuant to the provisions of the Contractors License PERMIT TO -
r 2 a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that Ise is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA) 5.00 _
of not more than five hundred dollars 18500)):
❑ I,as ownerthe property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
OCC.GROUP RES,UNITS
sole compensation,
ion,will do the work,and the structure is not
intended or offered for sole (Sec, 7044, Business and ProfessionsDRAINS•FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds our improves thereon,and wbodoes such work FIXTURES,PER TRAP 5,00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the Owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or inh BUILDING USE
Foust,for purpose of sale). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with V.B. .00El C3 El 0 _
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 6ASSESS, SPARC EL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,:rod who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmctorls)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tum exempt under Sea ,li.&P.C.I'o�this - WATER HEATER W/VENT 6.00 '
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
co IhefJ� S OO,La .CJ-ppg..///
QK3 C.
Q ❑ Certified copy is mreby urnlsh the -
Z Z Of COPY Is NI w,(II the �I inspection glivis' FIRE SPgINK ENERGY T-04
O Appl c (t-1=Y'Y 7-[ }%1 1 r �. MISC.- REFER TO ORD. [FLOOD
E N� Y [D N�
~ w PERMIT ISSUANCE 10.00
� CE FICAI EX17 FRN WORKIi RS' ZONE A.L-.U.C.
W > COMI'IiNSATION INSURANCIi G. o T NOt,1 PLG0 N0 V/� N�
G' O (This uclidn need not be completed if 0m permit is for one e L � TOTAL
::) Z hundred dollars IS 100)or less)
U OI certify that in the performancee ol'the work for which this per- 0 Y. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of Culifo_mia.
Q y Date Applicant BUILDING
>_ Carl NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0004F.M.) 4.00
CONSTRUCTION LENDING AGFNCY AIR HANDLING UNIT(OVER 110MC.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) '5.00
the performance f the war for which this permit is issued Bee. - MICROFILM
3097,Civ.C). /� ",}2L HEATING UNIT ITO 100,000 B.T.U.) 8.00
Lender's Name /' {.L � HEATING UNIT 100,000 B.T,U.)9.50
Lender's AAdress ELECTRIC
. I certify that l Imeercad this applicalion undslulf 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 relating to building construction, and BOILER-COMP(3H.P.Or100,000B.T.U.) 6.00
hereby authorize representatives of this city es enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL S
hereby authorize
properlyforinsp of this
purposes. -�
(We) agree to save, indemnify and keep harmless (he City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 z CONST.TAX
ay any way accrue against said City In consequence Ili- _
rantin of this permit. Ailaqll.C NT LIC.NO, MECH. So
�'� � TOTAL ./�7,ra.+�U TOTAL 2Q
re of Applicant/Contracta Date 53�k3 1 2/
OFFICE COPY