15777 POST THIS RD NEAR FRONT OF BUILDING `
. 1 'PERMIT NUMBER:
: CIOF CUPERTINO
` INSPECTION DIVISION
'JOB INSPECTION RECORD. t\
• . l./• • , . 2,) :2,3'
�/ qG� i PERMIT,EXP,RATION
JOB ADDRESS ,/V /.,Z3 ZV+ 'I'VO�FLr. X7S `, ` (l'l - UNIT# , _LOT,4 '
PERMIT EXPIRES If WORK
OWNER, 0 • iQ c`[' • 'F CONTRACTOR l S: 0ISNOT STARTED WITHIN
INSPECTION 'DATE INSPECTOR INSPECTION RECORD - 180DAYS OFPERMIT-ISSU-
ANCE OR 180 DAYS FROM
• NOTE: -LASTCALLEDINSPECTION. .
LIFER - ,.ALL GRADING AND DRAINAGE SHALL.BE INSTALLED
PREGUNI'TE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I
UNDERGROUND /SLAB ,
' PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL /•; BLDG' ELECT: PLG. MECH. '
P� ,p ❑ ❑ : 0t
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ` IILDIN 'PERMIT
WOOD FLOOR NFORMATIONnoN $JFT.
PLUMBING C ,�� "
MECHANICAL - - O&L-0
' ELECTRICAL PERMIT TO
... FRAMING (Ai7aUat �('� J2D;✓ ..±
INSULATION sTOHIE S. TYPE CONSTR.
OCC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SO.FT FLOOR AREA TOTAL ACREAGE '
• - .ROOF NOTE:NO FINAL INSP.SHALL BE MADEBEFORE 4
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING.USE
ROOF SHEATHING ,, ' ' • RES IND LON PB O'l-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. [1 ❑. El E '
r " AN0. i
' ROUGH sAN.a SSESSORS PARCEL'
PLUMBING ELECT.ENERGY
TRACING PARCELNO
TUBS&SHOWER PAN- PLUMBING ENERGY -
MECHANICAL. MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC onrE ACC.FILE No. ;
I FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING ZONING ErvG.SITE No
GAS TEST - GAS-
MECHANICAL �• FIRE SPRINK ENERGY T 24 •`
L ❑ N❑ ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - � ., -
EXTERIOR SHEAR ' - ELECTRICAL RELEASE O- LORD ZONE . A,Luc.
INTERIOR SHEAR FIREDEPT: .Y� N� _v❑, N❑
SHEETROCK GRADE'•' - FEE SUMMARY
EXTERIOR LATH - BUILDING Ito
INTERIOR 'LATH - TEMPORARY APPROVALS BUILDING
: .� SCRATCHCOAT ELECTRIC PLAN CHECK
GAS
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC'FEE ;'p.ov
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDINGTINAL 1S51GNED BY BUILDING INSPECTOR I MICROFILM
ARRANGE FOR.INSPECTION BY PHONING 252-4505, ELECTRIC
'
Lu
ONE ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
z .
— SEE PERMIT,FOR EXPIRATION'DATE'— 6 MECHANICAL
IMPORTANT! , CONST.TAX
PLEASE READ REVERSE SIDE BEFORE *1CALLING FOR FINAL INSPECTION. TOTAL' ST
OFFICE COPY "
J APPLICANT TO FILL IN INF MATION WITHIN RED LINES - USE B _L POINT PEN ONLY
_
BUILDING PROJECT IDENTI FIC PERMIT NUMB ER,NG
T
ADDRESS
ADDREEE q I 1 rh 7 7 7
X0123 N • L(90L rr� ( �/, BUI_LDING - ELECTRICAL-PLUMBING-MECHANICAL ',1i 1 V 1 '1 1
NIN
AMERS }F PLAN CHECK VALIDATION
• {�{ .� OTY. ELECTRIC PERMIT FE
4 'I•HONE
CONTRACTOR'S
NAmE UTLETS-SWITCHES-RECEP,'10.00/1.00
krzYIN bld.�KrYL`11W.LawN6K�
- LIGHTING FIXTURES �"'a,10.00/1.00
qO RACTOR's 3w ( -Lo6K. PPLIANCES-RESIDENTIAL ° "^3 4.00
ADo sa &A9g08J - .-v`.�irs.-.
PHONE PANELS 10.00 - DATE OF APPLICATION I
ARCHITECT _ PANELS LOVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR ENGINEER o. '193
'bl i7 SIGNS TRANS. 3.00
ADDRESS ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
-isk ZIP ' LIZ EMP.METER OR POLE INS. 20.00 -
A - MOTORS SEE FEE SCH.
ADDDRESSDRESS
,'AIMS SERVICE CHANGE 20.00
W o o LICENSED CONTRACTORS DECLARATION
MI hereby affirm that 1 am licensed under provisions of Chapter 9 / ISSUANCE DATE w (commencing with Section 7000)of Division 3 of the Business and
t ELECT. PLG. MECH.
F w Professions Co and my license is in full fort a t. ❑ El 11z O y - Lirense s Lic.Number
O a - o Dale�� Contraclor c
a x f ` ark DING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION - I'
3 a v INFORMATION
w ; w I hereby affirm that 1 am exempt from me Contractor',License - MISC.- REFER TO ORD VALUATION
u O a Law far the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 5/FT.
4y� J Cade:Any city or county which requiresa permit memoulxp:dler, _ - n11n--�
`¢ sap improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC. - lK./I/
W-C u requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO
$y he is licensed pursuant to the provisions of the Contractor's License t
HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the
i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE I III LLLlJJ1VV7
the basis for the alleged exemption.Any violas ion of Section 7031.5 1 STORIES TYPE CONSTR.
a; by any applicant for a permit subjects the applicant too civil penalty - ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE - 4.00 OCC.GROUP PES.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 does not apply to an owner of -
property who builds or improve,thereon;and who doe, Get,work FIXTURES,PER TRAP 5.00 SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
trentsarenetintendedorofferedforsalelf,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of"completion,the owner- GAS-Eq.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER30.00 RES IND CON Pe Omer
.
❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors m construct the project(Sec. 7044,Business I LAWN SPRINKLERS-1.INC 5 V.B. 6.00 ASSESSORS PARCEL NO,
r 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
contmcls for such projects with a cmdractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
file Comments License Law. TRACT NO. PARCEL NO.
❑ 9 am exempt under Sec. •,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATEAce FILE No,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
TI herchy affirm that I have a certificate of consent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab c'J64 0-r-y . .
Policy No. Cmnpany
❑ Certified co>y rshereby fumishe FIRE SPRINK ENERGY T-24
H p Ap"plTanit�eeish t r i pr tys }'ion division. MISC.- REFER TO ORD. v ry v N
LS(� ❑ ❑ ❑ ❑
L4 PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU CERTIFICATE E EXEMPTION FROM WORKERS'
CL need not he eON INSURANCE PLG.CONTE. LIC.NO, PLG. YE] N❑ Y❑ N❑
D Z hundred
section need not he contpleteJ if the permit is for one TOTAL
I
hundred dollars 1E 100)or less)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I Shall not employ any person in any manner so as to
O Go become subject to the Workers'Compensation Laws of California. q
Date Applicant BUILDING ( �
a ALTER OR ADD TO MECH. 5.00
} to NOTICE you
APPLICANT: If,after making this Workers'
Compensation
of Ex
F2
provisions
sheLbecome
e, youto Ise Workers'Compensation AppLIANCE . 5.00 PLAN CHECK
provisions io the Labor Cole, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LANDING AGENCY AIR HANDLING UNIT(OVER IO,000C.FM.) 6.00 SEISMIC FEE 6�
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 Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lenders Address
I.certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 -
. information n correct I agree m comply with all city and county, BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
informordinaacestion
and state laws relating to building l city uction,and co and my
hereby authorlee representatives of this city to enter upon.the BOI LER-COMP(Ova,100,000 STU)SEE FEE SCH, 'MECHANICAL
above-mentioned property for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the '
mnti fthis ermiL MECH.CONT. LIC.NO. MECH.
IINnaTe� �3' RI TOTAL TOTAL
Si o Apphca q on r r ,.Udo I
OFFICE COPY