16610 I '
POST THIS CARD NEAR FRONT OF BUILDING PFRMIT'NUMBER
CITY OF- CUPERTINO-
. � 166. 10
INSPECTION DIVISION .
JOB INSPECTION RECORD II// r I
' - •• 21 PERMIT EXPIRATION
JOB ADDRESS_�D (?.3 tl SAA h6P UNIT# ' LOT# ) "+ ((^^ -I
kMI/f 6XP�it'Esr, 'F WORK I
OWNER -Ee CONTRACTORCA. c IIS NOT STARTED WITHIN ;
INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU=
FOUNDATION • _ - .. - ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION. '
LIFER- _ ALL GRADING AND DRAINAGE,SHALL BE INSTALLED - I
TOCOMPLYWITH THE APPROVED.PLANS AND CITY OF PErmuT VALIDATION..
PREGUNITE CUPERTINOSTANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - -
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL+ - ISSUANCE DATE
BLDG. =ELECT PLG, MF.CH.
MECHANICAL - -El
El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING e+� -
MECHANICAL PAID
RMIT TD
ELECTRICAL
OCT 13
FRAMING 1988
'y uRIE TYPE CONSTR. '
INSULATION - -
City Of.Cupertino
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
50,FT.FLOOR AREA TOTALPCREAGE
•ROOF - NOTE.NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING RES IND CON Pe 01,11-1APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP, EL
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN
PLUMBING ENERGY• TRACT No. PARCEL No
MECHANICAL MECH.ENERGY
ACC.DATE . ACC.FILF.NO
ELECTRICAL - BUILDING ENERGY ' .
FRAMING 'ELECT.FINALTEST
ZONING ENG.SITE NO.
INSULATION PLUMBING ..
GAS TEST - GAS
FIRE SPRINK ENERGY ZG
MECHANICAL - -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING (] N❑ ❑ N�
FLOOD]ONE A.L C'
EXTERIOR SHEAR ELECTRICAL RELEASE -
INTERIOR SHEARFIRE DEPT. v E NY No
SHEETROCK GRADE - FEESUMMARY
. EXTERIOR LATH BUILDING
INTERIOR LATH
TEMPORARY APPROVALS BUILDING -
SCRATCH COAT ELECTRIC ':PLANCHECK
GAS _ 'FEE,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ; - SEISMIC FEE I'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDIN G INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu -
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
o' PLEASE GIVE JOB ADDRESS WHEN PHONING.
Ix� Z ' :4`- { MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE
II IMPORTANT! ' coNST.4Ax
;rA
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY'
APPLICANT TO FILL IN INFORMATION, WITHIN RED LINES ='USE BALL'POI'N ,PEN ONLY
BUILDI NP PROJECT IDENTIFICATION .PERMITNUM BER 1.
SO LDING APPLICATION'&PERMIT 6,61 O
.n; ADpREss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL y ..., 11.,6:1
OWNERS r - , ' - PLAN CHECK VALIDATION
NAME/ ,`/ yS f �1 1 QTY. ti' ELECTRIC PERMIT - FEE
a PHONE
CONTRA RS
_
NAME �-r �i ��j� UTLETS-SWITCHES-RECEP 10.00/1.00
y� '� 1. ,C.No.V % LIGHTING FIXTURES 10.00/1.00
ADDRESS TOR's / APPLIANCES-RESIDENTIA_ L 4.00
PANELS 10.00 DATE OFI'APPLICATION,^^
ARCHITECT y-� 516 PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR -
e ENGINEER
LIC.NO, SIGNS TRANS., 3.00 -
ARC
H.OR ENG. PERMIT VALIDATION
ADDRESS - SPECIALCIRCUIT 5.00
ZIP EMP.METERIOR POLE INS., '20.00 I. '
APPLICANTDORESSs MOTORS ;SEE FEE SCH.
SERVICE CHANGE rAlCkofoo
"'acoLICENSED CONTRACTORS DECLARATION - -
< u CT 1
rut 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE OATEN
y<y (commencing with Section 70001 of Division 3 of the Business and ,. BLDG.' ELECT. PLG. MECH.
r m i Professions Code,and my license Is in full force and effect - - ❑
o z In D 'cense Class r Lic.Number upe Ino ❑1.
r ate - Contractor Y" -
¢ y M sE` 'I BUILDING PERMIT
¢ ¢ w OWNER-BUILDER DECLARATION _ INFORMATION -
w ;°' w I hereby affinn.that I am exempt from the Contractor's License MISC.- REFER TO ORD '
u 00¢ Law for the following reason,(See.7031.5,Businessand Professions PERMIT,ISSUANCE - 10.00 Z.00 VALUATION $/FT. :
r - -` Code:Any oily or county which requires a permit to construct,aher,
¢ ¢4 p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. , LIC.NO. ELEC.
a
o¢t requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w $n he Is licensed pursuant provisions ofthe )o fDic!oon3 of the - -
i Law(Chapterand
Professions
Code)
with is exempt Division and p
a: Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE -
s4o
the balls for the alleged exemption.Anyliof Section 7031.$ - - 5 ORIES TYPE CONSTR.
a3•� by any applicant fora permit'subjects,ihe applicant
nt to a civil penalty ALTER-DRAIN St VENT-WATER (EA.) 5.00 '4
of not more than five hundred do11ars($500).)'.
❑ I,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 v
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 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered for sale.IL however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one 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 im- , RES IND 'CON PB Ohbar'
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. " 30.00' ✓
❑ I,as owner of the property,am exclusively contracting with ❑ ^❑ ❑ ❑ ❑
licensed contractors„to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 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 wlllh a contraetods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
. the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am.exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT ' 6.00 -
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO. -
WORKERS'COMPENSATION DECLARATION s' WATER TREATING EQUIP,- " 5.00 r !
I hereby affirm that I have a eertif is t of consent Rh self-insure, ZONING ENG.SITE NO.
a certificate of Workers Comps atmri Insurance a cern led _ _
COPY thelfp Gd -
Policy N o ny 2
O ❑' Certified Is re I'u is ed. FIRE SPRINK ENERGY T-24
Z Z ❑ Certifie op
s d it the city inspection division. MISC.- REFER TO ORD:
O pplicant 'Y❑ N❑ Y ❑ N❑
� N . CERTI FICATF.OF E FMPTIOsl FROM WORKERS' PERMIT ISSUANCE 110.00 r _FLOOD ZONE A L.U.C.
LU > COMPENSATION I INSURANCE PLC.CONTR. LIC.N0. .PLG. "
Z - (This section need not he completed if the permit Is for one TOTAL Y❑ 'N❑ Y Q ,N❑
hundred dollars 1$100)or less.)
U'O I certify that in the performance of the work far which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P, mil is issued.I shall not employ any person iwany,manner so as to
U become subject to the Workers'Compensation Laws of California.'
O�w Date -Applicant, BUILDING•
} co, NOTICE TGAPPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH, ,5.00
FI,Z eruption,you should become subject to the Workers'Compensation. APPLIANCE - 5.00 VELECTRIC
provisions,of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 -
cONSTRucTIONLENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 '
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.
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U:) 8.00 ^'�
Lender's Name - HEATING UNIT(OVER 100,000 B.T.U.)9.50 !•Lender's AddressIcertify that I haveread this application and state that the above VENTILATION FAN (SINGLE)- 4.00
Information is correct.1agree to comply with all city and county
ordinances and state laws relating to building construction and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city'(o enter upon the BOILER-COMP:IOvur 100,000 BTU)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 CONST.TAX'
may in any way accrue-against said City in consequence of the PERMIT ISSUANCE - 10.00
ranting of this permit. , MECTCONT. - LIC.NO. MECH. -
' - TOTAL TOTAL
Signature of Applicant/Contractor Date
OFFICE COPY .