16637 POST THIS CARD NEAR FRONT OF BUILDING "
' PERMIT NUMBER,
.
CITY, OF,-CUPERTINO: 1663"�
INSPECTION DIVISION,
JOB INSPECTION,RECORD
• • // - "o�`('-d,� PERMIT EXPIRATION ,
JOB ADDRESS ID��23 N1 kJ 01,5aT . UNIT# '_LOT#
PERMIT EXPIRES IF WORK -1
OWNER C4�,-r ,�/fr ' ;coNTRACTOR 0 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR IN PE TIO.. RE ORD 180 DAYS•OF PERMIT Issu-
FOUNDATION-
NOTE: ANCE OR 180 DAYS FROM'I'
UFER ` . . ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS,AND CITY OF -PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS'.
� - -AND
�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED qQy�
UNDERGROUND /SLAB
PLUMBING '
r
ELECTRICAL
Oy' {• /r a ' /
ISSUANCE UATE
MECHANICAL - c._ ,ELELr. PLc. MECR,
DO NOT POUR FLOOR UNTIL ABGVE,HAS BEEN SIGNED 4 ` . cV g BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING ,4 VALUATION giPT.
MECHANICAL � S�i
ELECTRICAL - - PERMIIT To
FRAMING ,{ fir-(OL/J�f• �NTr/L•Y
INSULATION ; 51URIES.. TYPE CONSTR.
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
•\ ROOF _ , SO.FT FLOOR AREA, TOTALACREAGE
NOTES NO FINAL INSP.SHALL BEMADEBEFORE
,✓)
DIAPHRAGM i THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING .. .RES INOUILDINNG USE
CON PB o9—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED♦ FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH . -
ASSESSORSPARCEL NO
PLUMBING a SAN. - - - -
ELECT.ENERGY
TUBS&SHOWER PAN' PLUMBING ENERGY s TRAcr No. PARCEL NO
MECHANICAL MECH.ENERGY _
' ELECTRICAL ' •• BUILDING ENERGY ^ Ace.onTE Acc.FILE No.
FRAMING • ELECT.FINAL TEST .,
ti INSULATION - PLUMBING zoNlNc ENO.SITE NO.
GAS TEST GAS '
" MECHANICAL FIRE SPRINK' ENERGVT.za r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑: N❑
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD ZONE A.L',UG. I
INTERIOR SHEAR - FIRE DEPT. "r❑ N❑ Y L7w N❑
THEETROCK - - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING , d-o
SCRATCH COAT ELECTRIC PLAN CHECK• '
GAS' FEE
L- NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY - ,SEISMIC FEE. -
OCCUPANCY OFBUILDING ISNOT PERMITTEDUNTILBUILDINGFINAL ISSIGNEDBYBUILDINGINSPECTOR. '
MICROFILM �
ARRANGE FOR INSPECTION'BY PHONING 2524505, ELECTRIC
I_ONE WORKING�DAY BEFORE REQUIRED,INSPECTION. PLUMBING PLEASE GIVE•JOB ADDRESS WHEN PHONING. ..
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE'BEFORE
CALLING FOR FINAL INSPECTION. '• TOTAL
OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT P.EN ONLY
BUILDING PROJECT I DENTI FICATION PERMIT NUMBER
poILDINo APPLICATION,& PERMIT 18637
r� AC FIESS, ,,s��T r nn OTO-B
ib'!L3 � • 1F� � P-0 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME
• /l['�G/,,,-,,,i�� R" QTY. ELECTRIC PERMIT FEE
PMON
57/
CONTRACTORS
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
U I Pro LIC.NO. LIGHTING FIXTURES ' 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESSarc
PHONE�-IYLJ) PANELS 10.00 DATE OF APPLICATION.
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 .. -
ENGINEER• I
LIC.NO, SIGNSTRANS. 3.00
nooness ENG. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20,00
AMOTORS 'SEE FEE SCH. ( .E•-�..�
AGGRESSDDHESS
SERVICE CHANGE 20.00 / / (gyp
00 LICENSE[)CONTRACTORS DECLARATION flfl �y(AA mJpI100 -
Q,u u I hereby affirm(hut 1 am licensed under provisions of Chapter 9 U 1v1]BOPNCE DATE
H Z w (commencing with Section 7000)of Division 3 of the Businessand
¢ n LOG. ELECT. PLG. -MECH.
F w Z Professions Cole, my license is in full f0
Z 0 y icensc s Lic.Number � I
❑ ❑
o � - U 9�
y r w Uutc ,�fiConlrudor_
¢ BUILDING PERMIT
¢ x w a ow
DECLARATION INFORMATION
MISC.- REFER TO ORD
X ;LL H I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
F u
04 Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE - 10.00
0 �, Code:Anycity orcounly which mquiresa permit to construct,alter,
-
SE a O improve,denmlish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
i w m, requires the applicant for such permit to file a signed statement that TOTAL .PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
F > Law.(Chapter 9(commencing with Section 7000)of Division 3 of the a %/
ic Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEEL
Ie I-a the basis for the alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER,(EA.) 5.00
Of not more than five ImndmJ dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole com pensu(ion,will Jo the work,and the struur
cte.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
properly who builds or improves thereon,and who doessuch work FIXTURES-PER TRAP 5.00SO,PT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year mf completion,the owner- - .
.
.-GAS EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving that he did not build or int- RES IND CON PB Other
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00
Ll 1,as owner of the property,am exclusively contracting with ❑' ❑ El ED 11licensed 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 with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA,200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM - 5.00
ACC.DATE ACC.FILE N0.
WORKE-RS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate of consent to self-insure, ZONING
or a certificate of Workers'Compensation InsurmsC,or a certified ENG.SITE NO.
copy thereof(Sec.3800,LOSE.).
Policy No. Company
O ❑ Certified py I5 by mishe FIRE SPRINK ENERGY T-34
Z Z '� Certif o f the city inspection division. MISC:- REFER TO ORD.
Afrplicant �_ Y❑ N❑ V❑ No
� y CERTIF-ICA11:OF EXEMPTION FROM WORKERS' 'PERMIT ISSUANCE 10.00 - FLOODZONE A.L.U.C.
L COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG.
CL O (This section need not be completed if the permit is"for one TOTALY❑ N❑ Y E] N❑
:DZ hundred dollars(S 100)or lessl Y
V O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued.I shall not employ any person in any manner So us to
U 41-0
become subject tO the Workeri Compensation Laws of California.
0 i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /
} to NOTIC17 TO APPLICANT: If,after making this Certificate of fix'
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 1doh provisions or this permit shall be deemed revoked _ AIR HANDLING UNIT(TO 1Q000C•F.M.)' 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=r-F.M.) 6.00 SEISMIC FEE Ste.
I hereby affirm that there is a construction lending agency Iia -' EXHAUST•.HOOD(WITH DUCT) 5.00
309performance
Civ.0 j°LC of the work for which this permit is issued(See. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city 10 enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-menlioaed property for inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- _ REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which - CONST.TAX '
ay in any we ace f against said City inconsequence of the PERMIT ISSUANCE 10.00
rant ngo s MECH.CONT. .LIC.NO. MECH.
TOTAL TOTAL
Ignatureof Applicant/Contractor )al
OFFICE COPY