16874 POST THIS CARD NEAR FRONT OF BUILDING..
PERMIT NUMBER CITY OF. CUPERTINO 1687 ,
INSPECT,ION,,DIVISION,.
JOB INSPECTION RECORD .
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r � / PERMIT EXPIRATION
JOB ADDRESS , ` (1.I Z3 N . ISD4 e _UNIT# LOT# ' -
,, -T - PERMIT EXPIRES IF, WORK '
OWNER' l ��� 519�-P' e � CONTRACTOR -G Cie" -td 5T 18 NOT STARTEDWITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- I
FOUNDATION 'ANCE OR 180 DAYS FROM',
NOTE: LASTCALLED INSPECTION.
UFER " ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - _ TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION'.
CUPERTINO STANDARDS. '
GARAGE SLABS i��y , C�.-,JS•'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - s^'. L-+14+:fi*•+ Nn�! rY�,^4�,..
ELECTRICAL- - Y IssuamcE uarE..
MECHANICAL, LOG, ELECT. PLG. ECH-
❑ ,�J ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD.FLOOR INFORMATION
VALUATION ' $"F T.
• PLUMBING -
MECHANICAL ` ' •RAIDI ,
ELECTRICAL .. - PERMIT TO
I' -
FRAMING ,43 o,,, i
INSULATION -. sro IEs rwE.mNSTR.. -
'OCC.GROUP RES,UNITS•
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'J SO.FT ILOOL.'A .TOTAL 4CREAGE '
ROOF' NOTE.NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID'
ROOF SHEATHING, ; CON
I'•REs INOILD GUSEPe O"'p,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 ❑ ..,El ❑ 1
• ❑
ASSESSORS PARCEL NO. '
ROUGH SAN.#
PLUMBING _ ELECT.ENERGY '
.
I TUBS&SHOWER PAN - �� PLUMBING ENERGY TRACT NOPARCEL NO� ,
MECHANICAL y-2fr— _44 MECH.ENERGY 'ELECTRICAL, - BUILDING ENERGY • ?CC DATE ACC.FILE rvO f,
.FRAMING ELECT.FINAL TEST -
.ZONING ENG.SITE NO.
INSULATION PLUMBING -
GAS TEST i GAS + '
MECHANICAL - - FIRE SPRINK ENERGY T.za
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� NE]
FLOOD ZONE A,L.U,C'
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. v ❑ No , Y ❑' . N❑
SHEETROCK - GRADE . FEE SUMMARY
EXTERIOR LATH BUILDING
. INTERIOR LATH _ : TEMPORARY APPROVAL eulLDwc.,'
1 .
SCRATCH COAT, ELECTRIC PLAN CHECK -
GAS FEE , . .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. ' MICROFILM pp
ELECTRIC - '
ARRANGE FOR INSPECTION BY PHONING 252-4505,
F ONE WORKING DAY BEFORE;REQUIRED INSPECTION. i"'I . PLUMBINGy� o - PLEASE GIVE JOB ADDRESS-WHEN PHONING.
Z MECHANICAL
— SEE PERMIT F,OR EXPIRATION DATE —
1 CONST.TAX
IMPORTANT!
PLEASE READ.REVERSE SIDE BEFORE + 'I
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY ,
I_
APPLICANT TO FILLIN.INFORMATION WITHIN RED LINES -' .USE BALL-POINT PEN ONLY
BUI LDI NG PROJECT I DENTI TION �y -PERMIT NUMBER
LDING APPLICATION &PERMIT
A n
AD Rys�. O� - 16874
' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL :e.
OWNER'S - "PLAN CHECK VALIDATION
•
NA/N/E/ - - QTY. ELECTRIC PERMIT 'FEE•AG VNONE .,
NAMe ACTOR's ., UTLETS-SWITCHES:RECEP 10.00/1.00 h� - -
LIC.No: . LIGHTING FIXTURES 10.00/1.00 -
CONTRACTOR'SADDRESS V401se-h/ - -
� 1 ..' 4#5' PPLIANCES-RESIDENTIAL 4.00 _
QnwPHONE PANELS 10.00 - DATE OF APPLICATION I
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMPI 20:00 _
ENGINEERARCH.OR -
uc: SIGNS TRANS. 3.00 r
ADDRESS ENG. ' SPECIAL CIRCUIT .5.00 PERMIT VALIDATION
'
ZIPr EMP. METER OR POLE INS.. 20.00
APPUCANTS4pO.S IER CT MOTORS SEE FEE SCH. /
ADDRESS ^^ww
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
Icv I hereby affirm that I am licensed,under provisions of Chapter 9
2 w - • II ISSUANCE DATE •"
ce a N (commencing with Section 7000)of Division 3 of the Businessland - 1 JVVV pG. ELECT. PLG. MECH.
r o z Professions Code.. icense is in full forciii rJsO ❑ ❑ ❑
Z D o License Class C Lic.Number r II DD -
F ,zi r J Date Con
a >< , '�9-9-8=- '�' C./.F_L__V�[��iT�,v1.._. City Of Cupertino
Ir w a OWNER-BUILDER DECLA ATload -N BUILDING PERMIT
°nO MISC.- REFER TO ORD INFORMATION
X 3,_ H I hereby affirm that 1 am exempt from the Contractors License VALUATION-T$/FT.
H u
O< Law for the following reason.(Sec.7031.5,Business and Professions 10.00 �� -
.,PERMIT ISSUANCE^
ar Code:Any city or county which requiresa permit to'construct,alter, a V
KWet improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. -/�
i O It requites the applicant for such permit to file a signed statemenLthat TOTAL �1�-V
X m he is licensed pursuant to the provisions ar the Contractor's License PERMIT TO '
�'z <
Law(Chapter 9.(commencing with Section 7000)of Division 3ofihe J' '1. '
4 O Business and Professions Cade)or that he is exempt therefrom andQTV. PLUMBING PERMIT FEE "\
w m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. -
e3 � - by any applicantforapermit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(4500).): -
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 o
their sole compensation,will do tile cC.GROUP RES.UNITS
e work,and the structure is not -
inteaded 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 improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO,FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
1 ments are not intended or,offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6,00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). RES IND - CON ."PB Omer
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
E] [3 [:] ❑ ❑
and Ptd, scions Cod to construct the project(Sac.7044,Business - LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The who
License s thereon,
docs not apply
to tr owner of property who bairns[r improves thereon,and who - LAWN SPRINKLERS-OVER 5(EA.) . 1.00' '
contracts for such projects with a eontractorfs)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL No.
❑ lam exempt under sec. ,B.&P.C.fur this
reason WATER HEATER W/VENT X6.00
Owner' Date WATER SYSTEM 5.00 ACC.DATE ACC.Fu.E No.
.WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
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.
copy[hereof IS 3800,Lab.'
Policy No. 'Company i ''
Ce [tied cop is h44•re u hed.
z Z C fit c y is Tde ihety sp n division. FIRE SPRINK ENERGY T-T4
' O App ea MISC.-' • " REFER TO ORD. v Q 'm❑ v ❑ N❑
� m CERTIFICATE XEXEMPTION FROM ORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE � A.LU.C.
W - COMP- SATION INSURANCE PLG.CONTR. LIC.NO. PLG. '
d O (This section need not be completed if the permit is for one - TOTAL Y"❑, IN Y ❑ N❑
D.2 hundred dollars IS 100)or Ica,)
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 any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California, BUILDING
Q.
Date Applicant ALTER OR ADD TO MECH. 5.00
} N NOTICE. TO APPLICANT: If,after making this Certificate of Ex-
F ? enhption,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 he deemed revoked. AIR HANDLING UNIT(TO.IO=C.F.M.) 4.00
r '• CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,OWC.F.M.) 6.00 SEISMIC FEE
1 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(Seo. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nine
Lender's Address HEATI NG UN IT(OVER 100,000'B.T.U.)9.50 ELECTRIC IQ• �Q
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 -
information is.correct.1 agree to comply with all city and county PLUMBING
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 to enter upon the BOILER-COMP (Over 100,0009TU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes. -
(We) a tee to save; indemnify and keep harmless the City of MISC.- REFER TO ORD.
U o ainst liabilitie judgments, costs and expenses which CONST.TAX
y in an way a rue airs[ said Ci consequence of the PERMIT ISSUANCE • '10.00
Ianting of is 1(yrm MECH.CONT., 1- LIC.NO. MECH.
TOTAL TOTAL BrSU
nature of Ap cant/ ontractor Dale s
OFFICE'COPY'.