17062 POST THIS CARD NEAR FRONT OF BUILDING
,��j' PERMIT NUMBER
CITY URCOPERTIN0 17.062 y'
; .
y 2 :,INSPECTION DIVISION ' '
JOB INSPECTION RECORD ✓I). :,
E%PI RATIONt
JOB ADDRESS ',•/'Q � 5- � , A't/�/L � �'' UNIT# _ _LOT#k •
'. / ., - _r PERlkl&OPIRES-IF WORKi
OWNER.
CON 18-NOT.,STARTED WITHIN
INSPECTI N DATE 'INSPECTOR INSPECTION RECORD 80 DAYS OF PERMIT ISSU- ,
FOUNDATION• - - ` •ANCE OR 180 DAYS:FROM`-i .
- •NOTE: . LASTCALLEDINSP ECTION.` '
U FFR;, " ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE'.' TO COMPLY`WITH'THE APPROVED PLANS AND CITY OF ,PERMIT VALIDATION
CUPERTINO STANDARDS
GARAGE-SLABS
OUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDFL8 •p,V IuU.` ' , " �.' rr`7 -,
UNDERGROUND /SLAB L .4 ,,J , '
PLUMBING amo
• ELECTRICAL'' .. Is UANCE DATE.
MECHANICAL' Dc ELECT PLC - MECw
►:� c 0
OONOT,POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED '.2Opjy ;3-1�,.�¢,Q: L'Ic - , ' BUILDING PERMIT
r .WOOD FLOOR INFORMATION
PLUMBING ' - .,taw
w AEUATION SIFT.
a
- MECHANICAL '
PERMIT TD
ELECTRICAL - - ; •_
r
FRAMING - - - :f -. Ln '• 'C"....�••VJ+A t.,r..I .
INSULATION - sroRlEs . TYPE NSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED.
;e. E ROOF NOTE'NO FINAL INSPSHALL BE MADE BEFORE so FT:FLooa nRSA +._rornL ACREAGE,• .
DIAPHRAGM THE CONSTRUCTION.TAX IS PAID
t BUILDING U SE
ROOF SHEATHING - ,r HES • IND CON PB .00,.,'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ''DATE INSP. I] X L El
-ASBESSO SPARCEL NO.
ROUGH SAN,# - -- '
PLUMBINGELECT.ENERGY - - '
. TUBS&SHOWER PAN PMBING ENERGY - TRnc'No PARCEL NO
LU -
-. MECHANICAL - - MECK ENERGY
- ACC.DATE ACC.FILE ND:
ELECTRICAL BUILDING ENERGY .
FRAMING - ELECT.FINAL TEST
INSULATION �'' ` _ PLUMBING .,ZONING ENG SITE NO.
GAS TEST. - GAS. ' , '
MECHANICAL "FIRE SPRINN ENERGY T@4
COVER NO•WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ No ,
o ` � N0.
ELECTRICAL RELEASE ' FLOOD ZONE.
A.L uc. ,
EXTERIORSHEAR - - _
INTERIOR SHEAR, FIRE DEPT. _ El N� Y-L �N�
� SHEETROCK ' GRADE FEESUMMARY
• EXTERIOR LATH'. BUILDING.•
NTERIOR"LATH TEMPORARY APPROVALS PE ..
SCRATCHCOATi< ELECTRIC ""GAS . yNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY, .` , �'OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDINGFINAL IS SIGNED BY BUILDING INSPECTORr
;.I.,
U.1
• ARRANGE FOR INSPECTION�BY PHONING 252-4505 ;
I— ONE WORKING DAY BEFORE REQUIRED INSPECTION PLuMBwc
O� PLEASE GIVE JOB;ADD'RESS WHEN PHONING '
SEE PERMIT FOR EXPIRATION,DATE = ? 'MECHANicAi
IMPORTANT! CONST.TAX
ANN,
,
PLEASE READ REVERSE SIDE BEFORE 3. ,' I"'" „ , }
CALLING FOR FINAL INSPECTION: { TOTAL �.hy, /1 -
OFFICE COPY � -
v
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE-BALL POINT PEN ONLY
BU�lIORG PROJECT I DENTIFICATI ON ; .PERMIT NUMBER _
aDILDIND �0 APPLICATION & PERMIT 17062
AODREss
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL „
5$2 - -
rvAME DTVPLAN CHECK VALIDATION
. ELECTRIC PERMIT FEE
/ Ii Pr� PMDNE OI /
CONTRACTOR'S
NAME -70O B� � OUTLETS-SWITCHES-RECEPCONTRA10.00/1.00 1
(NFD Llc.rvo.
CONTRACTOR LIGHTING FIXTURES 10.00/1.00 % / Qi
ADDRESS Z�
- PPLIANCES-RESIDENTIAL' 1 .4.00
ADDRESS • _
PHONE PANELS },' 0.00 " DATE OF APPLICATION' "
ARCHREC - PLAN CHECK FEE - P.C.NO.
AtIR NO PANELS (OVER'200 AMP) 20.00
ENGINEER Q/ ,Af/� t '
/Tf�(Jyl 775/�' LIC.NQ0770.9 SIGNS TRANS. " 3.00
PR KESS ENG 109 Cl�GST71/U/' /r' SPECIALCIRCUIT ' 5.00 " PERMIT VALIDATION
zIP9 ., TEMP.METER OR POLE INS. . ,20.00
APPLICANTS
ADDRESS �r�j C�/If �,jJ�(/r ST MOTORS ' .SEE FEE SCH. •�'� Z 7
DRESS
�'{ O 3 3 SERVICE CHANGE 20.00
o o _ LICENSED CONTRACTORS DECLARATION -
rt i w I hemby,affirm that I am licensed under provisions of Chapter 9 IS ANCE GATE
w ¢ n (commencing with Section 7000)of Division 3 of the Rosiness and DG. ELECT. PLG. MECH.
r w i Professions Code,and my license is in full farce and effect. El ❑ ❑
Z, i m w License Class _ Lic.Number FEB
F m r J Date Contract.,
a mBUILDING PERMIT
Iz o i U OWNI:R-BUILDER DECLARATION' INFORMATION -
K
3 u 1 hereby affirm that I am exempt from the Contractor's License MISC.- - VALUATION $/FT.
u O¢ Law for the following reason.(Sea 7031.5,Business and Professions
H _ N PERMIT ISSUANCE 10.00
Code:-Any city or county which requires a permit 1.construct,alter, D
¢ Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC. D D
4/4
D¢ requires the applicant for Such permit to file a signed statement that _ TOTAL PERMIT TO
F"Z m he is licensed pursuant to the provisions of the Contractor's License `^,
>
Law(Chapter 9(commencing with Section 7000)of Division 3 oftbe V`II C"
¢
Business and Professions Code)or that he is exempt therefrom and QTY. 'PLUMBING PERMIT FEE �V-,
¢ H $ the basis for the alleged exemption.Any violation ofSectionactin malty STORIES TYPE ONSTR.
aim by any applicant fora Demur appliwnnoacivilpenally 'ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than frvo hundred dollars($5001.1: _
❑ 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 '
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 I 5.00 SQ.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
merits 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 GAS-EA.SYSTEM-OVER.4 (EA.) - 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int- RES IND CON .PB -Omer
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively can lmcting with ❑ ❑' 1:1 ❑
licensed contractors to construct the project(Sec.7044;Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSO PARCEL NO.
- and Professions Code:The Contractor's License Law does not apply
` to an owner of property who builds or improves thereon,and whoLAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for suchprojects with a contractors)licensed pursuant to'
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 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 ACD.FILE NO.
wORKERS'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.lnsurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 . ❑ Certified copyis hereby furnished. ' FIRESPRINK -ENERGY Tia
.Z.Z - O Certified copy is riled with the city inspection division. MISC.- " REFER TO ORD.
p Applicant Y❑ N❑ Y ❑ N❑
= T CERTIFICAil:OP E%F-MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZGNE A.L.U.C.
LU > (704ENSATION INSURANCE PLG.CONTR. LIC.NO. PLD. -
a o (This Wcti6n need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
'D Z hundred dollars IS 100)or Iev5J
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to I -
become subject to the Workers'Compensation Laws of California. eQ
Ow - - BUILDING 3a�6
Date-Applicant APPLICANT:
I - ALTER OR ADD TO MECH. 5.00
} y NOTICE TO APPLICANT: IL after making orkcirs'Compe sa Ex- _ _
? Pt visions
you should become subject to the Workers'Compensation APPLIANCE 5.00 ,PLAN CHECK
provisions io the Labor Cit shall-be
you must forthwith comply with ,FEE
U such provisions or this permit shall.be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
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. - MICR ILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U:) 6.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.16.50 ELECTRIC
- Lender's Addressefof.
I certify that I have read this application and state that the above' VENTILATION FAN (SINGLE) 4,00 „r
• information is correct. I agree.to comply with all city and county PLUMBING
oNinanc and state laws relating to building construction, and BOILER-DOW(3 H.P.Or 100,000 B.T.U.) 6.00
hereb out rizc le&fiv� this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
intio d protion purposes.e I sarld keep harmless DIn City of MISC.- "REFER TO ORD.
mo g t lits, costs and expenses which pERMIT.ISSUANCE 10.00CONST.TAX
in a y ac City in conscq rice f te
ling MECH,CONT, LIG NO. MECH. '
Q1 TOTAL TOTAL 3621'/
SigjhappIic!WCoVctor Daist
OFFICE COPY