17070 POST THIS CARD NEAR`FRONT OF BUILDING
PERMIT NUMBER
CITY ,OF CUPERTINO . 17070
INSPECTION DIVISION
JOB INSPECTION RECORD
/ k � �
JOB ADDRESS ( D I Z3 /✓ r W0%}P/�iCCd �# _LOT# PERMIT EXPIRATION
p I^ � PERMIT EXPIRES IF WORK'
OWNER �l L Il S CONTRACTOR CQ �4T IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPEC ION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAS',.`ALLED INSPECTION.
UFER ALL GRADING AND.DRAINAGE SHALL BE INSTALLED a '
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF +PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS:
.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICALt U ertln0 ' 10 ISSUANCE DATE -
MECHANICAL BLDG ELECT I PLG. MECR
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT_
PLUMBING
MECHANICAL
ELECTRICAL PERMIT To
FRAMING
INSULATION sTORIE TYPE CONSITR. I
• I
OCC-GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.
ROOF NOTE:NOFINAL INSP SHALL MADE BEFORE SO.FTFLOOR ARE. TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES1:1 ING El ❑N PB
❑ ❑
' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL No
ROUGH SAN.q I
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TORS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACG.DATE ACC FILE No I
FRAMING ELECT.FINAL TEST
ZONING ENG SITE NO.
INSULATION � PLUMBING
GAS TEST EAS
MECHANICAL FIRE SPRINK -ENERGY T.94
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING [:] "❑ ❑ RIC]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD),ONE A L U.0
INTERIOR SHEAR' FIRE DEPT. `Y❑ NDI YL N❑
SHEETROCK„ GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
a
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
uJ "5 ELECTRIC D.D
LU ONE WORKING DAY BEFORE.REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.,
— SEE PERMIT FOR EXPIRATION DATE MECHANICAL'
IMPORTANT! _ CONST.TAX
I i(;
PLEASE READ REVERSE SIDE BEFORE
TOTAL ,Aj)
CALLING FOR FINAL INSPECTION. 10
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
�.� Ball LDI NG PRPJECT I DENTIFICATIO PERMIT NUMBER
aDIEDING APPLICATION & PERMIT '
AOogsss I�0 I�0
m BUILDING-ELECTRICAL-PLUMBING-MECHANICAL / 1/
OWNER'$
NA E PLAN CHECK VALIDATION
PHONE
7�'S"-0f"� TY ELECTRIC PERMIT FEE
CONTRgCTOR'
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
I TflA fl'S 17'11c,No. LIGHTING FIXTURES 10.00/1.00
'
ADORES 6l6 APPLIANCES-RESIDENTIAL 4,00
PHOWLS&O-0ae PANELS 10.00
ARCHITECT DATE OF APPLICATION `
On PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
ENGINEER
UC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG,
ADDRESS SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 (m,
ADDR Es.APPLICAN
MOTORS r �f(7
SEE FEE CH.
SERVICE CHANGE 20.00
o¢i
Foo LICENSED CONTRACTORS DECLARATION '
Fi w 1 hereby affirm that I am licensed under provisions of Chapter 9
Q (commencing with Section 7000)of Division 3 of the Has,
and
_ ISSUANCE DATE
F y 2 Professions Code,and my license is in full force and effect BLDG. ELECT. PLG. MECH.
z o_w- License Class LIC.Number.
m�_ w Date Contractor ❑ ❑ ❑
¢ y i J
a ¢ w< OWNER-BUILDER DECLARATION BUILDING PERMIT
E
a-A y 1 hereby affirm that I am exempt from the Contractors License MISC.- s R FER TO ORD INFORMATION
Fu0 ¢ Law for the following reason.(Sec.7031.5,dusinessand Professions VALUATION $/FT.
� vsy-' Code:Any city orcounty which requires a permitfoconstruclalmq PERMIT ISSUANCE 10.00 z-Ijp
¢ ¢ Q p improve,demolish,or repair any structure,prior[O its Issuance,alsU ELEC.CONTR. LIC.NO. ELEC.
iL C u requires the appliCaa for such permit Io file a signed statement that TOTAL�Q O
A w og M he is licensed p RR of to the provisions of the Confn¢toi s License PERMIT TO
r z ¢ Law(Chapler 9(commancing with Section 7000)oC Division3of the
f i o tlasiness and Professions Code)or that be is exempt therefrom and DTV. PLUMBING PERMIT FEE
au I-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIE TYPE CONSTR.
a ; by any applicant for a permit subjects the applicum faacivll penally -
ofnofmorelbanfivehundreddollars(8500).1: VINDUSTRIAL
DRAIN -WATER (EA.) 5.00
❑ I,as owner of the properly,or my employees with wages asOW PROTECT. DEV ICE 4,00
their sole cam pedneurn,will do the work,and the structure is nof OCC.GROUP RES.UNITS
I
ntended or offered for sale(Sec. 7044, Business and ProfessionsFLOOR,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 Anes such workS-PER TRAP 5.00 sO.PT.PLoofl AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended oreffered formic If,however,the buildingSYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,OR,Owner-
builder will have file burden of proving that he did not build or im- SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with 13 ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO.
I 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 contracfonto licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
l am exempt under Sec. ,B.&P.C.(or this
mason
WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE - ACC.FILE N0.
WORKF.RS'GOMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I heroby umrm that I have u certificate o1'eonse at to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Ihemof(Sec.3800,Lab.C.).
Policy No. Company.
O ❑Ai" py is her y furnisheZ Z ❑ opyd whhecityinspectio division. FIRE SPRINK ENERGYT44
O APPlMISC- REFER TO ORD. y[] Ny ❑ NOC 'AEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00A.LU.C.
W COMP17NSATION INSURANCE PLG.CONTR. LIC.NO. PLGIL ❑ eed nof be completed if the permit is for one TOTAL V❑ N❑ V ❑ N❑
Z h red dollars IS 100)or less.)
U O' verify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued.I shall not employ any person in any manner so as to
Ow become subject to time Workers'Compensation Laws of California,
A.
Date.Applicant 5.00
ALTER OR ADD TO MECH. - BUILDING
} Z NOTICE: TO APPLICANT: If,after making This Certificate of Ex� � '
F - emption,you should became subject to the Workers'CmR,cmmtma APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER110=C.RM.16.00 SEISMIC FEE
I hereby affirm that (here is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
file performance of the work for which this permit Is issued(See. - MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN ISING LE) 4.00
information is correct. I 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
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCE. MECHANICAL
e) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
pe Lino against liabilities,judgments, costs and expenses which
ay in any way true agajnsl said in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
ting of Ili'
MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL �.Z, 490
' amu icant/Cont for ` ate
OFFICE COPY
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTORS NOTICE
CITY OF CUPERTINO Q
C
To
You are hereby authorized to Connect electrical service for ! r.
Owner or Tenant
No.of Wires Size of Wires Size of Switch
Motor Load Voltage Phase
Heating Load K.W. Voltage
po
Light-110-New Service Reconnect
No.of Meters
Heal-]20-Three Wire More Service
No.of Add.Meters Power Three Phase Move Meter
O• ELECTRICAL INSPECTOR
1C�9�cS i C
S