17088 I• POST THIS CARD NEAR FRONT OF BUILDING '
PERMIT NUMBER
CITY OF CUPERTINO 1708
INSPECTION DIVISION '
JOB INSPECTION RECORD
s �o 07.
• IIZ� ' PERMIT EXPIRATION
JOBADDRESS _LOT#
PERMIT EXPIRES IF WORK
OWNER G7- I, o-S, CONTRACTOR'S C) b. IS,NOT STARTED^WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMITASSU-
-. FOUNDATION - ANCE OR 180 DAYSIFROM-
NOTE: - LAST CALLED INSPECTION,
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION .
CUPERTINO STANDARDS. '
GARAGE SLABS •, /' ...,I 7.— .•-,�/ i
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED c /-• etj
UNDERGROUND /SLAB Scu,pr_ ,p D
PLUMBING - C""`+a`�, �' C.C.•,
ELECTRICAL of nnP •DD a ISSUANCE DATE
MECHANICAL BLDG, I ELECT. PLG. MECH
El ❑ El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT,
-
MECHANICAL - - !
PERMIT To
ELECTRICAL
FRAMING _ yJ 1 s • i
INSULATION TON ES' TVP ONSTH, !
'
• OCC.GROUP RES UNITS
• PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL SHALL BE MADE BEFORE 50 FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION IONTAX IS PAID '
BUILDING USE
ROOF SHEATHING ' RES ' IND CON PB OR...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED . FINALS DATE INSP. ❑' Cl ❑ ❑ ❑
ROUGH $AN.N ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO ,
TUBS 8SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL` BUILDING ENERGY - ACC,DATE Ace FILE NO
FRAMING ELECT.FINAL TEST
TION PLUMBING .ZONING ENG.SITE NO.
INSULA
7—91c/ s
GAS TEST GAS
MECHANICAL _ FIRE SPRINK ENERGY T`]A
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, -, .,❑ No `'❑ No
' EXTERIOR SHEAR ELECTRICAL RELEASE , FLOOD ZONE 0.L LLC
INTERIOR SHEAR FIRE DEPT., Y❑- No Y N❑'
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING .F
INTERiOR.LATH TEMPORARY..APPROVALS BUILDING
SCRATCHCOAT - - 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 FINAL ISSIGNED BY BUILDING INSPECTOR. "' MICROFILM•
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O
z0 PLEASE GIVE JOB ADDRESS WHEN.PHONING. "d
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
-IMPORTANT! coNST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL rJIJ
OFFICE COPY
j`PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDINGPROJECTIDENTIFICATION - -PERMIT NUMBER
BUILDING -r a APPLICATION & PERMIT "' 17088 O p p
/O� �3 BUILDING- ELECTRICAL-PLUMBING-MECHANICAL .� 1 00
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE '
SII • /7 f- ,I PHONE
ONTRACTOR
NAM y/fJ UTLETS-SWITCHES•RECEP 10.00/1.00
/LV uC.NO. �(stS� " LIGHTING FIXTURES 10.00/1.00
ADDRESS
TRACTORS APPLIANCES-RESIDENTIAL ,4.00
ljiWl b ✓ PHONE -1%t_1qJe PANELS ' 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) - 20.00
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. .20.00 --1 7-<3
APPOCANTS MOTORS SEE FEE SCH /
ADDRESS
SERVICE CHANGE 20.00
w 0 o LICENSED CONTRACTORS DECLARATION
a u w I hereby with
that Sec I n licensed under provisions of Chapter 9 JAN 17 198.9 ELECT.CE GATE
H 2 "' (commencingith Section 7000)of Division 3 of the Business'and
w`<y w' LUG. ELECT. PLG. MECH.
r H z Professions Code, mE license is in full fofyyand,-f- ❑ ❑
o i a W License Class C .S LIc.Numbrc I Y of Cupertino
Dale Contractor
al Y f , - BUILDING PERMIT
rc S,w OWNER-R.BUILDER ATI INFORMATION
EO-L,
3.LL vHi 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
F a.04 Law for the following reason.(Sec.7031.5,Businc.mdProfessions PERMIT ISSUANCE 10.00 VALUATION $/FT.
u Code:Any city or county which requiresapermil toconstruct,alter.
rt Q 0 improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
wC a, requires the applicant for such permit to file a signed statement that e - TOTAL PERMIItTO
$ he is licensed pursuant to the provisions of the Contractor's License
Fzi Law(Chapter9(commencingwith Sectioii7OOD)af Divislon3ofthe '
a Business and Professions Code)m that he is exempt Therefrom and OTY. PLUMBING PERMIT FEE V
It F m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYP CONSTR.
,d ; _ by any applicant for a permit subjects the applicant toacivilpenolty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 _ OCC.GROUP REB.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 a
Code:The Contractor's License Law dues not apply to an owner or
Property who'buildsorimroves thereon,and who dries such work FIXTURES-PER TRAP - 5.00 W6 SO.FT.FLOOR AREA TOTAL ACREAGE
• mems are or
ugh intends ownemployees,for sale.
If,provided Th improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
mems are not intended or offered for sale.If,however,the building
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 ire- RES IND CON PB Other
IT
for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting withEl 13
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I 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 contractors)licensed Pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ ]Um exempt under Sec. ,B.&P.C.for this WATER HEATER VPHhEN-F 6.00 ,dd!
reason
Owner Dare WATER SYSTEM 5.00
ACC.GATE - /C0.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 n
I hereby alfrm that 1 have a certificate ofconsent to self-Insure, AIS re- ' ,Gn AA:D ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified '
copy thereof(See.3800,Lab.C.). aJ,IJ
Policy No. Company- `
O ❑ Rlirtified copy is hereby furnished. FIRE$PRINK ENERGY T-24
Z Z 1� Cenif copy is fled W�'Itl 1 - inspection division. MISC.- REFER TO ORD.
O APPlicant Y ❑ N V N�
~ va PERMIT ISSUANCE 10.00 �2•f�0
C TIFICA'rE OPIiXEMI'TION PROAL WORKERS' FLOOD ZONE A.LU.C.
LU COMPRNSATION INSURANCE P/1 LI0./N/O. / PLO.
CL o IThls section need not he completed if the Permit is for one /'!C rp
✓ B ff iNG yypJ�$J TOTA �d V IN V[J N[J
Z 11Lind red dollLux(S 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F 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 Calilornia. BUILDING
y Dem APPlicam ALTER OR ADD TO MECH. 5,00
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
I'- 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 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY 'AIR HANDLING UNIT(OVER 10=CEM.) 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. MICROFILM
3097,Civ.C.). HEATING UNIT'ITO 100,000 B.T.U.) 8.00
Lender's Name H EAT[NG UNIT(OV ER 100,000 B.T.U.)9.50
Lender's AddressELECTRIC
1 certify that I have read Ibis application and state that the ubove VENTILATION FAN (SINGLE) 4.00 D
information is correct, I agree to comply with all city and county PLUMBING e Q
ordinances and stare laws relating to building construction, and BOILER-CCNVIP(3H.P.or100,000B.T.U.) 6.00
hereby onthorim representatives of this city to Euler upon the BOILER-COMP (Over 100,000 BTU)SEE FEE BCH. MECHANICAL
above-mentioned properly 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
mSy
in any way accrue against s 'd ity in consequence of the PERMIT ISSUANCE 10.00
ranting Of[h is permit, MECH.CONT. LIC.NO. MECH.
I /./zLrTOTAL TOTAL 01)
gnalure pplicanl/Contractor Dalc
OFFICE COPY -