17094 5 p POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBERCITY OF CUPERTINO . 17094
INSPECTION DIVISION
/ I JOB I�.�INSPECTION RECORD ( �
•
JOB AD'DR ESS 1 ` Z� /V Q P PERMIT EXPIRATION
UNIT# - _LOT# PERMIT EXPIRES IF WORK
owNER. Go(f ,� ;� CONTIR CTOR ' ,Q IS NOT STARTED WITHIN '
INSPECTION DATE INSPtt;1UH � INSPECTION RE ORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - I ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
LIFER --- ALL-GRADING AND DRAINAGE SHALLBE INSTALLED
`• PREGUNITE TO.COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMII VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS ..
POUR NO CONCRETE UNTIL ABOVE-HAS SIGNED y •I �1�1
•- T UNDERGROUND /SLAB _:IAN 1 8 1989,
PLUMBING
ELECTRICAL - - - City Cf CDpET310D ISsuamcE u �.
MECHANICAL - BLIdD ELEcc Pt.a MECH
❑ - ❑ - ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BuILDINU PERMIT
WOOD FLOOR + . INFORMATION
' PLUMBING
VALUATION $IFT,
MECHANICAL'
ELECTRICAL - PERMIT To
FRAMING 'I
INSULATION sroRlEs r EcoNSTR;
• OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOFSO FT GLOOR AREP TOTAL ACREAGE
NOTE:NO FINAL INSP,SHALL BE MADE BEFORE I
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID'
ROOF SHEBUILDING USE
ATHING - HES IND CON PB 0,1.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING ELECT.ENERGY ' -
TUBS&SHOWERPAN - PLUMBING ENERGY - TRACT NO. PARCELND
MECHANICAL MECH.ENERGY'
ELECTRICAL - ACO DATE ACC.FILE No
BUILDING ENERGY
FRAMING. ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.I SITE NO.
GAS TEST GAS
FIRE SPRINK ENERGY T.2E
' MECHANICAL �� . ✓ . v ❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E] NE] N❑
EXTERIOR SHEARELECTRICALRELEASE FI.00D�ZONE. A.L u.c.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK - GRADE
FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH ' - TEMPORARY APPROVALS BUILDING
SCRATCH.COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
,MICROFILM
. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H 'ONE WORKING DAY BEFORE REQUIRED INSPECTION. ^ p
r,.' PLUMBING 1 Z OW
z PLEASE GIVE JOB ADDRESS WHEN PHONING. ;.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! Y CONST.TAX
k.
PLEASE READ REVERSE SIDE BEFORE ) '
CALLING FOR FINAL INSPECTION: TOTAL
OFFICE COPY
AP ICP„NT TO FILL' IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUIeDING PROJECT I DENTI,FIC TIO PERMIT NUMBER
91lILDING - 'APPLICATION & PERMIT
ADDRESS . . o
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
17094
'�'. Q 94
OWNER'$
NA - 'PLAN CHECK VALIDATION
E4
- OTY. ELECTRIC PERMIT FEE
ONE
CONTRACTOR'S
N OUTLETS-SWITCHES-RECEP 10.00/1.00 '
{' A.� LIGHTING FIXTURES 10.00/1.00 g _
CO TRACTOR'S '
ADD /ss�/� /J ,O� APPLIANCES-RESIDENTIAL - 4.00 -
{O(�X {!,e pmwNE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
DR Q a�,� .� nx 90-70� PANELS (OVER 200 AMP) 20.00
ENGINEER +T `^ -'
SIGNS TRANS. 3.00
AENG.
ADDRESS
DREss SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION '
ziP TEMP.METER'OR POLE INS. 20:00
' APPLICANT'S
ADDRESS MOTORS SEE FEE SCH. 1
SERVICE CHANGE 20.00
woo LICENSED,CONTRACTORS DECLARATION -
au 1 hereby affirm that I am licensed under provisions of Chapter9 - _
a e. (commencing with Section 7000)of Division 3 of the Business and 7 Art.
ISSUANCE DATE
H.w 2 Professions Co a y license io in full fo a aryryl1��eef�f�ct��, - J BL G. ELECT. PLG. MECH.
Z
0 m W License Cie _Lic.Number 7J)bb� ..
I- y H J Date Contractor Ei I0
" City Of CUpBItIOO
¢_ a w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
o MISC- 'REFER TO ORD' INFORMATION
X 3' w I hereby affirm that 1 am exempt from the Business
d Pr License VALUATION u o ¢ Law for the following reason.(Sec.7031.5,Business and Professions S/FT. "-
yy.� Code:Any city orcounty which requires a permit to constct,alter, PERMIT ISSUANCE
ru .10.00
¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, , -
i wO.M requires the applicant for such permit to file a signed statement that - TOTAL - MI
m" he Is licensed pursuant to the provisions of the Contractor's License
FZQ, Law(Chapter 9(eommencing with Section 7000)o(Division 3 ofthe
i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 11 PERT TO
IF H the basis for file he alleged exemption.Any violation of Section 7031.5 STORIES T E CONSTR.
a3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 -
of not more than five hundred dollars($500)):
❑ I,as owner of the property,or my employees with wages asWNDUSTRIAL
W PROT ECT.,DEVICE 4.00 OCC.GRODP. RES.DNIT6
theirsole compensation,will do the work,and the structure is notintended or offered for sale(Sec. 7044, Business and ProfessionsLOOR;ROOF,AREA,COND. 5.00 1Qt7Code:The Contractor's License Law does not apply tD an owner ofproperty who builds or improves thereon,and who does such workS-PER TRAP006Q FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improvemems are not intended or offered for sale.If,however,the buildingSVSTEM-11NC.40UTLETS 6.00 or improvement is'Sold within one year of completion, the owner-
builder will have the burden ofproving that bedid not build or intSYSTEM-OVER 4 (EA.) 2.00 SuaowGuSE .prove for purpose of sale.). ,. ' RES IND ' CON PB Other
❑ 1,as owner of the property,am exclusively contracting withIAL WASTE INTER. 30.00 'E] � E] ❑ ❑licensed contractors to construct the project(Sec.7044,Business IN KLER$-1 INC 5'V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs 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 contmctons)licensed pursuant to
tire to
e Contracr's License Law. a SEWER-SANITARY-STORM EA.200ft/10.00 .• TRACT NO. -PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER'HEAT,ER,WyMB�YT 6.00 <1
reason
Owner Date - WATER SYSTEM' - - 5.00 Zl 00qCC.GATE ACC.FILE NO.
WORKS RS'COMPGNSATION DECLARATION WATER TREATING EQUIP. , 5.00
1 hereby affirm that I have acerliEcate ofconsent toself-insure, _ • '
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy thereof(Sec.3800,Lab.C.). - d -
Policy No. Company
� I ❑ Certified copy is hereby furnished. a ,,:FIRE SPRINK ENERGY T-24 .
Z Z D Certified copy is Bled with the city inspection division.
f" O Applicant IMISC.- REFER TO ORD. . Y [:] NJ[] Y Q . 'N❑'
= Lo CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 �y DO FLOOD ZONE q.L.u.D.
LU > COMPENSATION INSURANCE . PLG.CONTR. LIC.NO. pL�,
4"O (Phis section need not be completed if the permit is for one TOTAL yV V❑' N V�' N
Z hundred doliars($100)or less.) '
U O I certify that in the perform m of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued, shall not empl ny croon in a manne so as to
U become suyl Worker mesion sof(, 'ami .
U.1
Dat"/�/ pplicant ALTER OR ADD TO'MECH. .' 5.00 BUILDING "
0 APDL ANT: I ,a ter making this Certifi 'of Ex-
Z emption,you should'beco subject to the Workers'C ensation APPLIANCE 5.00 <PLAN CHECK -
provisions of the Labor ode, you must forthwith comply with -FEE
U such provisions or this pe it shall be deemed revoked.: AIR HANDLING UNIT(TO 10,000C.F.11/0 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER'10p000.F.M.) 6.00 rSEISMIC 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 ISec. - MICROFILM
30971 Civ.C.L H EATING UNIT ITO 100,000 B.T:U.).'8.00
Lender's Name H EATI NGUNIT(OVER 100,000 B.T.U:)9.50 L' ELECTRIC
Lender's Address -
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) , 4.00 ' O
• information is correct. I agree to comply with all city and county - PLUMBING pp
ordinances and state laws relating to building Conslrumion, and BOILER-COI I3 H.P.or 100,000 B.T.U.) 6.00lir!
hereby authorize representatives of this city toenter upon the
above-mentBOILER-COMP (Over 100,000 BTU)SEE FEE SCH. ,MECHANICAL '
ioned'property for inspection purposes.
(We)•agree to save, indemnify and keep harmss lethe City of MISC.- REFER TO ORD. -
u no
against liabilities,judgments, costs and expenses which PERMIT ISSUANCE' 10.00 CONST.TAX
_ y any wayy��a/cyyy�yy�J///�uuuuue ago st said Cily inconsequenceoof the, - -
rant g o tis p4' �A MECH.CONT.' LIC.NO: TOTAL
Si tore of Applli`ic(•aannt/Contractor Date
TOTAL L2f0D
OFFICE COPY -, '