17197 ." POST THIS CARD NEAR FRONT OF BUILDING
-� - PERMIT NUMBER
CITY OF CUPERTINO 17197 ,
INSPECTION DIVISION
JOB INSPECTION RECORD
5'h- /v34 I i T. T
/ {,kPERMIT EXPIRATION
JOB ADDRESS—!U( Z3 N. M lA d UNIT# _LOT# tl I , , •
• PERMIT EXPIRES IF WORK
OWNER .� y a. CONTRACTOR 0v/- C, I'S NOT iSTARTED WITHIN
INSPECTION - DATE INSPECTOR INSPE TION RECORD 180 DAvs OF VERMITASSU-
FOUNDATION - ANCE OR 160 DAYS FROM
'NOTE:
UFER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNI7E TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERn9n VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 7-16 yy Cts / '� .. �� � '
UNDERGROUND /SLAB `
PLUMBING _ unp 07 WbJ .�re.{{ V114"
ELECTRICAL N�11f� ISSUANCE DATE
MECHANICAL CIV at Cupefto BLDG I ELECT I PLL, MEC.
X El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED S lac t -E BUILDING PERMIT
(S 1 INFORMATION
WOOD FLOOR 2— �jf IU U i�fl VALUATION $IFT.
PLUMBING Fz-- L9—�-9 Cit}t+
MECHANICAL coo
ELECTRICAL � � PERMIT TO
1 ,-y-� cl - � •r
FRAMING 1=' u'�•-
INSULATION II'STORIES TYPE COry TR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL AI MADE BEFORE 50•fr FLOOR AREA TOTAL ACREAGE
AX THE CONSTRUCTION TIS PAID 3368
DIAPHRAGM
• B W LDI USF.
ROOF SHEATHING RIES 'NO CON PB un.., '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 0 ❑. ❑
ASSESSORS PARCEL NO
. ROUGH - SAN.#
PLUMBING ELECT,ENERGY
TUBS&'SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY -
ELECTRICAL BUILDING ENERGY C ACC DATE ACC. No
.
ER AMI NG �, _ti2- Q ELECT.FINAL TEST ZONING ENG.SITE NO:
INSULATION PLUMBING y
GAS TEST - GAS
FIRE$PRINK ENERGY r.
MECHANICAL - I_/5- -�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� N�
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L U.C.
INTERIOR SHEAR FIRE DEPT. -%q i v ❑ N[]l 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"
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM �.---_
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL �1
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX s
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPL'tuANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FI ATION PERMIT NUMBER
901LOINGit 10 601 . APPLICATION & PERMIT 1 f] n
AOOREss I I J
E-j BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ��
O rvER' PLAN CHECK VALIDATION
NAME '�'f' OTY. ELECTRIC PERMIT FEE F1A 5.r t'�
rvnmERAcaoRs < UTLETS-SWITCHES-RECEP 10.00/1.00 "2 1S
LIC.NO LIGHTING FIXTURES 10.00/1.00 q ��,,,�11 /
. CONTRACTORS V APPLIANCES 4.00 �i--111MK) PD
oGREss J7�� I'1 2 5
D PANELS 10.00 DAROF AkCATIlk
ARCHrtECT -
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.NOUZ SIGNS TRANS. 3.00
Aooq'Ess ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
nooeCss Ts MOTORS - SEE FEE SCH.
SERVICE CHANGE 20.00
D ¢z lQ
Foo LICENSED CONTRACTORS DECLARATION
a v I hereby affirm that 1 on licensed under provisions of Chapter 9 _ '-
H 2 w ISSUANCE DATE
3 H (commencing wI[ $action 7000)of Division 3 of the Business end BLDG. ELECT. PLG. MECH.
s. L Z Professions Cod'u 1 my license is in full force _ VAR ❑ ❑ ❑
z O y - License CI ss Lie.Num be _
O w H w Dale Contacro
Citi
/���F��E�
¢ r a a OWNER-BUILDER wV d wEWe�i� BUILDING PERMIT
- ¢ w BUILDER DECLARATION
wo a " INFORMATION
I hereby affirm that I am exempt from the Contractor's License IMISC.- REFER TO ORD
VALUATION $/FT.
u O¢ Law farina following reason.(Sec.7031.5,Business and Professions 10.00
L- - PERMIT ISSUANCE
Ev, Code:Anycolish coumyir any requitersp prior
totonsuance,also
¢ Ce ¢ O improve,demolish,or repair any structure,prior lu its issuance,also ELEC.CONTR. LIC.N0. ELEC.
A wO M requires the applicant for such permit to file a signed statement that TOTAL
m he is licensed pursuant to the provisions of the Contractor's License N PERMIT TOI�
r 2 a Law(Chapter 9(canmencingwith Section 7000)of Division 3 of the
g 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; w by any applicant lora permit subjects the applicant toaciviI p enulty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ Las owner at the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS
their sole towner of til,will property,
the work,and the structure is not
intended or offered fur sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who build,lir Improves lhcrcon,and who does such work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.), RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 13 11 El 1:1 11licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 VB600 A$SESSORSPARCELNO.
and Professions Code:The Contractor's License Law docs not apply V.B. .
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts I'or such projects with u contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec. ,R.&I'.C.for Ibis
asoWATER HEATER W/VENT 6.00
n
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent In self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
on f .3 h.C.). �r
Poli l o tp
❑ Ce filled copy is hereby furnished.
Z Z Certified s t t 'hs action division. FIRE$PRINK ENERGY T-14
O Aplicant � MISC.- REFER TO ORD. Y ❑ NE] Y❑ N❑
1—QC W CERTIFICATE NIFROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
CL COMPENSATION INSURANCE
PLG.CONTR,CL LIC.NO, PLG,
(Tills seed6o lived not be completed If the mrinit is for one TOTAL Y E] N❑ Y C3N 11Z
hundred dollars($100)or IcssJ
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL
I. not is issued,I shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
W TO MECH. 5,00 1
Q.
Date-Applicant BUILDING 5/1�'J
>- N NOTICE TO APPLICANT: IL utter making tills Certificate of E. ALTER OR ADD
2 1
coalition,you should become subject to the Workers'Com ensation- proisionsof the Labor Code,you must forthwith comply with APPLIANCE 5.00 PLANCH CHECK
U such provisions or this permit shall be demned revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE �..
I hereby affirm that there is a eceituiction 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(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address - ELECTRIC
1 certify that 1 have rend this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is COrrcct.I agree to Comply with all city and county BOILER-COMP(3 H.P.Df 100,000 B.T.U.1 6.00 PLUMBING
ordinances and slate laws relating to building construction, and
hereby authorize representatives of this City to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned property fharmless the City of MISC.- REFER TO ORD.
uperino against liabilities,Alju I is, cost and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
limiting
ay in any way accrue agat City i consequence of the
of Ihls per IL MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 1,
Signature of Applicant/Contr et Data
OFFICE COPY