17281 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT
17281
' CITY OF :CUPERTINO -
INSPECTION D VISION
JOB INSPECTION-RECORD 52p9e,� /p37
i�ERMI7 EXPIRATION
I)
JOB ADDRESS_0I� f� , UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER ' CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU .
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH SHE APPROVED PLANS AND CITY OF .PERMIT VALIDATIONI
CUPERTINO STANDARDS.
GARAGE SLABS ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING O i np
ELECTRICAL �• T� ,GI V 989 06 ISSUANCE DATE
MECHANICAL d �J /Z E BLDG ELECT, PLG. MEC.,
C Of Cupertino ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIEr.,
MECHANICAL I coo
ELECTRICAL PERMIT TO
FRAMING N
STORIES TYPj CONSTR.
INSULATION.
. QLLi'r3pJ�i �{/.c•y�s G Occ.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 LT.FLOOR AREA TOTALACREAGE
• ROOF - - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE n�C
DIAPHRAGM THE CONSTRUCTION TAX IS PAID .G J
BUILDING USE
ROOF SHEATHING HESIND CON PB OIm. '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 1:1 ❑ ❑ ❑ ❑
A55E5SURS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.nnT2 ACC FILE NO
FRAMING . .ELECT.FINAL TEST
`tZUrvING ENG.SITE NO. '.
' INSULATION - PLUMBING — L�
GAS TEST GAS
24
MECHANICAL _L _ '� FIRE SPHINK ENERGY F] r N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD zorvE A.LUC.
INTERIOR SHEAR FIRE DEPT. v❑ N❑ Y ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING Z
52
INTERIOR LATH TEMPORARY APPROVAL BUILDING L�
SCRATCH COAT 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
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE '— MECHANICAL
IMPORTANT!, CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICAN-f TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BDI LDI NG PROJECT 1 DENTI FICATION PERMIT NUMBER_
%ILLINDRESs APPLICATION & PERMIT 1 -�
lO1d3 N. WOLFE #IL)S -7 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1
OWNER'S PLAN CHECK VALIDATION
NAME L//e}- OTV. ELECTRIC PERMIT FEE
t
. � PHONE
NAME CO-TRACTORS
NAME p OUTLETS-SWITCHES-RECEP 10.00/1.00 iJJ ar
R S U'I.LD uc.No. 4-1�ll LIGHTING FIXTURES 10.00/1.00
CONTRACTOR is ' -44-46 �, C3 PPLIANCES-RESIDENTIAL 4.00
ADDRESS PHONE
�!-
lgy C '� PHONE 7�Z�{7D PANELS 10.00 DATE OF APPLICATION'
ARCHITECT PLAN CHECK FEE P.C.N0.
on L,4IY1/ NJGES PANELS (OVER 200 AMP) 20,00
ENGINEE . �f //}} �j '
1 � OGKIc.No.(i d SIGNS TRANS. 3.00
ARCH.OR ENG I ' �. 7 SPECIAL CIRCUIT' 5,00 PERMIT VALIDATION
11
ADDRESS Q 1 -�7� '
7
714 ai$�� EMP.METER OR POLE INS. 20.00 'cJ0 e' /9Ncyx/Uwf
APPLICANT'S
ADDRESS MOTORS - SEE FEE SCH.
'gb �' { //7fJ
e�G OO POmOS SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
<
�U w I hereby affirm that 1 am licensed under provisions of Chapter 9 �A Bl�. J ISSUANCE DATE
H
(commencing with Section 7000)of Division 3 of the Business and BLDG. I ELECT. I PLG. MECH.
Fm i Professions Code nd y license is in full force' ff ® ❑ ❑
Zo OZ o w Licensee ass- Lic.Number
DrIcV1 [M Lr. S OCT 1 1989
a x E BUILDING PERMIT
¢ ¢ w OWNER-BUILDER DECLARATION _ INFORMATION
w0 u 1 hereby affirm'that I am exempt from the Contractor's License MISC.- WR TO RD VALUATION $/FT.
Hu 0s Law for the following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE ..
Code:Any city or county which requires a permit to construct,alter,
R ¢Q 0 Improve,demolish,or repair any slnreture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
o ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A m" he is licensed pursuant to the provisions of the Contractor's License
La Law(Chapter 9(commeneingwith Section 7000)of Division 3 ofthe
a Buslnees and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE Thr- I ret Imo/ I-•-
F ¢ D STORIES TYPE CONSTR.
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty gLTER+DRAIN&VENT-WATER (EA.1 5.00
of not more than five Imndred dollars(S500)r):
❑ I,as owner of the property,or my employees with wages as ggCK 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. 1044, Bpsiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ,
Code:The Contractor's License Lawdoes not apply to an owner of
properly who builds Or Improves thereon,and who does suclLWOrk FIXTURES-PER TRAP 5.00 SO,FT,FLOOR ARE TOTAL ACREAGE
himself or through his own employees,provided that net,improve-
.cuts are not intended or offered for sale.llG�-I';however,the building GAS-EA.SVSTEM-11NC.40UTLETS' 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that h .e Aid not build or ire- RES IND CON - PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00
❑ 1,as owner of the property,am exclusively contracting with '
licensed Contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
D.an owner of property who builds or improves thereon,and wire LAWN SPRINKLERS-OVER 5(EA.) - 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 - TRACT NO. PARCEL NO.
- the Contractor's License Law,
❑ l am exempt under Sec. ,B&PC.for this WATER HEATER W/VENT 6.00
reason
Owner Date _ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPF-NSAT[ON DECLARATION WATER TREATING EQUIP. 5.00
Phereby affirm that I have a certificate of coowat to scibinsum, ZONING ENG.SITE N0.
or a certificate aGWorkers'Compensation Insurance,or o certified ZONING
Policy No*J�.&L, lU nny
O, ❑ Certified c(py is here by f, nish'(I. FIRESPRINK ENERGY T2C
Z 2 (Certified ¢py Ileo vhh he city inspection division. MISC.- REFER TO ORD. y N� v.� NE]
O Applicant
P: rnPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CC CG F-I CATE OF EXEMPTION FROM WORKERS'
UJ 9' COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O (This section need no, be completed i1' lbe Fermi, is for one TOTAL Y N V N
::1 Z hundred dollars 151001 or Icss.)
U O I certify that is flue performance of ,,,work for which this per OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I7 mit is issued,'I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensu,ion Laws of California.
Dine Applicant BUILDING
- Go NOTICE TO APPLICANT'. If,after making this Cer,ificato of Bx- ALTER OR ADD TO MECH. 5.00 �-7
F.Z emption,you should become subject to the Workers'Compensation qpp LIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with - FEE
C.) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify 11,21 l have read this application and state On,fine above VENTILATION FAN (SINGLE)' 4.00
information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL .
shove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City.of MISC.'- REFER TO ORD.
aperNno against liabilities,Judgments, costs and expenses which - .. CONST.TAX (/0_ QQ
may in any wa accrue against said City in consequence of the PERMIT ISSUANCE 10.00 WSO
MECH.CONT. LIC.NO. MECH.
lO�b TOTAL TOTAL 1?
ig alure of Applicant/Contractor Data !cJ
OFFICE COPY