17309 " POST THIS CARD NEAR FRONT OF BUILDING '
PERMIT NUMBER
CITY 'OF ,CUPERTINO . 17309.
ILL INSPECTION' DIVISION
JOB INSPECTION RECORD Sp 21 D7
PERMIT EXPIRATION
JOB ADDRESS `rd Iz3 /� Id/'D�{e �� UNIT#, _LOT# '
PERMIT EXPIRES IF WORK
OWNER G( t✓. f a CONTRACTOR CB - IS, NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTrONRECORD 1 18o'DAYS OFPERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
LIFER " - LASTCALLED INSPECTION.•
ALL GRADING AND DRAINAGE SHALL BE�INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION -
'CUP.ERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDro . 7 � L� ' �4',c '
•+'
., UNDERGROUND /SL'AB FES
PLUMBINGV.+ Z,C"I
„ ELECTRICAL cltj ot ISSUANCEDATE
MECHANICAL BLDG� ELECT. PLG •-MECH,
❑ ❑ � . UI
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PER
WOOD FLOOR -_ INFORMATION
x
PLUMBING VALUATION - S/FT.
., � - ,3� � .. � � . .
MECHANICAL /O„ ✓ `L
ELECTRICAL PERMIT To' -
FRAMING -
INSULATIONST( TYPE NSTR.
i OCC,GHOUP - RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• "SN,FT.FLOOR AREA- TUTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
is
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - - .RFs IND 'ON PB 00—
APPLY-NO UNTIL,ABOVE HAS BEEN SIGNED FINALS, DATE INSP. : ❑ ❑ ❑ ❑ ❑
ASSE SSORS,PARCEL NO,
ROUGH sAN.q
PLUMBING -� '..Ao!3 ELECT.ENERGYTRACT NO, .PARCEL NO.,
. TUBS&SHOWER.PAN �'/ ,� PLUMBING ENERGY /G — �/ • -
MECHANICAL - MECH.ENERGY ./ _ _
ELECTRICAL ACG.DATE Acc.Fae No
BUILDING ENERGY
FRAMING ELECT.FINAL TEST '
INSULATION 20NING ENG.SITE NO.
PLUMBING
- GAS TEST - GAS
MECHANICAL _� FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING " 3_� _ Y❑' ' N� Y ❑ "❑
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE -A.Luc.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑. Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH. TEMPORARY APPROVALS 'BUI Lb LNG
SCRATCH COAT - - ' ELECTRIC ' ;I ' .PLAN CHECK
- " GAS - - . FEE
'NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN'SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY'OF BU I LDING IS NOT PERMITTED UNTI L BUI LDI NG FI NA LIS SIGN ED BY BUI LDI NG INSPECTOR. I
.MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
r H�' ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING
z PLEASE GIVE JOB;ADDRESS WHEN PHONING. b pig
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL e
IMPORTANT! I CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL Rm;a
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION, aERMIT NUMBER
B I INGs , a�o7 APPLICATION & PERMIT ) 17309
OORESS� �y
. / 4 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .
Owry ER'SPLAN CHECK VALIDATION
(WY)NAME OTY. ELECTRIC PERMIT FEE
G !.(Ay(� HorvE
CONTRACTORS UTLETS-SWITCHES
NAME -RECEP, 10.0011.00
Oke, UC.NO, 1LIGHTING FIXTURES 10.00/1.00
R.NTR TORS PCFw,'ttA GA /7JAPPLIANCES-RESIDENTIAL4.00
PHONE PANELS 10.00 DATE OF APPLICATION I
ARCHITECT PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ARCH.OR ENG.ADDRSPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. ; 20.00
APPLICANTS MOTORS SEE FEE SCH.
AO PUPS
d13441ESS R wf SERVICE CHANGE 20.00 tl {/{ �/1'I��J
0 0 o LICENSED CONTRACTORS DECLARATION � `O ` ' ' V_✓``I
< U U I hereby affirm that 1 am licensed under provisions of Chapter 9 IFEB 2 7 198 1— - ISSUANCE DATE
y<y (commencing with Section 7000)of Division 3 Of the Business and BLDG. ELECT. I PLG. J MECH.
r o i Professions Code,and my license is in full force and effect. 1p'1
o 0 A W License Class Lia Numbery. ❑ ❑- ® L^J-
Date Contractor
Y BUILDING PERMIT
¢ ¢ w eJ
REFER TO ORD
¢ OWNER-BUILDERMISC.-R-BUILDER DECLARATION INFORMATION
A O ce
X 3: u r 1 hereby affirm Ilial I am exempt from the Contractor's License VALUATION $/FT.
Fa. Law for the td1covingm.s.n.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
QQQQ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
It
- O M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
wsehe is licensed pursuant to the provisions of the Contractor's License
r z i Law(Chapter 9(commencingwlth Section 70001.(Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢=$ the basis for the alleged exemption.Any violation of Section 7031.5 - TD IES TYPE DONSTR.
by any applicant(..a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).):
Cl I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE - 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
J.. intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
•0'•, Code:The Contractor's License Law does not apply to an owner of
'!000 properly who builds or improves thereon,and who does such work a FIXTURES-PER TRAP 5.00 , D D. SO.FT.FLOOR AREA TOTAL ACREAGE
. 9O himself or through his own employees,provided that such improve-
0 cents are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
1 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
J builder will have the burden.f proving that he did not build or im-
�` a prove for purpose of sate.). INDUSTRIAL WASTE INTER. 30.00 RES ]NO 'CON PB Omer
❑ L as owner of the property,ton exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business I LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO,
T MvI 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 contractor(,)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
0 ❑ lam efiempt under Sec. ,H.&P.C.for this WATER HEATER W/VENT 6.00
J reason
4 Owner Dae WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
w 1 hereby affirm that I have a certificate of consent to self-insHrc. ZONING ENG.SITE NO.
,` Or a certificate of Workers'Compensation Insurance,or a certified
' copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
❑ CertiScd copy is hereby furnished. - FIRE SPRINK ENERGY T-24
Z Z )OF Certifie copy i^ fled with the it iyy,,p• on division. MISC.- REFER TO ORD.
Q Applicant ! LARN _f% I Y❑. N❑ Y ❑ N❑
Fy PERMIT ISSUANCE 10.00 �I) FLOOD ZONE A.L.u.C.
� > CIiRTI PICCOM F EXEMPTION FRN WORKERS' 1I
UJ _ reed Hot
be c. ,INSURANCE the PLG.CONTR. LIC.No. TOTAL -Op ❑ ❑ ❑ ❑
:' (This dollars need not bo completed If the permit is for one Y N V N
L) Z hundreddollarsthat(SI the a.less.!
LL O I certify tllm in the to employ
an.f the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I sloth not employ any person in any marine,
a Carso as to
O W become subject to the Workers Coinpensution Laws of California.
IL Uute ApplicaN ALTER OR ADD TO MECH. 5,00 s � p BUILDING
} N NOTICE TO APPLICANT: IL after making this Certificate of Ex-
F ? empli.n,YOU should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code,you most forthwith comply with AIR HANDLING UNIT(TO 10 C.F.M.) 4.00 FEE
V such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER t0,000C.F.M.16.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCTI 5.00
the performance of the work for which_(lis permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.001MICROFILM
3097,Cie.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.501 ELECTRIC
Lender's Address
I certify that I have read this application and stale Ilial the above VENTILATION FAN (SINGLE) 4,00 - / ,/�T
information is correct.I agree to comply with all city and county PLUMBING PD
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter Upon the BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. 'MECHANICAL �'
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 8
mn'ng of this permit MECH.CONT. LIC.NO. MECH.
. _ TOTAL 0� TOTAL b
Si acre of Applica t ontraclor Date
OFFICE COPY