18769 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER -
� IY OF CUPERTINO 16769
fNSPECTION DIVISION qq`
.JOB INSPECTION RECORD +,
.PERMIT EXPIRATION
JO B AD DR ESS,A&42:.j �� vwOL 'J�•�" + UNIT# ,LOT#
- - PERMIL.EXPIRES-IF WORK
OWNER deldAoeY -�" �� n% CONTRACTOR ISNOT. STARTED WITHIN .
INSPECTION DATE -INSPECTOR- INSPECTION RECORD 7Bo DAYS OF PERMIT ISSU-
FOUNDATION,.,, - .., `ANCE OR 180.DAYS FROM
NOTE: - LASTCALLED INSPECTION."
UFER - - ALL-GRADING AND DRAINAGE SHALL BE INSTALLED.
PREGUNITETO COMPLY.WITH THE APPROVED PLANSAND CITY OF PERMIT,YAUDATTON
- CUPERTINO STANDARDS. - .cq�• _ -- .
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ; I,• , •,Lf'h�r cc
.
UNDERGROUND /SLAB -
"i:' r..' PLUMBING . �. '
ELECTRICAL
ISSUANCE DATE
MECHANICAL - , BLDG, ELECL, PLG. MEGR„
ET
DO NOT.POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDINGPERMIT
WOOD FLOOR - INFORMATION
VALUATION_ SIFT.,
PLUMBING -. - , ' ,
MECHANICAL
PERMIT'TO
':ELECTRICAL }
,t
FRAMING'
INSULATION' ME IES., TYPE CONSTFi
. r .T 000..G Roue RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
• ,. sG Fr:PLoo+AREA TOTPL c E GE
. ROOF NOTE:NO FINAL INSP.•SHALL BE MADE BEFORE
DIAPHRAGM. . THE CONSTRUCTION TAX IS PAID',
) U -
ROOF SHBUILDINC.USE
EATHING ' - " E - , � IND COON •' B 0❑,",•,
APPLY.NO ROOFING UN
• TIGABOVE HAS BEEN SIGNED FINALS DAM,- INSP. Agsessoas PARceL NO .
ROUGH SAN.R'
'} PLUMBING ELECT,ENERGY
TRACING +'PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY `' '�• .
MECHANICAL MECH.ENERGW ' -
• ELECTRICAL BUILDING ENERGY - ACC.DATE AcceFILE No,
FRAMING ELECT.FINAL TEST.- -e - -
ZONING ENG.SITE NO.
INSULATION PLUMBING
GASiTEST GAS, -
MECHANICAL P[RE'SPRINK ENERGY T 2
'. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. ° ❑t ' "❑ ICD "❑
FLOOD ZONE .A.L ULC! -
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT: Y❑ No v ❑ N❑
• L"
SHEETROCK GRADE. - .. - - "FEE SUMMARY.
EXTERIOR LATH BUILDING ,
INTERIOR LATH .,TEMPORARY APPROVALS BUILDING'
SCRATCH COAT °'` ' ELECTRIC ' ,,I .PLAN CHECK
GAS FEE
I. N0 TTAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - 'SEISMIC FEE ,
OCCUPANCYOF BUILDING ISNOTPERMITT,ED UNTILBUILOING FINAL IS SIGNED BYIBUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY,PH0NING.252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED'INSPECTION PLUMBING
Z. PLEASE GIVE JOB ADDRESS WHEN PHONING. _
'. Z —SEE PERMIT FOR,EXPIRATION DATE = MECHANICAL
'IMPORTANT! CONST.TAX
' r PLEASE READ REVERSE'SIDE BEFORE„ TOTAL
:CALLING FOR FINAL INSPECTION. . LS.� r✓
OFFICE COPY„ . ;
ABPL'ICANT'TO'FIL'IL IN INFORMATION WITHIN RED LINES.;- USE'BALL POINT PEN ONLY-,,
" "�' v• �,BUILDING P.F1OJECT'IDENTIFICATIO "' - 4 I �' .PERMITNUMBER
auuDING APPLICATION &'PERMITv,':18,76
1 �] 9 r
AOORE55 O ',(` .. 1 9
- _ �UILDING—ELECTRICAL-PLUMBING-MECHANICAL A •���
• OWNER'S,// -
',/�Q A/JrlI�/ ,, / PLAN CHECK VALIDATION
NAME [
s,
IL_/ iia--W- W�-F• I—� QTY. ELECTRIC PERMIT FEE
PRONE
CONTRACTORS v - _ - " •'
rvaME, �. OUTLETS,SWITCHES'-,SWITCHES' 10:00/1.00
:5.+,e7*` L-�IL° 'ilc.ry 'LIGHTING'F.IXTURES, rI�5. 10.00/1:00 /' -
CONTRACTOR'S', I y
ADDRESS I + PPLIANCES RESIDENTIAL 400
/ PHDNE -AV ` PANELS _ lwi 10.00 r •p0 DATE OF APPLICATION I
. . ARCHITECT - P
., PLAN CHECK FEE;-' .C.NO.^
OR '+ :PANELS,(OVER 200 AMP) V "?a' 20.00 ..w y
ENGINEER . '. '� � L 5 I
c.No '� ',.SIGNS TRANS., ' . } 3.00
ARC OR ENG, J - - - }- + ^ .PEO MIT VALIDATION
ADDRESS'. - SPECIAL CIRCUIT r ' 5.00 44"00 y
ZIP TEMP.METER OR POLE,INS :' P 20.00
0,4p_
APPLICANTS
t
'SEE FEE SICK
- - SERVICE CHA(GE 20.00
AD RE ' MOTORS .,
-Ho ':LICENSED CONTRACTORS DECLARA ION d9^T}�^--f * ^�
Q,u u I hereby'affirm thrill am licensed under provisions of Chapter '++ _ I ��,•'-
z w - i 'ISSUANCE DATE `.
(commencing with Section 7000)of Division 3 of the Business and I BLDG: ELECT PLG., MECH.
'�" Profeseions,Co and I"•ase is in full to ,n,rr�y.,��..Cfect' + Lv / J u
r z �V - f. r
z i DLo
ata c Class' Wc.Number I y 1❑,'. '�.,, t.,
w,t w Date" Conlractor� �i' ' +
M m M < ` q,., BUILDING PERMIT _
¢ ¢ a, OWNER-BUILDER DECLARATION - - - INFORMATION
X ;u �' 1 hereby aft7nn lhaFl um exempt from the Contractor's sLicense MISC.— l I• ♦ D -
O ¢ Law for the following reason.(Sec.7031:5,Business and Professions .i VALUATION ;IFT
.PERMIT ISSUANCE I 570.00 1yp
Code:Any city or county which requires a permit to construct,alter - 1
¢ ar
¢ Q'O improve,demolish,or repair any stmcture,prior to its issuance also ELEC:CONTR'- �,` q LIC NO. ELEC°� _ J PyT ^i"•
wG¢ requires the applicant for such permit to file a signed statement that t'R' r '.TOTAL 1 - OI PERMITTO
m y' he is licensed pursuant to the provisions of the Contractor's License' y „' ql (,
> Law(Chapter 9(commencing with Section 7000)of Division 3 oflhu 1
io Business and Professions Code)nr that he is exempt therefrom and OTY. PLUMBING PERMIT iFEE
^ ¢ 1-oro- the basis for the alleged exemption.Any violation'of$ecti n 7031.$ �'•+ - ' vSTORIES 'TYPE CONSTR. •'
a3 _ by any applicant for a permit subjects the applicant to a civil penalty n ALTER-DRAIN.&.VENT-WATER (EA.) 500 x 51. .
of not more than flue hundred dollars(my em) - _ ,. -
❑ I,as owner at the property,or my employees with wagesas
et BACK FLOW PROTECT?DEV ICE'. 4.00 '' OCC.GROUP ^RES UNITS ,
Fheir'sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONDS 5.00 - Y -
Code:-The Contractor's License Law does.not apply to an owner of -
Properly who builds Or Improves thereon,and who does s act,work FIXTURES-PER TRAP, 500 50 FT FLOOR AREA TOTaLACREAGE'
himself or through his own employees,provided that such improve-
R,
-
corts are not
mprove-mcotsarenotintended or offered for sale.If,however,the building GAS EA.SYSTEM-O,INC.4OUTLET S 600 '
or improvement is 'Sold within one'year of completion,the owner- GAS,-EA':SYSTEM-OVER 4(EA.)` ';t 2 00
builder will have the burden of proving that he did not build or im- - - ,. - BUILDING USE
prove for purpose of sale.). •. RES IND, CON PB Other
❑+I,as owner of the ro cit am exclusively contracting with. INDUSTRIAL WASTE INTER 30 00
P P Y. ❑''.. 1:1, ❑ ❑ r
4 licensed contractors to constructthe project(Sec.7044,Business - LAWN SPRINKLERS-..1 INC5VB.,' . 600 _ :,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 MA.)_;'1.00
contracts foisuch projects with a emitraetor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT.No '- 'PARCEL NO �.
o nFam exempt under Sea ,B.&P.C.for this a WATER HEATER W/VENT
re -1600
Owner Date - WATER SYSTEM - -500
[ - ACC.DATE ACC FILE NO.
'WORKERS'COMPENSATION DECLARATION WATER,TREATING EQUIP "" '5.00 ° 1
1 hcreby ate of that I have m e Compensation
nnsuran nl to vett-insure: -j,• t (ZONING "'ENG SITE NO
or.a certificate of of Workers'Compensation Insurance,or a cer[d/ed
copy ther��,,ppl/ 380 Lb.C).
y PohcY NJ/IQ' anY f^flab0 -'
Q'' ❑' Certified copy Is hereby furnished FIRE SPRINK ENERGY T 24
Z Z o ❑ Certified upy is filed with the,city inspection division. MISC. REFER TO ORD +I s'
O ,- A plicant - - ,. �,, --: - - V ❑ N❑ ..,,V ❑ IN❑'r
HH t6.v a'rrp 6 PERMIT ISSUANCE' r "1000
� ' - CENTIIl 'ATE OF EXEMPTION FROM/WORKERS', P'1 FLOGOZONE ! ; ALUC' f
W ��x� ATI�i(WY�'.Sypgla'XJ�eTy' PLG.CONTR. LIC.IN PLG ❑ N❑ . 'V ❑. N❑'
D_ • (This section ne d t be.complete I t permit is for one ` '� TOTAL
Z hundred dollars(5100 or less.) - - -
U'O,. I certify that in the performance of the work for which this per. FEE SUMMARY
I - DTV. t MECHANICAL PERMIT $FEE i
LL!1- mit is issued,I shall not rkers' any,,ompenrson many of Calimannersoes to
U become subject to ilia Workers'Compensation Law:ofCalifornia'.
e - �Iw Date' Applicant - A . - -• a BUILDING '
}I N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH 5 00
entption,.you should become subject to the Workers'Compensation' gppCIANCE
5.00 ': >< -PLAN
provisions of,the,Eabor Code, you must forthwith comply with '" -
U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(T0.IQ000C F.M.)'-.4.00
'CONSTRUCTION.LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.RM.) 6.00 _ SEISMIC FEE' } 'I"
y - I he affirm that there is a construction lending agency for EXHAUST:HOOD (WITH DUCT), 5.00
` the performance of lire work foiwhich this permit is Issued(Sec, �MICROFILM y-
3097,CivC.). ,i% HEATING'UNIT.(T,0100,000BT.U.)- 800 r ."
.. Lender's Name - - ' 1 -
Leader's Add - HEATING UNIT(OVER 100,0008.T.U.)950 ^ 'ELECTRIC. " ��. .90.
I`certify that I have read this application and state that the above VENTILATION FAN'(SINGLE) r .,-.4.00
1 information is ecorrect,I agree to comply with all city and County 'PLUMBING r
ordinances and state law's relating'to-building construction and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 600
hereby authorize representatives of this city to enter-upon the _ BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. t s MECHANICAL
abm,annentimed property for Inspection purposes. -
(We) agree toasave, Inde 'fy' d keep harmless the City of MISC.- a - REF ER'TO ORD. e;, e- i -
upertino against Iiabi", ,lu lits, costs and expenses which 'PERMIT ISSUANCE :10.00 , CONST.TAX
" m_u any y accm g ' said Clly,in Conseq ence of the' k _
Ni oft
spermi MECH.CONT -LIC,NO. MECH. ✓ `
Ind 2; OTAS TOTAL. ' q0
t_
PPT,'b&LcXtractor - at }
"OFFICE COPY "
1
ELECTRIC SERVICE NOTICE P.G.a E.COPY
`` BUILDING INSPECTOR S NOTICE
CITY OF CUPERTINO
19
To _
You are hereby authorized to Connect electrical service for
i„ �
Owner or Tenant_/ T CA 14 e / (/L!S}
No.of Wires �(j(J ��!
j Size of Wires Size of Switch
i
Motor Load Voltage Phase
Heating Load K.W. Voltage
it j iy �y� �'/<z 7
Light 110�New Service Reconnect
No.of Meters
f Heot 1P0_Three Wve More Service
i T No.of Add.Meters Power Three Phose Move Meter.
/ 1
1 �� ELECTRICAL INSPECTOR //