18796 POST-THIS CARD NEAR`FRONT OF BUILDING
PERMIT NUMBER •
t CITY SOF OPERTINO: 8 96
INSPECTION`DIVISION ,;
JOB INSPECTION RECORD--
I (� ,1 PER MIT'EXPIRATION
• JOB ADDRESS_[ � � Z-� N'=�.A/e /�✓�' yc.lry_UNIT.# LOT 4t �
owNER -
`SV. \ PERMIT EXPIRES IF WORK
;CONTRACTOR - %ol e� IS NOT'STAR7ED WITHIN
INSPECTION . DATE INSPECTOR .INSPE TON RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - - ANCE OR 180 DAYS FROM
LIFER'
NOTE ` �'•'�� LASTCALLED INSPECTION.
ALL:GRADING AND DRAINAGE SHALL•BEE INSTALLEDI
PREGUNITE •- - TO COMPLY,WITH THE APPROVED PLAINS AND CITY,OF PERMIT VALUATION
+
' GARAGE SLABS CUPERTINO STANDARDS. pABG
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ¢_ G
UNDERGROUND*/SLAB ,p 'T 171959
. PLUMBING
ELECTRICAL
ISSUANCE UATEV
MECHANICAL' - - - BLDG. ELECT I PLG. MECH.
_ ❑:" ❑ ❑
DO NOT.POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
' PLUMBING - VALUATION.
SiEr.
MECHANICAL - -
ELECTRICAL vERMIT To
FRAMING
INSULATION. - _ "STORIES TYPE NSTR.`
.. - OCC.GHOUP. RES,UNITS
PLACE ND SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
-� ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD FT.FLooH ABeA..4 TornL AcwEAae
DIAPHRAGM' THE CONSTRUCTIONTAXIS PAID
ROOF SHEATHING auI
LO I NG USE
RES IND . CON PB 0111-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑'
ROUGH SAN.N _ ASSESSORSPAHCEL NO
PLUMBING ELECT.ENERGY
TUBS&SHOWERPAN - PLUMBING ENERGY TRACING. PARCELNO.
MECHANICAL MECH.ENERGY ,
ELECTRICAL - BUILDING ENERGY,:, ACC.DATE ACC FILE No:
FRAMING 7ELECT.FINAL TEST
INSULATION ' zoNING
PLUMBING ENG.SITE No
' GAS TEST ,'. � GAS - �
MEDHANIDAL, FIRE STRINK„ '. ENE
RG
Y T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ; ❑E . N❑. ' Y O. N❑
EXTERIOR SHEAR ELECTRICAL RELEASE /L/ EEoon zoNE A.L=
,
INTERIORSHEAR FIRE DEPT.- _ Y❑ N� rL 'N�
SHEETROCK . f GRADE t 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. ,:1, . • SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUI LDING FINAL IS SIGNED BY`BUILDING'INSPECTOR:
' - - - MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• O� ONE WORKING DAY BEFORE REQUIRED INSPECTION.',.,” PLUMBING.
PLEASE GIVE JOB ADDRESS WHEN PHONING-
- SEE PERMIT FOR EXPIRATION,DATE '-. , . MECHANICAL.•:
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION; TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES —`'USE BALL.POINT PEN ONLY 9�
• BUILDING PROJECT.1 DENTI I TION - - I - PERMIT NUMBER
BADILOING APPLICATION &'PERMITDS" 14 0 Fa 1 / - u
:Da. l G.N k.. BUILDING—,ELECTRICAL—PLUMBING—MECHANICAL 18 7 96
NAME PHONE U63 Hy /Nhy/G PLAN CHECK VALIDATION
T
• / DTV. ELECTRIC PERMIT, FEE
OIL K (,N, 53'S)Z 2
CONTRA TOR'S
NAME 'L OUTLETS.SWITCHES-RECEP 10.00/1,00 /2r70
S
6IYt�� LIC.NO 3 93 LIGHTING FIXTURES , 10,00/1.00,2
'urs i"An I OHS r APPLIANCES-RESIDENTIAL ' 4,00 .
ADDRESS
iS3 ' roas- ^.cs, PHONE gZ S-0$O6 PANELS - -
ARCHITECT 10'00 DATE OF APPLICATION •.«
OR - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER / _
C fJOGi41e IC.No., � SIGNS TRANS.-, 3.00
ARCH.oR eNG.
ADDRESS 9p 3S SPECIAL CIRCUIT . 5.00 PERMIT VA LIGATION
�s8 Quart DY Mr / a 4f zIP EMP. METER OR POLE INS. 20.00 I
APPLICANT'S "
AooREss ,J " MOTORS 'SEE FEE SCH. .dVr
S4 t 45 Co`. VALIOv SERV ICE CHANGE
20.00 �a
D ¢�
Foo LICENSED CONTRACTORS DECLARATION • -
a i w I hereby affirm that 1 am licensed under provisions of Chapter 9 w ISSUANCE GATE
Q y (commencing with Section 9000)of Division 3 of the Business and BLDG' ELECT. PLG. MECH.
O y i Professions Code,and my'license is in full force and effect.
z o m - License Class Lie.Number " ❑ ❑ ❑
4 m r w Date Contractor.
a City.of,Cupertino
¢,¢ w OWNFi R-BUILDER DECLARATION BUILDING PERMIT -
X 3` 1 hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD INFORMATION
quo¢ Law forthe Rcllowingrcason,(SIC,7031.5,Businessand Professions _ - VALUATION' $/FT.
u Code:Anycityorecmvy which requires PERMIT.ISSUANCE 10.00 (�
¢ ¢�^ Y r permit its i.tmace,after ELEG.CONTR. LIC.NO.
¢o- improve,demolish,of repair any sfruchne,prior[o its issuance,also ELEC. C�� Lt ,
K u requires the applicant for such permit to file a signed statement that TOTAL dd IXy L
n w m he is licensed pursuant to the provisions of the Contractor's License - PERMIT TO
r z i
Law(Chapter 9(commencing with Section 7000)0 f Division 3 of the
f E„o Business and Professions Code)or that he is exempt therefrom and, OTV. PLUMBING PERMIT FEE I-!l �`�. �.(�,
¢ I-m the basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR.
n 3'� by any applicant forl eloolded dollars the applicant toucivil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than five he prop dollars(myemp
❑ Las owner at the property,or my employees with wagesI aset BACK FLOW PROTECT. DEVICE
their sole compensation,will do the work'and the structure is net 4.00 OCC.GROUP RES.UNITS
intended a Cofferedntract for sale(Sec. 7044, Business and Professions4RI
NS-FLOOR,ROOF,AREA,COND. 5,00
property
ro e:The o builds
r'sOr License Law does not apply to an owner work' - -
himsertywhobuildsorimprovesthereon,andwhodoessuch workURES-'PER TRAP 5.00 .SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- `
•: ments are not intended or offered for sale.If,howcveq the building EA.SYSTEM-11NC.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 jm- EA.SYSTEM-OVER 4 (EA.) -2.00 BUILDING USE
prove for purpose asideJ. RES ' .IND CON PB Orhar
t ❑ I,as owner If the pioperty,dm exclusively contracting withSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business SPRINKLERS-1 INC 5 V.B. 8.00
I and Professions Code:The Contractor's License Luw't10es not applyASSESSORS PARCEL N0,
to an owner of property,who builds or improves thereon,and whm SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with aconlracml(sllicensed pursuant to '
the Contractor's License Law, - R-SANITARY-STORM EA.200ft/10.00 TRACT.NO. PARCEL No.
❑ 1 amexempt under Sec.reason - R HEATER W/VENT 6.00Owner Date ER SYSTEM 5.00ACCDATE ACCFILE N0woRKERs•,coMPENsnTION uF:cLARnTION R TREATING EQUIP. 5.00I hmby affirm that 1 have a certificate ofconsent[oself-insure,or a certificate ofWorkers'Compensation Insurance,or a certifiedr ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). -Policy No, Company
❑ Certified copy is hereby furnished.Z Z ❑..Certified ropy is Bled with the city inspection division. FIRESPRINK ENERGYT-24
p Applicant - - REFERTOORD. y� N❑ V ❑ +..N❑
y CERTIFICAI'EOF P.XEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE q.1,.u.C.
Lu > COMPENSATION INSURANCE PLG.coNTR.- - LIC.No. PLG.
CL O (This section need not be completed if the permit is for one TOTAL y Q NEI
y, N�,
0 Z hundred dollars(S 100)or less.) - -
U O 'I certify that in the performance of the work for which this per, OTV. MECHANICAL PERMIT FEE .FEE SUMMARY
LL U mibis issued,1 shall not employ any person In any i armor so as to
W became sub' n eWorkere'C/�ojJ cl Lo aw f�C,a�j'l���r1m.
Q_ Date) - Applicam� ALTER OR ADD TO MECH.' 5.00 BUILDING.
} 2 NOTICE'f0 APPLICANT: If cm tlh erti¢ate of Ex- - - _
F- _ emption,you should become subject to the Workers'Compensation APPLIANCE 500 PLAN CHECK.
provisions-of the Labor Code FEE you must forthwith*comply with .
V 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.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency (or EXHAUST HOOD(WITH DUCT) 5.00 - -
[he performance of the work for which this permit is issued(Sec.
3097,Civ.C.). HEATING UNIT(TO'100,000 B.T.U.)' 8.00 MICROFILM
”
Lender's Name - • -
u,✓ Leader's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC D
r. I Certify that 1 have read this application and state that,the above VENTILATION FAN (SINGLE) I r 4.00
information is correcL.I agree to comply with all city and county ',PLUMBING
ordinances and state laws relating to building construction, and' BOILER-CUMP(3 H.P.or 100,000 B.T.U.) 6.00
�. y aulhoriu re Presentatives of this city.to enter upon the
hereby .-
heeb mentioned property for inspection purposes BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL ,
(We)'agree to save, indemnify and keep harmless the City of MISC.- -REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in y y accrue a land said�City in consequence of the PERMIT ISSUANCE 10.00
gremlin ft per - /p` l' MECH,CONT. - _ LIG NO. - ,TOTAL
at SS-6o
tore of pp ma /Coniracmr - Dale TOTAL
'OFFICE COPY