18859 POST,THIS CARD NEAR FRONT OF, BUILDING
PERMIT NUMBER "
.- CITY OF CUPERTINO ' 18 59
INSPECTION DIVISION
JOB INSPECTION RECOR
PERMIT EXPIRATION.
J09 ADDRESS C2( �� C �' /) k_UNIT _LOT#
OWNER
v. PERMIT EXPIRES IF WORK'
1"— CONTRACTOR vre 4IS NOTISTARTED WITHIN
. P 6
'
INSPECTION DATE INSPECTOR I PECTION RECOR 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE•OR 180 DAYS FROM
LIFER GRAD NOTE: LASTCALLED INSPECTION. �
_ ADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OFPERMIT VALIOATION
GARAGESLABS CUPERTINO STANDARDS: ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED o —
~
UNDERGROUND /SLAB
LUMBING NOVO02 109 •� ,,� I ' �i V L� I
� � - -
ELECTRICAL ,/t v
MECHANICAL - B CUDBIf l), ISSUANCE DATE.)_
Hlf)G ELECT,I PLG'. MECH,
DD NOT POUfl FLOOR UNTIL ABOVE HAS BEEN SIGNED. - .. BUILDING PERMIT
WOOD FLOOR ' INFORMATION
PLUMBING - VALUATION $iFT.
MECHANICAL
ELECTRICAL - PERMIT.TO
FRAMING
INSULATION STORIES
PE corvsrR.
OCC GROUP HES UNITS '
PLACE NO SUB FLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT 1100.AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
ROOF SHEATHING. BUILOINGUSE
RES IND CON PB O,nr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ElEl 11 El
ROUGH SAN.# ASSESSORSPARCELNO.
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY '
• ELECTRICAL BUILDING ENERGY - ACC OATS ACC.FILENO
FRAMING ELECT.FINAL TEST -
INSULATION - PLUMBING zowmc " ENc,SITE No. .ii
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T}E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ .
EXTERIOR SHEAR, - ELECTRICAL RELEASE FLOOD ZONE A.LD.C,-
INTERIORSHEAR. ' FIRE DEPT. 'Y❑. N❑ Y N❑
SHEETROCK'. - GRADE
EXTERIOR LATH - BUILDING FEE SUMMARY
-
INTERIOR LATH "TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRIC
I- ONE WORKING DAY BEFORE REQUIRED INSPECTION." wMaINc O
I�
z PLEASE GIVE JOB ADDRESS WHEN PHONING. P
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL !6 -o�D
CALLING FOR FINAL INSPECTION.
OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY (/
,r WAI LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT S
ADDRESS � BUILDING -ELECTRICAL-PLUMBING-
WD% MECHANICAL 1 ^V r
•
NAME nA41,C 0 FT4SiN0A/P4� DTV. ELECTRIC PERMIT FEE
K PLAN CHECK VALIDATION
PRONE
CONTRACTOR'S
NAMEy 44 UES j7,(UMJ3/A/6 OUTLETS-SWITCHES-RECEP 10.00!1,00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
ADDRESS TORS pi/`yr, //S PPLIANCES-RESIDENTIAL 4.00 � "
7/ ( Mac 4/iT14PHDNE •-b/SQO PANELS 10,00 DATE OF APPLICATION'
ORCNITECTO 9AtbfC4 QHGO� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE G P.G.NO.
ENGINEER
' LIC.No. ISIGNS TRANS. 3.00
_ ADDRESS
ARCH.ORENG. ' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADD ESSTs p�./la'!••.AA'AID MOTORS . SEE'FEE SCH.
SERVICE CHANGE 20.00
E,o o LICENSED CONTRACTORS DECLARATIONar V
aU I hereby affirm that I am licensed under provisions of Chapter 9 - I I is �(xyon ISSUANCE DATE V
r z m (commencing with Section 7000)of Division 3 of the Business and
may - BLDC. ELECT. PLG. MECH.
7 z Is Cog�,.I li ease is in full to9/1041"
a d e
,i O 2- License Clasal=5 Lie Number / b ❑ ❑ ❑
2 Z - a DaUR CRs CDntraetor� Ch of Cupertino
a x E BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION '
¢ w u INFORMATION
woe H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
3 u m VALUATION $/FT.
Law for the following reason.(Sec.7031.5,Business and Professions
H _ PERMIT ISSUANCE 10.00
Code:Any city or county which Q requirespermit toconstruct,also Q¢ III1prOVe,demolish,Or repair any structure,prior IO its issuance, ELEC.CONTR. -LIC.N0. ELEC.
i D¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
H z <
Law(Chapter 9(commencingwith Section 7000)of Division 3 oftheII^^
i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE U�-V
¢ I-$ the basis for the alleged exemption.Any violation of Section 703 L5 STORIES T E CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EP.) 5.00
of not more than five hundred dollars(SSOID):
❑ 1,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
intended or offered for sale (Sec. 7144, Business Bad Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of p
property who builds or iniproves.thereon,and who does such work FIXTURES'-PER TRAP 5.00 y BO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
Of improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving Ghat he did not build or im- - . . .
REB IND CON PB Omer
. prove lot purpose of Sale.). ' INDUSTRIALWASTE-INTER. - 30.00
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 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
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 enntractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 in exempt under Sec. ,B.&RC.for Illy WATER HEATER W/VENT- 6.00
reason
Owner Date WATER SYSTEM 5.00ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 - I
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy Chr1,% '
Policy NioA6sny
1. 7-
0
Q
Certified copy Isre y furnished. FIRE BPRINK ENERGY T74
Z Z A{p,Certifie ca filed with the city inspection division.
O ppi MISC.- REFER TO ORD. y� NQ y ❑ N�
ICC- y PERMIT ISSUANCE 10.00 LA-V FLOOD ZONE A.L.U.C.
CIiRTI CATS ;MPTI ON PROM WORKERS'
LU > COMPI:NSA'I ION INSURANCE. PLG.CONTR. LIC.NO. PLG. y� N❑ V❑ N❑
0' o (This section need not be completed if the permit is for one, TOTAL " .Q
0 Z h u rid red doll.,IS IS 100)nr less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F. mit is issued,I shall not employ any person many armorer so as to
V become subject to the Workers'Compensation Laws of California.
y
Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate ofEx-
F.. ? emption,you should become subject to the Workers"Compensation APPLIANCE -5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PIXICEM.) 6.00 SEISMIC FEE -
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the parl'ormance of the work for which this permit is issued(Sec. ,MICROFILM '
3097,CN.C.) I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name _ HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and sLou That the Slave VENTILATION FAN ISINGLE)' 4.00 / n
information is correct. I agree tO comply with all city and county PLUMBING ! - If
ordinances and state laws relating to building construction, and 130ILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP Over t00,000BTU)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 wa rue against said City in consequence of the PERMIT ISSUANCE 10.00
mLLin h it. MECH.CONT. LIC.NO. MECH.
/Signa[ re TOTAL TOTAL
plBran
VMWactor
1
OFFICE COPY