18732 (2) *� POST THIS CARD NEAR FRONT OF BUILDING T -
•PERMIT NUMBER
CITY OF CUPERTINO PAID. 18732 ,
'=` INSPECTION DIVISION OCT . 319x .
JOB INSPECTION RECORD sµU°
�/ bivl of CalpritiRO PERMIT EXPIRATION
-
JOB ADDRESSi- �?o S I /�`G �[� . �"U LOT#
PERMIT.EXPIRES IF WORK
OWNER , U CONTRACTOR J I ���, IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - - - ANCE OR 180 DAYS FROM '
NOTE:
LIFER ALL GRADING AND-DRAINAGE SHALL BE INSTALLED LASTCALLEb INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
� �
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB Ll-169
PLUMBING - `TST
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG ELECT, PLC, ECR
❑ '❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATIONSIFT.
PLUMBING AL' s� "� '
MECHANICAL wh' .A.:..YS"irF14//.Lr IF( fl/c 1
ELECTRICAL - - PEHJMn To
- FRAMING.
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ID
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO IT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID'
BUILDING USE
ROOF SHEATHING HIS IND CON PB o'l •
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El El El4 ❑
ROUGH SAN.a ASSESSORS PARCEL NO
I
PLUMBING ELECT,ENERGY I
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARC L- .-NO
,\
MECHANICAL •� _ MECH.ENERGY - '•
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT,FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST - GAS
FIRE SPRINK ENERGY T24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE ALU C.
EXTERIOR SHEAR" - ELECTRICAL RELEASE
- INTERIOR SHEAR FIRE DEPT:
Y❑ NO ❑ "❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
• INTERIOR LATFiTEMPORARY APPROVALS BUILDING
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 IS SIGNED BY BUILDING INSPECTOR. -MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU
1.- DAY BEFORE REQUIRED.INSPECTION.
S 1.- + PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN.PHONING. . I y
— SEE PERMIT FOR EWP-IRATION DATE a MECHANICAL
IMPORTANT! CONST:TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
_ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILPI NG PRQ3 CT I DENTI FICATION .PERMIT NUMBER
,,
_
BUILDING , APPLICATION &'PERMIT
AOORE55 18732.
S BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 1,
OWNER'b • V PLAN CHECK VALIDATION
NAME CST DTV. ELECTRIC PERMIT FEAR'.
C{� 1-`E] HONE
NOMERAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.N8 ILIGHTING FIXTURES 10.00/1.00
ADDRESS rOR's APPLIANCES-RESIDENTIAL 4.00
ONTRAC qqt,q -
VJJ� PHONE �IS6Edi PANELS 10.00 - DATE OF APPLICATION '
ARC CT PLAN CHECK FEE
OR PANELS (OVER 200 AMP) 20.00 i
ENGINEER
LIC.No. SIGNS TRANS. 3.00 -
AOORESS erva. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00 /1a�UC\
APPLICANTS MOTORS SEE FEE SCH. H, V1
ADORE as
NNE SERVICE CHANGE 20.00 ^ '
0 o O LICENSED CONTRACTORS DIiCLARATION I i�(r,L,
1 t}1�itt�}
<o u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y a TM (commencing de, Section 700e i of Division 3 o he Bus BLOC- ELECT. 'PLG. M@CH.
F z Pro Cessions Codu,end my licenses in full fo ❑ ❑ ❑ .��Ix
Z, 02 m a License Class Lic.Numbe LUV
m r w Date-Contract.,
a Y 2 - BUILDING PERMIT
� a OWNER-BUILDER DECLARATION
E o a INFORMATION
E:
; u y 1 hereby affirm that I am exempt from the Contractor's License MISC.- F# FER TO OR
Huo¢ Law forthe following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code-Any city or county which requires a permit to construct,alter,
m p p' Y prior to its issuance,also ELEC.CONTR. LIC.NO.
¢ Fo improve,Demolish,or repair an structure,poi ELEC.
as o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
e w m he is licensed pursuant to the provisions of the Contractor's License
> Law(Chapter 9(commencing with Section 7000)o f Division 3 oflhe `
o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
IS I-$ the basis for the alleged exemption.Any violation of Suction 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars 15500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP R
ioES.UNITS
their sole compensation,will Jo the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply in an owner of ..
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
Rents are not intended or offered for sale.If,hcoetom,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 "
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND .CON PB Omer
11 L as owner of the properly,am exclusively conlraclirg 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 contructous)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
Oson wner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cerlil'icate of consent to self-insure, ZONING ENO.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
Copy thereof(Sec.3800,Lah.C.).
Policy No_Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z Cert' c Is fled wit Ih• cj in peer ion division.
H O Ap ¢ant�_{3s11i t x!' - MISC.- REFER TO ORD. Y ❑ N❑ I Y ❑ N❑
cc T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O.
LU COMPIiNSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y C] N❑ Y❑ N❑
DMZ hundred dullars($100)or less.)
V 0 1 certify that in the performance of the work for which this per' CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I Shall not ent ploy any person in any runner so as to
U become subject to the Workers'Compensation Laws of California.
' w Dmc Applicant UILDING �+
a ALTER OR ADD TO MECH. 1 ES.00
} m NOTICE TO APPLICANT': If,after making this Certificate of Ex.
� ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
ftovisions of the Labor Code, you must forthwith comply with FEE.
U such provisions or this permit sheii be deemed revoked. AIR HANDLING UNIT(TO 10=11C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I 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.C). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's NamAddr AddresHEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's s ELECTRIC
\ 1certify that I love read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating 10 building construction, and BOILER-COMP(3 H.P.Or 100,0008.T.U.) 6.00
hereby authorize representatives of this city lu enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpows.
(We)r agree to save, indemnify and keep harmless the City of 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 r-196B
raBing ofthis permit1 MECH.CONT. LIC.NO. MECH. T
0 q Tor L TOTAL I r3 g W
Signature f Applicant/Con actor Uate' T (� 39ys8�- y
OFFICE COPY