16862 (2) POST THIS CARD NEAR FRONT OF BU I.LDING
PERMIT NUMBER
CITY OF UPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORDf
;?3 q p / x� PERMIT EXPIRATION
� � L ( 7 I r" �e �A �•�`L UNIT# LOT
JOB ADDRESS PERMIT EXPIRES IF.WORK,'
OWNER ' U CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE OYSPECTOR INSPECTION RECORD 188 DAYS OF PERMIT ISSU-
FOUNDATION -ANCE OR 180 DAYS FROM
NOTE: - LAST CALLED INSPECTION. '
UFER ALL GRADING AND DRAINAGE.SHALL BE INSTALLED '
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAuuA r 10N
CUPERTINO STANDARDS.GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
. �It/vt.•4va .
ELECTRICAL ISSUANCE DATE
MECHANICAL BLOC' ELEcr. PLG. MecR
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - , - p-, LrLG E{ 911
BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION
PLUMBING
MECHANICAL
ELECTRICAL PAIP
- •, veRmrt ro
FRAMING b E
INSULATION - VI .p STORIES, TYPE comsrR.
Occ GROUP RES UNITS
r PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED sa rr.aoo1+Ar+EA rorAL AceEACE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
..�= ROOF SHEATHING RES IND CON ve om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH sAN.q'
PLUMBING ELECT,ENERGY TRACI NO. PARCELNo
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY '
ELECTRICAL 6 BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING. , ELECT.FINAL TEST
ZONING ENG SITE NO,
INSULATION PLUMBING
GASTESTGAS
MECHANICAL - FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Yo No ' NE]
EXTERIOR SHEAR ELECTRICAL RELEASE FLODD ZONE ALUC
INTERIOR SHEAR - FIRE DEPT. v NQ ❑ IN
. SHEETROCK GRADE -- i 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 SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FIN AL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ELECTRIC
ARRANGE FOR INSPECTION BY PHONING 252-4505,
'�� "' ONE WORKING DAY BEFORE REQUIRED INSPECTION. _ PLUMBING
il� z 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST, TAX
PLEASE READ REVERSE SIDE BEFORE qq, /�
CALLING FOR FINAL INSPECTION. TOTAL - u, r�p
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES — USE BALL POINT PEN ONLY .
•'�BUI LOING PROJECT 1 DENTI FICATIONPERMIT NUMBER
InLaU.NG APPLICATION & PERMIT 1 O C
(]
ADDREBUILDING—ELECTRICAL—PLUMBING—MECHANICAL
SS q I v 6J C Zd . � .,,
OWNER'S c �1b PLAN CHECK VALIDATION
NAME 1 �/�'r OJ/�1 Q J C. ELECTRIC PERMIT FEE
' kLe V PRONE 185 1
NAMERAcroR's p UTLETS-SWITCHES-RECEP 10.00/1.00 , Z�
sec.No. S3 LIGHTING FIXTURES 10.00/1,00 •�
CONTRACTO SPPLIANCES-RESIDENTIAL 4.00
D(R'E2M
ESS `+�
PHONE _Z 4'I PANELS 10.08 1 PATE OF APPLICATION fl
ARCHITECT PLAN CHECK FEE P.C.NO..
OR ( PANELS (OVER ER 200 AMP) 20.00L+r1� ..: x.
ENGINEER
I.C.No. I SIGNS TRANS. 3.00 7 . 0t ,
ADDRESS ENG. SPECIAL CIRCUIT 5.08 PERMIT VALIDATI(O�N
ZIP TEMP.METER OR POLE INS. 20.00
APPLIcaE MOTORS SEE FEE SCH.
�^
r�RE55
A �1 S TALOK (A SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION Z `0D
a u u 1 hereby affirm that I am licensed under provisions of Chapter 9 tl%q10iop ISSUANCE DATE
H G t (commencing with$cellon 7000)a(Division 3 o(the Business and D BLDG. ELECT. PLG. MECH.
r H z Professions Cod a dwy license is in lull Iorcy:LNd t ❑ ❑
z o m— License Cl ss ��NT-Q--Lic.Number 44y1l'' NOV N F [)ale�/.� _$S .C�ntractor•�I��q— 111 2 8 1988
4 : 2 -a BUILDING PERMIT
rc ¢ w 4 OWNER-BUILDER DECLARATION INFORMATION
woAD MISC.— REFER TO ORD
3 LL H I hereby affirm that I am exempt from(he Convador's License VALUATION $/FT.
Fay J Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE - t)
Cade:Any city or county which requires a permit to construct,alter. -
2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O LL requires the applicant for such permit to file a signed statement that MI-am �`� _ 2 115 3 TOTAL Z• PERMIT TO
w8 m he is licensed pursuant to the provisions of the Contractor's License .
Law(Chapter 9(cammencing with Section 7000)of Division 3 of Bra
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
2 F o the basis for the alleged cxemplion.Any violation nfSection 703 I.S. STORIES TYPE CONSTR.
u ;m by any applicant for a permit subjects lire applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).1:
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and lire 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 to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
menta;are not hrough
ownemployees,for sale.
If,ed that however.
the
improve- GAS-EA.SYSTEM-11 NC.4 OUTLETS 6,00
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that Ire did not build or im-
prove for purpose ofsale.). I NDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Orher
13as owner of the property, exclusively contracting with 11 11 E] 1:1
licensed
contractors to construct thehe project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor'sbuidLicense Law does not apply to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a conlruemr(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.—,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a Certificate of consent to self-insom, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sea 3800,Lab.C.).
Polic No. Company_ hl
0 JyyCertified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ?Certified copy is filed with the city inspection division.
Applicant ��_ � MISC.- REFER TO ORD,
O Y ❑ IN Y ❑ N❑
to CER IFICATF OF EX17MI-I ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU —> COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG.
CL TOTAL Y N O (This section need not he completed i(the permit is for one ❑ No,
V❑ N❑
=) Z hundred dollars IS 100)or less)
0 O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL F mit is issued.I shall not employ any person in any manner so as to
Ubecome subject to the Workers'Compensation Laws of California.
GO
Date—Applicant ALTER OR ADD TO MECH. 5.00 BUILDING '
>_ N NOTICE TO APPLICANT: Il,alter making this Certificate of li x- '
H ? emption,you Gould become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shell be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONs,rRUCf]ON LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.RM.) 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,Cm.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name - HEATING UNIT I0 VER 100,000 B.T.U.)9.50 '
Lender's Address ELECTRIC
I certify that I have read this application and slate 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 to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authori<e representatives of this city to enter upon (lie BOILER-COMP(Over 100,0008TU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep hu nn less the City of MISC., REFER TO ORD. -
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ranting of this permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of Applicant(Cnnl me tot Dale
OFFICE COPY r