17236 (4) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
- } CITY OF CUPERTINO
7236
INSPECTION DIVISION
JOB INSPECTION RECORD
QQ l(� hg
PERMIT EXPIRXTION '
�f JOB ADDRESS O t C �V hgr" An Zq. UNIT# - _LOT# �-'
`- /� PERMIT EXPIRES IF WORK
OWNER C� u`^C� r h 7o CONTRACTOR 0 Cn ^� IS NOT,STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD :180 DAYS OF PERMIT ISSU. .
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: - - LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF F , PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS s G
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED n
UNDERGROUND'/SLAB APR 11 imi,
PLUMBING - - j ; 42. �!Ntic,
Gr
ISI ELECTRICAL - oily, at cupefto ISSUANCE DATE
MECHANICAL BLDG.
y�LLDG L cT. PLC^. MECH.
/;PSI . � , �6J
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION-
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL l�gl-.od 10
ELECTRICAL vERM-//IT�.To
FRAMING ' y TY 1'd"UP
' 'STORIES TYPF CONSTR,
INSULATION ',� 1��t
C 5 OCC GROUP RES UNIT$
' "SER-Ft EC-' -GOR�ecri b L�
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED N 't,
SD"FT.FLOOR ARLA TOTALACREAGE
ROOF .NOTE:NO FINAL INSP,SHALL BE MADE BEFORE -
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - RCS IND CON PB Go— .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ EL
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
THACTNO PARCEL NO.'
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECR ENERGY '
ELECTRICAL " oN6 OV A BUILDING ENERGY ACC DATE - ACC.PILE No
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST, IGAS IE
MECHANICAL g FINE SPR INK ENERGY r.N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "� Y �_ ❑
• C
EXTERIOR SHEAR - ELECTRICALFLOOD ZONE AL UC.
RELEASE Lf '
INTERIOR SHEAR - FIRE DEPT. - v ❑ N0 Y'L� 'N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVAS _ BUILDING
L'
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 ISSIGNED BY BUILDING INSPECTOR, MICROFILM
.ELECTRIC
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ..
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING IV-toe
0�. PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - MECHANICAL'
— SEE PERMIT FOR EXPIRATION DATE — '
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. '
OFFICE COPY ('
APPLICANT TO.FILL IN INFORMATION WITHIN RED LINES'- USE BALL POINT PEN ONLY
I LDI
NO PROJECT IDENTIFICATION -PERMIT NUMBER
BUILDING S, APPLICATION & PERMIT 17236
' ADDRESS
D. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NAMER's Ol'T , P 1 O - PLAN CHECK VALIDATION
NAME tYC 71--'I'*' QTY. ELECTRIC PERMIT FEE �D
I PR°rvE r
NAME TO s OUTLETS-SWITCHES-RECEP 10.00/1.00 ,(J ��J1 O)
'A XIAIA
LIC.No. LIGHTING FIXTURES 10.00/1.00 L J
CONTRACTOR'S, PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PRONEPANELS 10.00 DA TE OF APPLICATION
OORRCHI cT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c-NO.
ENGINEER
UG NO. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
AZIP .P
EMP.METER'OROLE INS. 20.00
ADDDREDRESSSS MOTORS SEE FEE SCH.
,}
SERVICE CHANGE 20.00
ro O LICENSED CONTRACTORS DECLARATION v /�►-�/L IV_
Fi w I hereby affirm that I am licensed under provisionsof Chupter t.I ISSUANCE DATE
¢ (commencing with Section 7000)of Division 3 of the Business anti , B D ELECT. PLG. MECH.
H w z . Professions Code,and my license is in full force and effect J ,LSI
CC m o License Class Lic.Number _ }
¢ x J Date Contractor
¢ ¢ ¢ OWNER-BUILDER DECI-ARA'I'ION W WPB" BUILDING PERMIT
¢s,v INFORMATION
wLL N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ' VALUATION SIFT.
u O ¢ Law for the following reason.(Sec.7031.5,Business umd Professions
_ PERMIT ISSUANCE 10.00 ( .CD
Code.Any city or county which requires permit reconstruct,alter,
SE NO¢ improve,demolish,or repair any structure,prior to itissuance,also ELEC.CONTE. LIG NO. ELEC. // '�S h
au I'LL requires the applicant for such permit to file a Signed statement that TOTAL l v V U PERMIT TO
A w m he is licensed pursuant to the provisions of the Contractor's License
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
5 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ 1- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more then five hundred dollars(S504):
❑ I,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. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 a,00
Code:The Contractor's License Law does not apply to as owner of
property who builds Or improves thereon,and who does Such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
meats are not hrough
ownemployees,for sale.
if,ed however,the
improve. GAS-EA.SYSTEM-1 6.00
. meats are nal intended or offered for sale.It mpleveq the building
or improvement is-sold b within one year of completion,the owner, GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have[he burden of proving That he did not build or im- RES IND CON PR Other
prove for purpose of sale.), INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner Of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
Montrrs
licensed cactoto construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS FARCE L NO.
Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,msd who LAWN SPRINKLERS-OVER�5(EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to -
theContmctor'sLicenseLaw, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC,DATE ACC.FILE NO.
WORKERS'COMPF:NSATION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate of consent tD self-insun:. - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Se 3800,Lab.C.I
Policy No//Q$&WompanY ♦-jTq/
Q ❑ CetliRed ropy is hereby furnished. FIRE SPRINK ENERGY T 24
Z 2 ❑ Certified o y is fled with the city inspection division.
f" O Applicant- MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ No
CC m CI;RTI FICATE 01:17 XEMP I ION FROM WORKERS' PERMIT ISSUANCE 10.00 2106 FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG.CONTE. LIC.NO: PLG. ISE/,
Z (This section need not be completed if the permit Is for DILL' TOTAL( l /' L)A✓V Y N❑ [DY N
hundred dollars IS 100)or less.)
L) 0 I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL P mil is issued, I shall not employ any parson in any manner so as to
0 become subject to the Workers'Compensation Laws ol'Califnrniu.
w Date Appficant - BUILDING ppp
a ALTER OR ADD.TO MECH. 5.00 189-
} N NOTICE ption,TO APPLICANT: It after making this rs'Compe of lix-
400
F" ? empision you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Cade, you must forthwith comply with FEE
U such provisions or this permit shall he Jcamed revoked. - AIR HANDLING UNIT(TO 10,000 GF.M.) 4.00 •
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 2.10
1 hereby affirm that there.is a construction lending agaicy for EXHAUST HOOD(WITH DUCT) 5,00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CivG.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify first l have read this upplieatioo and coun
slate that Om above VENTILATION FAN (SINGLE) 4.00
'4. information is correct.I agree to comply with all city and t BOILER- H.P.or 100,000 B.T.U.) 6.00 PLUMBING
Ordi minces and state laws relating to building construction, and -d
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. g01 LER-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 any way accrue a8ain anti City in consequence of the PERMIT ISSUANCE 10.00 / 4
ranting Of'o enol[. MECH.CONT, - LIC,NO., MECH. p
2113 8 TOTAL It br TOTAL ,36120
SigrbrNEre6TWppfic&Kontravtor at
OFFICE COPY , 1