18584 (2) I
POST THIS CARD NEAR FRONT OF BUILDING.'
PERMIT NUMBER
CITY OF CUPERTINO 18584
INSPECTION DIVISION
JOB INSPECTION RECORD
. / AD
- PERMIT EXPIRATION
JOB ADDRESS_[ O3 A''.I7 5vnn_A Lmk� UNIT# • _LOT#
I' 'PERMIT"EXPIRES IF.WORK
OWNER L aONTRACTOR IS NOT STARTED WITHIN .
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION IANCE OR 180 DAYS FROM
. -NOTE:, 'LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH.THE APPFiBY�plf►NS AND CIT'OF P[Rnnr VALIDATION
PREGUNITE CUPERTINO STANDARDS. r_,IM
GARAGE SLABS 2L
D
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL - - issuANCE unre
✓j'�V
MECHANICAL BLOC ELECT PLG. M7�EC.
lS
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ BUILDING'PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION S/FT.
MECHANICAL
ELECTRICAL - - PERMIr TO
FRAMING / nx .0 l _
INSULATION STORIES - TYPE CONSTH.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$ FT 11. 1 IEA LOTAL ACOEA GE
.
-ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID y /7A/�
s? 'T' .
ROOF SHEATH NG 9Es IND UILOMON USEPBOtiv,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El 1:1 11 1.
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO� -
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE. ACC FILE NO
FRAMING =HEATING
ZONING ENG.SITE NO.
INSULATION
F GAS TEST FIRESPRINK ENERGY T-j4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED N❑ V E NoEXTERIOR SHEAR FLOOD ZONE A U.C.
INTERIOR SHEAR FIRE DEPT. n rc ort Y❑ NE] Y ❑ N❑,
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH . BUILDINGBUILDING _Oa
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN.8IGNED OCCUPANCY SEISMIC FEE Ste;
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. 'MICROFILM
LU ' ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICO-�U
~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMBING
z PLEASE GIVE JOB ADDRESS-WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 3�„}'�
IMPORTANT! coNST.TAX .
PLEASE READ REVERSE SIDE BEFORE , ..
CALLING FOR FINAL INSPECTION. TOTAL 6(9�, 2
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER -
BUILDINGPROJECT IDENTIFICATION APPLICATION & PERMIT '
II MOOING 18584
ADDRESS
J 3 u o yA ��.++�¢_ Pr. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ..
OWNER'S - PLAN CHECK VALIDATION
NAME Mr. /✓fit �aL9.•lfC'ra�' u QTY. ELECTRIC PERMIT FEE
• //PHONE
NAME croRs OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC No. LIGHTING FIXTURES 10.0011.00 • �I
CODDRES
ASNTRAS TORS, t!� PPLIANCES-RESIDENTIAL -4.00
PHONE PANELS - 10.00 DATE OF APPLICATION
ARCHITECT // PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEEOR P.
ENGINEER keret,,, rIO
uc.No. SIGNS TRANS. 3.D0
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
AooREs /_- Cy�tos
y7j MiSffe7o� lQdy Z- IP 03l EMP.METER OR POLE IN_S. 20.00
APPLICANTS MOTORS SEE FEE SCH. • _r "/
ADDRESS
SERVICE CHANGE 20.00 `,, J
oo LICENSED CONTRACTORS D17CLARATION J' �� V` \/1�
¢ is v I hereby affirm that I am licensed under provisions of Chapter 9 ! 'ISSUANCE DATE •I
aHi<w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r o z Professions Code;and my license is in full force and effect. �f 7f7 ]fY7
z o-- License Class Lie.Number _ CIO M IQL fCy. L�L
z Date Contractor -
a Y L BUILDING PERMIT
¢ ¢ w¢ OWNER-BUILDER DECLARATION INFORMATION
REFER TO ORD
R
S LL w I hereby affirm that I am exempt from the Contractor's License MISC.- VALUATION $/FT.
Hu. o J Law for the following reason.(Sec.703L5,Business Professions PERMIT ISSUANCE 10.00 yVT ` ry
Code:Any city or county which requiresa permit to construct,alter, S a.
s R¢ improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. d1
S m¢ - requires the applicant for such permit to file a signed statement that TOTAL 6• V PERMIT TO
K
he is licensed pursuant to the provisions of the Contractor's License ,{
F z a Law(Chapter 9(commencing with Section 7000)of Division
Business
the LLN.���np
3 4 O Business and Professions Code)or that he is exempt the refrom and QTY. PLUMBING PERMIT FEE ( x -
¢ r$ , the basis for the alleged exemption.Any violation of$ection 7031.5 -STORIES YPE CONSTR.
a3 - by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 t00
oft t more than five hundred dollars($5000f):
Lj�g I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS
th IKle compensation,will do the work,and file 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 on owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 r 0 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
mentsarenot mucadvelm.fend fol-sale.Ifav
,hower,0u:building GAS-EA.SVSTEM-1 INCA OUTLETS 6.00
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 he did not build or im- RES IND CON PB OR.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with El El El El El
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 in owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I um exempt under Sec. ,R&P.C.fur tis WATER HEATER W/VENT 6.00
reason
Owner _ Date WATER SYSTEM 5.00 r Q ACC.DATE ACC.FILE N0.
Wo 1RS'COMPEN ATION DECLARATION WATER TREATING EQUIP. 5.00 '
1 hereby affirm that I have a certificate of consent to self-insure. ZONING ENG,SITE NO.
or it certificate of Workers'Compensation Insurance,or it certified
copy thereof(See,3800,Lab.C.).
Policy No. Company
O O Certified copy is hereby furnished. FIRE SPRINK . ENERGY T24
Z Z ❑ Certified cup, is filed with the city inspection division. MISC.- REFER TO ORD, y N j Y ❑ No
O Applicant
I'•' in PERMIT ISSUANCE 10.00 ,p0 FLOOD ZONE A.L.U.C.
J CERTIFICATE 01'EXEMPNON FROM WORKERS' _
LU _ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. DD v N v❑ N
6. O (This section need not be completed if the permit is for one TOTAL
Z hundred d011ars(SIOD)Or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. I- mit is issued, I shall not employ any person in any manner so as to
O w became subject to the Workers'Compensation Laws of California. OQ
Date Applicant ALTER OR ADD TO MECH. 5.00 , O BUILDING ��•
NOTICE TO APPLICANT: If,after making this Certificate of lix-
F.. ? emption.you should become subject to the Workers'Coolpeomllon 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 10=C.F.M.) 4.00 ,r
CONSTRUCTION LENDING AG17NCY ' AIRHANDLING UNIT(OVER 10J=C.F.M.) 6.00 SEISMIC FEE U L 6
1 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 HEATING UNIT(TO 100,000 B.T.U.) 8.00 a S MICROFILM
3097,Civ C.). -
Lcuder%Name HEATINGUNIT(OVER100,000B.T.U.)9.50 ELECTRIC O,'b
Lender's Address
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. information is correct, 1 agree to comply with all city and County PLUMBING
ordince
ans and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUl SEE FEE SCH. MECHANICAL 36•
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uPertno against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 1.Vb CONST.TAX
may is any way accrue against said City in consequence of the
•runti f this pen 't. MECH.CONT. LIC.NO. MECH.
TOTAL .S D TOTAL
S alure fA heart/ .nntract Data
OFFICE COPY