17605 (2) POST THIS CARD NEAR FRONT OF BUILDING
'PERMIT NUMBER
CITY OF CUPERTINO 17605
INSPECTION DIVISION
JOB INSPECTION RECORD -
JOB ADDRESS PERMIT,EXPIRATION i
• UNIT# LOT# PERMIT EXPIRES IF WORK •_
OWNER CONTRACTOR IS NOT.STARTED WITHIN
' INSPECTION DATE INSPECTOR INSPECTION RECORD leo Dnvs OF PERMIT.ISSu=
FOUNDATION' ANCE OR-180 DAYS FROM
-NOTE: LAST CALLED INSPECTION. •
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF 'PERMIT VALIDATION -
CUPERTINO STANDARDS. . ,
GARAGE SLABS'. - - - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - — -
UNDERGROUND /.SLAB - `. -`-
PLUMBING
t�l
ELECTRICAL' - - APR �j ISSUANCE DATE, .
MECHANICAL BLDG. ELEcr. PLL. mECR.
flilty ❑ ❑ .
_ -DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- - . INFORMATION
WOOD FLOOR
VALUATION S/FT:
PLUMBING - +'
MECHANICAL - -�'
i e�vnRl To
' ELECTRICAL
FRAMING - - •, ;��. kt
STORIES - TYPE CONSTR.
i. INSULATION - � � - � � . .
. UCC.,ROUP RES.UNITS
S PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.'}�•� ' SO.FT FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
_ BUILDING USE
ROOF SHEATHING - - Res IND CON RB , El j
' El El Q ❑
APPLY NWROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DATE INSP.
ASSE SSOITS PAflCEL NO
ROUGH- SAN.# -
I PLUMBING - ELECT:ENERGY -
_' rflncT No. PARCEL No
TUBS B SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC onre ACC FILE No
ELECTRICAL BUILDING ENERGY
• FRAMING ELECT.FINAL TEST zoNlNc ENG,SITE No. .
INSULATION `, PLUMBING ' i
GAS TEST GAS '.
MECHANICAL• FIVE SPRINK ENERGY?2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING / v N� v N�,
.FLOOD ZONE A.L Uc.,
EXTERIOR SHEAR ELECTRICAL RELEASE -
INTERIOR SHEAR ' FIRE DEPT. y❑ NE] Y0 No
_ SHEETROCK'; GRADE 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' e . 'SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED,UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING. !
PLEASE GIVE JOB ADDRESS WHEN PHONING.
zMECHANICAL ,-' e
—' SEE PERMIT FOR EXPIRATION DATE
/ -
IMPORTANT! -)CONST.TAX' --
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION: TOTALi-
I' OFFICE COPY
APPLICANT'TO FILL IN INFORMATION WITHIN-RED LINES - USE BALL POINT PEN ONLY
_
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT y'
ByIILq Np - 17605
AUOREIs
Z � BUILDING - ELECTRICAL-PLUMBING-MECHANICAL P;
OWNER'S PLAN CHECK VALIDATION
NAME' 1 OTY. ELECTRIC PERMIT FEE
O S -130•SIM
-
CONTRACTORS CONTRACTORS
N4MeUTLETS-SWITCHES-RECEP 10.00/1.00
LIC
Do
2-- LIGHTING FIXTURES 10.00/1.00
CONTRACTORS..
ADDRESS
� PPLIANCES-RESIDENTIAL 4.00
Cq
"PHONE2, =, PANELS 10.00 DATE OF APPLICATION
AHCHrt ECT PLAN CHECK FEEPC.NO.
OR
PANELS (OVER 200 AMP) 20.00
ENGINEER ,
LC.NO. SIGNS TRANS. .3.00
ADDRESS ENG' - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 A
APPLDDRESS SNr$
ADDRESS
MOTORS SEE FEE SCH. X19IDRX-A
Q
SERVICE CHANGE 20.00 41 ILA 18q_
w o o LICENSED CONTRACTORS DECLARATION
a it w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
vH.a `w (commencing with Section 7000)of division 3 of the Business and BLDG. ELECT. PLG. MECH.
e, m a Professions Cut.-m{I y license is in full for J�Ui,
Zo z"o License Class sem-Lia Number- Tr I Q Q
Date_�..1_�._Convucm,_ _
¢y f ;N - BUILDING PERMIT
¢ ¢ it-
OWNER-BUILDER DECLARATION
�¢ o a " MISC.- REFE INFORMATION
w ; 0 H I hereby sobs ing R, arn.E exempt from the Qess and r.o Ciccone
LLo ¢ Law lion the following reason.(Sec.7031.5,Ifusinessand Professions PERMIT ISSUANCE 1000 VALUATION ;(FT.
�-yto-' Codc:Any city or county which requiresa,tero t loconstruct,alter,
¢ ¢ 0 improve,demolish,'.,repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
iLo u squires the applicant for such permit to file a signed statement that TOTAL
wPERMIT TO
FEE
B he is licensed pursuant to the provisions of the Contractor's License ` -
to z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a i 111.(1
o Businem and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT
¢ I- � the basis for the alleged exemption'Any violation ofSeclion 703 LS STORIES TYPE CONSTR.
s ; _ by any applicant for a permit subjects the applicant o.civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred Jollars(5500).):
❑ 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 Jo the work,and the structure is not
Intcndcd or offered for sale (Sec. 7044, Business and Profe3sioox DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code: The Co-naelm's License Law does not apply to an owner of
pmpetly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 So.FT FLOOR AREA TOTAL ACREAGE
himself re through his own emred foe,sale.
provided,however,
such imlrtuve-
memsarenotintendeJoroffereayees, that lhehu Pilot. GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is Bald within one year of completion, the owner- GAS-EASYSTEM-OVER 4 IEA) 200
builder will have the burden of proving than he did not build or ice- . . .
BUILDING USE
prove for purpose ofsale). . RES IND CON PB Omer
❑ I,as owner of the property,am .exclusively contracting with 0 ❑ ❑
licensed contractors to construct the project ISec. 7844,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Coda:The Contractor's License Law does not apply -to un owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER.5 (EA.) 1.00
contracts for such projects with a contmcmns)rcrewd-pursuant In SEWER-SANITARY-STORM EA.200ft/10.00
the Contraclar f License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dal, WATER SYSTEM 5.00 ACC.DATE' ACC.FILE NO.
WORK KRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate uI consent to self-insure. ZONINGor a cvalificale of Worker,'Compensation Issuance,no a ae,tiC,d ENG.SITE NO.
,op yl {�f�(. Lab.C.).'K....
Poli '[WG/.. impany-Akt kIA`-I'V&�,. -
0 ❑ erilicr y S hereby furnisher. - FIRESPRINK ENERGY T 24
Z Z _j2'Cmlife p is Is
with the oily inslu•clion division: - MISC.- REFER TO OR
Q
pp -
C,
P lcunl- _ Y [] N� YE] NE_
CC m CFR'I IFICATF OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c.
LU COMPI!NSATION INSURANCE PLG.CONTE. LIC.NO. PLG. Y N Y
(This section need not be completed if the permil is for one TOTAL N
handled dollars(51DD)or less I
L) o' 1 certify that in the performance of(lie work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ F mil is issued,I shall not employ any person in any manner so as to
0'w become subject l0 the Workars'Compenwtipn Laws of Calitomia.
a Dat`' APPI"'nt ALTER OR ADD TO MECH. 5.00 BUILDING
>_ Go NOTICE TO APPLICANT: If,after making this Certificate of Ez-
Z bmption,you should become subject to the Workers'Compensation APPLIANCE -5.00 PLAN CHECK
provisions of the Labor Coda you must forthwith comply with FEE
U such provisions or this permil shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNfP(OVER 10MOC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the Perfomwnce of the work for which this Permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 9.00
Lender's Name HEATING UNIT(OVER 1 DO,000 B.T.U.19.50
Concert AdJrcx - ELECTRIC
1 mono that I have read this application and now that d shove VENTILATION FAN (SINGLE) - 4.00
I, I romances n correct. 1 agree to amply with all city and county PLUMBING
ordinances and erre laws relating to building construction, hJ BOILER-COMP I3 H.P.or 100,000 B.T.U.1 6.00
w -
! hereby authorize representatives of this city enterer upon t
n the '
abovomentioned'properly for inspection Purposes. BOILER-COMP IO.er IDO,000 BTU)SEE FEE SCH. MECHANICAL
(We) xgre to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupert st lixb'Pirie udgments, costs and expenses which PERMIT ISSUANCE TB'OG (a CONST.TAX
may i an are a Inst mid City in consequence of the
sling hL /y MECH.CONT. LIG NO. MECN.
�r� TOTAL TOTAL a��
° SIISnatu of APPlicanllContractor Dale
OFFICE COPY