18337 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
" CITY OF CUPERTINO � 83�7
-- INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS
Q �! —�. I �QN/✓I�p E.��� PERMIT EXPIRATION
UNIT# _LOT#
"' - — PERMIT EXPIRES IF WORK
OWNER,' �2GTG'l��GL - CONTRACTOR .Q. rL IS 'NOT'STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION 'ANCE OR 180 DAYS FROM
.NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERnnT VALIDATION
GARAGE SLABS CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING �f
ELECTRICAL - IssunmcE DA TE
MECHANICAL BLDG. ELECT PLD. N1EGR
E] ❑ g-Lign
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING VALUnTION SIFT.
MECHANICAL
ELECTRICAL PEPER�nJnI�T�To�
FRAMING
INSULATION STORIES TYPE CONSTR,
Occ.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF TIT ITFLOOR ARE. TOTAL ACREAGE
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ,
DIAPHRAGM . 1 THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING BUILDING USE
RES IND CON PB Une
1 "APPLY NO ROOFING UNTIL ABOVE-HAS BEEN SIGNED FINALSDATE - INSP. ❑ ❑ ❑ ❑ ❑
SAN.q
ROUGH Assessoas PARCEL NO
�
PLUMBING ELECT.ENERGY
• TUBS B SHOWER PAN PLUMBING ENERGY rRnn rvo. PARCEL DD,
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY - - Acr,.OnrE Acc.wLE NO.
FRAMING ELECT.FINAL TEST
INSULATION - PLUMBING zoNlrvc ENc.SITE No.
GAS TEST GAS
FIRE SPRINK ENERGY T}G
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑' N❑ Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE -A.LUC
INTERIOR SHEAR FIRE DEPT. Y ❑ . N❑ Y ❑ N❑
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 SEISMIC FEE
OCCUPANCY'OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED13Y'BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
CIO PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE IS
FOR�EXPIRATION DATE - 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
i BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING
APPLICATION & PERMIT 18337
ao Ess
/7s Qvin 1s oi-t a� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL vq
OWNERS - PLAN CHECK VALIDATION
N S
I cl,L-�I-��/Iyf/TLL J ) HON �'J]1 ELECTRIC PERMIT FEE O V
CONTRACTOR
RACTORS
NA/x�E�� -/- q/ / TLETS-SWITCHES-RECEP 10.00/1.00
/NTRACTR (tiJi LIC.NO. LOO LI TING FIXTURES 10.00/1.00
CONTRACTORS PPL NCES-RESIDENTIAL 4.00
a/oo REsS A' ^ ' 'rn
Q� ( S�}Yf•-wlvHONE OC DATE PANEL 10.00 DATE OF APPLICATION
ARCHITECT PANELS (O ER 200 AMP)' 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
f j LIC.NO, SIGNS TRAN 3.00
ARCH.OR ENG. SPECIAL R 5.00 PERMIT VALIDATION
ADOREss
zry EMP.METER OR NLE INS. 20.00d�t
ADDRESS MOTORS S E SCH.
AOORCEss //^�^ (cII '
�55(0 r7 Yryi 1cc UT SERVICE CHANGE - .00 n p
o¢ i
' Foo LICENSED CONT RACT'ORS DECLARATION - �r non•� v`V� -
ao u 1 hereby affirm that 1 can licensed under provisions of Chapter 9 /t-•�' n C yr
2 i - ISSUANCE DATE
,HA< w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH
F y z Professions Cod Id,nt license is in full force L "t. ❑ ❑ \❑
z o m o License Class --L Lic.Number
o m j Date Contractor s or .-
w a ER-BUILDER DECLARATION 71
BUILDING PERMIT
°a " MISC.- REFER TO ORD INFORMATION
K
; y 1 hereby affirm that I am exempt from life Contractor's License
LL o j Law for the following reason.(Sec.703 L5,Business and Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter.
2 ¢Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
o ac requires life applicant for such permit to file a signed statement that TOTAL
6wm he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
HZQ Law(Chapter 9(commencing with Section 7000)ofDivision 3 oflhe \
5 i o Business and Professions Code)or that he is exempt therefrom and OTY PLUMBING PERMIT FEE
¢ I- m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n _ by any applicant for a permit subjects the applicant to a civil penalty
of nor more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of life properly,or my employees with wages as g/jCK FLOW PROTECT. DEVICE 400
their sale compensation,will do the work,and the structure is not . OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 '
Code:The Contractor's License Law does not apply to in owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself'or through his own employees,provided 11111.1 pmvc-
.cutsarenotintendedoroffend for sale.If.however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improveaem Is sold within one year of completion, (he owner- GAS-EA_SV TEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose ofsale.)' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,As owner of the proper Y.can exclusively convecting with ❑ ❑ ❑ 0 0
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PAfl CE L'NO.
and Professions Codu:The Contractors License Law Joe,not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
conlmc(s for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00
❑ TRACT NO. PARCEL NO.
rexfel am exmnpt under$ec. ,B.&P.C.lin this WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WUkk ERS'CO.M I'IiNSATION DECLARATION --WATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate of conien(m scl C-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thenyyl'��f�y,�3_lp Lah.C.lp, ,,,,, • N0.f /
Policy Notified copy
isomueb y J�W' "
Z Z � Certified copy is hereby tarnished. FIRE SPRINK ENERGY T
Certif ict rot y is fit• with he c ty inspection division. A 24
Applicant MISC.- REFER TO ORD. Y ❑ N Y C] No
~ o PERMIT ISSUANCE 10.00
LU - - Clikl'IEICCOMONSATI COMPENSATION
RtHWOkkERS' FLOOD ZONE A.L.u.O.
W � COMPIiNSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
d O (This section need not he completed if life permit is for one TOTAL V N Y NE]
Z hundred dollars IS 100)or less)
U O 1 certify that in life perfornhance of me work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL U not is issued,I shall not employ any person in any manner w as to
O W become subject to the Workers.-'Compensation Laws of Celitornia.
°-
Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICAN 1': If,after making this Certificate of Ex-
Z caption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
sha
provisions of the Labor Code, you Ams( forthwith comply with
U such provisions or this permit ll be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCPION LENDING AGENCY AIR HANDLING UNIT(OVER 10000.EM.) 6.00 SEISMIC FEE
I hereby affirm (hat there is a ru
consrclion lending agency for EXHAUST HOOD(WITH DUCT) 5.00
life performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 0
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
• I certify that 1 have read this application and state(hal the above VENTILATION FAN (SINGLE) 4.00
inlbnnation is correct. I agree to comply with if 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 authorize representatives of this city to enter upon the
shove-mentioned property for inspection BOILER-COMP (Over 100.000 BTU)SEE FEE SCH.
purposes. MECHANICAL .Uro
(We) agreega 1st save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
CupFor in
against liabilities.against
inst said l', COsin and expenses which CONST.TAX
For in any way accrue against said City in Ase ucnce of the PERMIT ISSUANCE }g;00 2,�
res fit this pennil' MECH.CONT. I.C.NO. MECH.
pit" /Z�D�oANI /� L// rz / / TOTAL
Q�/ TOTAL
S a[ rc of Applmant/Contractor are Q.9 �"I"n- f� k�
OFFICE COPY