18055 (2) i
POST THIS CARD NEAR FRONT OF BUILDING'_:
PERMIT NUMBER
CITY OF CUPERTINO 18055
INSPECTION DIVISION
JOB INSPECTION RECORD
• - - // �' r. - PERMIT EXPIRATION
JOBADDR ESS ��•tl 4�I :.(_L�p!� UNIT# _LOT*' "
PERMITEXPIRESIF WORK
owrveR '•� , "a .` coNTRActoR IS NOT STARTED WITHIN
INSPECTION, DATE ,INSPECTOR IN PECTI N'RECOR 1BoDAVsoFPERMITIssu- ,
FOUNDATION - - ANCE 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 ?ERMrt VALIDATION
' CUPERTINO,STANDARDS. - 1- +
'GARAGE SLABS - 9
FADPOUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �� .
-UNDERGROUND /SLAB
PLUMBINGJUL 2 U 1989
� !���-V� j 'J
ELECTRICAL ' - '+ ISSUANCE DATE•
MECHANICAL' "' '. - - - _ BLDG. ELECT PLG MICR.
' - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
. PLUMBING'
MECHANICAL -
ELECTRICAL - - //}��} vERn+IT To
FRAMING • • • /T� 'Qa"
INSULATION STOR -S Type corvsT .
,, ... OCC..GHOUP RES,UNITS,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP,SHALL,BE MADEBEFORE sD'IT.FLOGR AREA TOTAL.ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID "
BUILDING USE
ROOF SHEATHING - - DES IND CON Pe Gnm:
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El, ' El ❑ 1-1
ASSESSORSPAHCEL NO
. ,ROUGH SAN.#.
PLUMBING - ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO,
MECHANICAL - MECR ENERGY '
-
• ELECTRICAL ' � • ' BUILDING ENERGY -
ACC DATE ACC.FILL NO,
FRAMING' ELECT.FINAL TEST ;•r• ' �
20NING - ENG.SITE NO.
INSULATION - PLUMBING .
GAS TEST - GAS
MECHANICAL FIRESPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ ` ❑ NE]
•FLOODZONE A,LC.
.U,
. EXTERIOR SHEAR I ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. " y❑. �❑ Y L N❑
SHEETROCK ' GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR [ATH' . TEMPORARY APP R OVALS 'BUILDING
SCRATCH COAT ` - ELECTRIC - 'PLAN CHECK
y . GAS FEE
NO TAPE OA PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDINGFINAL ISSIGNED BY BUILDING INSPECTOR. ,MICROFILM- -
ARRANGE FOR INSPECTION &Y PHONING 252-4505, ELECTRIC
Lu, •ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ,aA
O -PLEASE GIVE JOB ADDRESS WHEN PHONING
M
Z ECHANICAL- O(7
- SEE PERMIT FOR EXPIRATION DATE:—
IMPORTANT! `" iCONST.TAX' `
` PLEASE READ REVERSE SIDE BEFORE - `
CALLING FOR'FINAL INSPECTION: "TOTAL.. i Oy�
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -'USE BALL POINT PEN.ONLY,
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
aUp1pLRDEINS G - APPLICATION & PERMIT -
• BUILDING — ELECTRICAL—PLUMBING—MECHAL d18055
A35 rwl✓1 ^n/ A -
'
t_ OWNER'S PLAN CHECK VALIDATION
6 -'.I -'t _ n�-311/ (� Y. ELECTRIC PERMIT - FEE
( PHONY D`T1G
CONTRACTOR'S
NAME PUTLETS-SWITCHES-RECEP 10.00/1,00
Pr+f assec.Na. L HTING FIXTURES .110.00/1.00 .
CONTRACTOR -
ADDRESS .�} r pP ANCES-RESIDENTIAL . - 4.00 • ~l' n l
- ^�•'f' 1:71"oJ l I
rA I I v4HONe/J'I 10 PANEL " 10.00 DATE OF'APPLICATION
\l ARCHITECT . PLAN CHECK FEE P.C.N0:
"1 oR ' PANELS VER 200 AMP) '20.00 _ -
1 ENGINEER - -
_ SIGNS TRA T'• '•3.00
`r ARLH.OR ENG. PERMIT VALIDATION
(Yl - aopREss SPECIAL CIRC T �•" �� ' ,5.00 '
1 - zIP EMP.METER OR OLE INS. : 20.00
APPLICANT'S
y ADDRESS of_�� MOTORS - . SEE FEE SCH. -
`— ✓•r-^'�- 'V SERVICE CHA NGE _ moo
w'¢2
H Be o' LICENSED CONTRACTORS DFCLARA'I'ION
< U I hereby affirm that l am licensed under provisions of Chapter 9 Lnag
ISSUANCE DATE
y G w (Comlhemem,with Section 7000)of Division 3 of lire badness'and - BLDG. ELECT. PLG: MECH.
r ,i Professions Code, d license is in full force e
Z 0 m_W Liccnsc Clnss_ 1-it.Number 9 ❑
r m J Date i1f��—yj1 Contractor ,
a m ' �/ `r�' _ BUILDING PERMIT
¢ a OWNER-BUILDER'DECLARATION
a 0 Be Or - - INFORMATION,
to ; 1- I hereby affirm that I am exempt from the Contractor's License MISC._ flEFER TO ORD
W VALUATION '$/FT.
'F U. J Law for the ity or countywhihe. uires a perBusmit
to
Professions PERMIT ISSUANCE - 10.00
u Code:Any city or county any Structure p prior
In construct,alter,also
¢ ¢ inspruve,demolish,or rcrylir any stnuc4ve,prior to its issuance,also ELEC.DONTR, LIC.NO. ELEC.
n w a., requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisiuns of the Contractor's License
F z Q.. Law(Chapter 9(commentingwl0l Section 7000)of Division 3 of the
i c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE � �•�
¢ I- the basis for the alleged exemption.Any violation of Section 7031.5 - _ STORIGO TYPE CONSTR.
i ; _ by,ony applicant for a permit subjects the up,liemit too civil penalty
of not mare than five hundrcddollars f$500).): ALTER-DRAIN& VENT-WATER (EA.). 5.00 -
❑ 1,as Owner of The property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their Sole Compensation,will do the work,and tire Structure is not OCC.GROUP RES,UNITS
intended or offered for sale(Sec. 7044, 0usiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code'.'flic Contractor's Licenso Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP ,5.00 so:FT.FLOOR AREA TOTAL ACREAGE
himself ar through his own employees,provided that such formic.
' mints are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-1 INC.40UTLETS ,0b
or improvement is sold within one year of completion,The owner- GAS-EA.SYSTEM•OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or ire BUILDING USE
prove for purpose ofsalv.l. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB .Omer
❑ I,as owner of the property,am exclusively contracting with - ❑�. -❑ ❑ ❑ ❑
licensed contractors To construct The project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. .6.00 ASSEssons PARCEL NO.
and Professions Code:The Contractor's License Law does not apply ,•to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conrractons)licensed pursuant To SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. . TRACT NO. PARCEL NO.
❑ I:un cxcmpoundtr Sec. ,B.&P.C.Otr this WATER HEATER'W/VENT 6.00 s
reason
Owner Date WATER SYSTEM 5.00 —KC-1ACC.GATE' ,FILE NO.
WORKERS'COMPENSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate or con%unl to sell-insure. - - ZONING ENG.SITE NO.
- Or a certificate of Workeri Com nsatmu Insurance,ora I d
Copy there Qfl 00b.(.J. _
Policy
No:L (Apany
O- ❑ CertiliC opy is hereby furnishd. - FIRE SPRINK ENERGY T-24
Z Z Certified cop �iled w' 1 the ily inspection division. MISC.- REFER TO ORD. '
AppliCanl_ _ Y N� _ tY N�
oto CE RTI FICATE 017 FXFAIPT ION K H RIS' PERMIT'ISSUANCE Z'DD .FL0002oNE A.L.U.c...
W COM1f PIiNSA'f10N INSURANCE P TR. LIC O - PLG. '
0. In (Thi; section need net be completed if the permit is for one ✓L TOTAL, 0d,, "Y N v ❑ - NQ
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MEC ANICAL PERMIT. FEE FEE SUMMARY
W F mit is issued,I shall nor employ any person in any manner so as to •?
Ow become subject to the Workers'Compensation Laws of California.
y Dart Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of fix.
2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -
provisions of [he Labor Code, you must forthwith comply with - ,FEE
U such•provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.K) 4.00 -
CONSTRUCTIONLBNDINGACI?NCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 'SEISMIC FEE ,
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT)
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.C.l. HEATING UNIT(TO 100,000 B.T.U.) '00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
Lender's Address
. I'centry that fbave real this application and shit that the above VENTILATION FAN (SI 4.00 T
information is correct. I agree to comply with all city and county PLUMBING - ` ,bd
ordinances and state Illws.relating to building constructinn;,uml 13�ILER•COMP(3 H.P.or 100,000 B.T.U.) ZE% •071
hereby authorize roprescntatives of this airy to enter upon the BOILER-COMP IOver100,000RTU)SEE FEESCH. - MECHANICAL /�.br-b'
above-mentioned properly for inspection purposes,
-
(We).
We) agree to save, indemnify and keep harmless the City or MISC._ REFER TO ORD. -) -
Cupertino i against liabilities,judgments,costs and expenses which' PERMIT ISSUANCE 0 2, CONST.TAX
said '
mny ony way u cm minet Clty in was )sec 'e mf the . .. -
r f of 11 Irl. MECH.CONT, I.C.NO.5 MECH.TOTAL• TOTAL. VV
gnat to ofA tic nt/Contractor etc (/ I r'`7_J /y!�b SO. • 1 .e.. '
OFFICE&PY'