18342 (2) POST THIS.CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 18342
INSPECTION DIVISION
JOB INSPECTION RECORD
I PERMIT EXPIRATION
JOB ADDRESS—I � ��__l..-YA 4--v c--_UNIT# LOT#'
PERMIT EXPIRES IF WORK
OWNER y d CpNTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INS ECTION CORD 180 DAYS 8 PERMIT I FROM
FOUNDATION LASTANCE AL 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS _ 1p/ un. ( _ r '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (
UNDERGROUND /SLAB N i 9 1999 .
PLUMBING I-•, i l��
ELECTRICAL pjj•, PR n,,,,irtjrtn ISSUANCE DATE lam'
MECHANICAL Bloc ELECT PLC, Meer+
Ej
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION slPr.
PLUMBING
MECHANICAL
PEHMII TO
ELECTRICAL ' p �
FRAMING " W !
STUDIES TV ECONSTR,
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE soFLooH'A+aIA roT nL nIn+EAau
.+T
DIAPHRAGM .THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - Res IND CON
oN vB 0"."
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. [1 0 E) 0 ❑
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE. ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL-TEST zoNlNc ENG SITE No.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY TQ4
MECHANICAL Y ❑ N0 v ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A,LI
E]EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. NE N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH• BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
FEE EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0
0 � PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
-
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL (f dU
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
,PERMIT NUMBER _
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT "
RD"°'"° 18342
A°ORES
jDRE�&`J3- M �-VX.. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL f,
OWNER'S PLAN CHECK VALIDATION
NA �79-�7yl
ME Q y, ELECTRIC PERMIT - FEE
• TcE l
� 8at4an v"oNE
CONTRACTOR'S
NA E ��S2�6 UTLETS-SWITCHES-RECEP 10.00/1.00
LICHO. LI TING FIXTURES 10.00/1.00
CONTRACTOR'S APPL NCES-RESIDENTIAL 4.00
r� A°/D`R(E'S�S �J�Q 17'7b L
� PHONEE / / / 7 PANELS 10.00 DATE OF APPLICATION ^
4RCHITECT PLAN CHECK FEE P,C.NO.
„) OR PANELS 10 R 200 AMP) 20.00
�V ENGINEER
Q R uc,Na. SIGNS TRANS. 3.00
AARCH.OR DDRESS ENG. SPECIALCIRCUI 5.00 PERMIT VALIDATION
\/ ,IP EMP.METER ORP LE INS. 20.00
ADD.CSS
ACSS rs MOTORS SEE FEE SCH.
SERVICE 20.00
o o LICENSED CONTRACTORS DECLARATIONBE zLrA-ki ' 1�
a u w 1 hereby affirm Thal 1 am licensed under provisions of Chapter 96 Inn ISSUANCE DATE
y G (cloomenang with Section 7000)of Division 3 of the Business and - y p .Ja L BLDG. ELECT. PLG. MECH.
F w z Professions Code n ny'license is in full force�JDq�s1efleet.
z o m - License Cla _ Lic.Number WN L ❑ El ❑
U+I
o ti Dam Co.(mcmr XL"
`a Y f7 1 City, of Cgn'rtIRO-r,G IPy BUILDING PERMIT
¢ BE i OWNER-RUILDLR DECLARATION rt' J INFORMATION
E:
; 1 hereby elfin that I um exempt from the Contractor's License MISC.- REFER TO OR
.. Oa Law for the following reason.(Sec.703 LS.Rusinessand Professions pEflMIT ISSUANCE 10.00 VALUATION S/FT.
Code:Any city or county which reyuiresa permit to construe 1,eller,
BE
¢¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
w- DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m he is licensed pursuant to the provisions at the Contractor's License
rz > Law.(Chapter 9(commencing with Section 7000)of Division 3 of the p L
SC I
< Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE PA
¢w- $ the basis for the alleged exemption.Any violation ol'Sed ton 7031.$ STORIES TYVE CONSTR.
d ; by any applicant for a permit subjects the applicant Ina civil penally ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
0 I,as owner of the prope,ty,nr by amployccs with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole 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,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of -
property who builds or improves therein,and who does such walk FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
mems are not intended oroffaradfo idle.If however,the building GAS-EA.S STEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,One owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or int. BUILDING USE
Prove for purpose of sale.). " INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB ower
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLER 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:"Thu Contractor License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS- VER 5 (EA.) 1.00
COaIrdFS for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
rcusm
Owner Data WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent 1.elf-insure, ZONING or a certificate of Workers'Compensation Insum e r a cert ed ENG.SITE NO.
- copy there I( ev. 80A,Lab.C.{, �q
PolicyN ffflln any�3 e,-.(/I/Lt� LL V�
p
Q CeHilln copy ishcrebyturni d. FIRE SPRINK ENERGY T 2
Z Z .Cenil icd py s 01c witb 01c city inspection division.
AAAII -f- MISC.- REFER TO ORD.
O pp¢ant>/I. L _,LGGL(,/[Y� v ❑ N❑ v ❑ IN E]
f- y ,jam PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU
CERTIFICATE COHIF EXEMPT[ON,, ')M WORKERS'
CL 7 COMPIit beNSAcal etedNSU \NCI: PLG.CONTR. LIC.NO. PLG.CL 0 Y❑ N❑ Y❑ N❑
Z) Z hundred
section need not be completed if the Pcnnit is for oat• TOTAL
hundmJ Jolla¢(5100)or less.?
U O I certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is issued,I s'Imll not employ any person in any nnannor so as to
O become subject to the Workers'Comperuation Laws of California.
y Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE '1'0 APPLICANT: If,after making this Ceniticate at Ex-
Z emption.you should become subject to the Workeri Campensaliun APPLIANCE 5.00 PLAN CHECK
provisions of Ole Labor Code, you must forthwith comply with FEE
U such provisions or this punnet shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LRNDING AGENCY, AIR HANDLING UNIT(OVER 10OW -FM.) 6.00 SEISMIC FEE
I 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.) �:QO MICROFILM
3097,Civ.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lenders Address ELECTRIC
I certify that I have read this application mrd sate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with ell city and PLUMBING
hereby
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.)_&QQ `
hereby a0horiee representatives of this city To enter upon the BOILER-COMP(Over 100,0008TU)SEE FEESCH. MECHANICAL �jo• Yr'
above-mentioned property for inspection purposes, v
(We) agree to save, indemnify and keep barrnhss the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which � CONST.TAX
y ' any way accrue against said City in corse acne of the PERMIT ISSUANCE 00
t of this permit. MECH.CONT. LIC.NO. MECH.
''�'/'�'�e n p �•-{- Q l� TOTA {1\ 2n /�
Ignatureof Applicant/r-C Nractor �alc �� QJ (-�.(.1,� 5G�l.4 `30 (�V TOTAL W ""
OFFICE PY