17046 (2) I
POST THIS CARD NEAR FRONT OF, BUILID ING PERMIT NUMBER
'CITY OF CUPERTINO.
JAN ;� 1x'046
INSPECTION DIVISION J40 T � '
JOB INSPECTION RECORD - f.,tfr+�r•„�IIInO. .
PERM T EXPIRATION
JOB ADDRESS_/ V �/ � _UNIT# _LOT# PERMITiCZIPIXMIF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR '.INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
_ NOTE:' LASTCALLED INSPECTION.
LIFER •ALL GRADING AND-ORAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS;
GARAGE-SLABS p"
_gyp e ,gn ?evyec;
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB; clINALEDIN
PLUMBING - - ^'
ELECTRICALpulc-l= RISSUANCE DATE
MECHANICAL'. - - - RLDG TFEFET. PLG. MECH.
DATEEPI
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- INFORMATION
WOOD FLOOR VALUATION .$TET.
PLUMBING ;. - - + - ..
MECHANICAL ELECTRICAL PERMIT- PEERRM,ITT�TO
FRAMING
INSULATIONSTORIES - TYPE CONSTR.
- , S . • � � � � -
'OCC.GROUP RES UNITS �a
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOO AREA TOTAL ACREAGE '
ROOF. ' ' • NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 25 O0 i
' DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING - - RES IND ILoCO USEPH0,,,
APPLY NO ROOFINGIUNTIL ABOVE HAS BEEN SIGNED -FINALS DATE INSP. 11El ElED E
A SSESSORS PARCEL NO
ROUGH SANA Iygg 1 u 90
PLUMBING - ELECT.ENERGY TRACT NO, PARCEL NO
TUBS 8 SHOWER PAN •' - PLUMBING ENERGY '
MECHANICAL MECH.ENERGY +
ACC DATE ACC.FILE NO,
ELECTRICAL - BUILDING,ENERGY' - i
F R AM I N Gy ELECT.FINAL TEST
+ ZONING ENG.SITE N0.
• INSULATION - � � � PLUMBING. +� - ,
' GAS TEST' - GAS
MECHANICAL -
FIRE SPRINK ENERGY Tr]A
' ' , � � � 1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED. HEATING Y [] N� Y ❑ N0.
EXTERIOR SHEAR ELECTRICAL,RELEASE FLOOD ZONE AT.0 C.
INTERIOR SHEAR - FIRE DEPT. ,Y N❑ Y ❑ NO
SHEETROCK ` GRADE m7
/ FEE SUMMARY
EXTERIOR LATH - BUILDING BUIL
INTERIOR LATH - TEMPORARY APPROVALS ` DING
SCRATCH•COAT ELECTRIC PLAN CHECK
- G
FEE
AS ~�
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SlISMIC FEE
�. .
OCCUPANCY OF BUILDING IS NOTPEHMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING'. . �'
• Z - MECHANICAL
' — SEE PERMIT FOR EXPIRATION DATE— - �7
T
N
OS .T'AX� �•�'fS®h '
.. ' IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN'INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' -
BY I LDING PROJECT IDENTIFICATION Y' .PERMITNUMBER
BUILDING APPLICATION & PERMIT
ADOR's0 / � fL��t MC BUILDING - ELECTRICAL-PLUMBING-MECHANICAL I I O"TV
C� '`1 L L_
NAMER's �j 7�Y� .L` PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE JDZAl.. gO
HONF �W v ' O
NAMERAcrons - UTLETS-SWITCHES-RECEP 10.00/1.00 '-J41b
Lo.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S -
ADDRESS APPLIANCES-RESIDENTIAL 4.00
-PRONE ' •PANELS -10100 DATE OF APPLICATION
ARCHITECT L//fg 0�e7v PANELS (OVER-200 AMP) 20.00 PLAN CHECK FEE' P.C.NO.
OR '
ENGINEER '
Lo.NO.G'D,j,�' SIGNS TRANS: 3.00
AARCH.OR DDRESS ENG.A-�J�r Q; /A//I (l•hC J,�^ SPECIAL CIRCUIT rj,00 PERMIT VALIDATION
y,L'L/ V �C�(/V7.1✓r CrL! 021/PG JCC/ EMP.METER OR POLE INS. 20.00
APPLICANT , �'� MOTORS SEE.FEE SCH. IGY\CYIId�ADDRESS
SERVICE CHANGE 20.00 JAN. as
w o O LICENSED CONTRACTORS DECLARATION I 1:�_ '
I hereby affirm that 1 am licensed under provisions of Chapter 9
at e" (commencing with Section 7000)of Division 3 DIMS Business and
a a n BL .J 'E MECH.
F o i Professions Code,and my license is in full force and effect.
0 z L ` . e
o License Class Lie.Number ,OGT
Dale Contractor
It y a J
¢ ¢ a OWNF.R-BUILDGR DECLARATION BUILDING PERMIT
¢ u, v - INFORMATION
X a. a. I hereby affirm that I am exempt from the Contractor's License MISC.- s REFER TO ORD
u O a Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION .$/FT.
L - Coulo Any PERMIT ISSUANCE 10.00 z,OC ' l�_JlJ
a improve,
countywhichany structure permit men issuance,also
SE
2 a improve,demolish,or repair any structure,prior t0 its issuance,also ELEC:CONTR. LIC.NO. ELEC. ;�-qV
i w m¢ requires the applicant for such permit to file a signed statement that TOTAL ] ll PERMIT TO
he is licensed pursuant to the provisions of the 1ofDivmr's License S j.
H z a Law(Chapterand
Processions Codeffig)or Section is exempt(hent 3 al the
4 o Business and Professions Code)or that he is exempt thercl'rom and DTV. PLUMBING PERMIT FEE
ICH $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES. TYPE CONSTR.
is. by anyapplicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00
of nut more than five hundred dollars(5500).1:
❑ 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 do the work,and the structure is not
intended nr offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conlrsetor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 sOr�FT.rL,QaR�ARFA TOTALACREAGE
meptlf re through his own employees, le.if,cd That such improve- y�--C�
me Improv not meet is
old w thinofferedrim,for
year
Ico however,the building GAS-EA.SYSTEM•1 INC.4OUTLETS 6.00 �G
or Improvement will
is sold within ono year of completion, the owner- GAS-EA.SYSTEM•OVER 4 (EA.) 2.00 -.J
., builder will have the alC). ,of proving that he did not build or int- BUILDING USE.
move for purpose of sale.). . INDUSTRIAL WASTE INTER - 30.00 RES IND CON PB pater
.
❑ I,as owner of the property,ore exclusively contracting with ❑ ❑
licensed contractors to construct the project(S..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 an owner of property who builds or improves thereon,and who LAWN SPRINKLERS•OVER 5(EA.) 1,00
contrathe Contract suchLicenects Lwithucontracm{(sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. a TRACT N0. PARCEL NO.
❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT, 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that l have a certificate olcousent to self-insure, - `2�� ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a Cnrtil'ied
copy thercof(See.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T-24
ZZ ❑ CerliliyQ 5ypY is filed i01 the city inspection division. -
O APPlicant_1/C- -- -LJ-B= MISC.- -REFER TO ORD. Y n .
!� Yo N�
~
CE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - -:10.00 ,DU FLOOD ZONE A.L.U.C.
� TI P ,
We COMPENSATION INSURANCE PLG.CONTR. .LIC.NO. PLG.
1 a ('this section need not be completed if the permit is for one � _ TOTAL � Y[:] N E] Y.[] N 0
D Z hundred dollars(I 100)or less]
U O I certify that in the performance of the work,for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
1L U mit is issued.I shall not employ any person in iy manner so as to
become subject to the Workem'Compensation Laws of California.
O Wa Date Applicant ALTER OR ADD TO MECH. 500 'BUILDING 97 rJt�
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex- .
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -
V such slrovls ons or this of the shall be deemede, you must d relvoked comply with AIR HANDLING UNIT(TO 10 FEE t �'
p v ,0000.F.M.) 4.0 Z
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6. EISMIC FEE � Ji7L
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.0
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.C.y HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name - ! HEATING UNIT(OVER 100,000 B.T,U:)9.50
Lcndcr's'Addruss - ELECTRIC r
I certify that I have read(his application and scute that the above VENTILATION FAN (SINGLEI 4.00
information is correct. I agree to comply with all city and county PLUMBING
Ordinances and state laws relating to building construction, and BOILER•COMP I3 H.P.or 100,000 B.T.U:) 6.00
hereby authorize representatives ec this (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for insp of chis city tytes enter upon the BOILER-COMP purposes. i
(We) agree to save, indemnify and keep harmless the City o! MISC.- . REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 IMP CONST.TAX ,
may any way accrue against said City in consequence of the t e.,
ran n of his pyrmiI n , / MECH.CONT. I.C.NO. MECH.
4�3P'S/A<�•Uy oL TOTAL 7cG SD TAL
Si azure of ATinicant/Contractor Date ( 1 .J fJ
OFFICE COPY 2