17842 (2) ' POSTTHIS'CARD NEAR FRONT OF BUILDING
- - PERMIT NUMBER
CITY OF CUPERTINO 17842
INSPECTION DIVISION
/ JC�JOB INSPECTION RECORD
PTT
JOB ADDRESS ` 9�� ( �I° �P� UNIT# _LOT# �a EXG RATION
r
PERMIT EXPIRES IF WORK
OWNER FiHGIi, Gve:r- CONTRACTOR EJ .B (9 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RLfCORD 180 DAYS OF PERMIT ISSU-
FOUNDATION , . ANCE OR 180 DAYS FROM
NOTE: 'LASTCALLED INSPECTION.
LIFER „6— ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGU IT '. TO COMPLY WITH THE APPROVED PLANS AND CITY OF 'PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS
POUR NO CONCRETEUNTIL A OV AS 8BEIM SIGNED
UNDERGROUND /SLAB PAID l) V` �L' IA VC 4 1
PLUMBING p�{ N eQ(�
` ELECTRICAL - MAY 16 1989 ISSUANCE DATE
MECHANICAL BLDG ELECT. Pt.GMEGH.
.
Clty of Cupertino
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUAT,OF_ SIFT,
PLUMBING
MECHANICAL ��
PERMIT TO
ELECTRICAL
tKwt
FRAMING "'1111'' y)r
�..,U�rL ! "��/.
STORIES TYPE CONSTR.
.INSULATION -
'OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE 5O FT `Loon AREA TOTAL AcneAel
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND , CON PB O,—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. I] ❑ ❑ ❑ ID
ROUGH SAN.k ASSE550RSPARCEL,NO
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY -
ELECTRICALBUILDING ENERGY ACC.DATE ACC.PILE No.
FRAMING ELECT.FINAL TEST t7, ZONING ENG.SITE NO.
't INSULATION PLUMBING '
GAS TEST `), �i$S' GAS
MECHANICAL i /r FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ No , Y I] N�
. EXTERIOR SHEAR ' ELECTRICAL RELEASE FLOOD ZONE A.L UC.
INTERIOR SHEAR- FIRE DEPT. Y❑ N[] Yo No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING 60G-
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK •„��
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE al
OCCUPANCY OF BUILDING IS NOTPERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING,252-4505, ELECTRIC 3.Oa
Fw ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
°z PLEASE GIVE JOB ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
I PLEASE READ REVERSE SIDE BEFORE TOTAL �0
CALLING FOR FINAL"INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN, INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY,
BUI LDI NG PROJECT I DENTI FICATION . - PERMITNUMBER
SOILDINGy . - APPLICATION & PERMIT 17842
AO4RESS4oa
PV lk,
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME - PHDNE QTY. ELECTRIC PERMIT FEE '
i
'
CONTRACTOR'S J q
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 L J x� PLL 7 Z
C.No. LIGHTING FIXTURES 10.00/1.00
ADORE iolss �� C�,07 APPLIANCES-RESIDENTIAL 4.00
' }r PHONE-4 7 7-7 O PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
oR �.TCG1�e( � PANELS (OVER 200 AMP) 20.00
ENGINEER
- UC.ND. Z SIGNS TRANS. 3.00
ARCH.OR ENG - PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00
Ars t L0#WP OB q(t; EMP.METER OR POLE INS. 20.00
ADDRESS
DRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 1. '
w OW o LICENSED CONTRACTORS DECLARATION N O K
La U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE _
yz w (commencin with Section 7000)of Division 3 of the Business and
¢ n g BLDG. ELECT. PLG. MECH.
r D A Professions Code,and my license is in full force and effect. 1:1 ❑
o D=W License Class Lie.Number
Date Contractor
19
a >< 2 d BUILDING PERMIT
S tc ¢ OWNER-BUILDER DECLARATION
o a U INFORMATION
1'xa 3 y 1 hereby affirm that I am exempt from the ConlracRR's License MISC.- REFER TO ORD
u O a Law for the following reason.(Sec.703 1.5,BLIductsand Professions VALUATION $/FT.
r - PERMIT ISSUANCE 10.00 Z� -,106
O 4
Qm� Code:Any city or county which requires ep riort Omnsuance,else
Q ¢ p improve,delr101ISI1,or sepal!any$tNflllrl',prior IO 11r IrSUanCC,a150 ELIC.CONTR. LIC.NO. ELEC. �' pft� /`� 0 D
tL iL m u requires the applicant for such permit to file a signet)statement that TOTAL (/✓ PERMIT TO
he is licensed pursuant lothe provisions of the Contractor's License q
F z < Law(Chapter 9(commencingwith Section 7000)of Division 3 critic .f�\l(I/L ( sed
4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES VVPE CONSTR.
by any applicant for a permit subjects the applicant to a Civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):*
❑ 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 de the work,and the structure is not
intended or offeredfor sale (Sec. 7044, Business and Prufcssions 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 thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-i INC.4 OUTLETS 6:00
or improvement is sold within one year of completion, the owner. GAS EASYSTEM OVER 4(EA) 200 BUILDING USE
builder will have the burden of proving that h - . - . .
e did not build or im- RES IND CON PD Omer
th
prove for purpose ofse.). INDUSTRIAL WASTE INTER. 30.00 El ❑ El ❑' ❑ ,
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I 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
contracts for such projects with a contractor(s)licensed pursuant to TRACT N0. PARCEL NO.
tile Ca
e Contractor's License w. SEWER-SANITARY-STORM EA.200ft/10.00
❑ lam exempt under Sec. ,B.&I'.C.for this
reason WATER HEATER W/VENT 6.00
-
Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE NO,
WORKERS'COMPENSATION DECLARATION' WATER TREATING EQUIP, 5.00
,} �I hereby a 'Ihat
ffrml have a Certificate of consent In self-insure,
or t certificate of Workers'Compensation Insurance,or a ccitified I ZONING ENG.SITE NO.
copy thereof(Sec,3800,Cah.CJ.
Policy No. ' Company-
Cert
ompany -
10 ❑' Certified_L�opy is hereby fun fished.
, '• z 2' q� Curl-il'ie,'dK1�"/"pJy'/1//-_/f et h t�•cihl i s�ej�b�1 WSIon. - FIRE SPRINK ENERGY T-24
O A(plirml" �ia`✓'"'-� MISC.. REFER TO ORD. � Y❑ NQ Y ❑ N❑
~ rn PERMIT ISSUANCE 10.00
- CERTIFICATF-OF EXEMPTION PROM WORKERS' FLOOD ZONE A.L.U.C.
LL-� COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG,
�
0 (This section need not he completed if the permit is for one TOTAL Y11 + N❑ Y [D N[3
hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per, DTV. - MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
O Wbecome subject to the Workers'Compensation Laws of California.
d Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING I6 2 r
} to NOTICES TO APPLICANT: If,after making this Certificate of Ex-
F ? empfon,you should become subject to Elle Workers'Compensation APPLIANCE 5.00 'PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE �-
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO iQ000OF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE Q S^
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(See. MICROFILM
3097,Civ.CA HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 (3 DD
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree tco comply with all city and county BOILER-CUMP(3 H,P.Or 100,000 B.T.U.I 6,00 PLUMBING
ordinances and state lows relating,to building COOstran8011
hereby aulhorim representatives of this city to enter upon the BOILER-COMP(Over 100,0000TU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purpows.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uptrlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay in any way ace a against mid City in consequence of the
mnti of permlL MECH.CONT. LIC.NO. MECH.
��������� TOTAL TOTAL �6 U
S�nreof Applicant/Con ac or UateApplicant/Con ac or Uate
OFFICE COPY