17029 (2) POST THIS CARD,NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17029 '
INSPECTION DIVISION
/�pY� JOB INSPECTION RECORD -
D�^y[ ,/CJ �e�-P " UNIT# LOT
PERMIT EXPIRATION I
JOB ADDRESS_ _• #
PERMIT EXPIRES IF WORK
OWNER 1 S V�OV'V r-a' ' S CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
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 PERMIT VALIjjkI N I
CUPERTINO STANDARDS. _ AA, I
GARAGE SLABS 7
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED-
UN.DERGTOUND /SLAB
IGNEDUNDERGROUND /SLAB
' PLUMBING '
ELECTRICAL 'ISSUANCE DATE
MECHANICAL - - BLDG, ELECT, PLG, I MECH
❑ El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $SFT,
PLUMBING '
MECHANICAL
ELECTRICA4 r PERMIT ro
-
FRAMING
INSULATION STORIES TYPE CONSTR.
_ OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So.P' FLoaR AREA TOTAL ACREAGE -
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDING USE
' ROOF SHEATHING Res : IND CON FB UIL..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSOR5 PARCEL NO
ROUGH SAN.q
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO. :..I.
MECHANICAL MECH.ENERGY `
ELECTRICALACC DATE ACC.FILE NO
BUILDING ENERGY ` "*�--p..
FRAMING ELECT.FINAL TEST s_ ZONING ENO,SITE NO.
INSULATION PLUMBING Jyl
GAS TEST GAS I
MECHANICAL
FIRE SPRINK ENERGY T 24
� � y
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
Y N � N�
EXTERIOR SHEAR - � _ ELECTRICAL RELEASE FLOOD ZONE A L V.C.
INTERIOR,SHEAR - FIRE DEPT.
0 N� L
SHEETROCK` N❑
" - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING Jc�'
INTERIOR-LATH TEMPORARY APPROVALS J
SCRATCH COAT ELECTRIC PLAN CHECK
GAS if
FEE '3I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY _ ISEISMIC FEE
OCCUPANCY-OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
� ;
�
ONE DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING. +
z MECHANICAL
-
-SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
BUILDING APPLICATION & PERMIT �]O Z(J
_ ADDRESS 1t L�1 o 1 J
102160 FRA -/s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL Y
OwrvER's
PLAN CHECK VALIDATION
AME
O DTV. ELECTRIC PERMIT FEE
0%% PHONE
CONTRACTOR S
UTLETS-SWITCHES-RECEP 10.00/1.00
IC NO. M�3 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS APPLIANCES-RESIDENTIAL 4.00
PHONE �• PANELS 10.00 DATE OF APPLICATION
ORcHrrecT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEEP.C.NO.
ENGINEEfl
LIC.NO. ISIGNS TRANS. 3,00
ADDRESS ENO SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS oZ.'1-'✓,!J
ASS MOTORS SEE FEE SCH.SERVICE CHANGE 20.00 ��"�� Pr
,00 LICENSED CONTRACTORS DECLARATION �+
<z w I hereby affirm that I am licensed udder provisions of Chapter 9 ISSUANCE DATE
H ¢u (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H m i Professions Co and my license is in full force'n f c ❑ ❑ ❑
z out - License CI Lic.Number -
w r w Uate �' Conlranor
¢ x s ~ BUILDING PERMIT
¢ tc¢ OWNER-BUILDER DIiCLARAT'ION
a e v INFORMATION
E:
3 U- n I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
u_O ¢ Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Anycity orcounty which requires a permit to construct.w ELEC.CONTR. LIC.NO.
Q M Q improve,demolish,Or repair any SLrnetnrq prior 10 Its ISSnllnCe,8150 ELEC.
d D LL requires the applicant for such permit 10 file a signed statement that TOTAL PERMITTO
w m he is licensed pursuant to the provisions of the Contractor's License
FZa
Law(Chapter 9(commencing with Section 7000)of Uivislon 3 offle
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
rc r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3by any applicant for a permit subjects the applicant loa civil penalty
of not more than five hundred dollars(85001.): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the properly,or lily employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,anti the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'The Contractor's License I,aw does not apply to an owner of
. property who builds or improves lhemon,and who does SUCK work FIXTURES,PER TRAP 5A0 SO,FT,FLOOR AREA TOTALAIREAOS
himself or through his own employees,provided that such innprovm
ments are not intended or offered]or sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or Hi PPOVenrent is sold within one year of completion,the owner- GAS-EA.SYSTEM,OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving tat he did not build ar im RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ 0 ❑ ❑
licensed contractors to construct the project(Sec. 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 properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a mn[metortsl licensed pursumlt to
the Contractor's License Law. SEWER-SANITARY-STORM V-STORM EA.200ft/10.00 TRACT No. PARCEL NO.
CII am exempt under See,-,B.&P.C.for this WATER HEATER W/VENT 6.00
Cason
00
WATER SYSTEM 5.
caner Date ACC.DATE ACC.FILE NO,
WORKI!RS'COMPI!NSATION DECLARATION WATER TREATING EQUIP;;-t- , 5.00
I hereby affirm that I have u certificate of consent to self insure,
or a certificate of Workers'Compensation Insurance r a ertified ZONING ENG.SITE NO.
31 copy lher SIS 38gp LabCpart' _r
It
P licy er! Company_r v
Q .4 iifiedcopy hereby furnished. �T- FIRE SPRINK ENERGY T-24
Z Z ❑ Certified S Oled with the city inspection division.
O Applicant MISC.- 1 8 YE) IN Y IN
y
CER FI '1>OIr EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W C( 1PIiNSATION INSURANCE: PLG.CONTR. LIC.NO. PLGEL 0 ,
Z (This section need not be completed if the permit is for one TOTAL Y[] IN Y O NE]
hundred dollars IS 100)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- mit is issued,I shall not employ any person in any manner so as to
O W become subject in the Workers'Compensalion Laws of California.
Date Applicant
>_ Go NOTICE TO APPLICANT: BUILDINGNT: If,after ne king this Certificate of Ex ALTER OR ADD TO MECH. 5.00 V�
Z caption,you should become subject to the 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 he deemed revoked. AIR HANDLING UNIT TO 10p00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE S
I hereby affirm that there is it construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify 11,311 havercad this upplicutionand state that the shove VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relining to building construconn, an J BOILER-COMPI3 H.Rof,100,000B.T.U.) 6.00
hereby authorire representatives of this oily to Cole, upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH, MECHANICAL
i above-mentioned property for Inspaclian purposes.
i (We) agree to sive, indeunl(y and keep harudess the City of MISC.- REFER TO ORD.
Cupertino against iia bii tics,judgments, costs and expenses which - CONST.TAX
may in 3 accrue igitCsl ,m(I City In conselluroce of tbC PERMIT ISSUANCE 10.00
ranting Ihisp mit MECH.CONT. LIC.NO. MECH.
� _3_3a TOTAL TOTAL Cr�IB
SamafuApplicant/Contractor Use
OFFICE COPY