17051 (2) • > POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17051
INSPECTION DIVISION
L, JOB INSPECTION RECORD
l✓�)T/0 / PERMIT EXPIRATION
JOB ADDRESS �r'P 1I\ L /� UNIT.# LOT#
e - - PERMIT EXPIRES IF WORK
OWNER' - - - CONTRACTOR - J 1^/` IS NOT STARTED WITHIN-'
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONNOTE: . ANCE OR 180 DAYS FROM
' UFER, :'• � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF F,ERMIT VALIDATION
-
GARAGE SLABS CUPERTINO STANDARDS. •� -
y
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDppnp��
UNDERGROUND /SLAB / =JI1Eu 1989
PLUMBING
ELECTRICAL - - v+V (it' upertIRD ISSUANCE DATE
.MECHANICAL HLUG ELECT PLG mecR
1:1 ❑ %,.
❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
•WOOD FLOOR VALUATION $TFT.
PLUMBING
MECHANICAL
ELECTRICALIj��; INTO
�
FRAMING (/1 "'l
INSULATION STORIES TV ECONSTO I
-
OCC GROUP RES UNITS -
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL'BE MADE BEFORE so 'T aooR AHeA TOTAL ncecncE
DIAPHRAGM ' THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING RES INouILO`NusE
ON PEI 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 ❑ ❑ El
ASSESSORS PARCEI,NO
} ROUGH SAN,#
PLUMBING ELECT,ENERGY
TRACT NO PARCEL NO.
TUBS I SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY - - -
ELECTRICAL - BUILDINGENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE N0.
- INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 24
YI COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "�
:
EXTERIOR SHEAR ELECTRICAL RELEASE FL000ZONIA,L'UC.'
INTERIOR SHEAR FIRE DEPT, Y❑ N❑ Y ❑ No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - TEMPORARY APP BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING`252-4505, ELECTRIC
. F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING -dD
PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! ` CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL / Ul
CALLING FOR FINAL INSPECTION.
OFFICE COPY„
XPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY.
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT �,- 17051
FOORC s
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I
OWNER
PLAN CHECK VALIDATION
NAMEF��A�/�.,(1 �I r '/ OTY. ELECTRIC PERMIT FEE
PHONE
COST
T R3
NAME x OUTLETS-SWITCHES-RECEP 10.00/1.00
A4 LIC.LIC.NO 7.a LIGHTING FIXTURES 10.00/1,00
R
CONTRACTORS AOORES �//FF PPLIANCES-RESIDENTIAL 4.00
Jk1�1. PHONa-7/_�7Q/ PANELS 10.00 DATE OF APPLICATION
OgcRITECT '{/ (// PANELS (OVER 200 AMPI '20.00 PLAN CHECK P.C.NO.
ENGINEER
_ uc.No. - SIGNS TRANS. 3.00 .
AARCH.OR
DDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
Azlv EMP.METER OR POLE INS. 20.00
ADDRESS.
MOTORS SEE FEE SCH. q_
'
SERVICE CHANGE 20.00
'09 LICENSED CONTRACTORS DECLARATION
M i w- I hereby affirm That I um licensed under provisions of Chapter 9 J A H! 91989
r ISSUANCE DATE
(cotntnemmng with Section 7000)of Division 3 of the 11ittatiess and
- BLDG. ELECT. PLG. MECH.
0 Z Profeseione Code m4yny liwnse is In full for d f •yy� 1 N 1
2 O �,- License Clas ^T Con Number , f_
9 m H w Dale � � COnlrattor
¢ m s BUILDING PERMIT
¢ II: w OWNER-BUILDER DECLARATION INFORMATION
son. MISC.- REFER TO ORD
X
;u y I hereby affirm that I um exempt tram the Contractor's License
Hum ¢ Law for the following reason.(Sec.7031.5,Ousiness unit Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Cade:Any city or county which o q uires a p,rnl irto construct,alter,
2 ca < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
rc w m LL requires the applicant for such permit to file a Signed statement that TOTAL PERMIT TO
he is licensed pursuant in the provisions of the Contractor's License
H z i Law(Chapter 9(comnlencing with Section 7000)of Division 3 of the J t
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEEWCV
E 3 o
M r$ by basis for the alleged it j ennit subjects
Any violation of Section malty03 1.5 STORIES TY CONSTR.
d; by any applicant fora permit subjects theupplicant[uncivil penally ALTER-DRAIN -WATER IEA.) 5.00
�
of not more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 imc.GROUP RES.UNITS
their Sale compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,unit who docs such work FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTAL ACREAGE
himselfor through his own employees,provided that such improv
ments are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 t VV
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of soledRES IND CON PB Other' INDUSTRIAL WASTE INTER. 30.00 11 El ❑ 1:1 El❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the prnject(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's U"nse Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projeclswith a conlrmtool)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKS RS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate ofconsent to cel Ginaure' ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ fortified copy is hereby Into hed. FIRE SPRINK ENERGY T-24
Z Z Certified opyI Nod h life city inspection division.
HMISC.'• REFER TO ORD.
O AppI ican 111 0� V 0 N Yo No
FLOOD 20NE A.L,LLC.
CC LO CERTI FICATIi OF IFROM WORKERS' PERMIT ISSUANCE 10.00 ZOl7
EL > COMPENSATIONSATION INSNSU RA NCE PLG.CONTR. LIC.NO. PLG,EL 0 I '�qq Y� N� Y � N❑
Z dollars meed not be completed if the permit Is for one TOTAL O V
Bandied dollars(51OCR or less.) .
U O 1 certify that in the performance of the work for which this per- OTU. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall not employ any person in any manner so as to
Ow become subject to the Workers Compensation Laws of California.
Date Applicant - BUILDING
Ca. ALTER OR ADD TO MECH. 5.00
} m NOTICF.TO APPLICANT: If,aper making this rs'Certificate to Ex
♦- ? emvision you should become c, you¢I Ise Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Iahor Code, you mull forthwith comply with FEE
m
U such provisions or this permit shall be deeedd revoevoked. AIR HANDLING UNIT(TO 10,000 GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOMC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that Ihere.is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the..,it for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT IT'(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and slam that Ih'above VENTILATION FAN (SINGLE) 4.00
• information n correct. I agree to comply with all city unJ county BOILER.COMP 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating m building construction, and
hereby authorize representatives for ins of this city to anter upon the BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertin Inst liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay i any ay accrue against said City in consequence of the
mini gofth' permit. MECH,CONT. LIC.NO. MECH.
6"�J e` TOTAL TOTAL
Sig ture of Applican/C ntractor Date
OFFICE COPY