17025 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER I
CITY OF CUPERTINO 17025
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS_I_ —� " �Qy_UNIT# LOT#
PERMIT EXPIRES IF WORKrn
I
OWNER - CONTRACTOR b&iI t-k 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 VALIDAnoN
OUPERTINO STANDARDS. ie O
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG ELECT I PLG. I MEC.
❑ ❑ ❑ ,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - vALu n siFT.
PLUMBING -5, F�1� f.�y -r)
M ECHAN ICAL FO TZ J
ELECTRICAL PER TD
FRAMING
C o 1988 %,.Y rYlr q t k,¢P:I I�,
sro.lEs TYPE corvsT.t
INSULATION
City of Cupertino
acc GRouP REs urvlTs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO IT I'LOOR AREA TDTAL AC.EAGE
. DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CDN Pe bll „•, I ,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 1:1 ID1:1 ❑. ❑
nSEESSORSPARCELNO
ROUGH SAN.N
PLUMBING — T- ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN —6_ J PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE, ACC.FILE NO,
FRAMING 'fir CoJW'e� I- - ELECT.FINAL TEST • ZONING END SITE NO,
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ No Y ❑ N�
FLOOD ZONE A L U.C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK. GRADE. - FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDINGI,(�t� .
SCRATCH COAT JELECTRIC - _ PLAN CHECK ))�/ �}
GAS FEE 4
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY ISEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING”
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
• 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
ADILGNG Is Poppy. APPLICATION & PERMIT 17025
0DREss PP y WAY BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I"•
C u e rtir ;u o CAG.
OWNERS PLAN CHECK VALIDATION
NAMEDTV. ELECTRIC PERMIT FEE
ares F. A. MOAlek 0 PHONE996'Q 78
NAMERacroRs UTLETS-SWITCHES-RECEP 10.0011.00
J Q uc.NO,Y -31'J~` LIGHTING FIXTURES 10.00/1.00
% no(oapessiORsSpdN�7>A CLAA09A � APPLIANCES-RESIDENTIAL 4.00
; 1p go CN c✓I N U 1 .HONE7,274796 PANELS 10.00 DATE OF APPLICATION
OORCHIiECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 r
ZIP EMP.METER OR POLE INS. 20,00 1:d aled
ADDRESS MOTORS SEE FEE SCH.
ADDRESS -
SERVICE CHANGE 20.00
O o LICENSED CONTRACTORS DECLARATION
a i w 1 hereby affirm that I am license([under provisions of Chapter 9 ISSUANCE DATE
Y
(emourencing with Section 7000)of Division 3 of the Business and a ¢y BLDG. ELECT, PLG. MECH.
H y¢ Professions Code and my license is in full forc��e:!!F ff eteI
2 o m - Liccnsc Clu _ hie.Numher_x YJS.S.7/ ❑ ❑ ❑
Q y E to Datc ContmaorrAL gep+_T_At 0,NA DEC 3 01988
a a f BUILDING PERMIT
¢ rt w 4 OWNER-BUILDER DECLARATION INFORMATION
E
3: N 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- R F R TO ORD yq LUATIppLL��I
uo¢ Law for the following C.S.R.r (Sec.703 1.5,Business and Professions PERMIT IS SU 10.00 VALW0 $/FT.
L W 0 Code:Any city or county which requimsa permit toconslmet,alter. �,-JJLLJJ L(J
¢ ¢ ¢ p improve,demolish,or repair any structure,prior In its issuance,also ELEC.CONTR. LIC.NO. ELEC.
D u requires the applicant for such permit to file a signed statement that TOTAL ITTO
w8 m he is licensed pursuant to the provisions of the Contractors PER
License Nt
HZQ Law(Chapter 9(Commeneing with Section 7000)of Division 3 ofthe T.Q1^mr{� /°�� Ir'
HE o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
W H$ the basis for the alleged exemption.Any violation of Sectam 7031,5 STORIES TYPE CONSTR.
aby any applicant for a permit subjects the applicant too civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S50OV)
❑ I,as owner of the property,or my employCes with wages as BACK FLOW PROTECT.DEV ICE 4,00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and 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 Law does not apply to an owner of
properly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or tlDough his own employees,provided that such improve-
ments are not intenbcdoroffered for sale.if,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
budGAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
der will have the burden of proving that he did not build or am-
,roseforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON ve One,
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed cmitinctm, to'construct ills project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions COde:'1'he 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 coutraclods)Iicerwd pursuant In
the Commeror's License Law. SEWER-SAN V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt Linder Sec.-,BAP,C.for this WATER HEATER W/VENT 6.00
reason
Owner - _ Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORK Ii RS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent of self-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ZONING SITE NO.
11 copy there ��eu�.�3�800 b.C.).
O W Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certif• ded i h• city inspection division.
O Applicant MISC.- REFER TO ORD. v ❑ N❑ v ❑. N❑
CC va PERMIT ISSUANCE 10.00
Q:- CIiRTIFICCO'JOFSAX I N INS PROMWURKGRS' FLOOD ZONE A.L.u.c.
W � COh1PIiNSAI'ION INSURANCE PLG.DONTR, LIC.NO, PLG.
Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars IS 100)Or less.)
V O 1 certify that in tine performance of the Work for which flu,per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any nmnner so as to
C) become subject to the Workers'Compensalion Laws of California. U 7�
y Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} GO NOTICE TO APPLICANT: If,after making Ibis Certificate of Ex-
F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK /I
provisions of the Labor Code, you trust forthwith comply with - FEE
m2yt 3O
U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10)O00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.RM.) 6.00 SEISMIC FEE � J
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. 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 that 1 have read this application and stale Ihat the above VENTILATION FAN (SINGLE) 4.00
n(nrmation is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.Or100,000B.T.U.) 6.00
hereby authorise representatives of This city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which pERM1T ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ranting Of this permit. eJ MECH.CONT. LIC.NO. MECH.
x CrLaG�L. E, /.2 .3 S O TOTAL TOTAL ?RISC
/ Signature o Ap m
Icant/Contrac ' Data
OFFICE COPY