18686 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
• INSPECTION,DIVISION 18686
JOB INSPECTION RECORD
�-/ PERMIT EXPIRATION
CG(,/ UNIT# _LOT#
J08.ADDR ESS - 1/ PERMIT"EXPIRES IF WORK
OWNER G ONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I
NSPECTOR
INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE; LASTCALLEO IN- UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO'STANDAR DS. - ne,
GARAGE SLABS ,
POUR NO CONCRETE UNTIL ABOVE HAS BE
UNDERGROUND /SLAB
PLUMBING- 7 4 O 1989
ELECTRICAL - OCTV IJVJ ISSUANCE UATE
BLU(:
MECHANICAL Ci
ELECT PL ECM.
-
ty Df, ('!! eriin!1 *?g ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION s/FT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING 1
INSULATION �dpr�ticl-Ir- STORIES TYPE coNsrR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE-HAS SIGNED_. '
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE 50,FT FLOOD PE(A TOTAL ACREAGEJ
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RLS IND CON PB Owe"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. I] ❑ ❑ ❑ El
ROUGH SAN.4 ASSESSORS PARCEL NO
PLUMBING - ELECT.ENERGY
TRACT No. PARCEL No
NUBS 8 SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO.
ELECTRICAL � -42-Y'g BUILDING ENERGY -
FRAMING �2�-'S'`t - ELECT.FINAL TEST ZONING ENG,SITE NO.
INSULATION - 'vx. { PLUMBING
GAS TEST- - GAS
FIRE SPRINK ENERGY T 2
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N[:] ° ❑ NE]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE : A u.c.
INTERIOR SHEAR FIRE DEPT. v❑ - N❑ v ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING 11-12-90 .-i
INTERIOR.LATH TEMPORARY APPROVALS BUILDING
SCRATCH-COAT ELECTRIC PLAN CHECK _
GAS FEE
NO.TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE S•O
OCCUPANCY OF BUIL DING IS NOT FERMI I I ED UN I IL13UILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ^' ELECTRICLU
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING -Y-
0 PLEASE GIVE JOB ADDRESS.WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX" �— {
R
PLEASE READ REVERSE SIDE BEFORE TOTAL y.LSo
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
OI LDING PROJECT I DENTI FICATION
PERMIT NUMBER
BUILDING APPLICATION & PERMIT 18686
p'f!A� PRo5VEDY ROPr]J BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S d'1_'44 Eby -.
=� NaME1 Q / .{((���A/���(( xL/ Er 4�V PLAN CHECK VALIDATION
IEAP4ZLf S F. I' AUI RCNE DTV• ELECTRIC PERMIT FEE
CONTRACTOR'S M1• OUTLETS-.SWITCHES-RECEP 10.00/1.00
ME o WNfS e LIC.NO. LIGHTING FIXTURES 10.00/1.00
DRHAcrpns
ADDRESS PPLIANCES-RESIDENTIAL 4.00
--�-- - '
PRONE. PANELS 10.00 DATE OF APPLICATION
aNR IT _ PLAN CHECK FEE P.C.NO.
OR F PANELS (OVER 200 AMP) � 20.00
ENGIN (/1SGO S✓
R--•" sec.NO. � SIGNS TRANS. 3.00 '
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS 7 � '1.J 14.10W-61 i4J SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00 "J O e-
APPLICANTS MOTORS SEE FEE SCH. A/VTOtivGG fi
ADoAMG .^ L eQOy SERVICE CHANGE Pimp• 20.00
Eco LICENSED CONTRJCTOIRISID�IiCLARATION it imp
a U 1 hereby affirm Ihai I am Ienud u •r provisions of Chapter 9 . ISSUANCE DATE ,
A w (commencing w'h Soni n 7 01 o rvis n 3 of the Business and
¢ + BLDG. ELECT. PLG. MECH.
D i Professions Cod and m lice Ise is i full f r e and effect - p ❑ ❑
z o L - License Class _ Lic. Ito
9 r °w Dote Cont or
y p BUILDING PERMIT
¢ a WNER-BU I 'CLA ATION CI of Cupertino
a 0 a O INFORMATION
w ; I_ I hereby affirm that I a exempt from the Contractor's License MISC.- REFER TO ORD
FLLa J Law for the following reason.(Sec.703 L5,Businessano Professions PERMIT ISSUANCE 10.00P-04; VALUATION
3w>4 Code:Any city or county which requiresapermino construct,alter, ('
IC
. <0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. I J b
a w m¢ requires the applicant for such permit to file a signed statement that TOTAL J /�Y pERMI T
he is licensed pursuant to the provisions ol'tire Contractor's License ^
ai Law(Chapter 9(commencing with Section 7000)of Division 3 of the
E x o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
M H$ the basis for the alleged exemplion.Any violation ofSeclion 7031.5 STORIES TYPE CONSTR.
e. _F by any licanI for a permit subjects the applicant lou civil penalty ALTER
11. (EA.) 5.00
_ of no ore than five hundred dollars(55001.1:
I,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 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 Profession DRAIN FLOOR,ROOF,AREA,COND. 5.00
Code: The Contractor's License Law does not apply to air owner of
r property who builds or improves thereon,and who does such work FIXTURES, PER TRAP 5,00 SOS.FT.
FLOORUREA TOTAL ACREAGE
^® himself or through his awn employees, le,If,ho that such improve. C
meats arc not intended or offered for sale.If,however,the building GAS-EA.S TEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SVS M-OVER 4 (EA.) 2.00
builder will have the burden Got lonving that lie did not build or Ito- BUILDING USE
prove for purpose ofsaleJ' INDUSTRIAL WA TE INTER. 30.00 RES IND CON PB Other
❑ I,as owner of the properly.am exclusively contracting with Q
licensed contractors In construct the project(Sec. 7044,Business LAWN SPRINKLE - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law docs 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 emanactodsl licensed pursuant lu SEWER-SANITARY-S RM EA.200ftI10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ exempt I -r Sec P. . or this WATER HEATER W/VENT 6.00
rens _
Ow le Dlte - WATER SYSTEM 5.00
ACG GATE ACC.FILE NO.
WORAERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm Il at 1 have a certific.le of consent to self-inmuc,
or a cer�Llw of W rs'Compens do surmise,or a emit ied ZONING ENG.SITE NO.
hYNYO 8f 1_.ny_ L(_T&p-
r 1
O ❑ artifi• copy is hereby furnished.
Z 2 ❑ li' d copy i- led with ty IYn dFIRE SPRINK ENERGYT Y4
APPI an _ _ MISC.- REFER TO ORD. Y[] N� Y❑ NC]
rnr PERMIT ISSUANCE 10.00
� - CIi RTI FICATIi OI'fi XliMl'I'ION FROM WORKERS' - FLOOD ZONE a.L.U.C..
W . COMI'I?NSATION I NSURANCE PLG,CONTH. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y[] N� V N[3
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY
U. F mit is issued, I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. n
y Date ' Applicant ALTE, OR ADD TO MECH. 5.00 BUILDING 0
} rn NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
I- ? emption,you should become subject to the Workers'Conlpens:dion APPLIA E 5,00 PLAN CHECK
provision of the Lahor Code, you must forthwith comply with
U Such provisions or this permit shall be deemed revoked. AIR HANDING UNIT(TO lomr-F.M.) 4,00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDUN NIT(OVER 10=C.FM.) 6.00 SEISMIC FEE g
I hereby affirm thin there is a construction.lending agency for EXHAUST H00 (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM •---��-
3097,Civ.C.). HEATING UNIT( 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT IOR100,000 B.T.U.)9.50
Lender's Address - ELECTRIC Lip
1 certify that I have read this application and state Ilia(the above VENTILATION FAN ( GLE) 4.00
information is correct.1 agree to comply wink all oily and county BOILER•OUMP 13 H.P.Or 10 000 B.T.U.) 6.00
uhovrmenlinned property for inspection purpthe PLUMBING
ordinances and snare laws relating ID building construction, and
hereby authorize representatives this oily to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
oses.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,j gmmsts os]s and xpenses which' PERMIT ISSUANCE 10,00 CONST.TAX
lay 'n any w accrue ng' a I suit ty in •µIn a of Ic
n IT of lei mit a/ MECH.CONT. LIC.NO. MECH.
( ih'VC TOTAL TOTAL ^�
Sgnature of Applicant/Contractor Date �•, f/
OFFICE COPY