17673 (2) POST THIS CARD NEAR FRONT.OF BUILDING PERMIT NUMBER
CITY:DF' CUPERTINO 17673
INSPECTION DIVISION
•;.'Y`l JOB INSPECTION RECORD _ -
�.. / ., -
It IT XP ATION
JOB ADDRESS . KeJ Jl `' s UNIT# _LOT#�
PERMIT?€XPIRES IF WORK
OWNER II-P'x` corvTRAcroR f S' `� IS�NOT�� TARTED WITHIN,
INSPECTION DATE ,INSPECTOR' INSPECTION RECORD leooays DF PERMIT Issu
_'' ANCE OR 180 DAYS FROM ,
FOUNDATION
%,i.... NOTER - •-, LAST CALLEDINSPECTION.
'OPER � � � .ALC GRADING'AND"DRAINAGE SHALL BE INSTALLED
1 PREGUNITE TO COMPLY'WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
• UNDERGROUND /SLAB , ••° O - qA '
PLUMBING /+`N�. IA u,[
>/ 3
ELECTRICAL City of Cupertind. IssuANce DATE ( r
MECHANICAL .. - BLuc rtu:ri. PLc. MECR.
• 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - .BUILDING PERMIT
INFORMATION
WOOD FLOOR - - VALUATION s/PT.
PLUMBING '
MECHANICAL. -
•
TERM ll i0
.ELECTRICAL' „y
-' - ��,. `•�G
FRAMING
STORIES IYPE CONSTR.,
.INSULATION .'
OCC.GROUP -RES.UNITS .
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 I T.R.00R AREA TOTAL ACREAGE
ROOF ^ ' ' NOTE.NO FINAL?NSP.SHALE BE MADEBEFORE
DIAPHRAGM''•' -;, THE CONSTRUCTION TAX IS PAID
V• BUILDING USE .
ROOF SHEATHING '- Res ' IND CON PB ow.-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ' DATE ?NSP. ; 0~ 0 ❑ ❑ I]
n SSESSOR
ISPACEI NP'.•
. . - , ^ ROUGH `. `..I : .SAN.0 -
PLUMBING "" - ELECT.ENERGY- -
�' TRACT NO PARCEL ND.
TUBS&SHOWER PAN.` - PLUMBING ENERGY :
MECHANICAL - " MECH.ENERGY.
ELECTRICAL - -
ACC.LATE ACC.FILL.NO.
BUILDING ENERGY
FRAMING . - - ELECT.FINAL TEST zoNlNc -ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
"' MECHANICAL' - FIRESPRINK ENERGY T-za
T.COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - - y Ej'' "� •` `N�
rLOOD mNE n.l..u.c.-
' EXTERIOR SHEAR ELECTRICAL RELEASE - v E] N[] _ Y L 'NO
INTERIOR,SHEAR FIRE DEPT. ..
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING /^
. . INTERIOR LATH - - TEMPORARY APPROVALS , - BUILDIyG V
SCRATCH COAT ' a ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE: .
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDMG FINAL IS SIGNED BY BUILDING INSPECTOR. mICROFILM
ARRANGE FOR INSPECTION BY,PHONING 252-4505 - ELECTRIC
�: ONE WORKING„DAY BEFORE-REQUIRED INSPECTION.' PLUMBING
0 1 ; _PLEASE'GI,VE JOB'ADDRESS WHEY; ONING.
SEE'PERMIT FOR EXPIRATION DATE — ,,. MECHANICAL
IMPORTANT! CONST. TAX
z PLEASE READ'REVERSE SIDE BEFORE'. -;
CALLING FOR.FINAL INSPECTION. TOTAL
`OFFICE COPY
�r?&etCANT TO FILL IN INFORMATION WITHIN RED LINES_ USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION 1 - PERMITNUMBER - -
BUILo"c APPLICATION & PERMIT 1 rJ
� r��j
AOOnE55 / '• ' ' ' , I 1 1
W BUILDING—ELECTRICAL—PLUMBING—'MECHANICAL �.
OWNER' PLANCHECKVALIDATION
-
R t "AMP QTY. ELECTRIC PERMIT FEE ;
PHONE
co
ACTOR
CO
N OUTLETS-SWITCHES-RECEP 10.0011.00
PLIC No Q LIGHTING FIXTURES 10.00/1.00
CONTRACTORS - '...APPLIANCES'-RESIDENTIAL, 4.00
., ADDRE S� . r
PHONE-,�7 .� 'PANELS 10.00 .DATE OF APPLICATION
ogcHiTecT -PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c.NO.•
ENGINEER .. -
'' uc.NO, ,:_' SIGNS TRANS. - 3.00
AARCH.08 DDRESS ENG! _ SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION
ZIP EMP.METER OR POLE INS_. 20.00
AADORCEss PPLISS - MOTORS ' SEE FEE SCH. T
' „ .y,
- - SERVICE CHANGE
00- LICENSED C(INTRACTOltS Df:CLARA'fION
a v w 1 hereby'affirm that I am licensed under provisions of ChSp(er 9 E AY 1 1 ISSUANCE DATE
,y < H (unamencing with Section 7000)of Division 3'0l'the Nosiness and - , BLDG. 'ELECT. ',_PLG- MECH'
F N z Professions Cod• anJ y cense is in full'fore def I-. Q� ,
¢ i to o Date�la-ss Lin.Number — �4�-_ CIa)'`OI Cupertino El El ❑ I
9 m r Dote_ /Lyf�//- Lic+ utor_ _
OWN'R-OUILDIiR DEGL ATI -•
BUILDING PERMIT
W'o MISC.— - REFER TO ORD INFORMATION
W ; 0 y I hereby affinn'Btat am excinpl Irom the Contractor's License - VALUATIONS $/FT• 1
F LL o ¢ Law for the fallowing reason.(Sec.703+.5,Basinessand Profess+ons PERMIT ISSUANCE .. - 10.00
Coda Any city oecounly whU re luhresal ernul r onstnml,x0et,
2 M ¢0 hmprove,demolish,orrepacany;tructuru priori d. isstance also ELEC.CONTR. . - LIC.NO. ELEC. q�
a. D¢ requires the applicant for such Permit to ode a signed statement License
_ TOTAL PERMIT TO ,
F
m a. he s licensed pursuant to the Provisions of the Contractor's state s ntthat
> ' Law(Chapler9(coatmencingwdh Section7000)o1 Dlvision3ofthe -
io Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE '
¢F the basis for the alleged exemption.Any violation of Section 7031.5 W STORIES TYPE CONSTR.
n ;_ by any applicant fora permit subjects the applicant toacNil penally -
affront more thamfivehundred rlollars($5001.). ALTER-DRAIN&VENT-WATER (EA.) 5.00 ` '
❑ I,as owner nL the property,or my employees will,wagca as BACK FLOW PROTECT.DEVICE 4.00 .'s
their sole compensation,will do the work,and the sl reclare is nn+ - - OCC.GROUP RES.UNITS
%� .. intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Codd The Contractor's License Law docs nut apply to an owner 61 -' -• .
himself Or tobuildss wnmployeereomand who docs such work FIXTURES-PER'TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himsclf or through his own employees,provided that such improve- -
mentsare not intended nraft'ered+'orsale.If.hmweveg+hi'building GAS-EA:SVSTEM-1INC.4 OUTLETS 6.00 '
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
'Hive for purpose of sole.). - INDUSTRIALWASTE INTER. - 30.00 RES' IND CON ' PB Other
❑'1,as owner of the property,am exclusively contracting with ❑ ❑ . ❑ ❑ ❑
licensed contractors tm construct tire S
e project(Sce. 7044,Business LAWN SPRINKLER -1 INC 5 V.B. - 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I in Contractor's Licunse'Law does not apply r
-' 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 contrucfor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft
the Contractors license Law. /10.00 TRACT'No." PARCELNO.-
01amexemptunder,Sec. ,11.&RC.for this
reason WATER HEATER W/VENT 6.00 '
Owner Dane WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0,
WORKERS'COMPENSA I]ON DECLARATION : WATER TREATING EQUIP. 5.00 ;
1 hereby affirm +hat I have a certificate of consent to self-insure. - -,
or"certificate of Workers'Compensation Insurance,or u certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company '
Q ❑ Certified 'tpy,ls h• by Turn istied. FIRE SPRINK ENERGY T-R4
Z-Z Cell ified f/l�y yy�,,��Y�e�r �wl�l�h �theity �insprrotion division.
F O A 1 jean!-1(li/_/f}/�' _1 MISC.- REFER TO ORD. v ❑ N❑ Y ❑ N❑
CC r2 CHH'IlF iTEOF EXEMPTION FROM WORKIERS•' PERMIT ISSUANCE- 10.00 I FLOOD20NE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC'.NO. PLG.
C' O I'I'his section'need not be .rmfl tvd'it the Permit is for one TOTAL I Y❑ N❑ Y ❑ N❑'
' Z hundred dollars IS l 00)or less.) -
U O 1 certify that in the perforntance of the work 1'or which thisper- TY. MECHANICAL PERMIT. FEE FEE SUMMARY
LL H mil is issued,I shall not employ any person in any manner so as to ' -
O w, become subject to the Worker Comperaction Laws of California. `h
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
.} W NOTICE TO APPLICANT: If after Tasking this Certificate of IEx- [[
♦--Z eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with �-
'U such provisions or this permit shall'he d (T
eemed revoked. AIR HANDLING UNIT O 10=C.F.W • 4.00 FEE' -
CONSTRUCTIONLiENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE fo '.�r�t--
I hereby affirm that there is a construction lending agency for EXHAUST HOOD)WITH DUCT) 5.00
the perrntance of the work for which this permit is issued+Sve. - MICROFILM
3097,Civ.C.).. a H EATI N G U N IT-(TO 100,000 B.T.U.) 8.00 ' - �-
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 r
' Lender's Address - ELECTRIC
I certify that I have read this application and stale that flee above VENTILATION FAN (SINGLE) 4.00 -
infnmmimn is correct. I agree to comply with all city and county - - PLUMBING
ordinmces-aod state laws relating to buildjng construction, and BOILER v COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby above-mentioned
orire representatives ec on this to e1 upon the BOI LER-COMP (Oia r 100,000 BTU)SEE FEE SCH. MECHANICAL
berida ma ilevitd property-oorinsp of
purposes. ,
i(We) agree to save, indemnify and keep harmless the City of '
MISC.-MISC.-
1. . REFER TO ORD. - r
Caper line against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said.City in conseyucnce'of lite
a gof+hie heroin 1
p MECH.CONT: LIC.NO. - MECH.' TOTAL o2p D4
JI/ , TOTAL
Sitiature of ApphcaarEJC tractor Dae _
?' °+' OFFICE`COPY,