17889 (2) POST THIS CARD NEAR FRONT OF BUILDING
- _ PERMIT NUMBER
CITY OF CUPERTINO 17889
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS_t>Ll- ' " S�e k- &T#' _LOT# 4y PERMIT EXP,IRgTION
r PERMIT EXPIRESIF WORK
OWNER L P oI.U.LO CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD, 1Bo•DAYS OF PERMIT ISSU-
FOUNDATION - PNCE OR 1860AYS FROM
NOTE:
LIFER CALLED INSPECTION.
. FER ' ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - PAID k _ 7—
POUR
—POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1 1. l7
'
UNDERGROUND /SLAB 'JUN 7 1989 ,j ,,�- H Lt 0 ",f L J
PLUMBING - {�
ELECTRICAL .CL) Of CUperuDOf
Issu ANCE DATE
MECHANICAL' BLRc ELEcr. PLC. ECR,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED` BUILDING PERMIT
WOOD FLOORINFORMATION
, /�
PLUMBING 55r� VALUATION' SIFT.
MECHANICAL - r!?' • ;,� '= •^. : •.1 . Gy . l N 13
ELECTRIC �1
��T PEPt N11^1'TTO
AL.. .._`- .I
FRAMING — �J
INSULATION . DATE STORIES T Eco"sTR,
UCC GROUP RES.UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROOF - NOTE:NO FINAL IN§P.SHALL BE ADE BEFORE °'Fr TY�_nnBCA •.oTAL AcveAne
DIAPHRAGM THE CONSTRUCTION TAX IS PAID . .1 O Llr/r
BUILDING USE
ROOF SHEATHING , 1, ,IND CON PB 0,1,,-r
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS, DATE INSP. ❑ 0 ❑ O
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING - ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY '
MECHANICAL - .MECR ENERGY -
ACC DATE ACC.FILE NO
ELECTRICAL- " BUILDING ENER
FRAMING - - ELECT.FINALT
INSULATION PLUMBING - zowNc ENC.SITE No.
GAS TEST I - GAS ,
MECHANICAL FIRE SPRwK ENERGY T.24 -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING " Y ❑ "�
FLOOD ZONE ,A,
EXTERIOR SHEAR ELECTRICAL RELEASE L UC.
INTERIOR SHEAR FIRE DEPT. Y "❑ ° ❑ "❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH . - - TEMPORARY APPROVALS BUILDING l�ll�,CO
SCRATCH COAT ELECTRIC PLAN CHECK,
GAS - - .. FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LOIN OR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC E
oo ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
T .
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORETOTAL
CALLING FOR FINAL INSPECTION.'.
OFFICE COPY
APF-LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION &.PERMIT. 1 ��O(�
ADDRESS - - �� I o J
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
NAME S L PLAN CHECK VALIDATION
DTV. ELECTRIC PERMIT FEE
D PHONE
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
GONTFACkOR S ADDAPPLIANCES-RESIDENTIAL 4.00
RESS
PHONE PANELS 10,00 - DATE OF APPLICATION
ORRCHIiEi PANELS (OVER 200 AMP) - 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCHE REN ISPECIAL CIRCUIT 5,00 PERMIT VALIDATION
--ZIP - EMP.METER OR POLE INS. 20.00
ADDRESS
APPLICANT'sMOTORS SEE FEE SCH.
'
SERVICE CHANGE 20.00 I .{A� K- ( U'may 'P•L vc4-:t
o in i J ` l'
r o o LICENSED CONTRACTORS DECLARATION
c U U I hereby affirm that I am licensed under provisions of Chapter 9 �i' ISSUANCE DATE
H 4 y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. I MECH.
F n z Professions Code,nnA my license is in full force and effect. r
o i m o License ClassLin.Number
Late Cont ructor City of Cupertino Pt
r m H j
BUILDING PERMIT
rt w u OWNER-BUILDER DECLARATION,
w ; H I if: affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
Fu0J Law for the following reason.(See.7031.5,Businesand ProfessionsPERMIT ISSUANCE 10.00 ] LqU VALUATIOD $/FT,
y� Code:Any city orcounfy wh11CI1mquit"aplrmlttuconsiriict,aller, /�j
au OD
¢ 0 improve,demolish,or repair any structure,prior to ils issuance,also ELEC.CONTR. LIC.NO. ELEC.
o ¢ reyulres the applicant for such permit In file a signed slutalu rl flat TSSOTAL �I l�
w m IT he is licensed pursuant to❑m withprovisions
ecti of the Contractor's License PE[iMOTTO
.Hz ¢ Law(ChapterProfessions
Code)with Section is 00)cxvpfttherefvision oofthe 1,/V^Y `�-If�(()T
M 4 o Business and Professions Code)or that vi is exempt Schon 0 and QTY. PLUMBING PERMIT FEE - 'P
M m the basis for the allege)exemption.Any violation of Section 7031.5 STORIES TINE CONSTR.
by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER (EA.) 5.00
r �Q
of not more than five hundred dollms(S5001.):
❑ 1,as owner of the property,or my em Ployces with wages as BACK FLOW 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 Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
- Code'. The Contractor's improve Law doer not who to an owner of
properly who builds or improves thereon,provided
who does such work FIXTURES-PER TRAP 5.00TO-7t-5f) SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided weal such improvr
or improvnotement
intended or Offend for sale.If,howetintth owneig GAS-EA.SVSTEM iINC.4OUTLETS 6.00 I�
or lder will
is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
' builder will Ituve the burden of proving that he did not build or iso- BUILDING USE
Ac ve for purpose of ale.). INDUSTRIAL WASTE INTER., 30.00 RES IND CON PB Omer
1,as owner of the property,son exclusively contracting with
lice sed 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 property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contructorls)licensed pursuant to SEWER-SANITARY-STORM EA,200ft/10.00
the Contractor's License Law. TRACT NO, PARCEL NO.
❑ lame •sot der Sec ,B.&P.0 thi>
reason WATER HEATER W/VENT 6.00 '
Owner Date for WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 eemby affirm that I have u certificate ofconsent to sell'-imm-c.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. -
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T]4
Z Z ❑ Certified copy is filed with the city inspection division.
H 0 Applicant MISC.- REFER TO ORD. Y [] N❑ Y [3 NE]
MT CERTIFICAT Ii OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 12J FLOODZONE A.L.U.C.
LU -2 COMPENSATION INSURANCE PLG,OONTR. LIC.NO. - PLG.
d O (This section need not be completed if the permit is for one TOTAL Y❑ N� Y N[]
L0 Z hundred dollars IS 100)or less.)
) 0 I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,I shall not employ any person in any manner. as lu
U become subject to the Workers'Compensation Laws of California.
a Date-Applicant ALTER OR ADD TO MECH. 5.00 ,DD BUILDING
} m NOTI C li TO AP PLICA N'I': 11,al'I cr making this Ccrl ificme of fix.
F. Z emption,you Should become subject to who 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 10AMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)D000.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a coostrucfion lending agency far 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.)
Lender's Name HEATI NG UN IT 100,000 B.T.U. B.5 - rT0
Lender's Address - ELECTRIC' dd
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 L
information is.correct. I agree to comply with all city and county BOILER•COMP(3 H.P.Or 100,OOD B.T.U.) 6.00 PLUMBING �Tf
ordinances and stale laws relating to building construction, and
d hereby authorize representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH, MECHANICAL
abovam muhmed properly forvesp of
purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00111CONST.TAX
may in an any a 4ue agai t said City in consuquencc of ther
rantin ,�j t., MECH.CONT. LIQ NO. MECH.
/_ 4 S'/S-0. 11TA -S7j TOTAL
Sig to C oPApphcant/Contrac Date -
OFFICE COPY