17598 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY. OF CUPERTINO 17598
INSPECTION DIVISION
JOB INSPECTION RECORD VV 1 ryCy1
�j RtMI`T EXPIRATION
JOB ADDRESS ^ IC�2n� CIQ7l.1 "�•LUNIT# _LOT#• '/ k�,�')�_/
PEhmiT' XPI ES IF WORK"
owNER �Lti e , CONTRACTOR IS NOT STARTEO'�WITHIN
INSPECTION DATE -I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM .
FOUNDATION "�. U NOTE:
LAST CALLEDINSPECTION.
UFER � ALL GRADINGAND DRAINAGE SHALL BE INSTALLED
PR EGUNITE , TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAI.IDn TION
CUPERTINO STANDARDS.
GARAGE SLABS QkKRO01 X41 OUL•,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �C ( (E . t, - ^!3 ,
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ' - ISSUANCE DATE
MECHANICAL HLLDG: ELECT_ PLG. MECH..
El . ❑ 0
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VALUATION SIFT.
MECHANICAL `
ELECTRICAL
FRAMING T
STORIES TYPE CONSTH.
INSULATION -
OCC GROUP RES U ITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 FT FLOOR AREA TOTALACREACL
ROOF •NOTE:NO FINAL INSP.SHALL BE MADE.BEFORE"_
DIAPHRAGM THE CONSTRUCTION TAX IS PAID ' ' ' •_
BUILDINGCON USE
ROOFSHEATHING . RES ING CON PE olnr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS' DATE INSP. ❑ ❑ ❑ ❑•
ASSLSSORSPARCEL NO
ROUGH SANA
PLUMBING ELECT,ENERGY
FIT
TUBS
- PARCEL NO
• TUBS B SHOWER PAN � PLUMBING ENERGY � '
MECHANICAL MECH.ENERGY
ELECTRICAL 019, BUILDING ENERGY' _ Acc ❑nre ACC.FILE No
FRAMING .I
ELECT.FINAL TEST
ZONING ` ENG SITE NO,
INSULATION - PLUMBING -
GAS TEST - - GAS
IRE SPRINK ENERGY T 2
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,, ❑ NY "�
ZONE
EXTERIOR*SHEAR - ELECTRICAL RELEASE FLoon A.LU,c•
INTERIOR SHEAR FIRE DEPT. - Y[:] N❑ v ❑ NEI
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH- BUILDING
INTERIOR LATH' TEMPORAR APPROVALS 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 FINAL ISSI GNEDBYBUILD ING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
O H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o 'PLEASE GIVE JOB ADDRESS WHEN PHONING.
z MECHANICAL
- SEE PERMIT FOR EXPIRATION_DATE -
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
e BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
BLIEDING APPLICATION & PERMIT.
ADOREss. 17.598_
1 20 C� � BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
' c• C. F PHDNEggI�-9.08
60NTRACTG 5
NAME OUTLETS-SWITCHES-RECEP 10.0011.00 RLIC.NO. LIGHTING FIXTURES - 10.00/1.00 :bo Jo
ADDRESS
APPLIANCES- 4.00DRS 's ��✓//- PAS
ADC -
PHONE PANELS 10.00 PATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
fl
OR ok, iG esil- PANELS (OVER 200 AMP) 20.00
ENGINEER
rp,J o uo No. ' SIGNS TRANS. 3.00 '
AR OR,OR ENG. PERMIT VA LIGATION
ADDRESS . Bute �] • SPECIAL CIRCUIT 5.00
A-9
I e z )0 R V EMP.METER.OR POLE INS. 20.00
AS - MOTORS SEE-FEE SCH.
ADDDREDRESSS .
C;cArqe C:s o-J. ne✓ SERVICE CHANGE 20.00
o 0 LICENSIiU CONTRACTORS DECLARATON - ,
Q [�w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
yz (commencing with Section 7000)of Division 3 of the Business and 28 1989
< °' A 8 198 BLDG. ELECT.- PLG. MECH.
H w z Professions Code,and my license is in full force and effect f'1 r V Y/ ❑ ❑ ❑
2 i m License Class- Lic.Number -
Da[e Conlructor ,,t
< '< 4 c� y6 Cupe BUILDING PERMIT
¢ ¢o OWNER-BUILDER DECLARATION INFORMATION
X 3 u y l hereby affirm That 1 am exempt from the Contractor's License MISC.- REFER TO ORD
ca a_ Law l'or the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION SIFT.
Code:Any city'or county which requires apermit to construct,alter, ZZ
¢ s ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. ELEC. J l.IX.JOO
K a, requires the applicant for such permit to file a signed statement(hat TOTAL
n w
as m he is licensed Pursuant to the provisions of the Contractor's License
H za
LawlChapter9(commencing with Section 7000)of Division 3 ofthe
f 4 G Business and Professions Code)or that he is exempt trombone and GTY. PLUMBING PERMIT FEE
¢ I- m the basis for the alleged exemption.Any violation of Section 7G31.5 STORIES .TYPE CONSTR.
i by any applicant for a permit subjects the applicant Lou civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ •1,as owner of the property,or my employees with wages us 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 I'or sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 6.00
Code:The Contractor's License Law does not apply to an owner of
_ property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 sa.• PT.FLOOR AREA Tar y�Ac GE himself or.through his own employees,Provided that such improve' �w�T yIL
ments are not intendedor offered l'or sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 S
or improvement is sold within one year of completion, the owner- GAS EASYSTEM-OVER 4 IEA) 200
builder will have file bwh of Proving that be did not b - . .
uild or int- - . IMF-
BUILDING USE
prove forpurpose ofsalc.). RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 El ❑ 0 0 11
licensed contractors to construct the project(Sec.7044,BusinessLAWN 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 contractor(s)licensed pursuant To SEWER-SAN V-STORM EA.200ft/10.00
the Contractors License Law. TRACT N0, PARCEL NO.
U I am exempt under Sec.-,IL&P,C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM - 5.00
ACC.OATE ACC.FILE NO.
WORKERS'COMPENSA'f ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby infirm that I have a certificate ol'abnsent to self-insure. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No, Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z U Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y [] IN y NEI
= N CERTIFICATE OF EXEMPTION I7ROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.UC.
W > COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG.
d 0 (This section need not he completed if the permit is for one TOTAL Y❑ IN Y ❑ ON
Z hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work titer which this per QTY. • MECHANICAL PERMIT FEE FEE SUMMARY
LL f mit is issued.I shall not employ any person in any manner so as to
Q W become subject to the Workers''Compensation Laws of California.
Q. Date AI'plicant ALTER OR ADD TO MECH. 5,00 BUILDING C
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Cade, you must forthwith comply with FEE 1
U such.provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 .
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 SEISMIC FEE Ar.�
I hereby affirm that there is a construction fending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this Perllllt is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Add, s HEATI NG UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC
es
I certify that l have read this applicminn and state that the above VENTILATION FAN (SINGLE) 4.00
. information is correct. I agree to comply with all city and'commy PLUMBING
ordinances and state laws relating to building construction, and BOILER-CONT(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter uponAhe BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs.Bnd expenses which PERMIT ISSUANCE 10.00 CONST.TAX
Sy any way accrue age' Said City in consequence of the
r ling,
in f[his permi ,
MECH.CONT. _ LIC.NO, MECH,
TOTAL TOTAL
Si tore of Ap lican[/Contractor Date -
OFFICE COPY