17308 (2) y POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMPER
CITY OF =CUPERTIN �;41 �- At-¢wv 17308
" INSPECTION DIVISION
JOB INSPECTION RECORD
PjERMITX^P'I'RXQTION
R IF WORK
JOB ADDRESS �' U 'rC'Q�/�-��- L3�Vd. UNIT4 O V_T##' _ 1 Y �•) 'S
OWNER vk O S CONTRACTOR .. S NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 1BU DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 1.80 DAYS FROM
NOTE: .LAST.CALLED
UFER � . ALL.GRADING AND DRAINAGE SHALL BE INSTALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMITVALIDATION
CUPERTINO STANDARDS. PAD
GARAGE SLABS - t
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED n,
UNDERGROUND /SLAB JUL 05 1989 '
PLUMBING -
ELECTRICAL 1: ^� ISSUANCE uATI.
MECHANICAL !ARBLDG ELECT I PLG. MEGA
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNE auaDlNc PERMIT
INFORMATION '
PLUMBING -WOOD FLOOR VALUATION ,a.P SIFT.
MECHANICAL '
ELECTRICALy �. PP•E_II`MITT TO
FRAMING C l [ ley""'.Wc E I`CE'(4l!'(q, P
INSULATION srOHles TYPE CONST
ucc r,RouP .R Es.UNITS
PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED NlowI -
F.O[11 AH.A TO]At.ACP:ACf
ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '
DIAPHRAGM'
ROOF SHEATHING THE CONSTRUCTION TAX IS PAID _
Res INouILOcoN USE
om.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ASS F.SSOHS YAHCF.I.NO
ROUGH sAN.N
PLUMBING ELECT.ENERGY
TUBS B SHOWER PAN PLUMBING ENERGY TRACT NO: PARCEL NO
MECHANICAL MECH.ENERGY
ACG DATE SACC FILE NO.
ELECTRICAL BUILDING ENERGY
FRAMING - ELECT.FINAL TEST
`ZONING ENG.SITE NO.
INSULATION PLUMBING '
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.zn
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ IN Y ❑ NO
0.LU C.
EXTERIOR SHEAR ELECTRICAL RELEASE ' FLOOII?ONE •
INTERIOR SHEAR _ FIRE DEPT. Y[) N� Y ❑ NO
SHEETROCK GRADE FEE SUMMARY +� '
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING 3z..3.,,
SCRATCH COAT - ELECTRIC . PLAN CHECK
GASFEE .. .�•��l
\ NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE' F-OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSiGNED BY BUILDING E -MICROFILM
• 1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC- , 4
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. 'PLUMBING
o PLEASE GIVE JOB'ADDRESS WHEN PHONING. 1
ZMECHANICAL
— SEE PERMIT FOR.EXPIRATION DATE"— ,
IMPORTANT! CONST.TA%
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. OTAL
OFFICE:COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
` BUI LDI NO PROJECT I DENTI FICATION PERMIT NUMBER
a7ILDING APPLICATION &P
AooREss7� /+ 3'0
D..77 yv�t�A�� BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S
ft .yqOTY- ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
PHONL/7 .V'��
CONTRNCTORS
NAMEA. Y ,(` p, 'ayOUTLETS
-SWITCHES-RECEP 10.00/1.00
0fP' �O 16L A.�17 LIC.Nc,3 LIGHTING FIXTURES 10.00/1.00 I
,,ONTRACTOR'5
anon ss(� „ �/ pQ� APPLIANCES-RESIDENTIAL' 4.00
c -
I�e O Niv ., / Q PHDNE�'�r yry3 PANELS 10.00 DATE -
ARCHITEC - DATE OF APPLICATION ”
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER�S.w J/Ar� ,f =INS. 20.00
f•� LIC.ND.et7.S ErEMP.
0
-PCH.OP ENG.
aODRE55 /' r_
SPECIAL00 PERMIT VALIDATION
ZIP011ODRESS H. JLPr0 L�LY 10 0 0 LICENSED CONTRACTORS DECLARATIONUJ G 1
a z W I hereby affirm that I am licensed under provisionsof Chapter 9
too
a mw (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
H M a Professions Cotte,and my license is in full force and effect. BLDG. ELECT. PLG. MECH.
z o L License Class Lia Number -
O z I_ � Dole Contractor
Q y E J
cr w u OWNER-BUILDER DECLARATION BUILDING PERMIT
w ;' N - I hereby alfinn that 1 am exempt from the Contractor's License MISC.— %%R TO ORD INFORMATION
ru Dst La w for the followl ng reason.(Sec.7031.5,Illidness and Professions VALUATION
PERMIT ISSUANCE 10.00' f D pp 5/qr'
� w- F Code AnY city or county which requiresu permit loconslnrd,alter, D
2 <(l improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR, LIC.NO. ELEC.
O¢ requires the applicant for such permit m file a signed statement[hat TOTAL
Iv w m" he is licensed pursu:ml to the provisionsof the Contractor s License PERMIT 7O
r z Q Law(caa adr9(com Heneing with Section 7000)nf Division3 of lire � r_—rlJe�,•�
i O tlosiness-nd Professions Codel nr that be is exempt Iherefrtm and OTY. PLUMBING PERMIT FEE 'C Ll ""`R
It H m the basis for IhC alleged exemption.Any violutiml of Section 7031.5 STORIES TYPE CON
n by any applicant for a permit suM1jeds the applicannoacivilpenalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of nor more than five hundred dollars($5001.):
❑ I,as owner of the Property,or my employees uviol wages as BACK FLOW PROTECT. DEV ICE• q,00
their sole cora pen
. ....n,woil
Jo the work,unA the slnmlure iv not OCC.GROUP RES.UNITS
intended or offered
for
sale (Sec. 7044, Business and nOwnerof DRAINS-FLOOR,ROOF,AR EA,COND. 5:00
Cade: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00
himself Or tlllough.his own employees,provided that such improve- 50.FT,FLOOR AREA TOTAL ACREAGfi
ments are not intended or offered for sale.Il',however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or_improvement is sold within one Year of completion. the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 - BUILDING USE
prove 1,as opner of sale.). INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB Oohs,
❑ L as owner of the property,he exclusively. 7044, ins with ❑ ❑ ❑ ❑
licensed colons Cod to construct the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:The Contractor's License Law docs not apply ASSESSORS PARCEL N0.
to an owner of property,wilt)builds or improves thereon,and who LAWN SPRINKLERS+OVER 5(EA.) 1.00
contracts for such projects will,to mntrador(sl licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCELNO.
❑ 1 am exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
owner Date WATER SYSTEM
5'00 ACC.OATE ACC.FILE NO..
WORK IiRS'COMPCNSATION UIiCLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm That I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO.
copy thereof(Sec.3900,Lab.C.).4-n.7"
O Policy No. Company fA Q��yf W.
1(,Certified Copy is he 'tarnished. -FIRE SPRINK ENERGY Lp4
'z Z� ❑ Certif y fil h the only inspection division.
F O V Applicant MISC.- REFER TO ORD. Y [] N� Y[] N[
� —
CF
RFICATIi OF FXEMPTION FROM WORKERS' PERMIT ISSUANCE
LU
FLOOD ZONE •q.L.u,C.
�� COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. '
d O LT'his section need not he colnpleted if the permit is for one TOTAL V❑ NC] y N
Z hundred dollars($100)or IessJ
0 0 I certify that in the performance of the work for which this per- FEE SUMMARY
LL 1- mil is issued.1 shall nut employ any pension in any manner so as to QTY. MECHANICAL PERMIT FEE
0 W become subject 10 the Workers'Com unillhol Laws of C.ifoonH,
CL Date Applicant
rt) BUILDING
} NOl'ICE TO AI'1'1-ICANT: IL after making Ihis Certificate of Ex- ALTER OR ADD TO MECH. 5.00 23e
F'- Z emption,you should become subject to the Workers'Compensation APPLIANCE. 5.00 ,PLAN CHECK
Provisions of the Labor Code, you must Orlhwilh comply with
C„1 such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
C6NS'rRUCT10N LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5. 0
the Perfonnancn,of the work for which[his permit is issued(Sec.
3097,CIv.C.L �� F/ HEATING UNIT(TO 100,000 B.T.U.) .0 MICROFILM
Lender s Name
Lender's Address HEATING UNIT(OV ER 100,000 B.T.U. 9.50 ELECTRIC
I call;fy Ihat 1 have read this application and stale that the above VENTILATION FAN (SINGLE)
or mmmion is
correct.1 agree to comply wish all oily and county PLUMBING
hereby au and state laws relating to is building construction, andthe BOILER•COMP(3 H.P.or 100,0008.T. 0
hereby authorize representatives of this city es enter upon the
abuvomen[inned property for inspection purposes, BOILER-COMP (Over 100,000 RTU)SEE ESCH. 'MECHANICAL
(We) agree,to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which'
Toy in an ay accrue against said City in co sequen a of the PERMIT ISSUANCE 10.00 CONST.TAX
Ming l' m:' MECH.CONT, ,LIC.NO. MECH.
^ e , �� I TOTAL _ ^
-lure of Applicant/Con ctor ate TOTAL' Od
OFFICE COPY