17971 (2) ,POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17971
INSPECTION DIVISION .
JOB INSPECTION RECORD
�_ �y� ��� Oe •)U PERMIT EXPIRATION
JOB ADDRESS 60 pu�� UNIT# _LOT# pERMIT�E%/PIRESJIF WORK
OWNER ( 7//v��YLi Fri---'t/ 'CONTRACTOR IS N06—T,AATAD-VVf'FHIN
' - INSPECTION DATE, INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT.ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM,
NOTE: - LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED'
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF / P,PruT VA LIGATION
GARAGE SLABS
CUPERTINO STANDARDS. / J
L•,7l ff//� ///
POUR NOXONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB .
PLUMBING pp/�
ELECTRICAL P-APM .ISSUANCE DATE
MECHANICALIIIUG. ELECT, I PLG, KIECM.
N0�''ll2 "I , ❑ ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _—_ =,,r,� BUILDING PERMIT
WOOD FLOOR Gitf OF CEUJ.Birlo INFORMATION
SIFT.
PLUMBING CvALUA_TION
� '
MECHANICAL _ 1 IN AL ED IN
ELECTRICAL w
(r' PERMn TO,
co-ml.. FRAMING . - . . v /'>�.— �T1`vro {A
INSULATION DATEs*oRIEs T
YPE coNSTR.
. _ J'. Y
r• - „QCCJGHOUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
!�__ • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE s°,rT,rLooR AREn romT ncncncE:
DIAPHRAGM THE CONSTRUCTION TAXIS PAID S I
BUILDING USE
ROOF SHEATHING RES IND CON PB DI..;
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 �O ❑ ❑
ROUGH SAN.N
A55ESSO. SlAiACLLNO.
- - .� -
PLUMBING - ELECT.ENERGY
T TUBS&SHOWER PAN — PLUMBING ENERGY iFACI NO. PARCEL NO
MECHANICAL MECH'ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE Acc,FILE No
FRAMING ELECT.FINAL TEST
INSULATION -
ZONING ENG.SITE NO.
PLUMBING
GAS TEST GAS
FIFE SPRINK F.NIiRGY T.?E
MECHANICAL - ❑ N❑ ❑ NQ
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -
FLOODZONE - A.L.U,C. '
f EXTERIOR SHEAR ELECTRICAL RELEASE .-
INTERIOR SHEAR FIRE DEPT. - Y❑ N❑ ,v ❑ N❑
SHEETROCK - GRADE . SJ _ FEE SUMMARY
EXTERIOR LATH _ - BUILDING
INTERIOR LATH TE'MPORARY•APPROV.ALS
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 ISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
l
/ w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
!� H ' i - ONE' PLEAWORKING DAY BEFORE REQUIRED INSPECTION. P
z � ',. SE GIVE'JOB ADDREPLUMBING WHEN PHONING.
— SEE.PERMIT FOR EXPIRATION DATE,— MECHANICAL ✓sem
IMPORTANT! coNsr.rnz
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
' I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FI ATION PERMIT NUMBER
N APPLICATION & PERMIT 1 (]q
L / �-�� BUILDING - ELECTRICAL-PLUMBING -MECHANICAL I J r
OWNER'! 1 Upr yl�9a�• PLAN CH ECK VALIOATION
afqNAME L I 1/c-G Cl/Ol /�-/l/ OTV. ELECTRIC PERMIT �' FEE
V VRONE_5� 10
Doe-,
IJ`
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
-
CONTRACTORS
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
COREu
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT p PLAN CHECK FEE .C.N .
on - PANELS (OVER 200 AMP) 20.00
ENGINEER
nc.No. SIGNS TRANS. _ 3.00 J�j
nooaEss R
Enc. SPECIAL CIRCUIT 5.00j'� ALlonnoN
Lff,4F0R TEMP.METER OR POLE INS. 20.00
' ADDRESSTa
( MOTORS ./-`,SEE-FEE SCH.
r� - t SERVICE CH .00
o o LICENSED CONTRACTORS DECLARATION
6 v I hereby aflims that 1 am licensed under provisions of Chaplet 9 ISSUANCE DATE
I N G w (commencing with Section 7000)of Division 3 of the Business and q BLDG. ELECT. PLG. MECH.
H m z Professions Code,and my license is in full.force and effect J _ a (\�, `� El El E] ❑
a z o v, - License Class Lie Number M V w
Z, Dale Contractor'
r. 1�k611^ BUILDING PERMIT
m a i
OWNER-BUILDER DECLARATION MISC.- s Ir ORD INFORMATION
I ss as I hereby affirm that I am exempt fromthe Contractors Licerue
LLOQ Law for(he following reaum.(Sec.7031,5.Business and Professions PERMIT ISS 1000 VALUATION ^�x SIFT.
� - Code:Any city or county,which riquim a permit to construct alter, N7 ON/
orre40 improve,demolish,or repair any structure.prior to its issuance,alio ELEC.CONTE. LIC.NO. - ELEC. /' VVVV✓✓✓✓
requires the applicant for such permit to file a signed statement that TOTAL PERMIT to
w m he is IicenuJ pursuam to the provisions of the Contractor's Lirense O
HiQ Luw(Cllvptcr9fmmmencing with Sect ion 70001 of Division3nf the - h a..� 1.
t f z o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE - R
ar f the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i3 by any applicant for a permit subjects the applicant to acivil penally ISSIXOT:
of noALTER-DRAIN& VENT-WATER (EA.) 5.00 ' Y
t more than five hundred dollars
f ❑c 1,as owner of the property,or rey employees with wages as BACK FLOW PROTECT.DEVICE 4.00 occ.cRouP RES.UNITS
1 their solo compensation,will do the work,and the slnsture is not
intended or offered for sale,(Sec. 7044. Business and Professions DRAINS-F "ROOF,AREA,'COND. 5.00
Code:The Contractor's License law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES R TRAP 5.00 !O,fT.FLOOR AREA TOTAL ACREAGE
himself orthrough intends ownemred for sale.
it,hole such improve- GAS-EA.SYSTEM-l 6.00 .�v ' I
himself
are not intended or offered for wlc.11;ed that r,the huildie-
or'improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA,) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). s INDUSTRIAL WASTE INTER. '30.00 RES - IND Cox PB one..
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑
licenwd contractors to construct the prujcct(Secs 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Cade:The Co 1, ant's License Low docs not apply
to an owner of properly syh uilds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ,
contracts for such p, Feet t u Cuntrdllotfsl licensed pursuam to
Zhu Contnnor's Li 4uc SEWER-SANITARY-STORM EA.200ft/10.00 . TRACT NO. PARCEL No.
I nA ,B.&P.C.lin this WATER HEATERIW/VENT 6.00 -
rca'
net__ _ _ Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. ,
WORKERS'CO PC 'SATION DECLARATION - WATER TREATING EQUIP. 5.00 '
y I hereby atfirm that l hove a certificate of conwm to sett=ia une. ZONING ENG.SITE NO.
or a certificate of Workers Compensation Insurance,or a ccuifkd
copy thereof(Sec.3800,Lab.C.).
s Policy No. • Company
0 ❑ Ccrliliedcopyishcmbyfurnishcd.' FIRE SPRINK ENERGYTP4
Z Z ❑ Certified copy is tiled with the city inspection division. MISC:- REFER TO ORD.
O Applicant Y .N E Y ❑ IN
~ va PERMIT ISSUANCE 10.00
Lu - FICATF OP SATIO TION FROM WORKERS' FLoOo ZONE a.L.u.c:
W 0 t �� }COAIPISNSATION'INSURANCIi PLG.CONTE. LIC.No. TPLG
OT Y❑ n❑ Y � E]
1 Q ('fhk(section need not be completed if flue N m l is for one i1 TOTAL N
Z h undied dollaa(S100)orlcis,)
U O '1 certify that in the performance of the work for which this per- QTYMECHANICAL PERMIT FEE 4/ FEE SUMMARY
LL F mit,is issued,I shall not employ any person in any mnaner so as to
U become subject to the Workers'Compensation Laws of California.
O d Date Applicant BUILD G
} ,n N'OTIO, 'f0 APPLICANT: If,after reakin,Oris Certlficutc of E4- ALTER OR ADD TO MECH. 5.00
Z_ eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK ax
provisions of the Lahor Code, you must forthwifh'comply with Q FEE d��,83
U such provision or this pertnit shall be deemed invoked. AIR HANDLING UNIT(TO 10MCF.M,1' 4.00 U
r CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.h 6.00 SEISMIC FEE 0
1 hereby affirm that there is a construction lending agency for 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 )DO B.T.U.) 8.00
Lender's Name HEATINGUNIT(OVER100,DOOB.T.U.18.50
Lendersnddmss ELECTRIC
- I certify that I have,cad this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct. I agree to comply with all city and coumy PLUMBING _
ordinancealand state laws relating to building construction, and BOILER-ODNP I3 H.P.or 100,000 B.T.U.1 6.00
hereby authorize representatives of this city to enter open the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. . MECHANICAL
shove-mentioned property for inspection purpows. -..LJ
(We) agree to save, ndemnlfy rend keep harmless the City of MISC,- REFER TO ORD.
Cupertino�agains Habil t ,,jud, enl4 costs and expenses which CONST.TAX
ay in any w ec al,ai sold City in consequence of the PERMIT ISSUANCE 10.00
nun of this cr o Y f� MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
ignasu TAVnl/C ctor to
OFFICE COPY