17010 (2) ,POST THIS CARD NEAR FRONT OF BUILDI.NG"'
_• •I 4'P,..IT NUMBER
C`ITY1I-'OF CUPERTINO 1
17010
INSPECTION DIVISION
I' • "";`JOB INSPECTION RECORD-I.
PERMIT EXPIRATION y"
JOB ADDR ESS -AS C ~ • - UNIT# LOT# �I 7 7 - � ;/ +.�
_ _ r C• ,a PERMIT EXPIAES•IF ORK
OWNER 'PST£r TI-f_0r"AS.... CENTRACTOR � � .," "SIS NOTC TIiRTED�WIVJIy k
r - INSPECTION DATE INSPECTOR INSPECTION RECORD 186,DAYS OF�PERMLT„ISSU.
FOUNDATION - _ - ,'ANCE'-OR 180 DAYS FROM
NOTEt.� LASTCALLED INSPECTION. '
ALL GRADING AND-DRAINAGE SHALLBE INSTALLED
PREG UNITE .• TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERpnnT 11IbIDAT1oN
' • ' CUPERTINO STANDARDS. 1
GARAGE SLABS 11
-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB p • I -- �. / 1 ._ �V�
PLUMBING O T)�'-C7R SI �O�AvvP.'
MAR 7j �} WUP, 6 ., 1 '+ '
ELECTRICAL - - I !Ju^��QE�:� . U1�"' ISSUANCE DATE
i MECHANICAL � � 01��. 1'IP2.8>(14Fj, �, ^.. B @c EL[❑c,. PLC: .NECK.
W ❑ .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED •1421-95 eM�NI NS 1 I,fj�(hb¢�, eul 7,01M PERMIT
J I IN FO1I�yMATION
WOOD FLOOR (` D VALUATION SIFT.-
WOOD
.PLUMBING r 3
MECHANICAL . - ' ; - LI
ELECTRICAL - - r • ' veRMIT To .
` FRAMING
INSULATION , STORIES ,L TYPE CONSTR.
4.
OCC.
, GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
•,.
"ROOF ` - NOTE:NO FINAL INSP;SHALL BEf MADE BEFORE sG.FT,FLOOR AREA , TOTAL ACREAGE
.'THE CONSTRUCTION TAXIS PAID
DIAPHRAGM BUILDING USE _
ROOF'SHEATHING HES ' IND CON PR 00—
APPLY NO�ROOFING UNTILABOVE'HAS BEEN;SIGNEOL
m.,APPLYNO�ROOFINGUNTILABOVE`HAS'BEEN;SIGNEO' FINALS`�"',' 3-`DATE .v 'INSP:" - �•• � '� �
A55RSSORS PARCEL NO
ROUGH SAN.# - - -
PLUMBING - - ELECT.ENERGY'
i TUBS B SHOWER PAN PLUMBING ENERGY.' - TRACT No. .PARCEL No.
_ MECHANICAL. MECH.ENERGY - �
ELECTRICAL BUILDING,ENERGY ACC.DATE - ACC.FILE No.
' FRAMING ' ELECT.FINAL TEST` -
'ZONING - ENG.SITE NO.
'
:INSULATION _ PLUMBING - -
GAS:TEST GAS'
,FIRE$PRINK ENERGY T,2e
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �" 'N NE],
I FLOOD ZONE A.L U,C.
EXTERIOR-SHEAR ELECTRICAL`RELEASE
INTERIOR SHEAR ' FIRE;DEP,T. Y Q N,E_ Y L NL,
. SHEETROCK GRADE FEESUMMARY
.EXTERIOR LATH-._ BUILDING
'INTERIOR LATH ., TEMPO RAR APPRO ALS BUILDING
SCRATCH COAT ELECTRIC+ ' PLAN CHECK
GAS FEE
'^- NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY, SEISMIC.FEE yv ;TI
OCCUPANCY OF BU I LDI NG IS NOT PERMITTED UNTI L BU I LD ING F I NAL IS SIGN ED BY BUI LD I NG I NSPECTOR. MICROFILM
ELECTRIC
— " ARRANGE FOR INSPECTION BY PHONING'252-4505, I .
F� ONE;WORKING DAY BEFORE REQUIRED INSPECTION PLunnBlNc' i
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
SEEMI
SEE PERT FOR EXPIRATION DATE:-
IMPORTANTI CONST.TAX
aA J
„ PLEASE READ,REVERSE SIDE BEFORE ^J,
CALLING,FOR FINAL'INSPECTION. TOTAL
OFFICE COPY i
....1 Y 011
APPLICANT TO FILL,IIN INFORMATION, WITHJN'RED LINES - USE BALL POINT PEN ONLY
•
PERMIT NUMBER
—BUILDING NG PROJECT.I DENTI FICATION '•` - . -
aDiLDiNG' -s 0 1APPLICATION & PERMIT 17 1_
ADDRESSW0,20 6r1w ' BUILDING-ELECTRICAL=PLUMBING -MECHANICAL 1' I 10
G fl ld0%CA . 1 4-
0 NER'S, wr1 y� � - +r. ' I PLAN CHECK VALIDATION
°1 "AMEpt:-/ + f+/ �•'^ - QTY: - =ELECTRIC PERMIT • FEE
ti '4
CONTRACTORS .., „ - UTLHTINETSG-"SWITCHES-RECEP;-10.00/1.00FIXTURES 10.00/1.00
NAME
l/ '
•' .IU _ IC//I GN,£.LICLIG
.NO. �'•- '
CONTRALTO 's ' .Cow .�p' PPLIANCES-RESIDENTIAL' 4.00'
AC.RES5I 3 [ �L-[
CN PHON Z-0 PANELS- 10.00 DATE OF APPLICATIO P.C.NO,
ARCHiTECTICJ SI�. PANELS (OVER 200-AMP) 20.00
OR /�
ENGINEER �•�µu' �1 � y.�•�)y � ,, 3,BD
uc.este"- SIGNS TRANS ;,r "
ARCH.OR ENG ID . SPECIAL CIRCUIT. 5.00 'PERMIT VALIDATION
ADDRESS 1� '
• -$AA) .1-'4K�Ip` 7Gb a'21P "1'. EMP. METER OR POLE'd NS 20,00
APPucnrvTs ��A� � .• v MOTORS SEE FEE SCH. •/AIM IL�1y`^�C1
ADDRESS �W�/4!, '
SERVICE CHANGE,; 2000.
o o LICENSED CONTRACTORS DECLARATION., Vy 1
a v U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE -
H G & ' (commencing with Section 7000)of Division 3 of the Business and _ ELECT. PLG. MECH.
H o z Professions Code and my license is it;full force and effect ❑
`i
C . ; License Class 93 Lie Number U4" - ❑ ❑
--O'Z'Hw Uute /9�5�-0�_Contractor ¢Goy 2
i Q,w r - \ 1 BUILDING PERMIT` OWNIi R.BUILDER DECLARATION INFORMATION e'
x ;n i- 1 hereby affirm that I um exempt from the Contractor's License MISC,- "1 i ' -REFER TO ORD
.w y p ofcssions 'VAL ATION $/FT.
S'.]0 1.5 I u inc
ss and Pr
F u o a'' Law fur the following lesson l ec 3 � PERMIT ISSUANCE. a• '1' •10.00
Code:Any city or county which requires.permit to construct,alter, 17AOD
QQ 4 improve,demolish,or repair Tiny store tire,prior to its Issuance,also ELEQ CONTR. L(0.NO. ELEC.
Le O S requires the uppli[apl'for such permit to file a signet)statement that + TOTAL PERMIT TO
°' w he is is licensed pursuant to the provisions of tie Contractor's License
H Z r
Law(Chapter 9(commencingwith Section 7000)Of Disnion3ofthe
a Business and Professions Code)or that he is exmnpt therefrom and' QTY. PLUMBING PERMIT- _ FEE �-S
I t C' - STORIES TYPE CONSTR.
SC i- the basis for the alleged exemption.Any viola)to of Section 7031.5
a3F by any applicant for it pemiil subjects the applicant lnucivil pemlty ' ALTER-DRAIN&VENT-WATERJEA.) 5.00
of not more than five hundred dollanx($500).): '
- ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE -4.00 OCC.GROUP RES.UNITS
their sole compenwlion,will do the.work,and the structure is not _
intended or offered for sale (Sec.,7044;'Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an -owner of - - -
s property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
himselnm
If or Ihugh his own eployees,provided that site',improve- s GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
m nts are not intended r offered for sale If,however,the building _ Q�'
orimprovement send within one year of completion, the owner GAS-EA.SYSTEM=OVER 4 IEa) `2.00 "BDILDING USE
h Ider,will have ti burden of proving that h dal n t build or im- RES IND CON PB Osuer
+ prove toi pulp)' of ale.). INDUSTRIAL WASTE'INTER. 30.00
- O I Paxmwnr11 theproperly,am exclusio ty contracting' with - ❑ ❑ ❑ 1❑ ❑
licensed contractors tconstruct the project (Sec,-7044, Business. .• LAWN SPRINKLERS-1-INC,5 V.B.: 6.00 ASSESSORS PANG"NO.
and Professions Code:'I li•Contractors License Law does not apply -
to an owner of property who builds or Improves tu.reon,and who LAWN SPRINKLERS-.OV ER 5(EA-,) 1.00
contracts for such projects with a commetods)licensed pursuanLto SEWER-SANITARY-STORM V-STORM EA.2001t/10.00
the Contractors License Law. W TRACT NO. PARCEL NO.
❑ I am exempt under See .II:&P.C:for this
WATER HEATER W/VENT 6.00
reason
Owner - 'Date _ WATER SYSTEM 5.00 'ACC.DATE ACC.FILE NO.
1.
WORK IiRS'CUMPIiNSATION DECLARATION WATER TREATING EQUIP.'. + 5.00 _
_ YI hereby affirm that l have n...tiiicxlenf consent toself incur r ZONING
or a cerific, "(
le of r a Workers'Compensation Insurance,ocertified ENG.SITE N0.
copy thereof(Sec.3800,LAC.). - �
Policy No. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGYT24
Z Z Certified copy is fled with.the city inspection division. MISC.-'` - REFER TO ORD. -y❑ N❑ y ❑ IN
y " PERMIT ISSUANCE 10.00 FLOOD ZONE aL.u.C.
fr CERTIFICATE 01'EXEMPTION FROM WORKERS' _
111 > C.0417NSATION INSURANCE ` PLG.CONTH. LIC.NO, PLG. +
CL,0 (This section need not be completed if the permit is for one TOTAL ❑ IN El Y ❑ N❑
::) Z hundred dollar,(S1000or leis.) - _ _
00 1 certify that in the pe,to'rmafec'.Ltne work foto whlch,this per. QTY. -MECHANICAL PERMIT "''FEE )'- FEE SUMMARY
LLH mit i,issued,I shall not employ any person imm�y luoonerso as to + - - - --
O W beccmesubjeo to the Workers'Compersation•Lawsof California; BUILDING' Q
Date Applicant ALTER OR ADD TO MECH.' 5.00 .D
NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F-. ? emplum-,m]should become subject to the Workers:Compensation APPLIANCE; - '5.00 PLAN CHECK
provisions of the labor Code, you mustd'orthwith comply withFEE.
U • such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000QF.M.) 4.00
CONS'I'RUCTIONLFNDINC'AGI_NCY AIR HANDLING UNIT(OVER 10,00DGEM.) 6.00 SEISMIC FEE ,
I hereby affirm fiat there is,a construction lending agency far EXHAUST HOOD.(WITH DUCT) ' ' 5.00
the Fell orm...c of Hu'wnrk Ibfwhich this permit is issued(Sec. MICROFILM
3097,Civ.C.). r HEATING UNIT(TO 100,000 6.7".U.)` 8.00 ,
Lender's Nam,' 'a HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Y
Lender's Addrtss '
I certify that'have read this application and state that the abo VENTILATION FAN (SINGLE), -': 4.00
information is correct. I agree to comply with all city and county i PLUMBING
,1 + ordinances and state laws relating to building construchon, and BOILER-COMP H.P.or 100,000 B.T.U.) 6.00
I3
hereby authorite representatives of this city tsielver upon the r ,
above mentioned properly for inspection Purposes.
I BOILER-COMP IOver 100,000 STUI,SEE FEE SCH. MECHANICAL
(We)'ligree to.Save, 'indemnify and.keep harmless the,City cd: MISC.- - , REFERTOORD;
' Cupertino against liabilities,judgments, costs ,nd expenses which CONST.TAX
may in any,way a crue'ugin
ast said City m con,equence of the PERMIT ISSUANCE "10.00
of lln'pctn't>, '- 1 MECH.CONT .v, - .LIQ NO MECH.
/z ZZ oT'A. i ^ TOTAL 9J�
ignature of pplicanl/Contractor Date y
r' OFFICE COPY.
,