18849 (2) POST THIS CARD NEAR-FRONT OF-BUILDING
t'� "•^ - • PERMIT NUMBER
CITY OF CUPERTINO ` 18849
INSPECTION DIVISION
JOB INSPECTION'RECORD
PERMIT E11P4RATION
JOB ADDRESS
'260 u s • S 'L'J +//U�NIT# _LOT# PERM/
OWNER G, I�."� CONTRAaTOR R{/.F/C. ��' /�CL f/ IS NOIT STARTED WT EXPIRES IF ITHIN
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 CITY•OF P 9IT VALIDATION
- CUPERTINO STANDARDS. �jam^ + "
GARAGE SLABS ' (f Cr-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
-
' UNDERGROUND /SLAB
PLUMBING. - p
ELECTRICAL- LWV)P R[JATE
MECHANICAL - BL ELECT PLG. .MECH
he.
El
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
` PLUMBING - VALUATION i SIFL
MECHANICAL ' ,. %,LLE✓ L
`
ELECTRICAL PERMIT TO
- FRAMING '
INSULATIONSTORIES -TYPECONSTRS-
• '` . �• �' '. �
4;
OCC.GROUP RES UNITS
PLACE NO•SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- SO FT-FLOOR AREA TOTALACRF"AGE
}} ROOF '.NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
H DIAPHRAGM THE CONSTRUCTION TAXIS PAID
'�•" BUILDING USE
ROOF SHEATHING RES IND • CON ' PB he, '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.. ❑ 1:1 SP . El '171
ASSESSORS PARCEL NO.
ROUGH SANA
PLUMBING' - ELECT.ENERGY "
TRACT NO - PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY • ACC DATE, ACC FILE NO
FRAMING ELECT.FINAL TEST `
' ZONING ENG.SITE NO.
INSULATION, _ ,'( PLUMBING - -'
GAS TEST, GAS , -
MECHANICAL FIRE$PRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,.N❑ ° ❑ "❑
- ' ELECTRICAL RELEASE FLOOD ZONE ALu.c.
EXTERIOR SHEAR, "
INTERIOR.SHEAR- - FIRE DEPT. �Y ❑ N❑ Y ❑ N❑
" SHEETROCK ' GRADE . - - FEE SUMMARY
EXTE RI OR,LATH BUILDING -
.INTERIOR LATH ' • TEMPORARY APPROVALS , BUILDING .
SCRATCH COAT ELECTRIC - PLAN CHECK �* .
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE _OD
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC"
ETIONE WORKING DAY BEFORE REQUIRED INSPECTION. `
i.-I'� 'PLUMBING ,
4// PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE -' MECHANICAL
• IMPORTANT! coNST:TAX
PLEASE READ'REVERSESIDE:BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY, ;
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT lDENTIFICATION • PERMIT NUMBER
ADAPPLICATION Sl PERMIT, ' ,
ADDDRESSRESS 9;
BUILDING-ELECTRICAL-PLUMBING- 1884 MECHANICAL h`''
LV
OWNER' PLAN CHECK VALIDATION
NAME � � TV. ELECTRIC PERMIT FEE /�
Q _ PHONE 14&-110 �C)
CNA
ONTRACTOR 3 OUTLETS-SWITCHES-R ECEP. 10.00/1.00
uc.NO. LIGHTING FIXTURES 10.00/1.00
ADDREACTOR's
' aooREss S14GCq APPLIANCES=RESIDENTIAL 4.00
10M e464=Q4X.L PHONE PANELS 10.00 DATE OF APPLICATION T
ARCHITEC - PLAN CHECK FEE P.C.NO.
OR +=A PANELS (OVER 200 AMP) 20.00
END INEEM
' LIC.NO. ISIGNS TRANS. 3.00
ARCH.OR ENG - E MITVALIDATION
ADDRESS(SSS �ps Gr1"tob SL pilAen SPECIAL CIRCUIT 5.00 Cf�- �t
ZIP EMP.METER OR POLE INS. 20.00 �7
APPLICANTS MOTORS SEE FEE SCH. r$R4
ADDRESS g
'C•('f/�
SERVICE CHANGE 20.00E
•Jn� (t 1.1
�oo LICENSED CONTRACTORS DECLARATION f1 Up i95U ._
a i w I hereby affirm that 1 am licensed under provisions of Chapter 9 - I$ U NCE DATE
a (commencing with Section 7000)of Division 3 of the Business and - BLq" N MECH.
H O i Professions Code,and my license is in full force and effect. - ❑• _a ❑
o 0 w C License Class _ Lic.Number
t w Dale Contractor IS w st OWNER-BUILDER DECLARATION BUILDING PERMIT,
E a a' u INFORMATION
w ; w I hereby affirm that I anexempt from the Contractor's License MISC.- REFER TO ORDoa Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE '10.00VALUATION' $/FT.
Code:Any city or county which requires a permit to Construct,alter,
aaa¢p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO ELEG '�/O0�
i w m IS requires the applicant for such permit to file a.signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
f i C Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE Y'G
Or 1- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ 1,as owner of the property,or my'employeeswith 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,•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-PER TRAP 5.00 so.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
t{� ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
Y or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) - 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- - RES IND CON PB Orber
1,aso
prove ofsole.): INDUSTRIAL WASTE INTER.- 30.00 1:1 ❑ Cl -� 11
❑ I,as ownernee of the properly,am exclusively contracting with
licensed 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,e.&P,C.fur this WATER HEATER W/VENT � 6.00
reason
Owner Uale. WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER'TREATING EQUIP. 5.00 .
I hereby affirm that 1 have a certificate of consent to self-insure, _
or a,certificate of Workers'Compensation Insurance,or a certified _ _ 20NING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.� - �p_
•
Policy No. Company .4�W 19URA F �•
0 '❑ Certified copy is hereby furnished FIRE SPRINK ENERGY TZ4
Z Z ❑ .Certified copy is filed with the city. inspection division. MISC- REFER TO ORD.
p 0 Applicant Y ❑ N❑ . Y I] NE]
rn
- CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.Lu.C.
LU COMPENSATION INSURANCE PLG.CONTR. - LIQ.NO.• PLG. ❑ �
Q. o (This section need not be completed if the permit is for one TOTAL Y❑ [:fl
N Y N❑
::) Z hundred dollars($100)or less I -
U 0 I certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
ELF mit is issued,I shall not employ any person in any manner so as to
O W become subject to tine Workeri Compensation Laws of Cnlilbrnla. -
y Date Applicant BUILDING //�
>- m NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTEROR ADD TO.MEC H. 5.00 I(Dz
F-. Z emption,you should become subject to the Workers'Compensation APPLIANCE :t 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00DGF.M.) 4.00
CONSTRUCTiON LENDING AGENCY AIRHANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE US
1,hereby affirm that there is a construction lending agency for EXHAUST H000 (WITH DUCT) 5.00 -
the performance of the work for which this permit is issued(Sec. - MICROFILM /•
3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T,U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) ' 4,00
Information is correct. I agre •0 comply with all city and county PLUMBING
I� ordinances and state Taws a[ing to building consiraction, and BOILER-COMP(3 H.P.or100,000B.T.U.) 6.00
hereby authorize represe atives of this city to enter upon the BOILER MECHANICAL
100,000 BTU)SEE'FEE SCH. MECHANICAL
above-mentioned proper for inspection purposes.
(We) agree v indemnify and keep hurmless4he City of MISC.- REFER TO ORD. -
Cupertino a off if hies 'udgment os and expenses whichPERMIT ISSUANCE .10.00 CONST.TAX
may in way rue cost sa' n consequence of the
' matin fthisp MECH.CONT-. LIG NO. 1 MECH.
roTAL
Signa re of nt/C acro Date I: , TOTAL /6 3,0,
OFFICE COPY
' r