17523 (2) POST THIS,CARD.NEAR FRONT OF;BUILDING
V. ,. .0 ,IIRMIT NUMBER •,
CITY, OF,.CUPERTINO 17'523
INSPECTION DIVISION
JOB INSPECTION RECORD
(�) - L •�_ L PERMIT EXPIRATION
JOB ADDRESS .D UNIT# LOT# y �). L �•
,PERMIT EXPIRES IF'WORK.
l OWNER',' N 11 a CONTRACTOR �'IS'NOT STARTED'WITHIN
INSPECTIO DATE INSPECTOR INSPECTION R CORD 180 DAYSoF PERMIT ISSU.,
- ANCE OR 180 DAYS FROM
FOUNDATION NOTE: •. -
„LASTCALLEDINSPECTION.
..
UFER BALL GRADING AND-DRAINAGE SHALL BE INSTALLED
' PREGUNITE TO.COMPLV WITH THE APPROVED PLANS AND,CITY OF PERMIT VALIDATION -
" CUPERTINO STANDARDS.
GARAGE SLABS - "I't1i�' 'i L•/'�,� `4K. ! -.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p p p r -
UNDERGROUND /SLAB 44 _Ri ,9891 {d�
PLUMBING •�, . - - J'. ,*`t 7V 1 JCG I
ELECTRICAL - r cit W Cl pew" IssunNcc DATE
MECHANICAL •`t - "''" •• .',_ 16_+I�q 4e� .rc�: 1'j e-`m,' ELECT, PLC
MCRY
i ,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .����-•(�p.p. •'�jC�,p, Q,�,'{� - BUILDING PERMIT
INFORMATION -
. WOOD FLOOR vALDATiDN... �siFT..
PLUMBING - �/ OD
MECHANICAL, _ (P V _ '
ELECTRICAL' - P RFA i I1TO �1
FRAMING
RIES -v TYPE CONSTR.,
a INSULATION i }�
' DEC.GROUP RES UNI[5 '.
.PLACE NO'SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.[LO EA TOTAL ACREAGE
_ ROOF ' ' NOTE:NOTINAL INSP SHALL BE MADE BEFORE' ^�
' DIAPHRAGM THE CONSTRUCTION TAXIS PAID - p��✓ _ .�-
�' ' BUILDING USE
ROOF SHEATHINGRLS' ,aIND 'CON PO DI.,'
APPLY NO ROOFING UNTIL,ABOVE HAS BEEN SIGNED FINALS, DATE INSP: 0 ❑ E ❑
ASSESSORS PARCEL.NO,
- ROUGH SAN.N - -
• PLUMBING ELECT.ENERGY TRACT No. � PnRCE�No-
TUB58SHOWER PAN - - - PLUMBING ENERGY
MECHANICAL ,' • MECH.ENERGY -
' ELECTRICAL' ACC.DATE ,ACC,EIDE:NO,
'� F BUILDING ENERGY-
FRAMING' ELECT.FINAL TEST zowlvc ENC,SITE No.
INSULATION + �, PLUMBING ,
GAS TEST _ GAS
'FIRE SPUNK
, ENERGY T24
MECHANICAL ,
COVER NO WORK UNTIL'ABOVE HAS BEEN SIGNED ' HEATING Y NEI .Y N❑
FLOOD LONE A'.L U.C.
- EXTERIOR SHEAR - ELECTRICAL RELEASE vQ' N� :YL NO
INTERIOR SHEAR FIRE DEPT. -
SHEETROCK , � .E GRADE:' FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR 'LATHTEMPORARY,APPROVALS BUILDING !'
SCRATCH COAT ELECTRIC' - ' PLAN CHECK.
GAS -s FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED, OCCUPANCY T • , SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING.FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR,INSPECTION BYIPHONING252-4505, ' ELECTRIC d
o ONE WORKING DAY BEFORE REQUI'REVINSPECTION PwMeiNG
,rl z PLEASE GIVE'JOB ADDRESS WHEN PHONING
SEE PERMIT FOR EXPIRATION.-DATE .MECHANICAL
IMPORTANT
!.CONST:TAX.
PLEASE READ REVERSE SIDE.BEFORE TOTAL
CALLING FOR FINAL INSPECTION„
OFFICE COPY
APPLICANT TO FILL'IN INFORMATION WITHINR ED LINES - USE-,BALL POINT PEN ONLY
•' .SUI LDIf1G PROJECT 1 DENT[FICATION' PERMIT NUMBER
BUILDING APPLICATION & PERMIT, q l7Cnf�
CuP
ADDRESS DING - ELECTRICAL-,PLUMBING-'MECHANICAL : I I J 2 J
v
OWNER's I i PLAN CHECK VALIDATION
NAME"� • 'QTV. , ELECTRIC PERMIT . FEE- a '
PHorvE
CONTRACTOR
NAME. - 'gyp `1 OUTLETS-SWITCHES-RECEP 10.00/1,00Ro
NoV/ TLIGHTING FIXTURES - 10.00/1.00
ADDRESS , 5 PPLIANCES-RESIDENTIAL -4.00 IO.a'D _
CONTRA OR's
%
• '7,1i A 4NE PANELS - :10.00 DATE OF APPLICATION '
ARCwTEC�x PLAN CHECK FEE, P.C.NO.
OR PANELS (OVER 200 AMP) " 20.60
ENGINEER
euc.NO t. SIGNS TRANS. 3.00
AAP CH,On DDRESS D.C. , V L SPECIAL CIRCUIT PERMIT VALIDATION
zup EMP.METER OR POLE INS.
APPLICANT'S • - MOTORS - SEE FEE SCH.
ADDRESS L -
' �I E - SERVICE CHANGE - 20.00sJ ,(,J}. �p I
o O LICENSEUCONTRACTORS DECI:A RATION ' (•! w��Vr�Ur" '"
Q o W I hereby afftrttt that ].am it it order prnvlslmis of Chapter J. ISSUANCE DATE '.
yz tcommenemg with Section 7000)of Division 3 of the Business and
a c B OG. ELECT. PLG. - MECH.
N i Professions Cod nd y license is in full fore a fgft.73 J
.2 o h - License Class ( - % L N oberrI,{�s
O w Date��z_ LiJYaFComrunor-r - • /" T-'
City of Cupertino _ BUILDING PERMIT
Q ¢ a
OWNER-BUILDER.DECLARATION -
ix W. U - INFORMATION
w ; e i- I hereby affirn that 1'am exempt from the Centra tars License MISC,- REFER'TO'ORD _
a- LLO j• Law for the following Penson (See 7031.5,thus n ssand professions fessions 'VALUATION - ,$)FT,
L ' Code.An I n cunt 'whichD uirsa PERMIT ISSUANCE" "- •;.10.00 �Z-(y'. W�� v
Any y l perinit tovonsfr construct, ELEC.CONTR. LIC.NO:
¢ rc ¢ 2 Improve,demolish,or repair any structure,prion to its issuance, ELEC. �^p
G 2 requites the applicant for such permit to file a signed statement that '� 8 7 OTAL-� V Aro P RMIT TO
A.r Z a he is licensed 9(c mut en the provisions of the Contractor's License = ��'�� -tel l' I
r Law(Chapter 9(commencing with Section 7000)of Division7of the _ I _ �J
E 4 D Business and Professions Code)orethat he is exempt therefrom and QTV. PLUMBING PERMIT FEE .
¢ o the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES P ,
aim by any applicant for a permit subjects Nie applicant toa civil penaltygLTER-DRAIN&'VENT-WATER (EA.) 5:00 Q'a S
of not more than five hundred'dollars(55001.1: ZI I:rVI?-I—
❑ I,as owner of Inc property, w
or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Z. OO. OCC.GROUP RES.UNITS -
Iheir role coinpensution,will do the ork,and the structure Is not -
intended or offered for srk'(Sev. 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 O SQ.FT.FLOOR JREA TOTAL ACREAGE
himself or through his awn employees,provided that such improv"* GAS-EA.SVSTEM-11NC.4 OUTLETS 6.00 ��Q
-�•- ments are not intended or offered for sale If,.however,the building .
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 inr - BUILDING USE
prove for purpose of sale:).' - " INDUSTRIAL WASTE INTER. 30.00 'RES IND CON PB ane,
❑ 'I:as owner of the property,;int exclusively contracting with, ❑ • ❑ .' ❑ , '❑ ❑
licensed contructors.t0 construct the proiret(Sce. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codi+:The Contractor's License Law does not apply
` to an owner of property who builds or improves Dtcreon,and who LAWN SPR IN KLERS-OVER 5.(EA.) ' 1100 -
contracts for such projects with a contractors)licensed pursuant to '
tho Contractor's Lice nsc Law. ' SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ I am exempt un der Sec. B:&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date" WATER SYSTEM 5.00 • �0� Ace.DATE Acct FILE No.
WORKERS'COMPENSATII:IN DECLARATION WATER TREATING EQUIP. 5.00 '
" Ihereby affirm'Nrll lhave a 'r,tih.c ufensentt -elf-inare, '� '
or a:certificate of Workers'Compene ition Insurance,or a cerlit ed -?ONING _ "'ENG.SITE NO
copy[hereof(Sec 3800,Lab-Cane^.
policy Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
z Z 6i�Cert wl'copy-ie w The city in eUion division.
O Applieamt MISC.- ' REFER TO ORD. v❑ n❑ -v ❑ N❑
"kyr. t(CERTIFICA'IEIF 'ROMWORKertS, PERMIT ISSUANCE :10.001•2•DD FLOOD ZONE .A.L.U.C. .
" Wa 0COMPIiNSA'I'ION INSURANCEPLG.CONTR. LIC. T"
N AL TO
hinnAxn�� ❑. ❑ ❑ k ❑
•.tk section 'need net be completed if the permit Is for One E W • " V N Y N
•° Y hundred dollars IS 100)nr less I P - - _
I ..tifythat m the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE' - FEE SUMMARY
LL F mit is issued, I sliall not employ any person in
any manner so as to e -
O Ubecome subject to the Workers'Compensation Laws of California.
Is. Data Applicant '- ALTER OR ADD TO MECH. '5.00 BUILDING S'�'
} to NOTICE TO AITLICAN'I': If,after making this Certificate Of E.
F ? emption.'yen should become subject to line Workers'Compensation ' APPLIANCE 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=C.F.M.) ' 4.00
,CONS'TRUCTIO'N LENDINGACINCY," _ AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ` 3 Z
I loneby plTirm that there Is a emL[trtictioiilending asocy lot I• EXHAUST HOOD (WITH DUCT) 5.00
the performan cc of the work for loch this permit is Issued(See 4Sa MICROFILM
3097,Civ.C.): HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name' HEATING UNIT(OVER 100,000 B.T.U.(9.50 . 'ELECTRICr /O
Lender's Address --
I.certify that 1 base rad this apple alio"and'slme flu,, he above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with 11 city and county PLUMBING I QD
r� ordinances and state laws relating to.building'construction, and BOILER-COMPI3 H.P.Or 100,000 B.T.U.) 6:00
' hereby,amhorr representatives ol.this city In, "ter upnn the BOILER-COMP IOJer to0,00o RTU15EE EEE SCH. - MECHANICAL
above-mentinted p rolierty for inspection purposes.'
'(We),agree to save, indemnify and kcep•hormless the City of MISC.'- • REFER TO.ORD.
Cupertino against liabilities,judgments, costs and ekpenses which PERMIT ISSUANCE' t 10.00 CONST.TAX
may in any,way accrue against said City in consequence of the Z1 DO
ranting of this cn 'I. , MECH.CONT. LIC:NO. MECH. G
3" _ orAL'`' S� TOTAL
ig atureo p ¢ Co_n[ractor Date - • 3C r
OFFICE COPY,'.