17897 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 17697
INSPECTION DIVISION
i JOB INSPECTION RECORD
��— PERj-� T7XP�RATTION
JOBADDRESS_jol L'o ��lr � UNIT# LOT# `7r A
PERMIT EXPIRES IF WORK
OWNER DVL tA-yl_ CONDRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE I IN PECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU-
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 PERMIT VALIDATION -
CUPERTINO STANDARDS.
- GARAGE SLABS • � ._�lv,7l/
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /
UNDERGROUND /SLAB I " ''r= 1289
PLUMBING
ELECTRICAL - ot cow,um ISSUANCE DATE " �+1• .
MECHANICAL' - LOG• ELECT, PLG. MBCH
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDINGPERMIT
INFORMATION
VALUAT
WOOD FLOOR I S6rf
` Yp
PLUMBING - � � �,
MECHANICAL
,ELECTRICAL CA PERn'I(}To
FRAMING, V
STORIES TYPE ADNSTR.
INSULATION
� n
OCC GROUP RES UNITS
GJ
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
_- ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFOREsZd A TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAXIS PAID • I
BUILDING USE
ROOF SHEATHING RES IND CON PB a"'r,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 1:111
❑ 1-1
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING - ELECT.ENERGY
TRAGI NO PARCEL,NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ELECTRICAL • BUILDING ENERGY - ACC DATE ACC,FILE No
FRAMING' ELECT.FINAL TEST
ZONING ENG SITE NO.
' INSULATION - PLUMBING '
GAS TEST. GAS
MECHANICAL
FIRE SPRINK ENERGY T 24
• -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ Y Q' N[]
EXTERIOR SHEAR : ELECTRICAL RELEASE FLOOD ZONE A L U C
INTERIOR SHEAR FIRE DEPT. Y NQ Y ❑ DO
SHEETROCK - GRADE - FEE SUMMARY
EXTERIOR LATHBUILDING -
INTER�OR. LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE /191
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, [,4 ELECTRIC
�
ONE WORKING DAY-BEFORE REQUIRED INSPECTION. I ; PLUMBING
°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
CITY'OF CUPERTINO TJJJ
INSPECTION DIVISION .,
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
SaIEDING APPLICATION & PERMIT , P' 17897
ADDRESS
O/ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME
SCO✓IS9,76-9711 OTY. ELECTRIC PERMIT FEE
M FrG PHONE
NAMERac.oR's OUTLETS 10.00/1.00
l5" 117 Pc( rf� lfS�
LIC,NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARRCHITFLT PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
O
ENGINEER
LIC.NO SIGNS TRANS. 3.00
ADDRESS FNc. SPECIAL CIRCUIT 5.00 �s PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 y ,�
aPPucanrs
ADDRESS MOTORS SEE FEE SCH.
�O�ZO GIIQS�tWIIH$•�/I SERVICE CHANGE MIM.00
o o LICENSED CONTRACTORS DECLARATION
FUW 1 hereby alfinn that I Can licensed under provisions of Chapter 9' ( ' cl ` . ISSUANCE DATE
a (commencing with Section 7000)of Division 3 of file Business and DG. ELECT. PLG. MECH.
H ❑ va Professions Code,and my license is in full force and effect. El ❑
z O L - License Class Lia Number -
9 w H w Dalc _ Contractor
a m - BUILDING PERMIT
rc o c OWN lz R-BUI I.DI:R DECLARATION 'INFORMATION
wg LL y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u O A Law for lire following reason.(Sec.7031.5,Businc%and Professions PERMIT ISSUANCE VALUATION S/FT..
- 4 10.00
Code:Any city or county which requires a permit to construct,alter, -
QQ Q II11prDVe,dL•In0I15h,Or repair any stlnCl ar0.prior t0 its ISSpaOCe,aISD ELEC.CONTE. LIC.NO. ELEC. � 0,90
w0 1 requires the applicant for such permit to file a signed statement that TOa. TAL PERMIT TO
m Ile is licensed pursuant to the provisions of the Contractor's License /
H z a Low(Chapter 9(commencing with Section 7000)of Division 3 oftlle \e M 1
4 D Business and Professfuns Code)or that he isexempt therefrom and OTV. PLUMBING PERMIT FEE v k YY//Q
.. ¢ H $ the basisforthealleged exemption.Any violation of Section7031.5 STORIES TYPECNSTR.
ar by anyapplicam for a permit subjects lire applicant Ina civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
X I,as owner of the property,or my employees with 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 docs not apply to an owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT FLOOR AREA TOTAL ACREAGE
• mems f or mmol ugh intends ownemployees,for
providedihatsuch improve- GAS-EA.SYSTEM,-I 6.00
mems are not intended or offered for sale.Tided that s the building
Or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING builder will have the burden of proving that he did not build or im- RES IND CON PB Other
prove for purpose of the.). INDUSTRIAL WASTE INTER. 30.00 ❑ � ❑ 0 0
❑ I,as owner of the property,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 contracum(s)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITAR Y-STORM EA,200ft/10.00 `TRACT NO. PARCEL NO.
❑ IunLC•xemptunder Sec. ,B.8,P.C.fOrthls WATER HEATER W/VENT 6.00
reason
OwnorUate WATER SYSTEM 5.00
ACC.DATE 'ACC.FILE NO.
WORKI:RS;COMPISNSATTON DECLARATION WATER TREATING EQUIP. 5.00
- I hereby Mfirn that 1 have a aertific:de of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO.
copy thereof(Sce.3800,Lab.C.).
" Policy No. - Company
❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T44
Z Z ❑ Certified copy is fled with fl, city inspection division. ❑ IN❑
MISC. C:] ❑
H O Applicant _ - REFER TO ORD. Y v N
� y Cl:RTI 17 ICATI:O E'I:X Ii M PITON 17 ROM WORKERS' PERMIT ISSUANCE 10.001 FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE. _ PLG.CONTE. LIC.NO. PLG. ❑ ❑ ❑ ❑
CL 0 (This section need not be completed if the Permit is for one TOTAL Y N V N
:) Z hundred dollars(S 100)or Iess.).
U O 1 certify that in the performance or the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
O to become subject to the Workers'Compensation Laws of California.
BUILDING
O_ Date Applicant
} to NOTIC17 TO APPLICANT' m
: If,after making this Certificate of lix- ALTER OR ADD TO MECH. 5.00 r OQ
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
- provisions of the Labor Code, you must Inrthwith comply with FEE
U - such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE rJ�
I 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(See.' MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's NiartHEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is Correct. I agree to Comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMPI3H.P,Or100,000B.T.U.) 6.00
hereby authorise representatives of this city to enter upon the BOILER-COMP IOver 100,000STU1 SEE FEE SCH. MECHANICAL
above-mentioned property 1'or inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, Casts and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
may in any wny accrue against said City In C0I1S,reaCe of the
ran g of this perinl
MECH.CONT. LIC.N0. MECH.
TOTAL TOTAL
Nii`gnature of Ap ea t//-Contractor Date [ lI V
OFFICE COPY