17975 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NDMBBR
CITY OF :CUPERTINO 1.797
f INSPECTION DIVISION'
JOB INSPECTION ECOR D. E
nr PERMIT•EXPIRATION
JOB ADDRESS r'd Z3 (V.- O' + - UNIT# " _LOT# T
A ji ( �C( - PERMITS EXPIRES . WORK
' OWNER IcaNrRncroR (j• " � - IS SNOT STARTED.WITHIN)- '
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS,OF PERMIT ISSU:
FOUNDATION ' - - ANC. OR,180 DAYS FROM
LIFER ALL GRADING L"
NOTE: ` �NG AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.'.`
"� � .�
PREGUNITE TO COMPLY.WITH'THt APPROVED PLANS AND CITY OF ,PERMIT VALIDATION
CUPERTINO STANDARDS ' '•T' '
GARAGE'SLABS �
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _�?' • --UNDERGROUND /SLAB
89'11 IN 1
y r1 �Fk
PLUMBING ,
ELECTRICAL - - - f11R0 IssuarvcE DATE
MECHANICAL - HLDGF, :ELECT, I PLG,, DECK
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
' WOOD FLOOR - - INFORMATIOtd
PLUMBING - "VALUATION SIFT.
MECHANICAL ` : }' -
-
ELECTRICAL -PERMIT TO
� � - � � •� r-; -'� . .
FRAMING r ... „- �r' .C-yvo cc
INSULATION $TORI TYPE CONSTR.
OCC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
50,FT.FLOOR AREA TOTAL ACREAGE
• ROOF - - NOTE:NO FINAL INSP.SHALL'BE MADE BEFORE
DIAPHRAGM' THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING `• '' - " RES - IND CON PB om.''
APPLY NO ROOFING UNTIL ABOVE HAS BEEN.SIGNED FINALS '' DATE INSP. ❑ ' ❑, ❑ O ❑
_
ASSESSORS PARCEL NO.
ROUGH sAN.a • ,
PLUMBING' ELECT,ENERGY
TRACT NO,; • PARCEL NO,
TUBS&SHOWER PAN PLUMBINGENERGY •
MECHANICAL - I MECH.ENERGY
ELECTRICAL BUILDINGENERGY Acc.oATe Acc.FILENo
-
FRAMING - - ELECT.FINAL.TEST zoNlNc
INSULATION . PLUMBING •• ENG-SITE NO,
GAS TEST GAS "
- MECHANICAL* FIRE SPRINK .ENERGY L]A
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '� ❑ "❑ "`�-❑� "❑
,U.C,
EXTERIOR SHEAR ELECTgI-CAL_.RELEASE FLOOOZONE A:L
INTERIORSHEAR - FIRE DEBT. = Y❑ N❑ _YL N❑
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING -
° INTERIOR.LATH TEMPORARY APPROVALS BUILDING '
SCRATCH COAT. ELECTRIC. I : PLAN CHECK '
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEES -
OCCUPANCYOFBUILDINGISNOTPERMITTEOUNTILBUILDINGFINALISSIGNEOBVBUILDINGINSPECTOR. ,MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, 1' ELECTRIC UD
`. ELI
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE'GIVE JOB ADDRESS WHEN PHONING ;'
,+
— SEE PERMIT FOR EXPIRATION DATE —' ' MECHANICAL
IMPORTANT! " coNsT`TAx
PLEASE READ REVERSE SIDE.BEFORE ,' 1 TOTAL
^'I' `CALLING FOR FINAL INSPECTION.
OFFICE COPY A.
APPLICANT30O),RLL,IN INFORMATION WITHIN RED LINES —,USE,BALL POINT PEN ON'L'Y
UI 'DIN PR JECT IDEN IFICAT e:S- :,aa "` i, 'PERMIT NUMBER
BUILDING I. t 7kY L'ICATION & PERMIT
Z bx.. 9
• 6'1F� l�m'Vl`� 'l S' � BUILDING '—.ELECTRICAL—tPLUMBING=MECHANICAL ' -E•• 4 1 1".V 1'�, I .
OWNERS - • .f - -- 'PLAN CHECK VALIDATION /
NAME QTY. ' ;ELECTRIC PERMIT _ . FEE
'v1lorvE
�} ( f
'. CONTRACTORS e
' NAME .. ! UTLETS-SWITCHES-RECEP '10.00/100 11,
Z r 1,.
'Luc.rvo �S LIGHTING FIXTURES'-' '10.00/1.00 I
CONTRACTOR'S1 a '•r'
0 APPLIANCES-RESIDENTIAL 4.00
PHONE „J PANELS - 1000 " ` ,DATEOF APPLICATION
ARCHITECT y PLAN CHECK,FEE P C,NO. +
OR t' PANELS (OVER 200 AMP) 20.00 `
ENGINEER �q II// - '
1` Ctii4l
L .NO..r SIGNSTRANS. 3.00 ' d'
ARCH.OR ENG.- - PERMIT VALIDATION "
A��RESS�I - SPECIALS CIRCUIT" - 5.00 �!
`6 1 TV✓�C. zIP EMP.METER OR POLE INS'. „20.00 j 6.V— !
APPLICANT'S
Ao Esl� MOTORS SEE FEE SCH. '3
`z0 ,4
z0 • ., - SERVICE CHANGE - 20.00 f • - x
O W'o - LICENSED CONT A ORS 'CLARATION.
aE ti u' I hereby'affirm that 1'•am licedsedlunder provisions of Chapter 9 - j
Q a w - ' on p 'I I . IBSUANCE9gTE
y a: N' (commencing with Section]0007 of Division 3 of the Business and - BLDG. ELECT: PLG. MECH,
w i. Professions Code,and my license Is in full force and effect., .. n
o'z w,o License Class '• L¢.Number - IIpQ-jn8 •s, '- •, '.�!''• E)
Date actor 1^'
J Contractor' ' • .. .
¢ ¢ w a '. OWNER-BUILDER'DECLARATION ?' BUILDING PERMIT t
w ° ' " MISC.' REFER TO ORD ;'' INFORMATION
3—y I hereby affirm that I am exempt from.the Contractor's License
¢ Oj Law for the following reason.(Sec.7031.5,Businessand Professions
- ,VALUATION.
PERMIT ISSUANCE - 10.00 $/FT.
'
Code:Any city or county which regmresapermlt to construct,alter, I I�'
¢ Q,� impmve;demolish,or repair any structure,priogto Its issuance,also ELEC.CONTR.: LIC.NO. ELEC I "
w m.¢ requires the applicant for such permit to file a signed statement that . TOTAL 2 j0 PERMIT TO
F
he,Is licensed pursuant to the provisions of the Contractor a License '
H i i Law(Chapter 9(commencing with Section 7000)ofDrvlslon 3 ofthe ' •�
. Business and Professions Code)or that he is exempt therefrom and QTY. ' PLUMBING PERMIT FEE' vG PC-'
¢ r m the basis for the alleged exemption Any vwlation of Section 7031.5 r _ • STORIFIB. TYPE CONSTR.
by any applicant for a permit subjects the applicmi t tea civil penalty B z
of.not more than five hundred dollars(5500).1: . . ALTER-DRAIN,&'VENT-WATER'(EA.) 500
F' '•❑ I,as owner ofthe property:or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 -
their sole compensation,will do the work,and the stiuctureis not OCC,GROUP RES UNITS
intended oroffered'Lor 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 I• orimpinvea thereon,and who does such work FIXTURES-PER TRAP 500' -50.FT.FLOOR AREA TOTAL ACREAGE
himself rthrough his own employees provided that such improve-
' me e improvmentiendcd orofferedtararo I Lmpletinl the o owner-
builder
GAS-EA.SYSTEM-IINC.4OUTLETS 600 4_
or improvement is sold burden
o one year of completion,rule owner- GAS'-EA.-SYSTEM,.-OVER 4(EA.) 2.00
builder will have the buNen of proving Ilio[he did not build or im- - BUILD ING,USE
` prove for purpose of sale.)..' • ' INDUSTRIALWASTE INTER. 30.00 RES,- IND eON. PB Omer
❑ I,as owner of the property,am exclusively,contracting with El
licensed contractors to construct the project(Sec.7044,BusinessroLAWN SPRINKLERS;1',INC 5 V.B. " 6.00 f ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply -
to an owner of property who builds or improves fhereo_m and who LAWN SPRINKLERS-OVER 5(EA.),' 1.00
contracts for soch.projects with a eolitmcmas)licensed pursuantro
the Contractor's Lireme.Law. I . SEWER-SANITARY-STORM EA.200ft/10.00 .. •TRACT NO, PARCEL NO.
- ❑ I amexemprundei Sec: ,B.&RCforYhls WATER HEATER W/VENT:•
reason :''6.00 _
Owner Dote WATER SYSTEM 5.00 f' ACC.OATS ACCFILE NO
WORKERS'COMPF.NSATIONDECLARATION WATERTREATING.EQUIP.. 5.00 .`—
I hereby affirm that I.have u certificate of ronsent.to set(-insure,
or
is certificate of Workers'Compensation'Imueamcc or'a certified ,1 ' ZONING .,ENG.SITE NO,
copy'lhercof(Sec.3800,Uab.C.). -
P 1' YNo.- Cnmpany
Z ' Certified co ur ish
FIRE SPRINK ENERGY.T Z4 ,
F p " A P nt op wi ''tY ms on d _ LSC. ,'- REFER TO ORD. Y�,Q;. N •Y Q 'ruQ -.
= yCERTIFICAT80f EXEMPTION FROM WORKERS' ,, PERMIT ISSUANCE ' 10.00 . ,FLOOD ZONE,: ALUs^+,
W _ •COMPCNSATION INSURANCC PLG.CONTR: LIC.ND. PLG. ' ,O ❑ ❑ ❑
'- d0 (This section need,nol be completed if [he'permit is for one _ TOTAL t Y N Y N
Z hundred dollars(5100)orlessJ a - - _ -
U O., I certify'that in'the performs f the work for whlch'lhis per- QTY.'- MECHANICAL PERMIT, FEE, FEE SUMMARY `
-'W 1- init is issued,I shall not employ y person in any manner so,as to ,
O.w,-, become subject to the Workers Compensation Lawsof Callfornin *'
i Date - Applicant Ij 'ALTER'OR ADD TO MECH.; 5.00 BUILDING
} tail � NOTICE TO APPLICANT: If,after making,Ing Certificate of Ex-
' emplion,'you should become subject to the Workers'Condensation APPLIANCE _ _ "e 5.00 a '-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=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY- -, . AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 6 SEISMIC FEE,.
I hereby affirm that,there is a construction lending,agency Tor EXHAUST HOOD(WITH'.DUCT)" 5.00
the performance of the.work for which this permit is issued(Sec "MICROFILM"
3097,Civ.C.). .: ',:'HEATING UNIT LTO 100,000,B.T.U.1. 800 '
Lender's Name _ HEATINGUNIT,(OVERd 00,0008.T.U.1950
Lender's Address ELECTRIC 'u
certify that l have read this application and state lhmLthevabove „' VENTILATION•FAN'(SINGLE)" 400 - V� r,!y
• - Information is mDect I-agree to comply with all city and countyBOILER-COMPI3 H.P,Or 100,000 B.T.U.1 6.00
'.PLUMBING
+ ordinances and state laws relating to'buildjag L Construction, and 'I
hereby authorize representatives of this city to enter upon the BOILER-COMP•IOver 100,00.0 BTUI SEE FEE SCH. ' MECHANICAL
above-mentioned property for inspection purposes - - .,<
'(We) agree, to save, indemnify•end-keep hdrmless the City of MISC.- 'REFER TO,_ORD
upertino against liabilities; ts, costs 'eases whmh _,PERMIT ISSUANCE '10.00
CONST:TAX
may in any a a et t ai City I DOi... uenca of the _ll
ra I en 't - ?` MECH.CONT. LIC.N0. -' MOTAL - - TOTAL
Signa ore of A lican[ ractor
OFFICE COPY a' '
u!