18588 (2) POST T.HISCi9QD;NEAR .FRONTOF. BUILDING '.
+ - 'PERMITNU MEER
y ClTY,,0F CUfERT.INO 1 $5E$
INSPECTION DIVISION
JOB INSPECTION RECORD
)PERMIT EX`'IRjATION�
JOB ADDRESS U IT# OT• `- {(/ : I i P 1 7
_ '• rI gERMMMgiT, ExPI R"'EEES IF WORK
OWNE9 1` ;' - 'CONTRACTOR
.� �. I NO,T S AI
INSPECTION DATE INSPECTOR IN EC •10 R ORD r iBO DAYS OF PERMIT ISSU-
FOUNDATION ` - - .ANCE OR,180 DAYS,FROM '
NOTE !". ' LAST CALLE D I NSPECTI ON.
'LIFER 'ALL,GRADING AND DRAINAGE SHALL BE'INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF + _ PERMIT VALIDATION
`CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB e �
Jt. A PLUMBING't,. - v im+ 4Y 1909
• ' `" ELECTRICAL _ ISSUANCE DATE.
MECHANICAL BLDG, ELCC/ + PLG. MECH.
_ DO NOT POUR FLOORUNTILABOVE HAS BEEN SIGNED - - 'BUILDING PERMIT --
' WOOD FLOOR ^ INFORMATION
VALUATION'
PLUMBING - -
MECHANICAL'
ELECTRICA'L' eRMIT.rO
.� FRAMING .IF:t �•' '�4 r. 5'_:
INSULATION STORIES r TYPENSTR:
I -
,Y v OCG RGUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
! \ .• 50FT,F000R APER TOTALACREAGE '
'I ROOF NOTE:NO FINAL INSP:SHALL BE MADE BEFORE
• DI'APHRAGM' THE CONSTRUCTION TAX IS PAID
mow ' ROOF SHEATHING .. RES IND coPBo
APPLY NO ROOFING.UNTIL ABOVE HAS BEEN SIGNED FINALS i DATE 'INSP.-7 ❑ El ,1T 'Eli' .❑ �F
ASSESSORS PARCEL,NO.
- ,ROUGH '• SAN.# '
P,LUMBINGi- _ ELECT.ENERGY
TUBS&SHOWER PAN - PLUMBING ENERGY TRACT No, PARCEL No.
MECHANICAL MECH.ENERGY - +•
ELECTRICALiACC.DATE ACC.FILE NO '
BUILDING ENERGY
FRAMING'. ELECT.FINAL TEST
ZONING , ENG-$ITIENO.' ( `
INSULATION - PLUMBING
GAS TEST : - - GAS
MECHANICAL EiRa,sPRINK „ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NE
-
EXTERIOR SHEAR ELECTRICAL RELEASE EJ FLOOD ZONE..
. A.L U '
i INTERIOR SHEAR • FIRE DEPT. °❑ - N Y ❑ N❑'
SHEETROCK. GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING - '
BUILDING T
INTERIOR LATH - - - '.TEMPORARY APPROVALS "
SORATCH,COAT ` ELECTRIC ' PLAN CHECK
GAS
FEE a-•�»..,.
- � -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE y--^—^
OCCUPANCY OF BUILDING.IS NOT PERMITTED UNTIL BUILDING FINAL I SSIGNEDBY BUILMNG,INSPECTOR: MICROFILM »•^"`"•'
w' ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
F_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. " PLUMBING
t z PLEASE GIVE JOB ADDRESS WHEN PHONING
i SEE PERMIT FOR'EXPIRATION-DATE MECHANICAL•; — -^
IMPQRTANTI ` CONST TAX --�
PLEASE'.READ REVERSE;SIDE BEFORE `a 'tdcxa TOTAL.
CALLING FOR FINAL INSPECTION. . "}-'
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,
PERMIT NUMSER4
• BUILDING PROJECT IDENTI FICATION - .-
ADDRESS APPLICATION & PERMIT
ADDRESS IM23 0 �� 18-588.
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
r
OWNEP'a
PLAN CHECK VALIDATION
NAME
CITY., ELECTRIC PERMIT
FEE
P)
P..NE.2S3-0 V
CONTRACTORS
rvM /A OUTLETS-SWITCHES-RECEP .10.00/1.00
/wNzLc.No, Zllv
1
LIGHTING FIXTURES , 10.00/1.00 '
CONTRACTORS Sv�F�6Z APPLIANCES,-,RESIDENTIAL - 4.00
lL,v 'PHONE �'� OS PANELS av - 10.00 DATE OF APPLICATION
ARCHITECT - 'PLAN CHECK FEE P.C.INO.
OR - - PANELS (OVER 200 AMP) 20.00
ENGINEER
- uc,Na. SIGNS TRANS. 3.00
ADDRESS ENG - SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00 �/1���6�� .
APPLICANTS
ADDRESS MOTORS SEE FEE SCH. J �J11
SERVICE CHANGE 20.00 '
wO O LICENSED CONTRACTORS DECLARATION '
1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
I- (commencing with Section 7000)of Division 3 of the Business and
w<c BLDG. ELECT. PLG. MECH.
H m i Professions Code nil m license is in full force'g�jfi�eq� ❑ ❑ . ❑
z o w- Licelsc lass Lia Number J.L-Z y�
N E w
1)ate Contractor iELSOO.w_�.-/1 lVf7s�, -
rt ma OWNER-BUILDER DECLARATION l[LIf['r' ,vVJ BUILDING PERMIT
¢ 0 a ° MISC. TO ORD INFORMATION
E
g u H '1 hereby affirm that I am exempt from the Cnnlruclor's License
r u w 4 Law fortlse following reason.(Sec.7031.5,Businessand Pr .VALUATION „$/FT.
ofessions PERMIT ISSUANCE -
Code:Any city or county which requires a permit to construct,alter, 10.00'
2 rt Q improve,demolish,or repair any structure,prior,to its issuance,also ELEC.CONTR. LIC.NO. ELEC. - -
e- w m¢ requires the applicant for such permit to file a signed statement that TOTAL RMT 0
he is licensed pursuant to the provisions of the Contractor's License
FZQ Law(Chapter 9(commencing with Section 7000)of Division3 ofthe
is Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
¢s-$ the basis for the alleged exemption.Any violation of8ection 7031.5 STORIES TYPE C STR.
w. by aGy.pplicanl for a permit subjects the applicant toacivil penalty - ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(55001.):
D Las owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE' _ 4.00 O G uP 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 s .P L OR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve. .
mems a is not intended or offered for sale.ll',however,the building GAS=EA.SYSTEM-11NC.40UTLET$ 6.00 '
Or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.)•. 2.00 BUILDING u
builder will have the burden of proving pial he did not build or no RES IND CIN PB Other
prove for purpose of sale.). _ INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am CxClusively Contracting with. - ❑ '• ❑ ❑ ❑ '
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B.' 6.00 - 'AssE"ORSPARCEL 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. PARCELING.
❑• I am exempt under Sec. ,B.&P.C.I'or this WATER HEATER W/VENT - 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, 20NING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy lhereoffSec.3800,LAC.). _
Policy No. Company _
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
_Z 2 ❑ 'Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ NQ v ❑'.' N❑
~ rn PERMIT ISSUANCE 10,00
� -
..CERTIFICATE OF PROMWORKIiRS' FLOOD ZONE a.L.u.c.
COMPENSATION INSURANCE PLG.CONTR. LIC.NO, - PLG. -
0- 0 (This section need not be Completed if the permit is fill on_e TOTAL v❑ N❑ Y [:] N❑
hundred dollars IS 100)or less.)
0 O I certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
O W becot Id )t t the Workers'Con p•Asa do a�P C' il'o.,
y Uate14l _Applicanl � ALTER OR ADD TO MECH. 5.00 BUILDING
} W NU I CF."R�AT (CANT: I ,a to n:king t' s Cbrll Irate of Iix-
F ? emption,you should become subject to the Worken'Compensatiun APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
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(Sec. - MICROFILM ..
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Noma HEATING UNIT(OVER 100,000 B.T.L119.50
Lender's Address ' ' ELECTRIC
I certify.that],have read this application and slate that the above ' VENTILATION'FAN,(SINGLE) `4,00
information is correct. 1 agree to comply with RII city wul county - PLUMBING ,
ordinances and state'laws relating to building Construction, and BOILER-CCJMP(3H.P.or100,000B.T,U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC r- � REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue ag 'ns t said City in cons uen of the PERMIT ISSUANCE .„ 10.00
ranll g fa permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL �rPf1
g a FE-CA.. r hcan Contractoa e
OFFICE COPY