18632 (4) t @OST THIS CARD NEAR FRONT OF BUILDING ' PERIOD NUMBER
CITY OF CUPERTINO PAID
1863
INSPECTION DIVISION-- OCT 91989
JOB INSPECTION-RECORD ' '
/ /1 / ) us a City Of Cupertino ',VER ITI Exi�il 41 ON
• l6I2 L V' '-+ p UNIT# _LOT# '`JI � 3 I '
JOB ADDRESS - PERMIT XP FLUES F WORK
owiSER b .z -CONTRACTOR _ IS NOS ,NT D WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD - 18o DAY OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION - NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERmIT VALIDATION
PREGUNITE CUPERTINO STANDARDS. \ 1
' GARAGE SLABS' +-E AN Ip'7(�IfiG�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB to 19
PLUMBING 071
-
ELECTRICAL ISSUANCE DATE
BLO ELECT. PLG. MECH
MECHANICAL' - E:i El ED
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED • ' - Buao RM PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING-
MECHANICAL - oO d•
RMII TO
ELECTRICAL -
FRAMING _ _
STORIES TYPF,CONSTN.
INSULATION - -
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT ILOORAREA TOTAL ACREAGE
'ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
• DIAPHRAGM THE CONSTRUCTION TAX IS PAID
.BUILDING USE
RES IND CON PB Omn
ROOF SHEATHING. - 11 �' E
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 70SSOHS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY,
ACC DATE .ACC FILE NO.
ELECTRICAL - - BUILDING ENERGY
FRAMING ELECT,FINAL TEST- ZONING ENG SITE NO.
INSULATION PLUMBING L(_
GAS TEST GAS 'FIRE SPRINK ENERGY T 2A
MECHANICAL Y E N❑ r E NEI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING 'FLOODZONE AL.uc
EXTERIOR SHEAR ELECTRICAL RELEASE _/
INTERIOR SHEAR FIRE DEPT. v No Y ❑ N❑
SHEETRI GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING -/ - BUILDING
INTERIOR LATH' TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED 10CCUPANCY , SEISMIC FEE ® '
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE.,REQUIRED INSPECTION. PLUMBwc
. PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL'
- SEE PERMIT FOR EXPIRATION DATE -
• CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFOFIE TOTAL
CALLING FOR FINAL INSPECTION.'
OFFICE COPY
kPPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
y - .PERMIT NUMBER
BUI({ NG PROJECTIDENTIFICATION APPLICATION &'PERMIT
- e 18632
BUIL 1G 3
ADDRESS �j''
•afGO P pin.� Co �Y BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .-
OWNER'S - Y PLAN CHECK VALIDATION
• NA.0 , d�N F1 "(� -( OTY. ELECTRIC PERMIT FEE
(J vHONE �. 1
CONTRgCTOR'S � l�
NA-myE- OUTLETS-SWITCHES-RECEP-10.00/1.00
/EJ �•, uc.rvD. S LI GHTI NG F IXTURES 10.00/1.00 n 1
CONTRACTORS APPLIANCES 4.00ADDRESS SAN *,:'r -
El
Q PHONE d,2yipir, PANELS t 10.00 DATE OF APPLICATION '
A CHITECT q•E✓�C (y•��p PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER �� ` _IO C' `�
L.C.No. SIGNS TRANS. - 3.00 '
ARCH.ORE PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
�4-pHJJJVI.0 ✓r W xlv `p 903 EMP.METER OR POLE INS. 20.00
APPLICANTS f
ADDRESS r l MOTORS SEE FEE SCH. Ariar✓G�,\
SERVICE CHANGE - 20.00
10k9 I C/C7
0 o LICENSED CONTRACTORS DECLARATION 1
a i W I hereby affirm that I am licensed under provisions of Chapter 9 SSUANCE DATE "
(commencing with Section 7000)of Division 3 of the Business and
rn¢ BLDG ELECT. PLC. MECH.
H m z Professions Code nd my license ism full force an effect ❑ ❑ ❑
0 O m - License Class Lic.Number-SBI
Q w F w Dale Contractor�72� •
¢ x s P BUILDING PERMIT
¢ 0 n - GWNIi R-BUII.UIiR DECLARATION INFORMATION
w ; LL m I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
VALUATION $/FT.
F u O J Law for the following reason.(See.7031.5,Bminessand Professions -. PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter, << "-0-/t
2 ¢N improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. V �`' I•'a
y
E. 0 u requires the applicant for such permit to file a signed statement that TOTAL PERMIT IU
w $ he is licensed pursuant to the provisions of the Contractor's License
Fit Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢t $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIESTYPE CONSTR.
a ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT,DEVICE 4.00 OCC.GROUP RES.UNITS
(heir 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 -
propertywhobuildsorimprovesthereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
meets
eetsse lare net hrough
m.fferwn loyecssle,If,ed that however,
improve- GAS-EA.SYSTEM-1 6.00 '
mems are not intended or offered for sale If,however,(he building
or improvement is sob within one year of completion,the owner- GAS EASYSTEM-OVER 4(EA) 200 BUILDING USE
builder will have the burden of proving that h - . . .
e did not build or int- RES MD CON PS Other
prove 1,as owner
of the.). - INDUSTRIAL WASTE INTER. 30,00 ❑ ❑ El IJ ❑
❑ d as owner of the property,he exclusively.7044c(ing with
licensed contractors to construct the project(sco.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's improv Law does not apply
to contracts
owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 file
ctor'shcenects Lwimha eon(mctorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00
the Contractor's License Law. - TRACT NO. PARCEL NO.
❑ I`em exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800 I .C.L
Policy No. m
Q ❑ Certifiedcop sh a finished. - - FIRE SPRINK ENERGY T24
Z 2 Cert ifie vitt city inspection division.
O AlKic.ct MISC.- REFER TO ORD. YNY ❑ N�
~ w CIiRTIICATF:OF XF:MPTION PROM WORKERS' PERMIT ISSUANCE '° 10.00 - FLOOD ZONE❑ A.L.U.C.
W > COMP SATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This Section need not be completed if the permit is for one TOTAL Y[:] N� Y F] N�
hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of Calil'omia.
0 i Date - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING r7,2q
} W NOTICE TO APPLICANT: If,after making this Certificate of Itx- -
F Z emption,you should become Subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK .
provisions of the labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10 FEE
U such provisions or this permit shall be deemed revoked. =C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /el• P'�j
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.CJ.
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information n estate(. I agree to comply with all city and county PLUMBING =-
ordinances and state laws Noting m building Construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) -6.00
hereby authorize representatives of this city to enter upon the 801 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property Jar inspection purposes.
(We) ago ve, indemnify and keep haimless the City of MISC.- REFER TO ORD.
upertino galf pties;judgments, costs and•expenses which CONST.TAX
may m ny�zW`99 cc(La against said City in consequence of the PERMIT ISSUANCE 10.00
-rant% y m iiiiiif� h MECH.CONT. LIC.NO. MECH,
/O ii B9 orAL' TOTAL
Sign re of Ap ant/Contractor Date -
OFFICE COPY