18037 POST THIS CARNEAR 'FRONT OF BUILDING
D.
FERMIT NUMBER .`•
CITY. OF 'CUPERTINO:' .. ; PAS 8037 .
INSPECTION DIVISION:
JOB INSPECTION RECORD ACT y NS ~
.! c y Df rFj .,. IRU RMIT EXPIRATION
JOB ADDRES � UNIT# _LOT# '
-- _ - 'PERMIT EXPIRES IF WORK,
OWNER CONTRACTOR IS NOT STARTED WITHIN
.INSPECTION -DATE INSPECTOR ' INSPECTION RECORD 180 DAYS OF PERMIT ISSU. '
".FOUNDATION - � _ANCE OR 180 DAYS FROM
NOTE: ' '? .-LASTCALLED INSPECTIONLll
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED. � �o
PREGUNITE' - ( _ TO COMPLY WITH THE APPROVED PLANS AND CITY.OF VALIDATION
CUPERTINO STANDARDS. .
-GARAGE SLABS d .9�✓To•-L-C/c�.�i `
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
. :.; .UNDERGROUND'/SLAB _ .• . .. <;
PLUMBING - -
ELECTRICAL IssuANce udrE
tl CDG. ELECT. PLG. MECH.,,
MECHANICAL
.� ❑-. ❑. 1:1 �I
t
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
,• WOOD FLOOR L VALUATION STFr.
PLUMBING -
r.•. -
'. MECHANICAL.
EPERMIT�,. - � . -
. .. . vnviTO
u FRAMING
INSU CATION• STORIES TYPE CONSTR.
., - / C' • �'"4ir'
OCC.GROUP. ,RES UNITS•
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• .-• OC FT FLOOR AREA TOTAL ACREAGE.
- ROOF, NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
BUILDING USE
ROOF SHEATHING RES`•,'IND CON PB OI...
APPLY.NO ROOFING UNTIL ABOVE HAS'BEEN SIGNED - 'FINALS ' ,. 'DATE INSP. ,: �
ROUGH SAN.N
ASSESS ORS PARCEL NO.
' ' -'
PLUMBING . ELECT.ENERGY
.
TUBS&SHOWER PAN � � �• `- PLUMBINGENERGY', TH ACT NOPARCEL NO
MECHANICAL - MECH.ENERGY
ELECTRICALBUILDING'ENERGY ACC.DATE .ACC FILE NO.
`
FRAMING - ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION - PLUMBING -
. . GAS TEST GAS '.
FIRE SPH INK ENERGY T 2
MECHANICAL —
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING " ` �] "El `-E] "L
EXTERIOR SHEAR - ELECTRICAL RELEASE - 'FLOOD ZONE - A,Lu c_
' INTERIOR SHEAR FIRE,DEPT: yLl 'V.L "o,
SHEETROCK GRADE FEE SUMMARY,
EXTERIORi'LATH - A BUILDING
INTERIOR LATH s. TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
- GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -
OCCUPANCYOFBUILDINGISNOTPERMITTEDUNTILBUILDINGFINALISSIGNEDBYBUILDINGINSPECTOR'. MICROFILM ,
ARRANGE FO.R INSPECTION BY PHONING 252-4505, ELECTRIC
E- " - ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING. y
zMECHANICAL /•�.;
- SEE PERMIT FOR EXPIRATION DATE
-" IMPORTANT! CONST.rnx, r
PLEASE READ REVERSE SIDE BEFORE ` TOTAL ' .
CALLING<FOR FINAL INSPECTION.
OFFICE',COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADD18037
R S
/1145�-Paloma, 41' BUILDING-ELECTRICAL-'PLUMBING-MECHANICAL - t.4:
OWNER'S PLAN CHECK VALIDATION
"AME l S-1 l_l as z_ pc�5 TY ELECTRIC PERMIT. FEE
C1 / J TGTGe r eHONE jJ
CONTRACTOR'S1 �
! ' UTLETS-SWITCHES-RECEP 10.00/1.00
CONTRWTORS uc'NO. / �`S 4L LIGHTING FIXTURES' . 10.00/1.00 ,OCT 9 •989
ADDRESS
PPL NCES-RESIDENTIAL 4.00 1
ADO[RE'ss 1(� 7 ///111 ��-
/JS rr'(�, t�l•^-(�r PRpNE� /�r/ PANEL -10.00 , OAT OF APPIJ TION
ARCHITECT llRE P.C.NO.
OR PANELS (0 ER 200 AMP) 20.00 --fir�•.�Q ,.
ENGINEER
I� LIC,NO, SIGNS TRANS. 3.00
TRC. OP ENG. - - - PERMIT VALIDATION
`h^' ADORess SPECIAL CIRCUI. . 5.00
ZIP TEMP.METER 08 POIsE.INS. 20.00
APPLICANT'Sr
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 ��r��vGLI
00 LICENSED CONTRACTORS DECLARATION
a v u 1 hereby allirnh that I am licensed under provisions of Chapter 9 ISSUANCE DAT 111
y 4 m (commencing with Section 7000)of Division 3 of the Business and OLDG. ELECT. PL MECH.
F y z Professions Cod jic y sense is in full force a ( G ❑ ❑ ❑
z O m - License Class "�✓ Lic.Number
g m O Date Contractor lad
g s BUILDING PERMIT
s s w a OWNER-BUILDER DECLARATION
0 A. U MISC.- - REFER TO ORD INFORMATION
wg u I I hereby affirm That I am exempt from the Contractor's License - VALUATION'
Fuoa Law for lire followingrcason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city ur County which requires permit mconslrllcl,alter,
fera ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
ar
0 s requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
wm I he is licensed pursuant to the provisions of the Contractor's License
Fzi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the - -
- a Business and Professions Code)or that he is exenpt theret rum and Y. PLUMBING PERMIT FEE
UE I e, the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for it pemhiI subjects the Said icantao a civil pen aIty LTER-DRAIN&VENT-WATER (EA.) 5.00 -
ofeetmore than tire hundred dollars($500)J. '
❑. 1,as owner of the property,or my employees with wages asg CK FLOW PROTECT.DEVICE 4.00
their Sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
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 Ilaceon,and wllo does such work FIXTD ES-PER TRAP. 5.00
$ts FT.FLOOR AREA TOTAL ACREAGE
himselforthrough his ownemployees,fors Providedthat such improve- - '
ments mselfo not ugh his or uttered fees,pr if.however,
the buildup,' e- GAS-EA. YSTEM-1 INC.40UTLETS 6.00
or improvement I,sold-within one year of Completion,the owner- GAS-EA.S TEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or ier-
IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL STE INTER. 30.00
❑ I,as owner of the property,a exclusively contracting with ❑ El El 11 1:1licensed contractors to construct the proiect(Sec 7044, Business LAWN SPRINKLE S-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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-ST MEA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I um cxenhpt under Sea _ ,B.&PRC.for this WATER HEATER W/VEN 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 1 have a certificate ore...ent to self-inane. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insuranee,11�a,c/etli fid
copy there u 00,n aDCJs? h l�
- Policy Nojj n puny /map
O ❑ Certified copy is hereby lurnklel. FIRE SPRINK ENERGY T74
Z_ Z @Certified Copy is upped with n, cit' inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
0 ApplTmamYJ.�z_c- v N V N
i-T-I PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CrCL - CI7 RTI FICA'1'Ii OP EXIiM PTION I'ROAt RKERS
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y N v N
C 0 (This section need not he completed if the permit is for one TOTAL ❑ ❑ _ ❑ ❑
Z) Z hundred dollars IS 100)or less.)
U I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any canner so as to -
U become subject to the Workers'Compensation Laws ofCalil'ornia-
O w Datc. Applicant BUILDING .
a ALTER OR ADD TO MECH. 5:00
} m NOTICE TO APPLICANT If,after no king this rs'Compe of F,--
F_ Z caption,you should become subject m the Workers Compensation APPLIANCE 5.00 FLAN CHECK
provisions of the Labor Code, you meal revoke comply with - FEE
U such provisions or this permit that be deemedit revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) , 4.00
CONSI'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE L
I hereby affirm that there is a constructionlording 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.) 'S 9r Q� MICROFILM
3097,Civ.C.). '
Lender's Name
Lenders Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
immrrances n correct. 1 s rel to g to b with all city and county PLUMBING
ordinances and state laws relating to building construction, andmy BOILER-COMP13 H.P.or 100,000 B.T.U.1. 6.00 /
hereby authorize representatives of this city Io Inter upon the BOILER-COMP (Over100,000BTU)SEE FEE SCH. MECHANICAL al' 0b
above-mentioned property for inspection purl ous.
(We) gree to sive, rudenmily and keep harnllClB the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and ex henses which �^^ CONST.TAX '
eny way accrue against Said City in conn acne of the PERMIT ISSUANCE o-QQ 17,'(this pemhiL MECH.CONT. LIC.NO. MECH.
TOTAL�.(I� TOTAL ��,FEloof ApplicaotjContrq Date `�" I D r
OFFICE COPY