18522POST THIS CARD NEAR FRONT OF BUILDING
'
CITY OF CUPERTINO - '
INSPECTION DIVISION
JOB INSPECTION RECORD
�'p'
.I O6.J O h. �- UNIT# _LOT#
JOB ADD/R�1ESS
OWNER' ( M (V CONTRncroa' D Q(r ('
'PERMIT NUMBER
1$522
d `P��ERMIT EXPIRATION
PERMIT EXPIRES IF WORK .
IS 'NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
- INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL' BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
1
ME)
UFER
PREGUNITE
PERMIT VALIDA ON
I ,_ �� IIs
%' I
15sUANCc DAZE J`
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
6989 1
SSP �+ B 989
UNDERGROUND/SLAB
PLUMBING
pYl� 71.r
� � CUQ@t�IJl�
ELECTRICAL -
MECHANICAL.
-
BLDG
E ECT.
• 'PLG. M c
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
_
BUILDING PERMIT
INFORMATION
:WOOD FLOOR
VALUATION
SIFT.,
PLUMBING
MECHANICAL
ELECTRICAL
-
•PEHMIT O'
1(��'` + {�J77_�.
FRAMING
INSULATION
-
STORIES,
TYPE CONSTR.,
.
'UCc. GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SO FTFLOOR Ai A
T &b I '
TOTAL ACREAGL
DIAPHRAGM
ROOF SHEATHING
BUILDINGUSE
TIES IND CON
oN Pe 0"1"APPLY
� ❑, 0 ❑ ED
NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE " INSP..
ROUGH
SAN.a
ASSTSSURS FARCE L NO.
PLUMBING
ELECT. ENERGY
TUBS 6SHOWER PAN -
PLUMBING ENERGY
TRACT No.
PARCEL No
MECHANICAL
MECH.ENERGY -
ELECTRICAL �, [
BUILDING ENERGY
ACC.DATE
.ACC, FILE NO
,
FRAMING' _
ELECT. FINAL TEST
INSULATION -
PLUMBING
ZONING
ENG. SITE NO.
GAS TEST
GAS '
,F H SPR INK,
ENERGY T?a
I] NEI
MECHANICAL /
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
_
ELECTRICAL.RELEASE
F rtJ (zoNL
v N�
n. L.0 c.
--I NQ.
INTERIOR SHEAR
FIRE DEPT. ,
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILEiNG
BUILDING
(f
INTERIOR LATH -
TEMPORARY APPROVALS
SCRATCH COAT-'
ELECTRIC'
PLAN CHECK,
FEE
GAS -
SEISMIC'F,EE;'„
�.- Z.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNEDBY BUILDING INSPECTOR,
'MICROFILM
ARRANGE FOR INSPECTION"BY PHONING M-4505,
I- ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
—SEE PERMIT FOR EXPIRATION DATE —"
ELECTRIC
O . y
PLUMBING
MECHANICAL
CONST. TAX.
---
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
APPLICANT TO FILL IN INFORMATIONVITHIN REDLINES - USE BALL POINT PEN ONLY
j BUILDING PROJECT 1 DENT( FICATION
,ILDING
ADDRESS _
GA IRO.6A �r-
w -
APPLICATION & PERMIT
' `
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
.PERMIT NUMBER
18522
OWNER'S
NAME ]t �/r
o
A. Mrs, S•/�in PHONE ,`ss•7A
QTY. ELECTRIC PERMIT -FEE
- -
PLAN CHECK VALIDATION,
-
DATE OF APPLICATION '.
CONTRACTOR'S
NAME
7,CCJ2O�Yk2fY- 7706
OUTLETS 10.00/1.00 r VU
LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
DDREss CMWO W v+ PROry AA -TI
• APPLIANCES -RESIDENTIAL - 4.00
PANELS 10.00 r�
ARCHITECT
ENGINEER
LIC. ND.'
PANELS (OVER 200 AMP)' 20,00
PLAN CHECK FEE P.c.No.
J
'
SIGNS TRANS.. 3.00
ADD Ess ENG.
ZIP
SPECIAL CIRCUIT 5,00
PERMIT VALIDATION
�/I [
1 �
TEMP. METER OR POLE INS: 20.00
AvvucANrs
iy Dr.
MOTORS SEE FEE SCH.
SERVICE CHANGE 0.00
LICENSED CONTRACTORS DECLARATION
-
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Class Lie Number
Date Contractor ' •
ISSUANCE N EDA
DATE
_ - -
. -
BLDG.
ELECT.
PLG. MECH.
❑ - k-/�
/U�C�t
y
QW, of �pp/}IAA'
MIT
BUIL INFORING MATION'
INFORMATION'
OWNER -BUILDER DECLARATION
1 hereby affrm that I am exempt (turn the Contractor's License
Professions
CodeLaw : Any
Code: Anymolish county a permit
orcountywhi he. requires
requinim,pioittoconstrucLaalso
MISC. - REFER TO ORD
-
PERMIT ISSUANCE 10.00 '�-'V�
VALUATION
Qa
T
S/FT.
ELEC. CONTR. LIGNO.
-
ELEC. 9 /Q/i
,TOTAL J -
any prism its issuune0. also
improve, demolish,Or repairanyrmil to file
the applicant for file permit lo'fi e a signed Sctor', nt that
require, alicensed eta ofthe ) nrivisios License
hes 1 d l S u to to file withSection
cingd iort tI n7severnt theren3olthc
Law (Chapter Profession,
Business Joel 1 Code) or that lie it exempt Sherd ran oriel
/�y�J
PERMIT TO
J �{r'.
�OO4.q„ 418 E16v
l
- t
TV. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
the basis for lite alleged exemption. Any violation of Section 7031.$-
e alleged i
by any applicant tar a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (5500).):
'
xx ALTER -DRAIN & VENT -WATER (EA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their Sole compensation, will do the work, and the structure is not
g CK F LOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DR NS -FLOOR, ROOF, AREA, CONDI. 5.00
intended or offered for sale (Sec 7044, Business and Professions
-
Code: The Contractors License Law does not apply to an owner of
property who builds or lntproves'thercun, and who docs such work
himself' or through his own employees, Provided that such improve-
mems are not intended or offered lin sale. If, however, tire building
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of Sale,). '.
❑ I, as owner of the property, am exclusively contracting with
FIXTU ES - PER TRAP 5.00
So. FT FLOOR A EA
OL
0
TOTALACREAGE
GAS -EA. STEM-11NC.4OUTLETS 6.00'.
GAS.- EA. SV EM -OVER 4 (EA.) 2.00
. BUILDING USE
RES coo CON PB Amer
p ❑ ❑ ❑ ❑
INDUSTRIALW TE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon. and who
LAWN SPRINKLER -1 INC 5 V.B:' 6.00
_
ASSESSORS PARCEL NO.
LAWN SPRINKLERS'- bVER 5 (EA.) 1.00
contracts for such projects with a contractions) licensed Pursuant ID
the Contractor's License Law.
SEWER -SAN ITARY-STOOM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
.❑ I um exempt under Sec.-, B.&P.C. it,, this
reason
-
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM • •5.00
ACC.'DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
. WORKERS'COMPENSA'I' ION DECLARATION
1 hereby utfinn that I. have a ec R,Iiemcuf consem to self -insure
or a fertifcute of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
3: _
copy thereof(So,. 3900, Lab.C.).
Policy No._ Company-
❑ Cerlifiet t' py is a Lrnish`
1� Cenil'isd m I the city inspection division.
Pphcanl-
FIRE SPRINK
Y ❑ III E:1
ENERGY T 24
- V ❑ N❑
MISC. - REFER TO ORD:
CERTIFICA1 F OF E%E.IPTION I7RONI WORKERS'
PERMIT ISSUANCE , 10.00 -
FLOODZONE
A.L.UC.
COhiPFNSATION INSURANCE
ITh is section need not be compleled it ' the permit is for one
N❑
Y❑ N❑
PLG. CONTR, LIC. NO.
-
PLG. J.v❑
TOTAL .
QTY MECHANICAL PERMIT * FEE
FEE SUMMARY '
hundred dnllura (S I00) ur Iv,,f -
I certify that in the performance W the work for which this Per-
mit is issued. I shall not employ any person in any manner so as to
BUILDING
become subject to the Workers Compensation Laws of California.
Date Applicant -
NOTICE 1'0 APPLICANT: It, after making this Certificate of Ex-
ALTER OR ADD TO MECH. 5.00 %-B
APPLIANCE 5.00
-
PLAN CHECK
�1
emption, you should become subject to the Workers' Compensalion
provisions of lite Labor Code, you most forthwith comply with
sush
ch provisions or this Permit all be deemed revoked
FEE'
AIR HANDLING UNIT (TO 10PW C.F.M.) 4.00
AIR HANDLING UNIT (OVER IQOODC.EM.).6.00 -
SEISMIC FEE
III Z
CONS"I' RUCfION(-ENDING AGENCY
Thereby afl'irtn thin there is a conitructioo lending agency Her
the performance of the work for which this permit is,issued (Sec.
3097, Civ.CJ.
EXHAUST HOOD (WITH DUCT) -. 5.00
- -
MICROFILM
-
HEATING UNIT (TO 100,000 B.T.U.)' 8.00
HEATING UNIT (OVER 100,000 B.T.U.)6.50-. - t
ELECTRIC
. e
Leede`Name
Lender'ss Address
I. certify that l have read this application' and state that lite above-
information is correct, I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and
VENTILATION FAN (SINGLE) ,,.4.00
'
BOILER- COMP (3 H.P. or 100,000 B.T.U.) '6.00
BOILER -COMP (Over.100,000 BTU( SEE FEE SCH.
MECHANICAL
�,; �. O�
hcieby uuthoriw representatives of this city to anter upon the
abovenonlinear]property for inspection purposes.
- MISC. - REFER TO ORD.
,(We) agree to Save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue a ain't wid City 'n consequence of the
ran[ fib pcn,if .�
1' -
CONST. TAX
.
"'. PERMIT ISSUANCE 10.00 L-
MECH. CONT. - LIC.NO.
-
MECH.
TOTAI�� 00
TOTAL
-
e
�7�Z
Sinttme of APPlican[/Contractor ate
OFFICE COPY