17408 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
• :. CITY OF -CUPERTINO4
INSPECTION DIVISION "O "
JOB INSPECTION RECORD
'��I PERMIT EXPIRATION
JOB ADDRESS �� k �Y-o UNIT# LOT#
PERMIT EXPIRES IF WORK .
OWNER CELL. CONTRACTOR S', _•" (1-0 IS NOT STARTED WITHIN
INSPECTION DATEI I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
_ NOTE: ' LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL,BE,INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAUDAT1oN
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND/SLAB '
••. uL. /!1may-
• PLUMBING MAR
ELECTRICAL - -ISSUANCE DATE
MECHANICAL BLDG, ELECT PLC. MECH.
DO NOT POUR FLOOR UNTIVABOVE HAS BEEN SIGNED /l '46��V BUILDING PERMIT
INFORMATION
WOOD FLOOR. '000��rr t(i�pp VALUATION SIFT. -
PLUMBING T`"-IYi-OI--izf
MECHANICAL \ 'LS*Yc9 O(j,' •
.. -
• O - -� el. \: r PEHMIT TO
ELECTRICAL
FRAMING - e I -Ikkv�`C
INSULATION STORIES - TYPE CONSTR.
- _ DCC GHODP HES UNITS
PLACE NO-SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF NOTE NO FINAL INSP.SHALL BE MADE BEFORE So.n.FLooR ARCA TOTAL ACBEAGL
DIAPHRAGM'
THE CONSTRUCTION TAX IS PAID D . `
BUILDING USE
- ROOF SHEATHING � � - � � I+is IND. coN PB ou,r.,
APPLY NO ROOFING UNTIL ABOVE'HASBEEN SIGNED FINALS DATE INSP. L L L ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
TRACT NO.. PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL, MECH.ENERGY -
ACC,GATE ACG FILE NO,
ELECTRICAL . BUILDING ENERGY
FRAMING0, ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION- PLUMBING -
. GAS TESTI GAS
FIRE SPRINK ENERGY T_24
MECHANICAL Y ❑ N❑ y L No
COVER NOWORKUNTIL ABOVE HAS BEEN SIGNED HEATING
ROOD ZONE A.L U.C.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. - - Y.❑ NL Y L NO
SHEETROCK _' p. GRADE FEE SUMMARY
EXTERIOR'LATH BUILDING'
.INTERIOR LATH TEMPORARY APPROVALS BUILDING Q
SCRATCH COAT ELECTRIC' - PLANCHECK
GAS FEE -2e
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1 a
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. p;1ICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
' Lu 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 TOTAL �7
CALLING FOR FINAL INSPECTION. L
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON -PERMIT NUMBER
BoILD1N 6 T/W APPLICATION & PERMIT I T 174OS '
AODHE
2/0 MW GOA BUILDING-ELECTRICAL—PLUMBING—MECHANICAL
OWNER' \ PLAN CHECK VALIDATION
NAME .Qd/QE/17 L/jy�/r,E,+Q/ OTY. ELECTRIC PERMIT FEE
PHONE —
CONTRACTORS
/•IC
NAME JY rjfjdle r•.O 1J7QiPG 70 0— UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.,,T1200 FIXTURES 10.00/1.
coNrHAcr'}Q/Hs
APPLIANCES RESIDENTIAL - 4.00
ADDRESir ser _ ._
ONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
oR `/ PANELS (OVER 200 AMP) 20.00
A/0 A/C
ENGINEER /k' ,
Lic.No. SIGNS TRANS. 3.00
ADDRESS ENG' - SPECIALCIRCUIT-' 5,00 PERMIT VALIDATION
—' ZIP EMP.METER OR POLE INS. 20.00
aDo FSS A Ul rle. *az MOTORS SEE FEE SCH.
G SERVICE CHANGE 20.00 /
0 0 LICENSED CONTRACTORS DECLARATION
U U I-herehy affnn that I hm limnsed under provisions of Chaider 9 - ' ISSUANCE DATE
vHi a y (commencing with Section 7000)of Division 3 of the Business and BLDG. I ELECT. PLG. MECH.
r H z Professions Code,and my license is in full force and effect. F99
- ❑ F_ ❑
0 0 w W License ClassLic.NumberMAR 16
Date Comracmr
a m Y -a " BUILDING PERMIT
¢ a w ¢ OWNER-BUILDER DECLARATIONCIty INFORMATION
od " MISC.— TO ORD
K
g u J hereby infirm That 1 um exempt from the Corlmcmrs Licenu VALUATION', $/FT.
cc Law for The following reason.(Sec.7031.5;'Business and Professions PERMIT'ISSUANCE 10.00 Z ^y^r
Code:Any city or county which requiresa permit to construct,alter, ✓� I J
¢ S Q 0 improve,demolish,or¢pair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
o E requires the applicant for such permit to file a signed statcmeN4hat TOTAL PERMIT TO
ec E
he is C apse pursuant to the previsions of The Contractor's 3i of
F a a_ Law Fusin and ProcommenC de)or Section 70001o(Dtherefom the the
bass and he alleged eCode)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ fO The basis for the alleged czcmption.Any violation ufSeclion 703 t,5 STORIES - TYPE CONSTR.
by any uppllemit for o Remit subjects the applicant to a civil penalty ALTER,-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dullors(5500).):
❑ I,as owner of the property.or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure n not ,
intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves(hereon,and who does such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employacs,provided that such Improve-
RentsarenoTimendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold withimune year of completion,tle owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
bdBder will have The burden or proving that lie did not build or int- PES IND CON PB Osbr
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
Cl 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑. ❑ ❑
licensed contractors To construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Profession,Cale:The Cummer is License Law does not apply
to an owner of property who builds or improves diction.and who LAWN SPRINKLERS.-OVER 5(EA.) 1.00
contracts for such projects with a contractors)Ilcnised pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ lamuxcouptunder Sec. ,B.&P.C.om-thi, WATER HEATER W/VENT a 6.00
reason
Owner Date WATER SYSTEM- 5.00 ACC.DATE ACC.FILE NO,
W'ORRERS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby ulfirm,ihat 1 have o certificate of consent to self-insure,
or a,curlificule of Workers Compensation Insurance,or a certified ZONING ENO.SITE NO.
copy thcsof(Sec.3800,
Policy No. Company
O ❑ Certified copy is hereby fumished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified.copy is riled with The city inspection division. - MISC.- REFER TO ORD.
O Applicant Y❑ N❑ Y ❑ N❑
� N CER'TIF[CATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LUL.
LU > COMPEN'SA'f10N INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This x'cto m iced not Iw completed if the Pennon is fur one TOTAL v❑ N❑ v❑ N❑
Z hundred dullirs(5100)or less.) '
U O 1 certify that in The perfonmanw of the work list which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
O beanr{�ybje �/Lo�he Workers oyI No l"a"CRs (Cali(o nice.
U sua Date-7/ l/l_7_ApplicanT3-V_ CJyg� � ALTER OR ADD TO MECH. 5.00 BUILDING
} N N'OF - I( AP LICANT: It,seller making This Certihcatc of Ex-
? cmpTirm,you should become subject to the Workers'Compensation APPLIANCE .5.00 PLAN CHECK
provisions of the Labor Codc, you must 1o00lwith comply with FEE "3 1
U such provisions or this permit,hull he dcemcd revoked. AIR HANDLING UNIT(TO 10=1C.F.M( 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)"CF.M-16.00 SEISMIC FEE a 60
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,CN.C.). ,�/ HEATING UNIT(TO 100,000 B.T.U.) . 8.00
Lender's Name �//t',/
Lender's Adds HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
res
I certify that I have read IN,application and slate that The above VENTILATION FAN (SINGLE) 4.00
information is cornet. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-CDMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize represemativas of this city to enter For the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs uiid expenses which CONST.TAX
my in any way accrue againel said CiI in ...asequence of the PERMIT ISSUANCE 10.00 ..
ling ill'this Pcrnsil. - MECH.CONT. LIC.NO. MECH.
•!/ r IS TOTAL TOTAL �/
grata pp man[ on/F ,Iftr or Is e t
OFFICE COPY