17441 POST THIS CARD NEAR FRONT.OF BUILDING ERwIT NDmeER
CITY. OF, CUPERTINO 174 1
INSPECTION DIVISION
JOB INSPECTION RECORD
1 p PERMIT EXPIRATION
JOB ADDRESS 1 Tly Vk��✓ j4-�ry}T# LOT#
PERMIT EXPIRES IF WORK
OWNER 'Col,,,. CONTRACTOR AT(' IeL IS NOT STARTED WITHIN
INSPECTION DATE NSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU-
ANCE OR 180 DAYS.FROM
FOUNDATIONS NOTE:. CASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLYWITH THE APPROVED PLANS AND CITY OF PERMIT VALIOArION
CUPERTINO STANDARDS..GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED MAR I• '( W0 37
UNDERGROUND /'SLAB • ',.c ry�,,�, �M ,�tt 1
PLUMBING •• ��-el N, � I�u LIC�./
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG. ELECT] PLG. MECII
El ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'jam BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION
L . siPa.
PUMBING
MECHANICAL -
ELECTRICAL rERem To
FRAMING -
INSULATION . . .. s7oC,1.3 TYPE Co S v.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'ROOF NOTE:NO FINAL INSPrSHALL BEMADEBEFORE SO,rr:FLOOR AREA TOTAL ACREAGE
DIAPHRAGM.' - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res IND CON PB Om.,
El 13
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. , 1:1 El '
AeSEBBORSPAHCEL NO:
ROUGH - SAN,# - - - -
PLUMBING ' ELECT,ENERGY -
TUBSBSHOWERPAN PLUMBING ENERGY TRACT No. PARCEL NO,
MECHANICAL MECH.ENERGY
ELECTRICALY BUILDING ENERGY- ACC.DATE 'ACG.FILE NO
FRAMING ELECT.FINAL TEST
INSULATION
ZONING , ENG.SITE NO.
_ PLUMBING
GAS TEST GAS - -
"RESPRINK ENERGY T�]E
• MECHANICAL v NO v Ej ''rr[3
. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE 0.L UC.
- EXTERIOR SHEAR ELECTRICAL RELEASE
. .INTERIOR SHEAR FIRE DEPT. v "� ND'
SHEETROCK GRADE - FEE SUMMARY '
EXTERIOR LATH BUILDING
INTERIOR LATHTEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS ' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
- OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUICOING FINALISSIGNED BY BUILDINGINSPECTOR. 'MICROFILM '
'ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 • PLEASE GIVE JOB ADDRESS WHEN PHONING.
—,SEE PERMIT FOR EXPIRATION DATE,- y MECHANICAL:
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.-. ,oD
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BuInING APPLICATION & PERMIT
ADDRESSSiS
tt 17 441
/0{9(a A�. 'jJ1-.JT/�o 4,kjF_ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNERS - Sry+�� - '-PLAN CHECK VALIDATION
-
NAME JJ II 9 QTY. ELECTRIC PERMIT FEE
I!T/�O �r� 'HONEOZ� 1
CONTRACTORS i
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 end
/LlOA•-r hS"T F, 6t• LIC.No. 606% LIGHTING FIXTURES 10.00/1.00
CONTRACTOR S. /. �6 pp LIANCES-RESIDENTIAL 4.00
f..✓
J •, b"r PHONE 0Z�3 PANELS 10.00 DATE OF APPLICATION.,_'
ARCHITECT , PLAN CHECK FEE .NO.
OR PANELS (OVER 2(10 AMP) 20.00 .
ENGINEER
uc.No. SIGNS TRANS. 3.00
ANDH.RESS ENG, PERMIT VALIDATION
AR HER SPECIAL CIRCUIT 5.00 r5 ,
• J
ZIP EMP.METER OR POLE INS.
APPLICANT'S - MOTORS SEE FEE SCH. 71 ( V
ADDREW _
SERVICE CHANGE 20.00 Dom` L',�I�.1L VGA 1
0 LICENSIi D CONrRAC FORS DECLARATION
¢ U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w G m (commencing with Section 7000)of Di,i ion 3 of the Business and .) BLDG. ELECT. PLG. MECH.
r m z Professions Codr nJ 06'Jicense is in full for ❑ ❑ ❑
z o oD - License ass�� Lica Numbs -
9 r Date-
l2Conlrudor yy,�,
¢ l2 z city ot Qwdm I BUILDING PERMIT
¢ ¢ n a OWNIi R-BUILDER DECLARATION -
MISC.- REFER TO ORD INFORMATION
E:
m I hereby affirm that I um exempt from the Cont actor's License VALUATION S/FT.
u o a Law far the following reason.(Sec.7031.5.Buainessand Professimu PERMIT ISSUANCE 10.00 Q
an I Code:Any city or county which requiresa permit to construct,alter.
Qx Q 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O ¢ 'requires the applicant for such pennit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
w $ In
Hit Law(Chapter9(commencingwith Section 7000)01Dlvision3ot the -
a Business and Profeuions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �i
¢ r D the basis for.the alleged exemption.Any violation of Section 7031.5 S ORIES TYPE CONS
TIT
i ; � by any applicant for lumd,ed dollarsthe0).):: am toacivil Penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of tire'property,or my cmployecs with was'',as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the stnature is not
intended or offered for sale (See, 71544, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 Sal FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
. cents are not intended or offered l'or sale.If,however.the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 -
or improvement is add within one y,a,of completion,the owner- GAS-EA SYSTEM-OVER 4 IEA.) 2.00 BW LOING uSE
builder will.have the burden of proving that he did not build or ice'
prove for purpose ofsaleJRES IND CON PB OrM1n
: INDUSTRIAL WASTE INTER. 30.00 E
ClElI,as owner of the property,am exclusively contracting with El El 1:1
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL No..
and Professions Code The Contractor's License Law does not apply
to as owner of properly who builds or improves thereon,and who . LAWN SPRINKLERS-OVER 5(EA.) 1.00.
contracts for such projects with a contractors)licensed pursuonl to
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam CxCMPtunder Sec. .B.&P.C.forthiS WATER HEATER W/VENT 6.00 .
ams
Owncr ' Date WATER SYSTEM 5.00
_ ACC.GATE ACC.FILE NO.
WORK ERS'COMPENSA'I'ION DECLARAf 10N WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-inshue. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy they f P((IOI foupy ). / .�D '
Policy NoNpq� `.npany_
o ❑ rlhfedc �y sfl ereby furnished. FIRE SPR INK ENERGY T 24
Z_ Z Ccrli opy is Itl nspcgiun division.
O 1A,Imicant _ MISC.- REFER TO ORD. - YE] NE] Y ❑ N❑
� rA v - PERMIT ISSUANCE 10.00 FLOODZONE
L - CIiRTlPIGOM SATIOl'INS FROM WORKERS'
CL 1 ' need red he ora INSURANCE ' ' PLG.CONTR. - LIC.NO.CL PLO. Y❑ N❑ Y � N❑
10 C. If hundred
delta,,
sed not he completed if the permit is for one TOTAL
hunJrcddollars lSl001 or less.l '
U O 1 certify that in the pmrformance of the work for which this per- Qtr MECHANICAL PERMIT FEE FEE SUMMARY -
LL.U mit is issued.I shall not employ any pawn in any manner so as to
Uw _. income subject to the Workers'Conhperlsation Laws of California. BUILDING
a Date Applicant ALTER OR ADD TO MECH. 5.00
} w NOTICE:TO APPLICANT: IL after making this Certificate of rix-
F Z cretion,you should become subject to the Workers'Compensation APPLIANCE _ 5.00 PLAN CHECK
provisions of the labor Code. You most forthwith comply with FEE
U mmli provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) -4.00
CONS1RUCfION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby affren that there is a construction lending i,eday for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this Peruil is issued(See MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100.000 B.T.U.) B.00
• Lender's Name
Lender's Address HEATI NG UN IT(OVER I DO,DOO B.T.U.)9.50 ELECTRIC p�
1 certify that I have read.lhis application and state that the above VENTILATION FAN (SINGLE) - 4.00
information is correct. I agree t0 comply with all city and county PLUMBING -
ordinances and state laws relating to building construction, and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Ova,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.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against mid City in consequence of the PERMIT ISSUANCE 10.00
t g of this Ire iL MECH.CONT. LIG NO. MECH.
TOTAL TOTAL 7 D D
ignmoreofA Hector/Contractor Date -T- '-
OFFICE COPY