16363 a'> POST THIS CARD'NEAR F R ONT OF EI UI PEaMITNUMBER
CITY OF CUPERTI.NO � 16363
INSPECTION DIVISION
JOB 4NSPECTION RECORD-.
... l - '• .F I PERMIT EXPIRATION' S
°.• JOB ADDRESS /y //7 -'>¢.D2i/i"1�A- �`-t✓�
/(I �T A UNIT# ,LOT# PERMIT EXPIRES IF WORK
OWNER •4, .��N7 /'U,Q�jQ , CONTRACTOR IS NOT;STARTED WITHIN';
INSPECTION DATE 'INSPECTOR INSPECTION RECORD . 180 DAYS OF PERMIT ISSU-
ANCE OR 180,DAYS, R
N FROM
OTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED,
PREGUNITE!; ,- - .I TO COMPLY WITH THE APPROVED PLANS AND CITY OF NRnnt VALIDATION
CUPERTING STANDARDS. ;.--
' IGARAGE•SLABS -.' ' � - --
POUR NO CONCRETE UNTIL r.BOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - , ,p�►
PLUMBING' x m. ..
!ELECTRICAL - qq �I \ ISSUANCFUATE _
,IMECH ANICAL BLDG fLECT l PLG-, ,MECH.,
' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED rltu Ot iplNc vE❑RMIT ❑
INFORMATION
WOOD FLOOR I -VALUATION SIFT
PLUMBING ,
(MECHANICAL.'
!ELECTRICAL „I - - ' I - - - PcHMIT To n
!FRAMING
i
INSULATION SIOHIES TYPE CONSTR.
, I � . -T � � • �
., OCC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I - -
\� I
c � 1 111,1T,I'OOR ROOF � NOTE.NO FINAL INSP:SHALL BE MADE BEFORE AREA( TOTAL ACRE AGE
IDIAPHRAGM., HE CONSTRUCTION TAX IS PAID '
„ .•. BUILD(NC USE
IROOFSHEATHING I , ,. I HES IND, cON Ps Ow.,
I APPLY NO ROOFING UNTIL"ABOVE HAS BEEN SIGNED FINALS` ^ DATE 3INSP...-� ' 0 ❑ . ❑ - -fl-
ROUGH .. (SAN.# + F. nssessuHS PARCEL NO, - )
I PLUMBING ELECT.'ENERGY - rencT No Pn HCeL No.
!TUBS 8 SHOWER PAN PLUMBING ENERGY
IMECHANICAL _ MECH ENERGY
ELECTRICAL ACC DATE ACC.FILENO
BUILDING ENERG ,
I FRAMING I ELECT,FINAL TEST . I _ I I ioNING ENC slre No
INSULATION „ I 'IPLUMBING I .: I
GAS TEST - ; I , IGAS
IMECHANICAL I I FIRE SERINK rNERGY I :4
COVER,NO WORK UNTIL ABOVE'HAS BEEN SIGNED (HEATING �, I I I 10 No I
r FLOOO ZONE A,L UC
EXTERIOR SHEAR . `• (ELECTRICAL RELEASE( �/-� J'�"I
(INTERIOR SHEAR'. (FIRE DEPT.' . I' ' - I� �` 11 N� - r 1] N�
ISHEETROCK - (GRADE ' I I ' ' I ;FEESUMMARY
-(EXTERIOR LATH IBUILDING I I•, <,
(INTERIOR LATH • ` I ,, ;, ' TEMPORARY APPR OVALS',` - I BUILDING,
- (SCRATCH COAT (ELECTRIC,' •�' PLAN CH ECK
I . IGAS ( 'FEE .• . I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED !OCCUPANCY ! sEIBMIC FEE., I I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 'I
ARRANGE FOR INSPECTION BY PHONING 2524505, _ I'ELECTRIG �.0V -
O� ONE WORKING DAY BEFORE REQUIRED,INSPECTION. PLUMBING
E'J
' PLEASEGIVOBADDRESSWHEN'PHONING. I '
G fp 'I Z
SEE-PERMIT FOR EXPIRATION DATE —" IMECHANICAL
' � ' I CONST TAX• I "
IMPORTANT!
-PLEASE READ REVERSE SIDE BEFORE- TOTAL''
CALLING'FOR FINAL INSPECTION.• w L- ', • .
OFFIC*COPY
APP4ICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT•PEN Oili
PERMIT NUMBER.
BUILDING PROJECT lDENTIFICATION APPLI AC T•10111 & PERMIT
A.,LD SE •:.163.6 3•
- aooRESS (� - ,�/� � " '
IO117 �IX( L0.(�A ITa BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 1 .
OWNER'S n + PLAN CHECK VALIDATION
PHONE +
If NaM�V{ _ lJC'Q{�,� �SS)IZS qTy`'• , ELECTRIC PERMIT FEE r -
C11s--L x/
I y CONTRACTORS ,
/'+NAME ECEP OUTLETS-SWITCHES 10.00/1.00 ��
LIC No �� LIGHTING FIXTURES 10.00/1.001
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.001 '
" PHONE I 1PANELS 10.001/a SSA DATE OF APPLICATION 4
ARCHITECT PLAN CHECK FEE, P.C'NO.
OR •(PANELS (OVER 200 AMP) 20.001
ENGINEER
uc No I ISIGNS TRANS. 3.001
ARCH OR END PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT ' . "5.001 .-
nP EMP.METER OR POLE INS. "' .' 20.001
nooeessTS MOTORS • SEE FEE SCH. �n
�Y�' SERVICE CHANGE 20Ae1k`
oa z - CT7
F o o + LICGNSLU CONTRACTORS DGCCARATION " ^" q h 1C - / ,.
Zw 1 hereby al firm that am hcensed under proWSUn..of Chim0.'i ISSUANCE DATE
y a A (commencing with Section 7000)of Division 3 of the Nosiness amt I , , G- 1 .BNE. ELECT PLG. MECH.
H N i Professions Code,and my Imense is in lull force add el'lect.
O o m - ( te License Class Lot.Number
•❑ ❑ v
Z r��' Ua _ Contractor y -
a x s < r I BUI�NG PERMIT
Ic ¢ a OWN(?R-BUILDIik DECLARATION
Z o d - .INFORMATION
w g LL h I hereby ul0rnt that I am exempt fluor the Cortractor's License MISC.- REFER TO ORD _
VALUATION - " $/FT
u o 4 Law for the following reason (Sec.703 1.5,Business and Professions PERMIT ISSUANCE �/a
HW Code'Any city Or county'which re9uiresu permit to construct,after,
0
T Q Improve,demolish,or repair any structure,poor to its tasuancr,also ELEC.CONTR. LIC.NO. ELEC. '�/ 0
o u regwres the applicant fir such permo to Iglu a nigneJ statement that TOTAL a li
A,wm he is licensed pmeuant to tire PERMIT TO
A e provisions of the Contractor's L accuse T
r z 4 Business avdrl'rofess ono Co 1)tolrshat he i000emPt Division
iheretromfalfd QTY. PLUMBING PERMIT d. I`FEE
M r o the basis for the alleged exemption.Any violation of Section 7031.5' STORIES TYPE CONSTR.
A. ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&C (EA.) 5.00
of 01 more than five hundred dollars($5000.).Jlet I,as owner of the property,or my employees with wages as I BACK FLOW PROTECT. DEVICE 4.001
I let)Sole compensation,will do the work,and the structure Is nil OCC.GROUP RES UNITS
intended or offered,for sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.001
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.001 So.FT.FLOOR AREA TOTALAw EAGE
himself or through his own employees,provided that such Improve-
on.usarenetint ended or offered for sale If,however,the building) GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.001
P'op"provcment a sold wnhln unc year of completion, Ibc owner-
' builder will have the burden of proving that he did not build or up- GAS-EA.SYSTEM-OVER 4 (EA.) 2001 BUILOi NO USE
Y. ? •P RES IND CON PB 'Uh.,
prove 1,as O nee of sale.).' INDUSTRIAL WASTE INTER. 30.001 ❑ ❑ ❑ '❑ ❑,
❑ d as owner of the properly,run ones iv Se contracting with •'
and Pro contractors to re Cmntra the pmlect(See 7044,Business (LAWN SPRINKLERS-1 INC 5 V.B. 6.001 ASSESSORS PARCEL NO
and Professions Code The Contractor's Liceme Law dies not apply
to an
tr owner of property who builds or mlproves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.001 ) -
tire Costs for such projects with a con traetnr(sl licensed punuant t-1 SEWER-SANITARY-STORM EA.200ft/10.001
the Contractor's License Law.� TRACT NO I _ PARCEL NO
❑ I-em exempt under Sec B'&P.C.for this WATER HEATER W/VENT 6,001
mason
Owner =S, - Dan' ?_-e:94 WATER SYSTEM 5 001 •+ACC.DATE .ACC FILE NO
WORK HRS'COMPENSATION DECLARATION 1 WATER TREATING EQUIP, 5.001 ,
I herchy infirm that I have a certificate of convent 10 self-ois lte,1 1
or a certificate of Workeri Compensation Insurance,or a certdter' ZONING END SITE ND.
7" copy thereof(Sec.3800,Lab C j.
1'obcy No. - Company_
O - . ❑,Certified copy,is herchy furnished. I FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the coy Inspection thvuion - •
O-A Applicant 1 MISC.- REFER TO.ORD. Y ❑ N❑ Y❑ N❑
~ rn 1 PERMIT ISSUANCE 10._00
Lu
CE kTI PICATI:OP I COMPENSATION ON PROM WORKERS'' FLOOD ZONE A.L.0 C.
W - CDMI'F:NSATION INSURANCIi I PLG.CONTFU ' LIC.NO. PLG. '
CL O IT is.section need out he completed If the permit is for one I TOTAL - e Y❑ N❑ v❑ ry❑
Z) Z hundred dollars IS 100)or less)
U O 1 verily that in the pertorm:mce of the work tar whmh this per QTY MECHANICAL PERMIT . FEE ,:FEE SUMMARY ,I
LL i- our is issued, I shall not employ any person in any manner so as to - _
O W become subject to the Workers'Comp w
ensaton Las of Cxldorn not r I y
Date Applicant •BUILDING
IALTER OR ADD TO MECH. 5.00
} co NO HCE TO APPLICANT If,after making Iles Certiticzlc of Exw
�•? -enlpron,you should become subject m the Workers'Compensaton qpp LIANCE 5.00 1 PLAN CHECK '
provisions of the Labor Code, you must forthwith comply wI[I at`
U such provisions or this permit shall be deemed revoked. 1 AIR HANDLING UNIT(TO 10AOOC.F.M.) 4.00 - I FEE ,
CONSTRUCI ION LENDING AGENCY • 1 I AIR HANDLING UNIT(OVER10,000 C.F.M.) 6.001 , SEISMICFEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.001, •.
{ the performance of the work far which this permit is issued(Sec I I MICROFILM
m^
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.( 8.00 I
Lender's Na HEATING UNIT ER 100,000 B.T.U.19.501 J ELECTRIC
Lender r^=='s AJO , �..
r„fIl'e'•# I cerlily Wet I have read this appi caHOn and state Bum the ahoy, 1 VENTILATION FAN (SINGLE) 4.001
information is correct I agree to comply with all coy and county - PLUMBING '
u ordinances and State laws relating to building construction, anJ (BOILER-COMPI3H,P,Dr 100,000B,T.U.) 6.001
V herchy authonze representatives,of this city to enter upon Lhe gOILER-COMP (Over 100,000 BTUI•SEE FEE SCH.1 MECHANICAL
'a`''u'' above-menhoned property for ispectmn purposes.
(We),agme la save, indemnity r .
6 y :Ind keep handless ex the City of 1 MISC.'- REFER TO ORD.1
Cupertino agemel accrue against judgments, rosin and expenses which 1 PERMIT ISSUANCE 10.001 . CONST.TAX
• inay in anY way accrue against sail City m cnnseq uence of the
granting fthis permit MECH CONT. LIC NO. . MECH ' ' - - '•r
-_ up-Q� • 4-12- ,W w- TOTAL, ".j TOTAL'
Stgnatureof Applicant/Contractalt Date -II
OFFICE COPY