11660 POST,THIS DNEAR.FRONT.OF`BUI^L`DING' '� .
' . .'l +), S 'PFRAIIT NUM9CR
C,IT OF `CUPERTINO a` J. 9
_ INSPECTION DIVISION 1 �o `
.,JOB INSPECTION RECORD '
'.,PERMIT EXPIRATION•'
J08.,ADDSS il/1Cwf/liL_j 1r/
LOT •PERMIT.EXPIRES IF.WORK ..
.: OWNER " !/. , ,; . CONuTRACrPla / . . TED"WITHIN
SP T ONr — ' DATE INSPECTOR CTI ON K CORD" . 180 DAYS OF PERMIT,ISSU--
ANCE OR 180 DAYS�FROM'
N' '
FOUNDATIO :.,, '
' UFER t P •ri , .• .,• "LAST CAILEDINSPECTION.
2-']'7�SZ7 4>l�' '
PREGUNITE' ' PERMIT VALIDATION f(<,
POUR NO CONCRETEUNTIL ABOVE HAS B :EN SIGNED I., A ,, _ , •,t I ;, ' .,• �� i.,.•'; ?
'UNDERGROUND./SLAB
'. PLUMBING -
, .
_ (ELECTRICAL'j•, ' '- s " +•' ISSUANCE DATE
PLUG ;ELECT PLC MECH„
IMECHANICA
, o Ell o , a�
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu1LDI PERMIT
'WOOD FLOOR r+• INFORRMM ATION
VALUATIO
, N,,'. $/FT
^PLUMBING '.. t ..
MECHANICAL`:' `(` ,
ELECTRICAL - ' . pERmn ro
FRAMING 3-'1-R7 - ,,, . . .. T,-,7. -DNS
TR
• STORIES — TYPE CONS
INSULATION.':"
_ ^ I,• ' # - I OCC GHOUP RES.UNITS
! I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
1 S.0 FT .FLOOR AREH TOTAL ACREAGE'
' ROOF
TJIAPHRAGM' •,.I " •• BUILDING USE,
, • 0 RES IND CON I 00";
I APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �i' ' r '. ,�,El ❑ - E El ' ❑- . "
ASSESSORS PARCEL NO
ROUGH .• . , I, t4 _ _ ;. ;": p�
I (PLUMBING '_ a,�A�`
.; IGAS TEST �,, •''•. ., .n ) II'''��'`�T'�•_ L`W, TRACT NOS, PARCEL NO + ,
i// � '�jAC�' LOW'':/NSrA )
IMECHANICAL L{';ll - 'J '✓�/�O/�/-7+"''
ELECTRICAL: , !': ACC DATE ACC FILE NO
I' L/,17-cQ!AJ"•� FINALS s DATE INSP. I
iI FRAMING 'r , - 4=PTO/'' SAN 401, J 8P, 06pl• �' P.
/ ZONING ENG SITE NO Al I T, I INSULATION ;_, ,!S J PLUMBING _
GAS"
F "I ,r• + 1 • e ' y /// �� / I FIRE SPRINK ENERGY T20
MECHANICAL ' /(� L
I COVER NO WORK U�N/TI,L,�ABOVE HAS BEEN SI NED ; HEATING 11141'
LATH-INTERIOR o(�j*ow-,).A#wy •(pl/j' ELECTRICAL FLOOD ZONE Awc
:(LATH-EXTERIOR FIRE DEPT. '`'o' N0 •r I] N❑
ISHEETROCK•,'l y,.., r �$�,. � ' GRADE locT�.7114/f, FEE SUMMARY 1,
';SHEAR INTERIOR ' BUILDING ! f—/ �� '
; 'c•. BUILDING
'.'ISH EAR EXTERIOR y-14-/7 ' �, :'TEMPORARY APPROVALS •
~'.;IFIREWALLS .. E LECTR IC FEE
CH ECK I '
n , .:` . •• GAS //' .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY .r ;.I SEISMIC FEE
(' OCCUPANCY OF BUILDING IS NOT PERMITTEDUNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. 'MICROFILM
4 w` ".ARRANGE F OR]NSPECTION.BY PHONING 252=4505„ ; '• • ELECTRIC
. F ONE WORKING''DAY.BEFOREREQUIREDINSPECTION. PLUMBING Y:'. •
0 PLEASE GIVE JOB ADDRESS WHEN IPHONING.
- SEE PERMIT'F,OR EXPIRATION
'DATE - �; ''MECHANICAL ,.;.• ,..._ I'
,•; 4, CONST.TAX',
IMPORTANTI , .
P LEASE READ REVERSE SIDE BEFORE ye
TOTAL:'"
CALLING FOR FINAL INSPECTION. . f�
OFFICE COPY.
APPLICANT TO FILL IN INFCf 1ATION'WITHIN RED LINES - USE BAIL POINT PEN ONO' .a)
_Bi LDJ.NG PROJECT,(DENTI FICAM PERMIT NUMBER
RUILDIN('� �d.76 a APPLICATION & PET 11 rh60
ADDRESS - _
VII.cYAL�'DE iBUILDING - ELECTRICAL-PLUMBING-MECHANICAL
�.OwNER'S PLAN CHECK VALIDATION
t;;;��(�+++ ""ME �� QTY. ELECTRIC PERMIT FEE
. .. "� INE PRONE aJ"8 yQ/�l
CONTRACTORS /
NAME �jZ OUTLETS-SWITCHES-RECEP 10.00/1.00
�T�nr4J RROWlJ CO A97 7/LIGHTING FIXTURES 10.0011.00
CONTRACTDR'S O
_ AooRESS ' a.l7a-I I APPLIANCES 4.00 �3 - / 6
G1ZANfktR qV@ PHONE996-372-7- 1 PANELS 10.00 �O DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE PC NO.
OR
NGINEER
1h��VC uc.NO.R�3DIZ'76 SIGNS TRANS. 3.00 PPf-W-
A CH OS EEC SPECIAL CIRCUIT 5.00 pmk,If VALIDATION
zlp' 1 TEMP.METER OR POLE INS. 20.00,c20 20.00,c20 ^ r p 3 1987
APPLICANTS C MOTORS BiE FEE SCH. S r Q
ADDRESS 3
11603 Go SERVICE CHANGE l °y��.e20.00 COP�Ino
woo LICENSED CONTRACTORS DECLARATION FF A + WWWl �`(f 7
a E,w I hereby affirm that 1 am licensed under prowsions of Chapter iI _ IS DANCE BATE
y a A (cnmmencmg with Section 7000)of Division 3 of the Busmein and I i CitY �JD@f�ON BLDG. ELECT. PLG. MECH
r y a, Professions Cod• nil my license¢ra full force ejl'ec Z Y '• r,�.
,e o m - .Lcense Class _ Lic.Number I`^Y`Il
O� r w PDate Contractor
a m BUILDING PERMIT
¢ a w OWNER-BUILDER DECLARATION _ INFORMATION
- w 0 LL I- I hereby uffirnt that I am exempt from the Contractor's License MISC.- REFER TO ORD ,
Fa. Doe Law for the following mason. 7031 S,Business and Professions) PERMIT ISSUANCE 10.00 VALUATION
Code:Any city or county which reglnresa permit to construct.slot, Q'
¢ 2 40 improve,demolish,or repair any structure,prior to its issuance,also ELEC CONTR. ' LIC.NO ELEC.
i LL requires the applicant for such permit m file a signed statement that TOTAL�� b i PERMIT TO
-W$ --he is licensed pursuant to the provisions of the Contractor's License ('
0� Law 9(commencing F i o Business anidrProfetsions Code)ior Section
hat he�000empt0thierefromfand QTY. PLUMBING PERMIT FEE II " w
¢ 1- the bans for the alleged exemption Any violation of Section 7031.5 I STORIES TYPE'C/ONSTR.
c ; $ by any applicant for a permit subjects the applicant to a civil penalty) ALTER-DRAIN&VENT-WATER (EA.) 5.00 Z S /VNSTB ,
of not more than five hundred dollars(55001.)
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
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 in owner of
property who bolds or improves thereon,and who does such work FIXTURES ES-PER TRAP 5.00 ,,/
himself or ihn ngh his own employees,provided that such imp.t. R 'T'Q 50.FT.FLOOR AREA TOTAL ACREAGE
ntYafi not intended or offered for sale lL however,the buOdmBl ( GAS-EA.SYSTEM-,I INC.4 OUTLETS 6.00 6 aao3
or improvement is sold walut one year of completion,[he'owner-
u - + builder will have the burden of proving that he did not build or im GAS-EA.SYSTEM-OVER 4 (EA.) , 2.00 I BUILDING USE
prove for purpose of sale.). RES IND CON PB Omer
I (INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ! ❑ ❑ ❑ ❑
licensed contractors to construct the project(See.7044,Business (LAWN SPRINKLERS V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an'
n owner of property who builds or improves thereon,and who I I LAWN SPRINKLERS�O ER 5(EA.) 1.00 3/ .1 '- `/4 474 -�� 'I.
contracts for such projects with a contractors)licensed pursued to SEWER-SAP V- O ME Aryp ft/10.00
the Contractor's License Law. 11 d'1T94 /O "� TRACT NO. PARCEL NO. 'I
❑ I am exempt under Sec B&P C.I'ur this
reason WATER HEATEF�'IQ/ NT 6.00 -
Owner Date I WATER SYSTEM i� 5.00
p� ACC GATE ACC.FILE N0.
WORKERS'COMPI>NSATION DIiCLARA'I •'ION (WATER TR EATINO' DIP. 5.00 '
1 hereby affirm that I have a certificate of consent to sel Ginsom, / r I ZONING ENG.SITE NO
�aor a certificate of Workers'Compeppsat�'g}�I urance,or a certi0ed I1+
o thereof(Sec 3800,Lab,C.1. Fl E 1 N"1 z 99
Polcy No. Companya�c Ono'T•.101 cP,q I7f=' �-7 0a Or '
O ❑ Certified copy shereby furnished. I 1 FIRE SPRINK ENERGY T-Z4
Z Z ❑ Certifie cppy ¢ filed wrth the coy inspection division. I y❑ N❑ , V ❑ N❑
Fp/ Applicant nnxA.i� I (MISC.- REFER TO ORD.
0:,5 CERTIFICA'I'EOF EXEMPTION 1 7ROM WORKERS" I - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L U.C.
W - COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, '
1 D (This Li:mw ot n need n he completed if the pent Iv for one I ''I TOTAL -7)9!:S' V❑ N❑ V❑ N❑
0Z hundred dollars IS 100)or less)
L) O 1 certify that in the performance of the work for which",Pe QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F / mil is issued,I shall not employ any person m any manner so as to
U 1 become subject to the Workers'Compensation Laws of Caliornia.
0 i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING , 's?
} N NOTICE'1'0 APPLICANT. If,alter making this Certificate of Ex
F- 2 emp0on,you should become subject to the Workers;Compensalio6l (APPLIANCE 5.001 I PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. I AIR HANDLING UNIT( lO,OW C.F. 1 4.001 1
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVEI(10 .),6.001 ' SEISMIC FEE `: !?.73
I hereby affirm that there is a COIHtruction lemimg agency for I I EXHAUST HOO15ftmH MT) 5.00+ 1
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Co,C I 1 I HEATING UNIT(TO
��a1�0�0�pI{pp' , DD 8.001 0
Lender's Addr H EATI NO UNIT IOUBW1U0,000 B.T.U.)9.501 ELECTRIC j�6 IN I'
.Lender's Addre==
I certify that I have read this application and state that the above Z. I VENTILATION FAN (SINGLE) 4.00
in R
formation is correct. I agree to comply with all city and county r ;BOILER-COMP I3 H.P.Or 100,000 B.T.U.1 6.00 PLUMBING 77,'--1
ordinances and state laws relating to building construction, and
`� hereby authorize representatives of this city to enter upon the /
�f above-mentioned property for inspection purposes 1 BOILER-COMP (Over 100,000 BTU(BEE FEE SCH. I MECHANICAL
(We) agree to save, indemnify and keep harmless the City of 1 Misc.- REFER TO ORD.
Cupertino against liabilities, judgments, costs and'expenses which PERMIT ISSUANCE 10.00 CONST.TAX d/�g •g /�s
may in any way accrue against sand'City in consequence of the /V YSiS_-
grantingofthispernm' - MECH.CONT. LIC.NO. MECH.
n / -86 TOTAL a TOTAL / 0'�/3
Signature of Applic ntobniractor Date
OFFICE COPY,