16936 POSTTHISCARD NEAR FRONT OF:BUILDING"
- PFRMII NUMBER
CITY OF CUPERTINO.. : '' 16936
INSPECTION DIVISION'
JOB INSPECTION RECORD
[� ,{ PERMIT EXPIRATION
7T "
JOB ADDRESS ~ UPUN IT# _LOT
•PERMIT EXPIRES IF WORK{
OWNER ivl/ n'I 'Q �J".'. CONTRACTOR 2�rS rl 'f �• �•$ �' ' ' IS NOT STARTED VVITHIN;.: -
! INSPECTION I DATE INSPECTOR I INSPECTION RECORD 180 DAYS OF PERMIT ISSU--
]FOUNDATION- "I I NOTE:. ,�• ANCE'OR 180 DAYS FROM
UFER LASTCALLE DINSPECTION.
• I. • ' _I°' ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE I - - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAi10ATIOw
CUPERTINO STANDARDS. '
GARAGE SLABS, C" /' •;
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
i
UNDERGROUND /SLAB `., - .I '�'� I•°
IPLUMBING 'r' ! . ai lytvuc&✓•--'
IEL-ECTRICAL _
( •ISSUANCE DATE
IMECHANICAL I I BLDG E ECr I PLG. ME CH r
El
00 NOT POUR FLOOR UNTIL ABOVE-HAS BEEN SIGNED �UILDING PERMIT
I WOOD FLOOR I INFORMATION
I PLUMBING' I VALUATION SEPT
I .
IMECHANICAL'
. .. !ELECTRICAL �� PI.RMIl TO
.. (FRAMING �f�(ot" .zer
'�� 'II
INSULATION' - °„-I L, .`v ��68 SrCHIES_ TYPE CONSTH•17I
UCC GROUP RES'UNITS
I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I I• I ;
I ROOF. SD IT Fl OUR AH LA To TAI,aCR CacE
NOTE.NO FINAL INSP SHALL BE MADE BEFORE I I r_ -
"�7 IDIAPHRAGM - •,I ! [HE CONSTRUCTION TAX IS PAID
i , BUILDINC.USE
• (ROOF SHEATHING • I ,TES IND CON.. B 'O,nr,±I
APPLY'NO.ROOF ING UNTIL ABOVCHAS'BEENSIGNEO�'['Ct' "FINALS'°•" °''•' "DATE ' <"INSP: I: �' 0 ❑ ' ',�
ASSESSORS PAHCELND.
.,ROUGH• ' ' SAN.q - -
IPLUMBING , I I ELECT.ENERGY
TUBS PAN °I_ } TRACT NOPARCEI NO
I PLUMBING ENERGY I�' ' I -
IMECHANICAL ! ,: , ,.- I. , ,I MECH ENERGY I I
(ELECTRICAL. IBULDINQ ENERGY Acc.Onre ACC FILeNO. -�
!FRAMING - .•I _ I. I ELECT.FINAL TEST. II�• - I I •! .
IINSULATI ON :'I ' IPLUMBING - I I ZONING I ENG SITE NO f
(GAS TEST '':' (GAS
MECHANICAL FIRE STRINK ENERGY T 74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED 'HEATING _ I - I Y El '"� I Y [:3 'N❑
EXTERIOR SHEAR FIAUU ZONE, A,L V C
I ' -IELECTRICAL,RELEASEI�'2n.I,O%-7Y7Y I
INTERIOR SHEAR • I (FIRE DEPT.' •, I / I Y❑ N� I• v L N❑,
'ISHEETROCK" fl ' ' (GRADE
I I FEE SUMMARY
]EXTERIOR LATH (BUILDING
'_ I � 'I"
.(INTERIOR LATH I -TEMPO RARY'APPROVALS euILDINC
ISCRATCH COAT I .I (ELECTRIC I PLAN CHECK
(GAS . Il I FEE' I 'I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED (OCCUPANCY .,� i I+ SEISMIC FEE I'
IOCCUPANCYOF BUILDING IS NOT PERMITTEDUNTI L BUI LDING,F INALIS SIGNED BY BUILDINGINSPECTOR'. MICROFILM
II
ARRANGE FOR INSPECTION BY PHONING 252-4505; I ELECTRIC T77 0I
z ONE WORKING DAY.BEFORE REQUIRED INSPECTION.. I PLUMeivc
PLEASE GIVE.JOB,ADDRESS-WHEN',PHONING. ',
- I
/ �,$ ,' ,• _ —'SEE PERMIT F MECHANICAL.
OR EXPIRATION DATE,— ''•. .•' •� .
IMPORTANT!) ' .•;, . CONST.TAX,,
L; 4.
PLEASE READ REVERSE SIDE BEFORE sg•' ±`-, ��
'CALLING FOR FINAL INSPECTION. ` I 'TOT'AL'
' OFFICE COPY' "
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION ,PERMIT NUMBER
San LDING - APPLICATION & PERMIT ^
ADDRESS `9
1L/J /1�. ((BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNERS v/��7 PLAN CHECK VALIDATION
N ME
TV. ELECTRIC PERMIT-'. FEE
•
Oto PHONE .-' . I
CONTRACTOR S '� -
NAME y OUTLETS-SWITCHES-RECEP 10.00/1.00 ' ,
ZQ S Z :C_ /rr/jhP& uc'NO, �0�97! LIGHTING FIXTURES . : ,10.00/1.00 ,
CONTRACTOR'S
,•a ADDRESS Y (!�] (J/�(��/�/J thG ..II APPLIANCES-RESIDENTIAL, " 4.00 +
V+ 0 �/� PHONE . f 9" /I PANELS : " 10.00__ _ DATE OF APPLICATION 1
ARCHITECT `1 " "' PLAN CHECK FEE P C.NO.
OR PANELS (OVER 200 AMP) 20.00 ><
ENGINEER
.uc rvo _ _ _ I SIGNS TRANS. 3.00 '
ARCH OR ENG. - , PERMIT VALIDATION
ADDRESS I SPECIAL CIRCUIT + 5.001
' zIP
APPLICANT'$ EMP.METER OR POLE INS. 20.001
,
ADDRESS � • ' yn MOTORS ' SEE FEE SCR. ,
_2.1g �9�1 I`7V_C- ( ,� - ./'ISEFIVICE CHANGE '20.001/L• S�,
XH
00 LICENSIiU CCINTRACTOtS U CLARATIO-N PAID :
a <i leommen mg Iw With thad 0001 0l Il,b in r3 of the Bi s ness and
ISSUANCE DATE
i L O �L❑DG E T El I MECH.,
r z PlofeSs,.ns Code,a ly license Ism full for 'nd 1, + 1q e I III JI
z 00. — .-License Cl... Ca Numhe
m� w Date Conirnclor ,�s{-p�• ", -
w - OWNERAWILI DIOLA RATION : J .a city wL CU @ BUILDING PERMIT l
+ I INFORMATION
w ;° N _ I hereby alfum that I am exempt from the Contractors License ' MISC.— .REFER TO ORD ,
LL O j Law for the I'ollawag Icasun (Sec 7031 5,BmincssanJ Profcalons 4 VALUATION $/FT.
L — PERMIT ISSUANCE• '1:'• L •'10.00 I�f1O
Code:Any city or county whichreyui resapermil to construct.alter,
QQ j Q Improve,demolish,or repair any structure,prior to Its Issuance,she ELEC CONTR - 'LIC.NO. ELEC.
DLL reunites the applicant for such permit to file a signed statement that
he Is licensed pursuant to the provisions of the Contractor's License TOTAL 2 y 1 j PERMIT TO
Law(Chapter 9 fcommennngwlth SeLbun 70001nfUsislon 3of the ,��+'7 I.
4 a Business and Professions Code)or that he Is exempt therefrom and OTV.I PLUMBING PERMIT FEE .YI'eL_ X qv^ �.IA
a I-$ the basis for the alleged caepetion.Any violation of Section 7031.5 • •1 STORIES TYPE CONSTR
by any applicant for permit subjects the loucwll penalty) - (ALTER-DRAIN& VENT,-WATER IEA.) 5.00 +11
I not more than fire hundred Jailers(S5001.)applicant 1 '
❑ I,as owner on property, my employees with wages', 'IBACK FLOW PROTECT. DEVICE 4.00
their sole Compensation,will do the work,and the sla Uetme n not - OCC.GROUP I RES UNITS
intended or offered for all(Sec 7043, Businvi nit Professions (DRAINS-FLOOR,ROOF,AREA,CO ND. 5.00 -
Code.'File Contractor's License Low does not apply to an uwner,ol
properly who builds or Improves 0mmon,and who does SUCK work I FIXTURES-PER TRAP 5.001 1 SO.FT FLOOR AREA( TOTAL ACREAGE
'or or through [its own employees,provided that such improve- I]
ments are not Intended or offered for sale.If,however,the huddling GAS-EA.SYSTEM-11NC,4 OUTLETS 6.001
/ or Improvement S'sold within one year of completion,the owner
hullder will hove the burden of proving that he dad not build or on, GAS;EA.SYSTEM-OVER 4 (EA.) 2.001 BUILDING USE
- RES ND CON PB Other
prove 1,as owner of the INDUSTRIAL WASTE INTER. 30.001 • ❑ ❑
❑licensed as owner of the property,con exclusively contracting
Buswith _ -
arid Pro contactors to construct the project(Sec 7044,Business I LAWN SPRINKLERS:1 INC 5 V.B! 6.001 ASSESSORS PARCEL N0.
and Professions prove The Contractor's's improves Law does
eon.an apply
totrowner al property who
will.cotrimprovesensedp,and who LAWN SPRINKLERS-OVER 5IEA.Ii 1.001 I - • ,
line Contractor's for such projects with a cnntracturl sl licensed pursuant In
the Contractor's License Law I SEWER-SANITARY-STORM EA,200f1/10.001 TRACT NO PARCEL NO
❑ I em exempt under Sec. i B.kl'C.I'nrbn^
reason WATER HEATER W/VENT' ' 6.001
•�
Owner " Date WATER SYSTEM. 5.001 ACC.DATE ACC FILE NO
WORKERS'COMPENSAT'ION DECI RATION- WATER TREATING EQUIP. 5.001
I hereby uflum (hat I have a cerllhcale ul conunl to sell-1111.X: •. ZONING ENG.SITE NO.'
or a certificate of Workers'Compensation Insurance,or a Combed
therenl(Sec 3900,Lah.C.I:
Policy No. Company
Q ❑ Cetldac shereby fur d. � E 4 I FIRE SPRINK ENERGY T-24
Z 2 ❑ Cerhh ip s (fed to inspechmi do'son
f- O • Applicant y - � MISC.- REFER TO ORD. 'i'-•Y N0 Y ❑ N]
V) PERMIT ISSUANCE ' 10,00
CIiRTI PICA'I'E 0P ESIiMPTION PROM WORKERS' ' FLOOD ZONE A t u a
W — COMPENSA'PION INSURANCE I PLO.CONTR LIC NO I PLC.
n° 0 • n
(Thu section need ot be completed If lb' peon t,Is tar one TOTAL Y[D NC] Y El ,' NC]
•htmdred dollars l$1001 or less
U O ) - ,
.1 certify Dial In the performance(it the work for which this per. CITY MECHANICAL PERMIT I FEE FEE SUMMARY
LL I— con Is issued,I shall not employ any groan a any manner a,as to
O W hecomc subject to the Workers'Compensation Laws of Calitnnua. "
o. Date Applican' 5.00 BUILDING _
} N NOTICE 10 APPLICANT If,after
m ALTER OR ADD TO MECH. "
aking this Certificate of Ex-I-- 1 '
f" ? urnpbnn,You should become subject to the Workers'Compensation APPLIANCE ._ 5.001 ,1 PLAN CHECK ,
provisions of the Labor Code, you must forthwith LOmPIY will] FEE
U such provisions or this permit shall he devoted revoked - AIR HANDLING UNIT(TO 16=C.F.M.1 4.00
CONSTRUCTION LENDING AGENCY I - IAIR HANDLING UNIT(OVER 10=C.F.M.) 6.001 SEISMIC FEE
1 hereby af0in, shut th,iv is a ,mu4,c,tlfm lend ding;agency for EXHAUST HOOD (WITH DUCT) -5.001
the perfounadce of the work'or which thus permit is¢sued(Sec , MICROFILM
3097,Co c I. ��,� HEATING UNIT(TO 100,000 B.T.U.) 8.001 I ,
Lender's Nam" - I (HEATING UN IT(OVER'100,000 B.T.U.)9.501 / I ELECTRIC 41 wI
Lenders lxar e- =
I ceNlty that 1 have read this application and slate that the above VENTILATION FAN (SINGLE)' 4.001
Information is correct. I agree to comply with all city and county BOILER-COMP13 H.P.Or 100,000 B.T.U.) 6.001• PLUMBING
ordinances :and Stale laws relabnp In budump construction, and 1I
hereby iathonm representatives of this city,to enter upon the, (Over 100,000 BTU(SEE FEE SCH I; I MECHANICAL 'I
above-mentioned properly for inspection Purpoxs '
(We) agree to save,indemnify and keep harmless the City 011- MISC.- ° REFER TO ORD. "
Cuperti st I bdnies,judgments, costs and expenses which PERMIT ISSUANCE CE v 10.001 ' CONST.TAX
nr m any y accrue age ast stud CITY in consequence of tlm
ra o Is permit �..D. MECH CONT LIC.NO. MECH
/ � /L��� TOTAL . ,I TOTAL 2 y E01
L-signature of Applica an Cdn�__tmctor /Date
OFFICE,COPY '