16743 POST THIS CARD NEAR FRONT OF BUILDING ' "
.1 PERMITNUMBER
CITY OF #CUPERTINO 1574
INS PECTION,DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS_�T`5 �+FhSTc��L �C.,�/ -+ UNIT.# _LOT#
PERMIT EXPIRES IF WORK ;
CONTRACTOR .�'"—•�-cy�r• ,wtIS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD Rae DAYS OF PERMIT ISSU-'i
FOUNDATION ANCE"OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION. '
h UFER , ALL GRADING AND'DRAINAGE.SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAL.I NATION,
CUPERT[NO STANDARDS.,
GARAGE SLABS - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - , . J(�` yr?~• r�al
UNDERGROUND /SLAB , "
PLUMBING
ELECTRICALIssuArucEunre,
MECHANICAL - - - 'n Loc. ELECT. P,.G. ,MECH '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN.SIGNED BUILDING PERMIT
WOOD FLOOR .. INFORMATION
PLUMBING .. `"w VALUATION SIFT.
MECHANICAL - - 4 y
. . ELECTRICAL
FRAMING
INSULATION Rles T PE CONSTR.
Cit
• - .. _ OCC.GROUP RES_UNITs
PLACE'NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - '...,.
ROOF - - SO.FT,FLOOR AREA,_ TOTAL ACREAGE'
NOTE:NOFINAL INSP.SHALL BE MADE BEFORE F
,•, DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOFSHEATHING - - " BUILDING USE
' Res IND -CON :Pe QP—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS "DATE „ Y`. INSP. ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO -
ROUGH SAN.n "
PLUMBING ELECT.ENERGY•
RGASTEST
OWER PAN - PLUMBING ENERGY TRACT NO, PARCEL NO
CAL MECH.ENERGY
CAL BUILDING ENERGY - ; ACC,DATE. Acc,FILENO .
ELECT.FINAL TEST
ON PLUMBING O ZONING • ENG.SITE NO.
- GAS `
MECHANICAL EIRE SPRINK' ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED " HEATING - 'Y ❑ N❑ ` ❑ . N❑
EXTERIOR SHEAR ELECTRICAL RELEASE .. FLOOD ZONE A.I.UC..
INTERIOR SHEARFIRE DEPT. YE N❑ ° ❑ NO
SHEETROCK . _ GRADE FEE,SUMMARY . '
` - EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC '• ' PLAN CHECK,,'
GAS, FEE-.
- ' NO TAPE.OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY--. SEISMIC FEE ' ?
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM i
ARRANGE FOR INSPECTION BY•PHONING 252-4505,• ELECTRIC,
z ONE WORKING DAY BEFORE REQUIRED,INSPECTION PLUMBING
PLEASE GIVE JOB.ADDRE$S WHEN PHONING
— SEE PERMIT FOR EXPIRATION DATE -. ' . _ MECHANICAL
IMPORTANT! CONST.TAIX .
PLEASE READ REVERSE SIDE BEFORE !
CALLING.FOR FINAL INSPECTION. TOTAL 0 ,I
OFFICE COPY- .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES_ = USE'BALL POINT PEN ONLY
• BUILDING PROJECT IDENTIFICATION .- 'PERMITNUMBER
BUILDING APPLICATION & PERMIT
ADREES BUILDIN° ss - �/ '<� ". - ` $try ^
/7 SS - (�'L� •, G.'ELECTRICAL-PLUMBING-MECHANICAL16743,
. •
OWNER'S -
NAME PLAN CHECK VALIDATION
�y
MAI 1 5'ryV.Z�Cf`' "J5-3,5'7S�: QT�'. ELECTRIC PERMIT FEE
Q PEON
CONTRACTORS
F
NAME • 4 �1 OUTLETS-SWITCHES-RECEP 10.00/1.01
S7-?Ue A1iowSK LID NG''.Y S�o9S —
y,LIGHTING FIXTURES "10.00/1.00
7., CONTRACTOR$ - APPLIANCES-RESIDENTIAL 4.00 .
ADDRESS
PANELS
PANELS IO.00 DATE OF APPLICATION'
OgcHrecr, - PANELS (OVER 200 AMN 20.00 • PLAN CHECK FEE P.c.NO.
ENGINEER ♦ - ^. '
' ' uc.NO SIGNS TRANS. '3.00ARCH OR
'
A DORESS fNG - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR.POLE INS. 20.00 �--
r ARSNrs - - MOTORS SEE FEE
ADDRESS , \
SERVICE CHANGE 20.00BE
,0 ° LICENSED CONTRACTORS DECLARATION.
a u U '1 hereby affirm that 1 am licensed under Provisions of Chapter 9 ISSUANCE DATE
z "' (commencing with Section 7000)Of Division 3 of the Business and
BLp� LECT: PLG MECH.
Professions Code d my license is in full fore ff - no��1
z o w - License Class LI Number ��6 try-1 '
o y r Date H-3-16_L,aContractor L, K L..1_
rcsein ¢ OWNER-BUILDER DECLARATION - BUILDING PERMIT
° a" MISC.— REFER INFORMATION
X 3,-�U I hereby affirm that 1 im.exempt from the Contractors icense TO ORD
. F LL o J Law for the following reason.(Sec 7031 I.S.tlu nness and Professions PERMIT ISSUANCE' ' •1$00 t� J r✓ �VALUATION $/FT.
Code.Any city or county which req iresa permit to construct,alter,'
K sc p improve,demolish,Or repair any Structure,prior to its Issuance,al$o ELEC.CONTR, LIC.NO. ELEC. G /
° LL requires the applicant for such permit to file a signed statement that - �O �- T
w m
he is licensed pursuant to the provisions of the ContnmTOTAL PER MIT
License _
-H z ¢ Law(Chapter 9(commenting with Section 7000)of Division 3 ofthe
E ° Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE'
.KHm the basisforthe alleged exemption.Any violation of Seclion7031.5 �• - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
or not more than rive hundred dollars($500).)i
_ 1 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT..DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sce. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to as owner of
property who builds Or improves thereon,and Who docs such work. FIXTURES-PER TRAP �- 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own em Plnyces,provided that such improv
meets ine'not intended or offered for sale.If,however,the'building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 .
or improvement is sold within one year of coal plelion,-the owner-
' builder will"have the burden'Of Proving that he did not build or ire- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 - BUILDING USE
prove for purpose of sale.). " INDUSTRIAL WASTE INTER3000 'RES IND CON PB Omer
❑ -I,as owner of the property,am exclusively contracting w . .
ith 'O
licensed contractors to construct the project(Sec. 7044,Business ' LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions Code:The Contractor's License Law dons not apply to an owner of property who builds or improves Hereon,and whoLAWN SPRINKLERS-OVER 5(EA.) '-1.00 _ I
contracts for such projects with a contractor(,)licensed pursuant to
the Contractor's License Law. •
, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
- o lam exempt under Sec. ;R.&P.C .for this
reason WATER HEATER W/VENT .6.00
'
- OwnerDare WATER SYSTEM '5.00 Ace.DATE ACD.FILE No.
�l % WORKERS'COMPFNSATION DECLARATION' WATER.TREATING EQUIP. 5.00
I herchy affirm that I have o certificate cf consent beet Ginsure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
IN copy thereof(Sec.3900,Int, .). ��f).I���s/.
A Policy No. Company 1'C
Q ❑ Certified copy is hereby furnished. FIRE$PRINK ENERGYT-24
Z Z� D Certifi cop is fele p ity s tI n division:
� O - Applicant'' c t v.0 MISC.-', REFER TO ORD. .- Y [] 'N� ,Y ❑ N[]
cc to CERTIFICATE OF EXEMPTION FROM WOR ERS' PERMIT ISSUANCE FLOOD ZONE A.I..U.C.
`.Ed > 'COMPENSATION INSURANCE PLG'.CONTE. LIC.NO.CL PLG. t,
Z,- '(This section.need not be completed 1f the permit is Fill out. ` - TOTAL Cl—v V❑ N,� V. N
U O hundred dollars($100)or less.)
I certify than in the perfornnance of mework for which this per CITYMECHANICAL PERMIT FEE FEE SUMMARY
LL U.C„ mit.Is'issued,I shall not employ any person in any mamnerso as to
-,
C)(L) become subject to the Workers'Compenmtion Laws of California.
y / Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
}-m_ NOTICE.TO.APPLICANI'
: If,after ,taking this Certificate of F:x-
F Z volition,you should'become subject to the Workers'Compensation APPLIANCE _ 5.00 PLAN CHECK
' provisions of.the,Labor Cade, you must forthwith comply with FEE `
U "" such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00
CONSTRUCTION LENDING AGENCY' ., AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE
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,Civ.CJ. i HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name ,,NN
- Lender's Address " HEATING UNIT(OVER 100,000B.T.U.0.50 ELECTRIC
Icertify'that l have read this application rind state that the above VENTILATION FAN (SINGLE) •4,00 '�
information is correct I agree to comply with all city and county PLUMBING
�'- ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,0008.T.U.) .6.00
hereby a UlORLe.repoeCmtatives of this city,to enter upon the 'BOILER-COMP(Over 10.0,000 BTU)SEE FEE SCH. MECHANICAL
chane-mentioned property I'or inspection purposes.
(We) agree to save, Indemnify and keep•hur'ndess rho City of MISC.- ` - REFER TO ORD. _
aper' t liabilities,judgments, costs and expenses which CONST.TAX
may .any'wh�-e a against said City in consequence of the PERMIT ISSUANCE � � -IA:BB � � '
Ianling o emm�. - MECH.CONT. LIC.NO. MECH.
TOTAL l6 5 -TOTAL 6 7
Signature o(APPlican[ oil coon " Dale
OFFICE COPY