15186 POST THIS CARD NEAR FRONT OF BUILDING
_ .! PERMIT NUMBER
CITY OF CUPERTINO 151 $6
,' INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS' . 1.0407 )kven1C1d-, LdriO. UNIT# LOT#
.PERMIT EXPIRES IF WORK'`'
OWNER ... Z( tines Sedy CONTRACTOR ' ' • ,tF r IS ,;NOT STARTED;WITHIN
INSPECTION DATE •I INSPECTOR INSPECTION RECORD - ?ao;oAvs.oFPERMIr.Issu
FOUNDATION - - ANCE OR.180 DAYS FROM .,
NOTE: ": LASTCALLED INSPECTION.
UFER. ` - - - .ALL'GRADING AND DRAINAGE SHALL BE INSTALLED ,'
PR EGUNIT,E .TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PEHM,r vnuonn oN
CUPERTINO STANDARDS.
GARAGE SLABS -
d,
POUR NO'CONCRETE UNTIL ABOVE HAS BEEN SIGNED •, ,�- j � 1,1.1 ;�'_.. ,
- UNDERGROUND /SLAB '
PLUMBING
-
.
PAISSANCDATE
UAV I
MECHANICAL, o- - RLOG. ELECT PLG. MEcw
. , DO NOT POUR FLOOR UNTILABOVEHAS BEEN SIGNED ; Of Y Ll
INFORMATION
PERMIT,
.pp ATION .
UATION` 11FT.
WOOD FLOOR.' Wi tY.
- PLUMBING ' I 1 :-
MECHANICAL
PERMIT TO
ELECTRICAL ` � ,T" { -
FRAMING..
STORIES ,TYPE CONSTR
INSULATION, -
OCC,GROUP • RES UNITS'
PLACE NO SUBF,LOOR UNTIL ABOVE HAS BEEN SIGNED -
56 FT,FLOOR AREA ' TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
.!THE CONSTRUCTION TAX IS PAID
DIAPHRAGM -
' 9U RUING USE -
ROOF SHEATHING. - °! - RES IND CON PR Om,., I
APPLY.NO ROOFING.UNTIL ABOVE HASBEEN=SIGN ED? .., , L L E L ASSESSORS PAHCEL N
O P
ROUGH = SAN.#
PLUMBING " ELECT.ENERGY ,
TUBS&SHOWER PAN - PLUMBING ENERGYTR nr.7,No PARCEL No
MECHANICAL - MECH.ENERGY. I j po .
• ELECTRICAL , BUILDING ENERGY' "Acc.OnTe Acc FRE No. I .
�. FRAMING ELECT.FINAL TEST - ZONING
ENG s,1e No. '
INSULATION - - PLUMBING
GAS TEST _ Y.., GAS -
ITHE SPRINK ENERGY T 24
' < MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED` HEATING ' .j0 Y•[] �-N L 'Y L IN
FLOOD ZONE -ATT C
EXTERIOR SHEAR ELECTRICAL RELEASE -
INTERIOR SHEAR FIRE DEPT.. - - v NL YL, NL
SHEETROCK GRADE` ` _ FEE-SUMMARv
EXTERIOR LATH ! BUILDING %� (_ I r
IL
BUILDING
INTERIOR LATHT.EMPORARY`APPROVALS `
SCRATCH COAT ` ELECTRIC PLAN CHECK - j
_ GAS a .. FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ,
OCCUPANCY OF BUILDING IS NOT PERMITTEDUNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR.
.. MICROFILM"
ARRANGE FOR INSPECTION BY PHONING 252-4505 ECECTRic'
Lu� ONE WORKING DAYeBEFORE REQUIRED.INSPECTION. PLUKnBING
i o PLEASE GIVEJO,B ADD'RESS,'WHEN PHONING
GiMECHANICAL
— SEE PERMIT FOR EXPIRATION DATE.
IMPORTANT!, CONSTrnx
PLEASEAEAD REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. `
:,'OFFICE COPY :.0
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY _
BUILDING PROJECT I DENT]FICATI ON .PERMIT NUMBER
aOILpING APPLICATION & PERMIT .- A �` ^ /''1
ApoREss I 5 1 ,}S 6
/ps10,7 j-�✓e.�ida 4�o� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL -. VV VlJ
GwNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE ,
�• _75-meS .Sea PHONE 1?57-769/
CONTRACTOR'S
N E OUTLETS-SWITCHES-RECEP 10.0011.00
=17e ar 5&v3Uo530
(,r Llc.No LIGHTING FIXTURES 10.00/1.00
CONTRACTO S,
A.DAESs /nr' / APPLIANCES'-RESIDENTIAL 4.00 '
�R.q &rnmeveT�l ST PHONE 01/p LpD?. J/f, PANELS 10.00 DATE OF APPLICATION
AHCHITECTT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE "P.C.NO.
OR
ENGINEER
LIC No. SIGNS TRANS. 3.00
ADDRESS Sea. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS
MOTORS SEE FEE SCH.
ADDRESSSERVICE CHANGE 20.00 a Se 2i
Hoo LICENSED CON'T'RACTORS DECLARATION ,
Q U I hereby affirm that I an licensed under provisions of Chapter 9 ISSUANCE DATE'
H w
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H H i Professions C le adm reuse is in mbar my un elle k ❑ ❑
z o m - License la - - ic.Number
4 m w Date. � Com etLa
IF ¢W a OWNER-BUILDER iC RA I BUILDING PERMIT
° MISC.- REFER TOO INFORMATION
X g LL y 1 hereby affirm that I um exempt from the ,for is icense -
u_o¢ Law(or the following reason.ISec.7031.5,Businessand Professions =19QQL=UATION $/FT.
h W 0PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
Q La¢ 0 Improve,demolish,Or repair any structure,print to its ISfiIDnce,also ELEC.CONTR. LIC.N0. ELEC. ty OIt CU,
i w m, requires the applicant for such permit to file a signed statement that TOTALPERMIT TO
he is licensed pursuant to the provisions of time Contractor's License �s,t 1
H z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofihe ME
µ-
4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE -4. I 1
¢ H $ the basis for the alleged cxemplion.Any violet ion of Sect ion 7031.5 STORIES TYPE CONSTR.
u 3 by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 5,00
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 OCC.CROUP RES.UNITS
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 Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-i INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2,00 BUILDING USE
prove for purpose ofsale.). RES INDUSTRIAL WASTE INTER. 30.00 ❑ I❑ ❑N ❑ 0❑r
❑ d as owner rs the property,be exclusively Se contracting with
licensed contractors to construct Ibe 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 aim owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a conlractor(s)licensed poniard to
the Contmctor's License Law. SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO, PARCEL NO.
❑ Iamexemptunder Sec. ,B.&P.C.I'or Nis - WATERHEATER W/VENT 6.00
reason
owner Date WATER SYSTEM 5.00 ACG GATE ACC.FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby,affirm that 1 have acertiflcaleofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy there f(Sve 38 {{..,�tt CI 11
Polic No� �illlany uSF jr '
0 Certified copy is hereby famished. - - FIRE SPRINK ENERGY T-Z4
Z Z Curti '�d copy to d evi the 'ty inspe tion Division.
Fp Applicmmt MISC.- REFER TO ORD. YE] N❑ v ❑ N❑ �
Z, CER IFICATF-OF E EMPTI FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. - LIC.N0. PLG.
1 O •(This section need not be completed if dire permit ix for one TOTAL Y❑ NC] Y E] No
0Z hundred dollars or lass)
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any manner so as to
O Wbecome subject to the Workers'Compensation Laws of California. -
y Data Applicant ALTER OR ADD TO MECH. S,pp BUILDING
>- Z NOTICE TO APPLICANT'. If,after..making this Certificate of I'. -
- emption,you should become subject to the Workers'Compensation APPLIANCE 5 00 PLAN CHECK
provisions of the Labor Code, you rmst forthwith COGIPly with FEE
U such provisions or this permit shall he deenmd revoked. Alfl HANDLING UNIT(TO l0,Op0 C.F.M.ICd .00 _
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000GEM.) 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.C.). HEATING UNIT(TO 100,000 B.T.U:) 8.00
Lender's Name Lender's Address HEATING UNIT(OVER 100,000B.T.U.)9.00 � ' ELECTRIC
. 1 certify that I have read this application and state that the above: VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and County BOILER-COMP13 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives lot
otiins of this city es enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby
above-mentioned property tativesp ofth i purposes.
(We) agree to Save, mile..mify and keep harmless tie City of MISC.= REFER TO ORD. -
uperlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE a I CONST:TAX
I
y in any way accrue against Said City in consequence of the rV
ming of thleunnit. MECH.CONT. LIC.NO. MECH.
TOTAL j� TOTAL
t S' allure of Applic nt/Contmc ir Vale I
OFFICE COPY .
CONTRACTOR'S DECLARATION
BUILDING PROJECT IDENTIFICATION
lding
dress /0'/07 h✓eolda- /a✓le
owner' s oi59- 7
Name `TmeS 523 Phone:
Contractor' s
Name /-101re DiSee"Irl- &6-/-,r? A C ShC - Lic. No. : �3UOS3d
Contractor' s
Address 3Aa Cot-nmercr'a/ S7', ,. S,2,7 � se 9Si/d— Phone:
Architect or
Engineer Lic. No. :
Arch. or Eng.
Address Zip:
Applicant's
Address Zip:
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class . C-;;T0 ',C-3B 0-S/.3 Lic. Number &0053 0 n ��
• Date §-11shu Contractor=t eGOO� //ems-�/ZvJ
MMER-BUILDING DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following ;reason.
(Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
construct, alter, i.mnrove, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licensed
pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with
Section 7000) of Division .3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than five
hundred dollars ($500) .) :
I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the
building or improvement is sold within one year of completion, the owner-builder will have the
burden of proving that he did not build or improve for purpose of sale.) .
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code : The Contractor's License
Law does not apply to an owner of property who builds or improves to the Contractor' s License
Law.
101 am exempt under Sec. B.&P.C. for this reason
Owner Date
FD 30