16055 ' ,P,.OSTTHIS CARD NEAR FRONT. OF-BUILDING ,, PERMIT NUMBER. i
k ,
INSPECTION DIVISION
JOB INSPECTION RECORD
-•. PERMIT EXPIRATION '
JOB ADDRESS 7SZ -=�/�^�"-7 •UNIT# LOT# - '1
A PERMIT-EXPIRES'IF WORK I
OWNER i21 '/ y. '1 coNTRnci62 • �/,('Cy.� fir•' IS. NOT STARTED'WITHIN
INSPECTION . DATE INSPECTOR- INSPECTIO RECORD. 180 DAYS OF,PERMIT ISSU- i
FOUNDATION
ANCE OR 180 DAYS FROM
- ,NOTE �' _ i• 'm
UFER ' - (':. ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALIEDI NSPECTION. ,
TO COMPLY WITH THE APPROVED PLANS AND CITY OF, YPLRMIT.VALIDATION
PR EGUNITE CUPERTINO STANDARDS. • -
GARAGESLABS -
-POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ',. ., T
UNDERGROUND /.SLAB + . '' •'
PLUMBING,.
ELECTRICAL " '• ° ISSUANCI'.DAie. '
MECHANICAL x777 L eT PLG. 'MEC.
❑ ❑ .❑ ❑
DO NOT.POUR FLOOR UNTIL-ABOVE-HAS BEEN SIGNED `^ - ,BUILDING PERMIT
WOOD FLOOR - ' INFORMATION
PLUMBING
„ VALUATION $LFT.
- � '�
�.
p MECHANICAL`.'P - '''
ELECTRICAL PERhuT TO
FRAMING
INSULATIONrygf4 E5 '•TYPE CONSTR.
OCC F�N�UP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •G1tYD �Op6 -
il
511,'F T.FLGCR AREA TOTAL ACREAGE'•
I - ROOF - NOTE.'NO FINAL'INSP.'SHALL'BE MADE BEFORE
c DIAPHRAGM r THE CONSTRUCTION TAX IS PAID '
RUILDIND USE
ROOF SHEATHING" . - - RES IND L CON •PB 0.1"'. 1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. R
0 1]"- Q 'L ❑ -1:1
- ROUGH -' SAN,# .'1 .. - - ,nssessoasP CEL No,
PLUMBINGELECT.ENERGY
TRACT NO. PARCEL NO.,
TUBS 8 SHOWER`PAN .F - ,PLUMBING ENERGY r
MECHANICAL MECH.ENERGYz:
.
. ELECTRICAL � BUILDING ENERGY ACC.DATE ACC,FILE NO..
FRAMING _ ELECT.FINAL,TEST
INSULATION ZONING, ENG..SITE NO,,
PLUMBING
GAS TEST GAS -
FIRESPRINKENERGYJ.24
' .MECHANICAL, -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ^� ' ° p NO
' EXTERIOR SHEAR • ELECTRICAL.RELEASE � ', -1
FLOOD ZONE A,L'U,C:
INTERIORSHEAR FIRE DEPT. ❑ -`'❑ N[]
I - SHEETROCKGRADE
FEESUMMARY
EXTERIOR,LATH BUILDING. ' ,
INTERIOR' LATH •TEMPORARY APPROVALS BUILDING `• '
SCRATCH COAT ELECTRIC `E •PLAN CHECK,,
FEE '
NO.TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY L SEISMIC FEE
` OCCUPANCY•OF BUILDINGTSNOTPERMITTED UNTILBUILDING FINALISSIGNED BY,BUILDING INSPECTOR: MICROFILM
Lu
,. A"R RANGE FOR INSPECTI,O_N BY PHONING 252:4505,. ''` ELECTRIC
F�. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE RERMIT'FOR;EXPIRATION DATE - MECHANICAL ,
` ' CONST.TAX
. `'IMPORTANTf'. '. '
PLEASE READ REVERSE'SIDE BEFORE TOTAL
.CALLING FOR FINAL INSPECTION:
— OFFICE COPY
APPLICANT TO FILL IN.INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION 'PERMITNUMBER
' B'LDING APPLICATION& PERMIT 1' q •�
41 1��1/Z�/�!lsa, I U 51
A E BUILDING — ELECTRICAL—PLUMBING—MECHANICAL Q0[�
j1�
OWNER'S - PLAN CHECK VALIDATION
NAMEyy�x ^� V. ELECTRIC.PERMIT FEE' a
I U Y� ��A'Z—I u 0 GHONI _d/I .
CONTRACTOR OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
1IL40Puc,NO_ LIGHTING FIXTURES' 10.00/1.00 .,
CONTRACTORS 'APPLIANCES-RESIDENTIAL 4.00
ADDRESS
L h PANELS IO.00 DATE OF APPLICATION'^
ARCRI Eci - PLAN CHECK FEE .C..NO.
OR PANELS (OVER 200 AMP) -20.00
ENGINEER' LIC.No, ISIGNSTRANS. 3.00
AARC
DDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPucANrs l MOTORS - SEE FEE SCH. -
AOOREss
i 422, SERVICE CHANGE20.00 - p �
00 LICENSED CONTRACTORS DECLARATION z 1—r/
1 G
a v 1 hereby uDtoo that 1 am licensed Ruder provisions W Chapter 9 - ISBl1ANCE DATE — -
H G m (commencing with Section 7000)of Division 3 of the Business and1,10J - - BLDG. ELELT. PLG. MECH.
H w z License CaC I 'c se is in full for ct ❑ O ❑
z o — License Clus. Lia Number
-.o - F o Data s[�-aS Contractor
a m V - UJ BUILDING PERMIT
a OWNIi R-R UILDF.R DECLA A'il0 '
a o
po - INFORMATION
X g LL I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
a, LL o a Law for the following reason.(Sec.7031.5,Rusinessand Prodfinoions PERMIT ISSUANCE 10.00 VALUATION
i as Code Any city or county which requiresa crinit to construct,alto
ac a a p improve dem li'h,or repair any structure,prl h t its EsUa n e,also ELEC.CONTR. LIC.NO. ELEC. -
w
g wo rc n;y mn.a Ilse applicant for such permit to filo a signed that TOTAL - PERMIT To
$ he Is licensed pursuant to the provisions of life Contractors License
Low(Chapter 9(commencing with Section 7000)of Division 3 of the i �•
f 4 o Rosiness and Professions Code)or that he is exempt therefrom mad QTY. PLUMBING PERMIT' FEE
H o the basis for the alleged exemption.Any violation al Section 7031.5 + STORIES TYPE CONSTR
u ; E by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN (EA.) 5.00
of not more titan -
an five hundred dollars(5500).): -
❑ I,as owner of the property,or my.employees with wages as BACK FLOW PROTECT. DEVICE 4.00 ace.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044. Business and Profession DRAINS-FLOOR,ROOF,AREA,CONO
Code:'fife Contractor's License Law does not apply to an owner of p
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 U SG.FT.FLOOfl AREA TOTAL ACREAGE
G himself or throughhis own employees,provided that such improve-
mentsarenotintended or offered for sale.If.however,Ilia building GAS-EA.SYSTEM-I IN "TL
6. 0
I or improvement is sold within one year of completion,tae owner. GAS-EA SYSTEM-OVER 4 (EA. }.00 li
builder will have the border of proving that he did not build or Im- \ BUILDING USE
prove for purpose If sale;l. RES IND CON PB ORE.,
INDUSTRIAL WASTE INTER. 30.
❑ d as owner of the property,he exclusively contracting with -
.. licensed contractors Cod tD construct the project ISec.7044,of apply
LAWN SPRINKLERS- 1 INC 5 V.B. .00 ASSESSORS PARCEL NO.
and professions Code:The Contractor's License Law docs not apply -
to an owner of pmpetTy-who builds or improves Iheremh,and who LAWN SPRINKLERS:OVER 6(EA.) ' 1.00
anomets such projects with conlracmAsl licensed puecuunl lu -'
the Cnntrnnclctor's License Law. . SEWER-SANITARY-STORM EA.200ft/10.00 ' TRACT No. PARCEL NO.
0 I3na exempt under Sec. ,R.&I!C.bn IN, WATER HEATER W/VENT 6.00 '
reason
Owner Date WATER SYSTEM -660 PCC.DATE - ACC.FILE NO.
WORT:ERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofcnnsent to self-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
ropy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished.
��
Z Z ❑ Certified copy is filed with thFIRE SPRINK ENERGY T]4e city inspection division. MISC.- REFER TO ORD.
Q Applicant '' y CD NC] y CD NE]'
cc y CERTIFICATE OF 19XI-MPTION FROM WORKERS' PERMIT ISSUANCE 716:60 a FLOOD ZONE A.L.O.c.
UJ > :rpMPENSATION INSURANCE: G.CONTR. LIC.NO.; PLG. y❑- N❑ y❑ O
CL Z (this Section need not`be completed if the permit is for ne - TOTAL c—__ N
hundred dollus($1001 rlSx)
L) O 1 certify that In theperformance of the work for hI h t . per FEE SUMMARY
LL F I'll is issued,I shall not employ any rson Ana h her a as m DTV. - MECHANICAL PERMIT 'FEE -
Ow b n h'c�,�,yr i Workers'Co pas n w. fj'' rola
C. D t -+ 7CAI plicant C. is.
ALTER OR ADD TO MECH. 5.00 ' BUILDING
} y NO CI 1'0 I 1 ICAN't If aft r maki t . G I I' me of FS -
F Z_ emption,you should become subject to the Workers'Compensutiun APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith cannily with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00
.. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.FM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
One 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
Leader',bloat HEATING UN IT(OVER B.T.U.)9.50
Lender's Address ELECTRIC
I cattily than l have read thisapplication and state that theabove VENTILATION FAN (SINGLE) 4.00
s information is correct I agree to comply with all city and comely g01LER-COMP(3 H.P.Df 100,000 B.T•.U.) 6.00 PLUMBING ,
ordinances and slate laws relating to building conslruchoo, and
hereby entioned roperty for ins of This city es soler upon NoallovenBOILER-COMP,,(Over(00,000 BTU)SEE FEE SCH. MECHANICAL
hereby entioned'prepresc for inspection purposes.to
(We) agree to save, indemnify an keep berm lens the City at MISC.- REFER TO ORD.
Cupetlim against liabdithes " gme costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
Ely in any wa u gaanst s "City in consequence of hi -
rmhtin is rn J MECH.CONT: - LIC.N0. MECH.
.Y. .'i TOTAL .' TOTAL
Signa urn of Applicant/Contra for
Date -
r '` OFFICE COPY