15695 . ;'. POST THIS CARD NEAR`FRONT OF•BUILDING
PERXIIT NUMBER
"CITY ,0F LUPERTINO .. `° - 15695
INSPECTION-DIVISION: „•-
'
JOB INSPECTION RECORD '
r/��,, p. PERMIT EXPIRATION
JOB ADDRESS��lS76 ./�:'�"e�✓���7 �L UNITW •LOTo
+ PERMIT EXPIRES IF WORK%
i - ! tr � :c -7O . N .•;OWNER. A CONTRACTOR' TH
I SPECTION DATE INSPECTOR INSPECTIOWRECORD 80 DAYS OF PERMIT ISSU-
ANCEOR I
180 DAYS,FROM !
FOUNDATION- r •NOTE: "
- LASTCALLED INSPECTION.
LIFER - ALL GRADING AND DRAINAGE SHALL,BE INSTALLED
TO,COMPLY WITH THE APPROVED PLANS AND CITY OF• - PERMIT VALIDATION.;;
+ ,r PR EGUNITE 1 - CUPERTINO STANDARDS. ' ,
GARAGE'SLABS : •.
FOUR NO,CONCRETE UNTILABOVE HAS BEEN SIGNED -
' UNDERGROUND'/SLAB
PLUMBING•'..,
" - ELECTRICAL - ' ', IssunmcEunre
MECHANICAL. BLDGT ELECT. PLG MECw
t F PPao � �.�&
00 NOT.POUR FLOOR UNTIL.ABOVE HAS BEEN SIGNED '- au1LDING PERMIT
` ; s• INFORMATION'"
$/E
'WOOD'F LOOR : 1. oLunnoN - T.
PLUMBING' ,
MECHANICAL
ELECTRICAL PEHMITTO
FRAMING . . - Al ov,'+J•`J -L`d;'
STORIES TYPE CONSTH. .
INSULATION-
OCC,GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
1. .
-+ .ROOF � � NOTE:NO FINALINSP.�SHALL BE MADE BEFORE SO 1-T (LOOR AREA TOT AL ACEIACE
DIAPHRAGM THE CONSTRUCTION TAX IS•PAID .•
_ BUD.DING USE.
ROOF SHEATHING RES- IND CON PB _ OI,„,
APPLY NO,ROOFING UNTIL-ABOVE HAS BEEN SIGNED. FINALS,.. DATE ,INSP.• ❑ E' ❑ ❑ ' ID
ASSESSORS PARCEL NO.
RCUGH' SAN.#”
PLUMBING' - ELECT.ENERGY '
TRACT Nor PARCEL NO.
TUBS&SHOWER PAN- PLUMBING ENERGY - -
MECHANICAL .- ' + MECR.ENERGY
ELECTRICAL•:' BUILDING ENERGY ACC DATE ;.Acc.PILE No
FRAMING - - - 6 ELECT.FINAL TEST '
ZONINf, ENG.SITE N0.
INSU CATION c , - PLUMBING -.
GAS TEST.:..
MECHANICAL • " EIRE SPRINK ENERGY T-24
,77COVERAO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, Y N[:] NEI
. - EXTERIOR SHEAR.. ELECTRICAL RELEASE - ,, Y O, "❑ Y ❑ N❑
INTERIOR:SHEAR +'. FIRE DEPT.
'. SHEETROCK; GRADE FEE SUMMARY
EXTERIOR LATH s - , BUILDING BUILDING
INTERIOR LATH,:•'�. " - - ''. TEMPORARY APPROVAL -
SCRATCH COAT : . _ ELECTRIC - PLAN CHECK,
GASFEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1 -
OCCUPANCYOFBUILDINGIS,NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTORS "MICROFILM :
ARRANGE FOR-INSPECTION BY PHONING 252-4505, ELECTRIC
LU
~� ONE WORKING DAY.,BEFORE REQUIRED INSPECTION:* PLUMBING
O ' PLEASE GI.VE'JOB ADDRESS WHENTHONING.
ZSEE-PERMIT FOR EXPIRATION DATE _ MECHAN CAL . Ste:
C 'IMPORTANT! CONST.TAX
'PLEASE READ REVERSE SIDE BEFORE .' 1 TOTAL p gam'
CALLING FOR FINAL INSPECTION. ..: O oC
OFFICE COPY
APPLICANT TO FILL•IN,INFORMATION•WITHIN RED LINES- USE'BALL POINT PEN ONLY' - -
BUILDING PROJECT IDENTIFICATION ,.PERMIT NUrMBnER ,
BDILDING � APPLICATION& PERMIT
AD '
DRESS t, - J 88.5
S rw�4r BUILDING — ELECTRICAL—PLUMBING'—.MECHANICAL 15,8 V
OWNER'S - - • -• . ii PLAN CHECK VALIDATION
-'d "A ELECTRIC PERMIT ;'FEE 1 -
O�GOTYV OrvZ: .•� -PHONE Oe -17 - •' `
.� C NTRNCTOfl3 '
A E _. r 7 .OUTLETS-SWITCHES-,RECEP 10.00/1.00
OJ14� O o• uc NO /p0 . 15'
LIGHTING FIXTURES 10,00/1.00 _
ADDRESS fls
ADDRESS
- APPLIANCES-RESIDENTIAL "4.00 '
I�lfr � OM.bL E. 3-, T s , •PANELS 10.00 DATE OF APPLICATION' '
ARCHITECT
OR ,PANELS (OVER ZOO AMPI 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER L . , '
• - uc.No... SIGNSTRANS. 3.00
+ ARCH.08 ENG. .t - -( SPECIAL CIRCUIT ' 5.00 PERMIT VALIDATION
'SS I
ZIP EMP.METER OR POLE INS.• ,20.00 . -
APPLICANT rva - : MOTORS SEE FEE$CH: Q�p.V--�-«•
ADDRESS
V SERVICE CHANGE - 20.00 '
0 M Z'
r ��
o o LICENSED CONTRACTORS DECLARA"PION
h
1 rebs affirm Ihm I zm,l' .sed a der prusussons of Chapt"r 9 NCE DATE -
y.� n
(cut g wllh Section 70001 0(DI Irian 3 of Ole Rusrness and - 1ILD❑ T. PLG `NECK.
r w i 1 fie urns Cod nil my licen 's I f II fare ❑^
Z o y-- License C ss I L Number ; Q
yI- w Date _ 'Q>n Uaclor' - • - "
a .. - DING PERMIT
w a OWNER-I3 UILUI:R DI'CLA TI _ - , .
w ^INFORMATION
w ;LL y 1 heretiy affirm that 1 am exempt from ilia Contractor s License MISC.— c".t'? REFER TO GRD m
i. oa.' law for the following reason(Sec.70315,Ruslne6and Professions VALUATION
H - - •.PERMIT ISSUANCE �' - "t4:OD ( .---.
Code.Any city or county which r qu res a pennrt to constnrcL alcor, -
2 ¢ ¢ 0 Improv e,demolish or repair any structure,poor to lTs rssuancc,aI'D ELEC CONTR. LIC.NO. ELEC.. �1
D ¢ re4 tyres the apphc lot for such ptrmn to fill asignul statement(list I TOTAL, CO - PERMIT T
x 2 he is Iicenud pursuant to The pr isions of the Conti¢.l ns LiwnsC
La i Law(chapter
9(commcncing wish SeU ton 7000)of Ulvision3 oCthe 7(�
Norm's,and
1 roto..ons CodJ.or Ili iT he Ia uxcmpl therefrom a id V. PLUMBING PERMIT FEE
a I_,$'- the ban'for the alleged exemption.Any violulron of Section 7031.5 { STORIES .TYPE CONSTRr
by any applicant fur apermit subjects the applicant toacivil'penahy �. ALTER-DRAIN -WATER-(EA.).5.00 �o -
of not more than five hundred dollars(45001.1:,"
- .❑ I,'as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE ' -4.00 OCC.GROUP RES.UNITS
a ihtar'mle compensation,will dr The work,und.the nmchue is not
. moLaded;cir offered for sale (Sec. ]044, 0usiness and Profession' DRAINS-FLOOR,ROOF,AREA,CONE). 5.00 -
Code:'Che Contractor's'LicensC Law Joes not apply to an owner of -
property who builds or improves thereon,and who does such work I FIXTURES-PER.TRAP' 5.00 sD.PT.FLooR AREA TOTAL ACREAGE
himself or Through his own employees,provided tha I 11'su hopmv - -. "
ments are not Intended or offered for sale If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
.+ or Improvement is sold within one year of comp) Yon the owner GAS-EA.SYSTEM OVER 4(EA.)' 2.00
builder will have The burden of novi ig Oist he did ,of build c r im- - BUILDING USE
prove forpurpose aC sale.). - . - RES• IND ,CON PB Omar
'U. I,Io owner of the property,am exclusively contracting will; INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
IicenseA'co'ntractors to construct the project(Sec.7044,Business LAWN SPRINKLERS:-I INC�5 V.B. 6.00 ASSESSORS PARCEL NO..
and Professions Cade:The Contractor's License Law does not apply '
to an owner-of property who builds or improves thereon,,and who LAWN SPRINKLERS-•OVER.5(EA.) 1.00
contracts for such projects with contractoN s)licensed pursuant to 1' " +•
The Contractor'sLicense Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACLNO. PARCELNO.
❑ 1 am exempt under Sec. ,13.&P.C.for His - +
reason WATER HEATER W/VENT'S' .6.00
Owner - Dine WATER SYSTEM ' .5.00
ACC.DATE -A11 'ILE NO. i
WORKF,RS'COMPENSATION DI;CLARA'I'ION WATER TREATING EQUIP., 500
1 hereby:affirm that I Imve a ecbolic o.f consent To self=insure;
or certificate of Workers'Com u...ion Insuran' ,ora cc rtil'ied -. ZONING n ENG.SITE NOr
,mss copy Thereof(Sec 3800,LabC
policy No ` CompnY
aaXQN µ✓4..c�. . '. -
' 0 ❑ CerHfi,jcopyl rc fu ;;sled. aOlp FIRESPRINK ENERGY T-24
Z Z ❑ fetli(ied co s ed ith city inspection Jivrsl in.
pila;mt .
(-I: I`t " PERMIT ISSUANCE .1 -
CER'I'IFIC. EO X:. ON FROM WORK ERS' - rr FLOOD ZONE A.L.U.C.
L > -i COMPENSATION,INSURANCE PLG.CONTR. LIC.NO. PLG.
0- O (This Section need not be completed if The permit is for one TOTAL Q I Y'❑ No Y❑ N❑,
Z hundred dollars($100)or loss.) _
0 O'' I certify that in the parl'orinunce of the work for which this per- 'UTy. MECHANICAL PERMIT - FEE - FEE SUMMARY -
ly 1- mit is issued,I shall not employ any person in any manner so as To
U become suhjeci To the Workers'Compensation Laws of Caldomia.
0 a UatC Applicant ALTER OR ADD TO MECH! 5.00 - BUILDING �rd�
} 0NOTICE TO APPIACAN"I': If,after making this Certificale of rix- - _ J
? emption,soil Should become subject to the Workers;Compensation APPLIANCE _ .-6.00 PLAWCHECK r
provisions of The Labor Code, you must lorthwith comply with - - FEE
CONSTRUCTION LENDING AGENCY
U such provisions or This"pennit shall be deemed revoked. AIR HANDLING UNIT(TO 1Op00C.F.M.) 4.00 '
'
' ' AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE
+<-D
I hereby affirm That There is a construcitirn ICnding agency far I EXHAUST HOOD (WITH,DUCT) ,
the performance of the work I'or which this permit''is issued(Sec. - MICROFILM'
3097,Civ.C.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00
1-enders Name HEATING UNIT I0 VER 100,000 B.T.U.)8.50 a
Lenders Address- ELECTRIC
I certify that I haveroad this application and state that(lie above VENTILATION FAN (SINGLE) 4.00
�\
information is correct 1 agree to comply with urom
city cti county - LUMBING
ordinances his c state laws relating To building construction.
BOILER- H.P.HPor.100,000 B.T.U.) 6.00ction, y
hereby authorize representatives of on city m enter upon the BOILER-COMP(Over 100,000 STU)SEE FEE SCH. MECHANICAL FSZ
hereby authored property for inspection purpmesl t
(We) agree to save, indemnify and keep harmless the City of MISC.- + REFER TO ORD.
upertino against Iia ;(Aqtes,-judgment costs and expenses which CONST.TAX
may in any way Cj C a, Inst S" Sty ' consegUence of The ` ell-; "V
rantiPERMIT ISSUANCE ng of this ers4. - MECH.CONT. LIC.NO.-".i MECH.
TOTAL / S1'p-O
TOTAL
Signature of Ap Contr Ulite Iq
OFFICE COPY'