18671POST THIS CARD NEAR FRONT OF BUILDING
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CITY OF CUPERTINO
INSPECTION DIVISION`
/J7OB INSPECTION ///RECORD
" /� ¢` r Ty 1(477 ^ _ [
JOB ADDRESS J �`/�-C /'h`i�l/ NIT#'" _LOT #.
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OWNER CONTRACTOR C'L�—L�Lr(% y(f
PERMIT NUMB
g6'�1
PERMIT EXPIRATION'
`} "' l
PERMIT EXPIRES IF.WORK
IS.NOT'STARTED WITHIN
189 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
LASTCALLEDINSPECTION.
INSPE TION DATE I INSPECTOR
INSPECTION RECORD
FOUNDATION -
NOTE: -
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CIN OF
CUPERTINO STANDARDS. -
UFER -
PREGUNITE -
Z.
^P RMn VALIDATION
y
+,
:,v
ISS A CE DATE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
f'F' _
ELECTRICAL ,-
MECHANICAL
3K EL c
I PLC.MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
I{Y ,Rn 37P, R,A
BUILDING PERMIT
INFORMATION
WOGD•FLOGR
PLUMBING
VALUATION
�:%(11 p?r?•D
S/FT,
MECHANICAL
'ELECTRICAL
r _PERMIT TO
FRAMING-
INSULATION
STIRIES
TYPE CONSTR.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
OCC GROUP
RES-UNITS .
` ROOF
NOTE:
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FT. F LOOK AREA
/' .
NOTAL ACREAGE
DIAPHRAGM
ROOF SHEATHING �
BUILDING USE
R s IND coN Pe o,nP,
' ❑ ❑ . E
APPLY NOfROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
-
ROUGH
SAN.M
AssessDRS PARCEL No.
PLUMBING
ELECT. ENERGY
TUBS 85HOWER PAN .
PLUMBING ENERGY
• IRACT NO,
PARDEL NO
'
MECHANICAL
MECH.ENERGY
ELECTRICAL-'.
BUILDING ENERGY
ACC DATE
ACC, FILE NO
..
FRAMING
ELECT, FINAL TEST
INSULATION
PLUMBING
ZONING'
ENG, SITE NO.
-
GAS TEST I
GAS
MECHANICAL
FIRE SPRINR
ENERGY T�za'
❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
^FLOOD ZONE
Y ❑' N❑
'A L U.C.
Y ❑ No
INTERIOR SHEAR -
FIRE DEPT:•'
SHEETROCK_ -
GRADE
Y ESUMMARY
EXTERIOR LATH
BUILDING
BUILDING
INTERIOR LATH'
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE'
es!'
`
GAS I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECT
MICROFILM
'
ARRANGE FOR INSPECTION BY PHONING 252-4505,
U.1 ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
'-S EE PERMIT FOR EXPIRATION DATE -
ELECTRIC
J
PLUMBING
MECHANICAL
CONST. TAX
..IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE,-�
CALLING FOR FINAL INSPECTION.
NOTAL
OFFICE COPY
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CC
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Own
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL -PLUMBING -MECHANICAL
PERMIT NUMBER
86 1
0 v
n .
BUILDING
ADDREBS
�c 7 Ig;vL
OWNERS
NAME c )/,E M�
T�y .J /yn/,
vHo E ,rte /
V. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
G2S
DATE OF APPLICATION
CONTRACTORS
NAME
t C,0 uC.No, 6JJD
UTLETS-SWITCHES -RECEP 10.00/1.00 d,�
LIGHTING FIXTURES '10.00/1.00 4F
CONTRACTOR s /1!! ��/ >
Les fD�T` PH E `J _+ 7 1�j
PPLIANCES- RESIDENTIAL 4.00
d ANELS 10.00
ARCHITECT
OR L t.1-
ENGINEER
uC.NG,
ANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ADDRESS ErvG.
AOOHEH
fwd AA % Af�nP
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION /
EMP. METER OR POLE INS. 20.00
Av ucANrs
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 11
L .
LICENSED CON'T'RACTORS DECLARATION.
- L
I hereby at I irm that I Sin licensed under provoinos of Chapter 4
(commencing with Section 70001 of Division 3 of the Business and
Professions Codeyd y license is in full force a td effeetd Q
License CI ss O Lia Number b'6
Date 0; pA Contractor _L`_!!'CO
t , T. .Ann
+- V J
ISS NCE DATE
BL G. EL T. PLG. MECH.
❑
p
Q tV of
OWNER -BUILDER DECLARATION
License
I hereby f llo that I am exempt from the mess n and
Law fertilenity Oremrtywh ISec.7ire .a tlosinessand Professions
Cade: Any city or county which requires a permit to consu act,,
CI1D$f}I00
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
PERMIT ISSUANCE 10.00 d ''
VALUATION
$/FT.'
ELEC. CONTE. LIC. NO. ELEC. D
TOTAL QRMIT
improve, demolish, or repair any structure, prior n its issuance, also
also
requires the applicant for such permit to file, signed statement the
he is licensed mthe provisions of the Contractor's License
O
9 (co
Law (Chapter 9 (commencing
cing with Section of Division 3 of the
Business and professions Code) or [hal he is exempt therefrom and
is exempt
OTV. PLUMBING PERMIT FEE
the basis for the alleged exception. Any applicant
of Section malty
by any applicant for upernreddolsubjects rlmapplieant wacivil penally
of not more five hundred dollars (my
STORIES
TYPE CONSTR.
ALTER -DRAIN 5.00
woehim
❑ Las owner of the property, or my employees with wages as
employees
their sole compensation, will do the work, and tile structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended o, offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
FIXTURES - PER TRAP 5.00
GAS-EA.SYSTEM-11NC.40UTLETS 6.00
s0. FT. LOOR AREA
TOrALACREAGE n
property who builds or improves thereon, and who does such work
himself or through be own employees, provided diol Such improve-
mentsarenotinlendedorofferect for sale. It, however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that lie did not build or im-
prove for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
USE
R 5 IND CONBUILDING ING PB Omar
El.� El ❑
INDUSTRIAL WASTE INTER. 30.00
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 thereon, and who
LAWN SPRINKLERS- 1INC 5 V.B. 6.00
LAWN SPRINKLERS -OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
contracts for such projects with it commands) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ I am exempt under Sec. ,BARC. for this
reason
WATER HEATER W/VENT 6.00
Owner Dale
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
-
WORKERS'COMPENSATION D17CUARATION
I heehy affirm that I have a certificate (itconsent to self -insure.
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copy thereof�.(S�� 800, L,h.CJ. wo
PolicyN 'PI COmpxny
❑ Fortified copy is hereby furnished.
Cenifned ayfivthe cinspe ion divisio
Applicant
FIRE SPRINK
Y❑ NO
ENERGY T$4
Y❑ NC]CERTIFICATEOF'
MISC.- REFER TO ORD.
�y
FXEMPTION PROM WOR ,P
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
COMPI:NSATION I NSURANCI'
fthis section need not he completed if the permit is for one
Y❑ NE]Y❑
N❑
PLG. CONTE. LIC. NO.
PLG
TOTAL
hundred dollars IS 100) or less.l
I certify that in the performance of the work for which this per-
mil is issued, I shall not employ any person in any Thinner so as In
OTV MECHANICAL PERMIT FEE
SUMMARY
BUILDING
3 D
become�vs Th1' �el to the Workers' ensu lion Law a `.
Dute_T_r,L. ${Applicant
NOTICE TO APTT''LIICANT: If, after making s Cortificate of Es
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
FEE
..D
cmption, you should become subject to the Workeri Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions., this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=1.F.M.) 6.00
SEISMIC FEE
rTO
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.0
the performance of the work r which this penmil is issued (Sec.
3097, Civ.C.). r
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.
Lender's Name
Lender's AddAss ay
HEATING UNI T (OVER 100,000 B.T. .)9.50
ELECTRIC
D D
I certify that I have read this application and stale that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with All city and county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER-COMPI3 H.R or100,000B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTUI SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection ParyO.,.
MISC. - REFER TO ORD.
(We) agree to save, Indemnify and keep Ilarllnlcss the City of
upertino against liabilities, judgments, costs :md expenses which
may in any way accrue against said City in consequence of the
ranting of this permit.
PERMIT ISSUANCE 10.00
CONST. TAX
MECH. CONT. I.C. NO, MECH.
TOTAL
TOTAL
Signature of Applicant/Contmctor into
OFFICE COPY