16957 l
POST THIS•CARD NEAR. FRONT OF BUILDING PERnuTeNUMBER
Ile
CITY OF CUPERTINO 16957,.
INSPECTION DIVISION
JOB INSPECTION RECORD S
ITE koIBkTION)
JOB ADDRESS I ` (f 64
UNIT# _LOT# ^ �pERM1T EXPIRES IF WORK
OWNER CONTRACTOR c e- IS NOT STARTED WITHIN
INSPECTION D E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM .
NOTE: - LASTCALLED INSPECTION. .
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE•APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. J
GARAGE SLABS PAID
POUR NO CONCRETEBEEN SIGNED
UNDERGROUND /SLAB I, .�Y 011989
PLUMBING �y�.
ELECTRICAL cft Of COp@111D0 ISSUANCE.LATE
MECHANICAL BLDG LEC T P G. e R
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL y(
ELECTRICAL - Peamrn ro
FRAMING t - � P
STORIES TYPE CONSTH.
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• - 50.FT fLOOfi ANEA TOTALACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE'CONSTRUCTION TAX IS PAID ��•
BUILDING USE
ROOF SHEATHING '7-2S'--,�s`( � � - � �7yc�� IND CON PB DO,-
APPLY NO ROOFING,UNTIL ABOVE HAS BE SIGNED FINALS DATE INSP. "'
I ' ROUGH SAN,N nssessoas PARCEL/No
PLUMBING ---z-� ELECT.ENERGY
TUBS 8 SHOWER PAN =�I" PLUMBING ENERGY 7.-
TRA No. PARCEL No
MECHANICAL• MECH.ENERGY '
ELECTRICAL / BUILDING ENERGY- _ ACC DATE ACC FILE No
FRAMING ELECT.FINAL TEST ' 10 Agp
ZONING ENG,SITE NO
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPHINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NQ Y ❑ NE]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LU.0
Y[] NE] YL NEI
INTERIOR SHEAR FIRE DEPT.
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 JOCCUPANCY I I SEISMIC FEE,
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ' QQ
_ Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING i O IV
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX '
PLEASE READ REVERSE SIDE BEFORETOTALG3fU
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
~ BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT r' �(][�
ADDRESS J 5
'b .� eA
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 'n
OWNER'S - PLAN CHECK VALIDATION
NAME
1, ,r L+ �06 DTV. ELECTRIC PERMIT FEE
IY�, J PRorvs L
CONTRACTORS - q
NAE UTLETS-SWITCHES-RECEP 10.00/1.00 rQ, CpC� Z2�,,83
IC,ND, LIGHTING FIXTURES 10.00/1.00 x.Q r
CONTRACTORS
ADDRESS v� L-D�.oKC APPLIANCES-RESIDENTIAL ' 4.00
,0.� (o PHONPANELS 0.00 ' DATE OF APPLICATION '
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .C. O.
DR IN DA'I'1.1Af�SL 99to•04r64 --
SIGNS TRANS. 3.00
ADDRESS ena SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 /
APPLICANTS MOTORS SEE FEE SCH. ^` •`
�
ADDRESS f
U SERVICE CHANGE 20.00 _ 4 � 1.�G�
wo o LICENSED CONTRACTORS DECLARATION Ul _ -
a U U I hereby affirin that I am licensed under provisions Of Chapter 9 ISSUANCE DATE
w a vw (commencing with Section 7000)of Division 3 of the Business and i 1989
BLDG. ELECT. PLG. MECH.
o z Professions Cad• and my license is in full force and effect ,rye
License Class_V Lic.NumherA'3p.4./}RJ�._ ,� 'IPNI
e L .D Date}�a. A�QG CDntmetor . Cl/r, of Cu eftloo
P , f V D BUILDING PERMIT
E ¢w u OWNER-BUILDER DECLARATION INFORMATION
E
0 u I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ZA VALUATION $/FT.
F a o I Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE .10.00 .
m0 Code:Any city or county which requires a permit to construct,alter, ^ /' DOD'
Q Q ¢ 2 Improve,demolish,or repair any structure,prior t0 IIS Issuance,also ELEC.CONTE. LIC.NO. ELEC. 'S o 6
Ou requires the applicant for such permit to file a signed statement that TOTAL ;ZLLD PERMIT TO
w w he is licensed pursuant to the provisions of the Contractor's License - „
ri> Law(Chapter 9(commencingwill Section 7000)ofDivision 3 ofthe gVV.�..
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT - FEE (�A'��
a =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
aby any applicant for A permit subjects the applicant tea civil penalty ALTER-DRAIN&VENT-WATER (EA) 5.00 IWC F�.4
of not more than five hundred dollars(5500).): Z
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS
sok 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 Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 50 gFL UO SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
- mems are not intended or offered for Sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is Sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 IRIEESpS vIND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with Ll p ❑ ❑ ❑
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 does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 A'Q 36i.-ob"�
contracts fors. projectswilh ucontracmrls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. .PARCEL NO.
❑ I am exempt under Sac.-,U&P.C.for this WATERHEATER W/VENT 6.00
reason 1 U
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKBRS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation,lnsumnce,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company _
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant V❑ N❑ V [:] NE]
CCr2 CISRTI FICATf:OP EXEMPT PERMIT ISSUANCE - 10.00 1 ap FLOODZONE' A.L.U.C.
ON FROM WORKERS'
LU > COMPP-NSAI'ION INSURANCE. PLG.CONTE, LIC.N0. PLG. Q 1p
Y❑ N❑ Y❑ NE)a -(This Section need not be completed if the permit is for one _ TOTAL
Z hundred doll...0100)or less.)
fJ O I certify that in the performance of the work Car which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ F mit is issued,I shall not employ any person in any manner So as it),
.
U become su-je to porkers mpensatiogn Laws of Califor ' .rO
W Date licaul ALTER OR ADD TO MECH. 5.00 (� BUILDING
} rn NOT( TO AI'P ICANT: IL nakin•tits ertificac o Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply,with FEE
(� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IOPMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.EM.) 6.00 SEISMIC FEE ZZ
1 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 100,000 B.T.U.)9.50 ELECTRICyQ
I certify that I have read this application and state that the above�. VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING � Q�
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 l (''"y�
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTUTSEE FEE SCH. MECHANICAL a� J V
above-mentioned properly for inspection purpows.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperfino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against Said C' in consequence of the PERMIT ISSUANCE 10.00 �• (1
IS n ng of this permit. MECH.CONT. LIC.NO. MECH.
&A A o,o NN 5-41 OTAL�S S U TOTAL �bS 1 Z
Squiature of Applicant/Contractor U-Data
OFFICE COPY