17672 ' POS_ T THIS CARD•NEAR FRONT OF. BUILDING
PERMIT NUMBER.
CITY. OF •CUPERTINO 17672 .
? INSPECTION DIVISION
r� JOB INSPECTION RECORD p
" j{ PERMIIT�XPI�T�N
�. .:¢, 1' J08 ADDRESS D ` 'UNIT `_ LOTS# �..E•y Li V \
] PERMIT EXPIRES IF WORK
OWNER' .O✓ -� G CONTRACTOR IS NOT STARTED WITHIN
IN PECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR.180 DAYS FROM
NOTE: LAST CAL L ED I NSP ECTI ON.
LIFER r ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY�OF - PERMIT VAUDAATION
. PREGUNITE CUPERTINO STANDARDS. PMD '•'_-�•,:' :•,y,� /
GARAGE SLABS k'
POUR NO CONCRETEUNDERGROUNDY SLAB BEEN SIGNED MAY- 1'5'19&� y
l� v\.`f�N 0
PLUMBING n� of.i p
C
ELECTRICAL - LI V. DpBfGRD ISSUANCE DATE
MECHANICALzve
�EqL-E�cr, P�L�c. Medi '
.. . . . . fs D(Ic. .. ,". IYJ nLJ /lL'J •Ic/LT--Ji
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION O $IFT.-
PLUMBING .,.' . . . . ,. ..
0 ado .
MECHANICAL - PER ' o
ELECTRICAL - LUQ!'\-.3oGtO
FRAMING
INSULATION - d e STORIES TYPE COrvSTR.
OCL GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 9 : fi4i�G
.aooR ARFAoFAci c�cACE
ROOF NOTE:NO FINAL LL INSP.SHABE MADE EFORE sn.Fr
DIAPHRAGM THE.CONSTR� NN X IS PAID
ROOF SHEATHING I r -BUILDING USA-. r-
RES IND CON. PB OM" 1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DA INSP. ❑ El ❑A El 11ASSESSORS PARCEL NO
-. ROUGH SAN.N
PLUMBING I ELECT.ENERGY '
TRACT NO, PARCE 'N0.
TUBS&SHOWER PAN '
PLUMBING ENERGY - y
MECHANICAL � MECH.ENERGY
ACC.DATE ACG FILE NO
ELECTRICAL BUILDING ENERGY ,
FRAMING - ELECT.FINAL TEST
zoNlNc ENc.SITE No.
INSULATION - PLUMBING
GAS TEST - GAS '
6—�- ' MECHANICAL FIRE SPRIrvrc ENERGY rad
COVER NO WORK UNTIL ABOVEMAS BEEN SIGNED HEATING
FLOOD ZONE 0.LU.C.
EXTERIOR SHEAR ELECTRICAL RELEASE •
INTERIOR SHEAR 0 FIRE DEPT. Y❑ N� Y,❑ NEI
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH' - BUILDING - -
INTERIOR LATH _ O- TEMPORARY APPROVALS ' BUILDING � V?UOa.'
SCRATCH COAT T i ELECTRIC: PLAN CHECK
GAS' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - y SEISMIC FEE Zit
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION'BY PHONING 252-4505, ELECTRICLU
. F �'
' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING I ' P
0, PLEASE GIVE JOB ADDRESS WHEN PHONING. bb
Z _ A MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! ' ' CONST.TAX
''
PLEASE READ REVERSE SIDE BEFORE TOTAL.
CALLING FOR FINAL'INSPECTION.
OFFICE COPY.
APPLIC"sIT TO-FILL IN INFORMATION WITHIN RED LINES = USE BALLPOINT PEN ONLY. I
- BUILDING PROJECT IDENTIFICATION - PE T.NUMe R ..
„Y NUILLBE55 : �/ APPLICATION & PERMIT " a
Ur' l U BUILDING — ELECTRICAL—PLUMBING—'MECHANICAL { _ ,I 7 72 '-
OwrvER's PLAN CHECK VALIDATION .
NH .r r ,..
CIxx`7 Y ELECTRIC PERMIT - - FEE
PNONF
CON RACTOR'S
NAME , < OUTLETS-SW ITCH ES-RECEP °10.00/1.00
LIC.No LIGHTING FIXTURES 10.00/1.00 I D
CONTRACTOR'S
ADDRESSyt -PPLIANCES-RESIDENTIAL 4.00
r ~PHONE_ - , PANELS ' tO.00 I GATE OF APPLICATION "}.°
ARCHITECTN, PLAN CHECK FEE KC NO.
on IAB - �� PANELS (OVER 200 AMP) 20.00
ENGINEER , 0og 1�
LIC..No ' SIGNS TRANS. '.300. {
OR ENG.
ARCH. - PERMIT VALIDATION
AD Ess I' Ct SPECIAL CIRCUIT - - 500
_'ZIPM TEMP.METER OR.POLE INS. 2000
AiPLICANT'S, _
MOTORSSEE,FEE SCH.
Dm_z .. ��'�a li+h'tf iv 1{�J ✓. SERVICE CHANGE 20.00 ' s",-2 - LICENSED CONTRACTORS DECLARATIONI. t
a v u I hereby affirm that 1 am licensed under provisions of Chapter 9 h V
y< w (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE.
•t - , BLDG: ELECT. , PLG., MECH..
H z -
Professions Code,and my license Is In full force and effect a ,E,
o0 G - License Class Lic.Number - a, .Ryl' lyl "�,--
w H w Date Contractor - 1 I�JL�I /°-v
a , E - - ']' ' - '-ti 4': - BUILDING PERMIT
E o i u OWNER-BUILDER DECLARATION -c , INFORMATION y
w ; LL I hereby affirm thaC'I am exempt from the Contractor's License 'M ISG REF WRTI
RD
L O 4 Law for the following reason.(Sec.703 1.5,Business and Professions '•vD VALUATION $/F,T.
- Any •• ' PERMIT ISSUANCE .. 10.00
� Code: molish countywhichany structure perminomnsuance,alter, - - 7 /� /�//�
R ¢ ei 0 Improve,demolish,or repair any structure,prior to its issuance,also. ELEC.CONTR '- LIC.NO. ELEC. ` 0 ! QOT -
G u ki
requires the applicant for such permit to file a signed statement that' „' - „ _ _ TOTAL' -Z --pERMILT
w -
A 71
to m w be licensed pursuan Cto the provisions of the Contractor's License ,- ///� 1
Law(Chapter 9(commencingwitlh Section 7000)ofDivision 3 ofthe
44 D Business and Professions Code)or that he is exempt therefrom and CITY. . PLUMBING PERMIT FEE
M I- the basis for the alleged exemption.Any violation of Section 7031'.5 - ' STORIES TYPE CONSTR.
i 5 _ by any applicant for a permit subjects the applicant to a civil penalty. .F
ofnot more than five hundred dollars(S500).): -AALTER-DRAIN&VENT-WATER (EA.).5.00
` ❑ ,1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE :4.00 ."
their sole compensation,will do the work,and the structure is not OCC.GROUP,- a;,RES.UNITS
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 ownci of - ' - - R�s
property who builds or improves,thereon,acid who does sucliFLOOR AREA work FIXTURES:PER TRAP > 500 .y'i 90.FT. TOTAL rnEASE,,
himself or through his own employees,provided that such improve-
mems are not intended or offered for sale,if,however,the buildingGAS-EA.SYSTEM-11NC!4OUTLETS„600
or improvement is sold within one year of completion,the owne33,-� + - �'n
... builder will have the burden of proving that he did not build or im- GAS-EA:SYSTEM-OVER 4 (EA.) ”+ 2.00 : BUILDING U5
' prov for purpose of sale.). - RES _ IND CON.h B t +OhM1 r
'
one
I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
sensed contractors to construct the.project(Sec due,,Business LAWN SPRINKLERS-1 INC 5.V.B.` r 6.00 ASSESSORS PARCEL NO:
and Professions Codi:The honbuilds o improv s thereon.does non apply �.q-
to an cts fo ouchproperty
projects wi builds or impro licensedpursua who ' LAWN'SPRINKLERS-OVER 5(EA.)' 1:00 • 357- !!: 9 1
con tants for such projects with u contractions)licensed pursuant to -
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00' TRACT NO._- PARCEL NO.
"❑ tum vx2 under ge.: ,BAP.C.For t's WATER HEATER W/VENT 6:00 '
reason
Owner `Dale WATER SYSTEM .5:00 ' h
ACC.DATE ACC.,FILE NO.
WORKERS'COMPENSATION DECLARATION WATER.TREATING EQUIP.` 5.00
' I hereby affirm that I have a certificate of consent to self-Insure, V - '
or a certificate of Workers'Compensation Insurance;or a Certified 1 p2 'X 3•-z,' ZONING ENG.SITE NO.
copy thereof(Sec.3500,Lab.CJ. ,
Policy No. - Company _
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T"24
Z,2 ❑ Certified copy Filed with the city inspection division. MISC - 'REFER TO ORDJEt
O1„ ' �. I .❑ '
O. Applicant _ `..y N ', Y INC:]
~ rn PERMIT ISSUANCE - 10.0o 12-o FLOOD ZONE A.L.U.C. i
LU '
CERTIFICATE COMPENSATION
FROM WORKERS'
W � �'COMPENSATION INSURANCE - PLG.CONTR.. •iLIC.NO. � � -ypLG.
CL 0 (This-section need not be completed-If the permit is I'or one _ TOTAL V Q3 •NQ V i.N0
D 2 hundred dollars(S 100)os Ii,..) -U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT " FEE'SUMMARY
"LL H mit Is issued,I shall not employ any person in any mannerso as lm 0 ku become subject to the Workers'Compensation Laws of California.yy Dani Applicant - ALTER OR ADD.TO MECH. . 5.00BUILDING} ofNOTICE TO-APPLICANT. If after making this Certificate of Ex- +F ? eruption,you shouldbecome subject to the Workers'Compensation APPLIANCE : " 500PLAN CHECK
provisions of the Labor Code, you most forthwith comply with - FEE
such provisions or this permit shall be,deemed revoked �_ AIR HANDLING UNIT(TO 10,000 C.F..M.1• 4.00 � -
i�.
- CONSTRUCTION LENDING AGENCY- :. AIR HANDLING UNIT(OVER]0,000QEM.) 6.00 SEISMIC
IFEE-`
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITHOUCT) 5.00P-
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
t
Lender's Name H EATI NG U N IT IOV ER 100,000 B.T.U.1950 "
Lender's Address - - ELECTRIC qT
1 certify that I have read this apphcatiamand state that the above 'VENTILATION FAN (SINGLE) 4.00
formation is correct.I agree to comply with all any and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.Ih.600
• hereby authorize representatives of this city to enter upon the MECHANICAL,'
- above-mentioned property for inspection purposes -t BOI LER-COMP (Over 10 ,000 BTU)SEE FEE SCH. - �Z
'We'
ogre save„i demnify and keep harntess`lhe City of MISO.�=' f ,T—X EFER TO ORD: -
upertino ain ha i s,judgments, costs and'expenses which CONST.TAX% -
ay in y y r agar tteaid 'ty in co eruen• of thu` PERMIT ISSUANCE " .1060—
,
1000 �Zl� _
ranting f is i MECH.CONT LIC NO.,, MECH. 7'
TOTAL rZ7 TOTAL �%�( 3D
- Signature of Applican/Contractor - ,Uate - h' 3 ' . -
0FFICECOPY` .
CITY OF CUPERTINO OFFICE
COPY
GAS SERVICE NOTICE
I
To
, 19
You are hereby authorized to connect the GAS service for
Owner or Tenant �1-2.
At / /Sr J ' ti�f2meft
New Service
No. of Meters Reconnect t1�
No. of Add. Meters _Move Service
i
Move Meter
PLUMBING INSPECTOR
r
r '
POST THIS CARD NEAR FRONT OF BUILDING
CITY.' OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION
1T6
JOB INSPECTION RECORD
/ �^� + PERMIT kXPI TION
JOBADDRESS_LD 6D C ryy�4o�,(_ UNIT# _LOT# �-t. 'RML"EXPIRES
\ 4
�✓ G RMT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR " "° JNSPECTION.RECORD a 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER NOTE: - LASTCALLED INSPECTION.
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS CUPERTINO STANDARDS. PAID • ;.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED'
. UNDERGROUND /,SLAB MAY, 1T;�In U[ l
PLUMBING
ELECTRICAL City,Of.f�UperUno
MECHANICAL
ISSUANCE DATE
BLDG. ELECT. PLG, MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED eul�Dlyc PERM T. .,,:
WOOD FLOOR a:.UJpBRMgrtoN „I„.,,
PLUMBING ,VALUATION O VFT.
MECHANICAL V Cie
ELECTRICAL - PER Ir
FRAMING r•O'0M �(O
ANULATION d e «„�¢,� sroRlEs TYPE CONSTR.
OCG GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 2 IS.
ROOF �i;fi?o c- .
NOTE:NO FINAL INSP.SHALL BE MADE EFORE sn.Fr FLOOR AREA_ 1OrAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID !� r I ,,.L,. •;}
ROOF SHEATHING BUILDING us
RES IND CON PB I OR—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED, s�.I ;ijr.FINALSi (".fGl�, { 1'DATE 'L 4y1NSP. :" ❑ ❑ - ❑ ❑
ROUGH SAN.q ASSE$$GAR CEL NO
PLUMBING � - ELECT.ENERGY C -
AILCTUB &SHOWER PAN TRACT No. PAracPLUMBING ENERGY E No
MECHANICAL ;� ,
ELECTRICAL MECH.ENERGY
- BUIL DINGENERGY ^� Acc.oA TE Acc EILE No
FRAMING
T
INSULATION ELECT.FINAL TEST
zoNING
PLUMBING ENc.SITE No.
GAS TEST
GAS
Q2' 6'-FS MECHANICAL FIRE SPRINK ENERGY T,Za .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED 'I HEATING Y ❑ NO
1 ❑ N
EXTERIOR SHEAR O ELECTRICAL RELEASE FLOOOZONE A.LU c.
INTERIOR SHEAR 0 FIRE DEPT. Y❑ N❑ Y ❑ N
SHE Ei1R OCK GRADE ;. er.•.:'^”'
EXTER OR LATH
V,., „K',; -
BUILDING -
INTERIOR LATH Q TEMPORARY APPROVALS BUILDING
SCRATCH COAT I ELECTRIC PLAN CHECK
GAS FEE
APE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE
'ANCV OF BUILDING IS NOT PERMITTEb UNTI L BUIL DING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM r—
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F
LU
ONE WORKING DAY BEFORE REQUIRED INSPECTION. P
z
PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL _L�