15419 :. POST THIS.CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15419
INSPECTION DIVISION
JOB INSPECTION RECORD y
/ "
'PERM IT E1cP.I RATION
JOB ADDRESS �� / a/u+' C/�'A'�FB'✓ •4�F•l/Gs UNIT# - LOT 4k PERMIT EXPIRES IF WORK
owNER' 11� •C9<rS�-'L CONTRACTOR L d0 IS NOT STARTED WITHIN
INSPECT ON DATE INSPECTOR ANSPECTION RECORD .160 DAYS OF PERMIT iSSU.
FOUNDATIONNOTE: - ANCE-OR 180 DAYS,FROM
LIFER � �• ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION,•
CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND'
/SLAB
PLUMBING - 1':jE- PE'�
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT.] , PLG. MECH, '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR vAwAnON STFT.
PLUMBING
MECHANICAL J 7 fJ✓»' '•r^v ��
ELECTRICAL - PERMIT rD
FRAMING ?li/ • : .J- }'••J�,,,•
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES.UNITS'"
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.ET aooe AREA rorAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
PURLOIN GUSE
ROOF SHEATHING - RES IND CON PB- ou�.,
APPLY NO.ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q ❑ ❑ ❑ ❑
ASSESSUHS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY 1
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY Q ,
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY - ACC DATE ACC.FILE NO.,
FRAMING ELECT.FINAL TEST . d
ZONINGENG.SITE N0.
' INSULATION' � PLUMBING
i
GAS TEST �j- GAS
, FIRE SPRINK ENERGY'T'24
MECHANICAL '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ".L C v ❑ "❑ ° ❑ "❑
S.
.
EXTERIOR SHEAR � � ELECTRICAL RELEASE FLOOD ZONE AL:U C..
INTERIOR SHEAR, FIRE DEPT. Y❑ -01 : Y ❑ : N❑
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 BEENLSIGNEO OCCUPANCY SEISMIC FEE '. P
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
4
ARRANGE FOR INSPECTION BY.PHONING 252-4505, ." ELECTRIC w
� ��. ONE-WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
. O PLEASE GIVE JOB ADDRESS WHEN'PHONING.
z SEE PERMIT FOR EXPIRATION DATE — nnEcwnwcAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL LTI
OFFICE COPY• '.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,- USE BALL POINT PEN ONLY
BUI LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
y ADDRESS
1 ( Ln BUILDING -ELECTRICAL-PLUMBING-MECHANICAL r 15419
OW H'S PLAN CHECK VALIDATION
rvnmEeearrzed ,v^"� J TV. ELECTRIC PERMIT FEE 6•f Ilk• PHONE ,.rJ .. 7 `
C NTRACTORS
/ N E �� C5.3 'OUTLETS-SWITCHES-RECEP 10.00/1.00
INAJ LIC,NO. J LIGHTING FIXTURES 10.00/1.00
CONTRATOR'S -
AooREs APPLIANCES-RESIDENTIAL 4.00
IyVPHONE ��- PANELS, ' 10.00 DATE OF APPLICATION
OARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEEP.C.NO.
ENGIN
_ Ic.No. �Q SIGNS TRANS. 3.00
ARCH.08 ENG /J SPECIAL CIRCUIT 5.00 PERMIT.VALIDATION
aa��g(. k (JC't zIP / EMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDREss �J gg f n - ,
l Lin (/� .�[j,CL- SERVICE CHANGE 20.00
F o o LICENSED CONTRACTORS DECLARATION
<i w 1 hereby uffum that 1 am licensed under provisions of Chapter 9 ��(� 6 (� ISSUANCE DATE
a$ (commencing with Section 7000)of Division 3 of the Business and BLD ELECT. PLG. - MECH.
O Professions Cad• hn icense is in full for' 1,1J - -
Z O'= - License ss Lic.Numbe
9 m H w Delc Contras b
a x5 BUILDING PERMIT
¢ ¢ 3 ' OWNER-BUILDER"D17CLARATION
o d u INFORMATION
X I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
w 3 u y „ VALUATION - $/FT.
FLOG Caw for the following reason.(Sec.7031.5,Husinessend Professions PERMIT ISSUANCE 10.00 of
Code:Any city orcounty which requires a permit toeonstruct,alter, •�J /'
¢2¢ improve,demolish,or repair any xtrudure,prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC, g (/y 1 / OW rW `{
O u requires the applicant for such permit to file a signed statement that TOTAL tJ PERMIT TO
a w se he Is licensed pursuant to the provisions of the Contractor's License
F z i
Law(Chapter 9(Commencut,with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
3ZO
¢F$ the
nyapor the alleged exemption.Subjetstheaplicnt tSection 703L5 STORIES TYPE CONSTH.
d ; ,. by of in.applicantforpermit Subjects the toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not mom than five hundred dollars($500).):
❑ I,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 Dec.GROUP 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 owner of
property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SO.IT,FLOOR AREA TOTAL ACREAGE-
• himself or through his own employees,provided that such improve"
mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that Ire did not build or im. RES IND CON PB Other
. .
prove for purpose of sale.). - INDUSTRIAL WASTE INTER3000
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
- 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'sLicense Law does not apply
to an owner of property who builds or improves thereon.Jail who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a coronations)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,HAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM' 5.00
ALC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EOUIP. 5.00
I hereby affirm that I have a certificate of consent tD self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(See.3800,Lab.C.). L/,J Oo 4- 3d "-
Policy No. Company '
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z_ Z ❑ C "slit co y w w' the. ins t' I di@@"yon' MISC.- REFER T00
ORD. ❑ ❑ ❑ ❑
O /, Applicant 'I. LS- v N v N
CCT PERMIT ISSUANCE 10.00 O 'er FLOOD ZONE A.L.U.C.
LU CERTI FICCOM OF COMPENSATION
ON FROM WORKIiRS'
W COMPIiNSATION INSURANCE PLG.LONTR. LIC.NO. PLG.
G- O (This section need not he completed if the permit is for one TOTAL V❑ N❑ V ❑ N❑
0 Z hundred dollars(8100)or less.)
U O Fcertify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
O become:subject to the Workers Compensation Laws of California.
W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z anption,you should become subject to the Workers'Compensation APPLIANCE 5.00 1 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with - FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10PMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.EM.) 6.00 SEISMIC FEE -
1 hereby affirm tlml there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance MICROFILM
rmance of the work for which this permit is issued(Sec. HEATING UNIT TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address - HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC ,3
1 certify Ihao I have read this application and slate that be above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING Q
BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. S--
upertino against liabilities,judgments, costs and expenses which - CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 -(J Ignimof this permit MECH.CONT. LIC.NO. MECH.OTALas-r/7+ TOTAL03(kylplicantiContracitr 1 Dam 7'i '
OFFICE COPY