16648 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO668
INSPECTION DIVISION
JOB INSPECTION RECORD
'� I p� �1 PERMIT EXPIRATION I
JOBADDRESS_p�L!/ LD-S �C�IOS C UNIT# LOT# PERMIT EXPIRES IF WORK
1
OWNER �V _ c- CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS of PERMIT iSSU-
FOUNDATION 1.21-5b - - ANCE OR 180 DAYS FROM .
NOTE: LAST CALLED INSPECTION.
UFER �� ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VAu_DATJ,ov
CUPERTINO STANDARDS. G !y
GARAGE SLABS PIP m
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB FEB No'8 9IU9
PLUMBING
ELECTRICAL city Qf ISSUANCE DATE
MECHANICAL B/,L--D.,r ELECT PLG. �^,�CR
`LJ �•❑ n 'L1 I
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION S/FT.
PLUMBING 11
MECHANICAL ! � S31 DD�!i
ELECTRICAL I a n ro
FRAMING
INSULATION STURII.S. TYrE CDNSTR,
1
UCC GROUP. RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD Fr FLOOR AREA TDTAL AcaEACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING (tri `LSIND❑ F-1 ❑N El ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN S GNEO FINALS DATE INSP. AssEssoas1ARCEL No
ROUGH SAN.q
PLUMBING 6LTC' `15 J-)-esg ELECT,ENERGY;
TUBS 6 SHOWER PAN PLUMBING ENERGY TRACI NO, PARCELING-
MECHANICAL _ MECR ENERGY
ELECTRICAL BUILDING ENERGY • ACC DATE ACC.FILE Na
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS'
MECHANICAL
FIRE SPRINK ENERGY T 2
�. �
- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r NN[]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD/ONE A.L U C
INTERIOR SHEAR - FIRE DEPT. Y❑ NE] Y ❑ N❑
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH —'- TEMPORARY APPROVALS BUILDING •%-I��DO
SCRATCH COATELECTRIC PLAN CHECK �.
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE , 7
I
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC _ D I
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING DQ '
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
.IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI/L�DING PROJECT IDENTIFICATION
PERMIT NUMBER
BUILDING 4 I QII DOS pALQS GT APPLICATION & PERMIT
POORE99 16648
Cu E '=�O BUILDING- ELECTRICAL-PLUMBING -MECHANICAL ....
MHER'S
PLAN CHECK VALIDATION
NAME
GHQ/✓ 44579578441
Cwu TY. ELECTRIC PERMIT FEE (�
.� WtrN
J-TSrNCyy PHDE4oszs� 140 �.�fis
CONTRACTOR'S
NAVE Q OUTLETS-SWITCHES-RECEP 10.00/1.00 6119
LIC.NO, LIGHTING FIXTURES 10:00/1.00
CONTRACTORS
ADDRESSDHESSAPPLIANCES-RESIDENTIAL 4.00
A
PHONE PANELS 10.00 DATE OF APPLICATION
ARCwTECi PLAN CHECK FEE .C:NO.
1 oR �a_1 - iT GPANELS (OVER 200 AMP) 20.00
ENGINEER (iK L//I. C-'�Qp� SIGNS TRANS. 3.00
uc.No.
ARCN.ORINC. PERMIT VALIDATION,
ADbe,
ss 917 {0�{�YI GIa AV. SPECIAL CIRCUIT 5.00
Mateo O I rev EMP. METER OR POLE INS. 20.00
ADDRESS Ts 2-1911 DOS R-,IPS C-t. MOTORS '. SEE FEE SCH. V
Cape-r-6no, 01 9,57DI4 SERVICE CHANGE 20.00
o ¢ i
Foo LICENSIiU CON'I'RAC TORS UECLA RATION
:�?e
a t w 1 hereby affirm that I am licensed tinder ioSS
nder provisns of Chapter 9 IUANCE DATE
ti Q , (Commencing with Seclion 7000)Of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r H i Prof-ssions Code,and my license is in full force and of feet FEB 2
a
Z o u,- License ClassLie.Number
o r Date Contractor ,1a -
a >< EGy Of BUILDING PERMIT
¢ ¢ ON'NI'R-BUILDER DECLARATION
R o; D INFORMATION
X ;LL I- I hereby BIUnn Dwt 1 am exempt Irons the Contractor's Licenw MISC.- - REFER TO ORD
I) u O j taw for the fallowing reason.(Sec 7031.5,Business and Professions VALUATION $/FT.
` _ PERMIT ISSUANCE 10.00 1,..
Code:Any my or manly which requires a permit to constmet alter,
C, ¢O improve,ccnmluh,er rcpui,any slmclunt,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC --y`� OOO
O u requires the applicant for such permit to file a signed statement that TOTAL 3•G PERMIT T
K
he is licensed pursuant to the provisions of the Contractor's License
P zj Law(Chapter9(contmetming with Section 7000)ofDivision 3 of the I�
at Business and Profvions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE I
¢ =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a by any applicant lin a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 -Q
of not mom than five horrified dollars($500f)
❑ 1,as owner of the properly,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole cumpenvtion,will do the work,and lire 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 thercun,and who does such work FIXTURES-PER TRAP 5.00 4fl00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employee,provided that such mimprove- GAS-EA.SVSTEM-1 6.00 F/�/�
mes are not intended or offered for sale.If,however,the building IDD-
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 MA.) 200
builder will have the burden of proving that he did not build or im- . BUILDING USE
prove for propose Ufsalc.). INDUSTRIAL WASTE INTER. 30.00 BEs IND CON PB Omer
jyyf 1,as owner of the property,em exclusively contracting wish 0 ❑ ❑ ❑ ❑
lifenuit contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
( and Professions Codc:'Fine Contractor's License Law docs not apply'
to nn owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ I urn exempt under ties. ,BAP.C.for thh WATER HEATER W/VENT 6.00
e onA If
neo- Date f:7 r" WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COAIPE, ATION DECLARATION WATER TREATING EQUIP. 5.00
ail I hereby alfirm that 1 have a ertificrle of"""or w sdhiluurc.
t or a certificate of Workers'Compensation Insomnee,ur a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.L
Policy No. Cnmpuny
0 D Certified copy is hereby furnished.
FIRE SPANK ENERGY T-24
Z ❑ Certified copy is fled with the city inspection division. ❑ ❑ ❑ ❑
MISC.- REFER TO ORD.
Q Applicant V N V N
~ rn PERMIT ISSUANCE 10.00
LU CERT(PICAI COI PE IA TIO VI[ON PROM WORK1iRS' VI FLOOD ZONE A.L.U.C.
W COM net SATION INSURANCE PLG.CONTR. LIC.NO. PLG. �s as .e>;1 ❑ ❑ ❑ IN F]i d hundred
section need not be completed if lire p<nnit is for one TOTAL V V N Y
� Z hundred JUllars IS IOO)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
I- mil is issued,I shall not employ any person in any manner so as to
0 w 1 become subject to the Workeri Compensation laws of California. � p 010>_
a Dale Applicant ALTER OR ADD TO MECH. 5.0 l a7� BUILDING �O N NOTICE TO APPLICANT: If,after making this CcHificele of Ex-
F" ?� emptier,you should become subject ID the workers'Compenvtion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE \
U wch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000OF.M.1. 4.00
CONS'TRUCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3f 7
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 H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
l certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00DD
orkdiornaincccs aen correct. I agree to comply with all city and county PLUMBING
ordinances and smlc laws relating to building construction. and BOILER-0C1fuP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOser 100,000 BTU)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.
Cupertino against liabilities,judgmcnls, costs and expenses which PERMIT ISSUANCE 70,00 CONST.TAX
my in any way acente against said City in consequence of the Z•v
ranting of this perm. MECH.CONT. LIC.NO. MECH.
TOTAL / TOTAL Q r �
gra reo Applicant mractor Vale
OFFICE COPY