15160 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15160 .
INSPECTION DIVISION
JOB INSPECTION-RECORD.
' // F� -;PERMIT EXPIRATION
JOB ADDRESS �W'�3 bu F?t}3 UNIT# LOT# -
PERMIT'EXPIRES IF WORK
OWNER �ie<s[.r WOOL-- CONTRACTOR 41-1774,N Otl4—S_ IS NOT STARTED WITHIN
INSPECTION DAT INSPECTOR INSPECY10N RECORD100 QpYS'OF PERMIT ISSU
FOUNDATION ANC�+OR 180 DAYS FROM
NOTE: LAST�CIL LED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED j
PR EGUNITE — TO COMPLY WITH THE APPROVED PLANS VWWF PERMIT VALIDATION
CUPERTINO STANDARDS. I�'lI'"7111
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1r •� + +I I IL .i.,
UNDERGROUND /SLAB -
PLUMBING o. - '
ELECTRICAL ISSUANCE DATE
MECHANICAL e Oc. ELECT.I Plll. Im2CR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
WOOD FLOOR )OCAINFORMATION
VAWATION $/FT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
INSULATION STORIES IYET CONSTR.
OCC GROUP IT UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT FLOOR AREA TOTAL ACREAGE
'•APHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROc.0 SHEATHING - RES IND CON PB OTF-
APP.Y NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El Ll E) El
-
ROUGH ASSESSORS PNICEL NO
SAN.#
PLUMBING ELECT.ENERGY
IRACI NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENER
ACC.DATE ACC.FILE NO
ELECTRICAL � � BUILDING EN Y
FRAMING ELECT,FINAL
INSULATION PLUMBING ID rl 4m
zoNINES ENG.SITE NO.
GAS TEST " GAS I DATE
I MECHANICAL FIRE SPRINK ENERGY T 2
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING V ❑ N❑ y ❑ No
FLOODZONE ALuc
EXTERIOR.SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ -ED
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS-BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPA NCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252,-4505, ELECTRIC Cz
1-_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING os,
o PLEASE GIVE JOB ADDRESS WHEN PHONING. d
7_ MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL So�
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY _
43U LDI NG PROJECT I DENTI FICATI ON - PERMIT NUMBER
amLDINc APPLICATION & PERMIT 1 ^ O -
AOORE55 I b
3 Ua4 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
' L N 9
/ NAME /// 3PLAN
/d�� �6 y OTS- ELECTRIC PERMIT FEE CHECK VALIDATION
rvE �s� p
A Rs 7�OUTLETS-SWITCHES-RECEP 10.00/1.00
- rvA E 2-s3
LICNO. /9017 1 LIGHTING FIXTURES 10.00/1.00
AooF FSS ro R's
PPLIANCES-RESIDENTIAL 4.00
9 -- �WIAw7>qrZ V
PANELS 10.00 DATE OF APPLICATION _
ARcertecr PANELS (OVER 200 AMP) 2
OR PLAN CHECK FEE
0. .C.NO.
ENGINEER
LIC.No. I SIGNS TRANS. 3.00
AENG.
ADDRESS SPECIAL CIRCUITPERMIT VALI DATION
Afha
ZIP EMP.METER OR POLE INS. 1��I'7� -
ADORE55 Ts MOTORS SEE FE 110 �-7f I I I`�7''l/k�U
SERVICE CHANGE 20. 81 Ib
1 188
F
00 LICENSED CONI'R,\CI'ORS DECLARATION
< u u 1 hereby affirm that 1 am licensed ander provisions of Chapter
io9 ELe-e7 —�,� L ISSUANCE DATE
G a w (commencing with Section 7000)of Division 3 of the Business and
H m i Professions Cod, n nt license is in full force apd ff, BLD ELECT. PLG. MECH.
z o w License Cls r' Lic.Nmnber 'y0/7 rF'7(
O y t Date Con Uactor
a fz J BUILDING PERMIT
¢ d OWNIiR-BUILDIiR DI_CLARATION I INFORMATION
w y I hereby alfon shut I am exempt from the Contractor's LicensePELEC.
MISC.— REFER TO ORD
a o A Law for the following reason.(Sec.7031.5,Businessand Profesvbrti VALUATION
t — ERMIT ISSUANCE 4ggg a — :t/FT
4w� Code:Any city or county which requiresa permit loconvmvt,alter; _
¢ S ¢ 0 improve,demolish,or repair any structurt,prior to its issuance,alsoCONTR. LIC.NO. ELEC.
¢ requites tele applicaul for such permit to lila a signed statement that TOTAL L'�C
n w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
HiQLaw(Chapter 9(commencing with Section 7000)of Division 3 oflhe S(,(-f�%.f A, /A/&-
0
yNQ„ �do L.
4 D Business and Professions Code)or that he is exempt Therefrom and CITY. PLUMBING PADE4
FEE
IL¢ H o the basis for the alleged exemption.Any violation ofSection 703 L5 —STORIES TYPE CONSTR.
; m by any applicant lot a permit subjects the applicant Ica civil penalty
ALTER-DRAIN&VENT- (EA.) 0 2—' s
of not mom than five hunJrit Jolla fie a p li �/
❑ Las owner of the property, r my employees with wages as BACK FLOW PROTECT. DEVICE0 (e
their sole compenmtion,will dot work,and the stmcmre is not OCC.GROUP RES.UNITS
intended Or offend for sale (Sec 7044, Business and Profsslom DRAINS-FLOOR,ROOF, D. 00 a
�. Code: The Contractor's License ase don not apply to an owner of
property who builJs or improv thereon,and who Jas such work FIXTURES-PER TRAP0 so.FT.FLOOR AREA TOTALACREAGE
self or through his own em loyen,provided that such improve-
Is are net I,mendedoroff ed for mea.If,howeveq the building GAS-EA.SYSTEM-I INC0 --
provement is sold with one year of completion,file owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
y cr will have the horde of proving Ihut he did not build or inn- BUILDING USE
prove for purpose ofsale.) INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa omar
❑ 1,as owner of the roperty,am exclusively contracting with - ❑
licensed contractors m onstulcl the project(Sec. 7044,Holiness LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
El
and Professions Code: e Contractor's License Law dun not apply ASSESSORS PARCEL NO.
to an owner of pro ly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such p jeers with a conlractons)licensed pursuant to 13,59—z -O Z
the Contracwr's Li ,nese Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Imo exempt under Sec..,B.&I'.C.for this WATER HEATER W/VENT 6.00
son
Owner Ulm WATER SYSTEM 5.00
H�pgI;HRp ACC.DATE ACC.FILE NO.
H4JC r�"9 MPI:NYZI�1jN HECLARA'['ION WATER TREATING EQUIP. 5.00
I hereby ul firm t ml fTT have uaaceGGrt l'- ccate of consent to self-insure,
or cerlilicate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
mpy r nof(Sec.3800,lab C,LAAgLnJiv,¢L 4,f /OA/
Policy co. Com pany_F1
O CI C tiliad 'opy Is hereby furnish
Z Z GYCertifigys!op s Jed fly inspection division. FIRE&PRINK ENERGY T 24
FO ApplicenPJl- MISC.- REFER TO ORD. YE] NEJ Y0 NE]
L2 Clik'f 114CA'I'Ii OP IiXIi wPTION IsROh1 WORK IiRS' PERMIT ISSUANCE _
_ FLOOD ZONE A.LU.C.
W COMP of be completed
INSURANCE PLG.CON TR. LIC.NO. PLG. ^ �
CL hundred
section ceeJ not be completed if the permit is for one TOTAL CJS Y❑ NE) Y❑ NE)
0Z hu1 ertifyturst5 0)or sJ
U O I certify 1hm in the P ono ulo,of the work for which this per. 'Ory MECHANICAL PERMIT FEE FEE SUMMARY
IL F hit is issucJ,I shell n employ any person in any manner so as to
O W become subject to 1 orkers'Compenanion Laws of California.
Date I ALTER OR ADD TO MECH. 5.00 BUILDING 7/
} h NO'T'ICE 1'0 A LICANT: f,alter making this Ce Nit icote of liz-
F ? emption,you out l lecomc sl bleat to Thu workers Compenmfinn APPLIANCE 5.00
provisions of the labor Code, you must forthwith comply with PLAN CHECK
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Op00C.F.M) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1 .F.M16.00 SEISMIC FEE /�.
I hereby ullirm tlIm there is a construction lending agency liar EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CIv.0)' HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nmne
Lenders Address HEATING UNIT(OVER 100,000 B.T.U. AELECTRIC
- — I comity that l 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 O ( �
urd'yramcn and slat, laws relating to building construction, and BOILER-CC1NP(3 H.P.or 100,000 B.T.U.) 6.00
I by authorize repfnentatives of this city to enter upon the
ve-mentioned properly for inspection purposes. BOI LER-COMP (Owr 100,000 RTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify end keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgtn,ms, mats and expenses which /
toy in any way accrue against mse
Said City in consequence of tile CONST.TAX
e PERMIT ISSUANCE �a —
anting of the pe iL MECH.CONT. LIC.NO. MECH. --ss
TOTAL ''11
Sig afore of Applic of 'ontraclor pule saC O S� TOTAL / v—
I
OFFICE COPY /