15552 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15552
INSPECTION DIVISION
JOB INSPECTION RECORD
OB ADDRESS _ PERMIT EXPIRATION
JT
PERMIT EXPIRES IF WORK
owrvER CIJLsLL coNTRAcroR U �� S7 IS NOT STARTED WITHIN '
INSPECTION DATE INSPECTOR INSPECTIONRECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ljk6k ANCE OR 180 DAYS FROM
NOTE: ^ LASTCALLED INSPECTION.
UFER g ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE 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
ELECTRICAL ISSUANCE DATE.
MECHANICAL BLDG. ELECT PLO. MECH.
o PQ E a
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'pPAW BUILDING PERMIT
WOOD FLOOR FORMATION
PLUMBING ION SIFT.`A\ r(,
MECHANICAL
ELECTRICAL - PER M'II T
FRAMING —
INSULATION STORIES TYPE CONST
GS CIE DCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
IN FT 11111 AREA TOTAL ACRCAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION fAX IS PAID
BUILDING USE
ROOF SHEATHING
RES No CON PB O�m.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSE SSORS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY4TRACT No PARCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY M Acc DAre ACC FILE No
FRAMING ELECT,FINAL TEST T
T
INSULATION PLUMBING L� ZONING ENO.SITE No.
GAS TEST O�.SSaf� GAS L� -
MECHANICAL FIRE SPRINK ENERGY T.7a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Al 8 v ❑ N❑ I ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE TT FLOOD ZONE ALUC
INTERIOR SHEAR FIRE DEPT. - y❑ N❑ ° ❑ 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 BEEN SIGNED OCCUPANCY SEISMIC�FEE a7�
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
_ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC a6
PLUMBING
oi1 ONE WORKING.DAY BEFORE REQUIRED INSPECTION.
1 4� PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL � /
OFFICE COPY
. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
A "' BUI LOI NG.VROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
4a 15552
AoaE G
C LPS _M BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
.f OWNEH'S PLAN CHECK VALIDATION
tT NAME QTV ELECTRIC PERMIT FEE
vHonE ) AA
CONTRACTCT OR'S
rvamEOUTLETS-SWITCHES-RECEP 10.00/1.00
w:
VTCCJJ%rn, LIc.No. I/ .S LIGHTING FIXTURES 10.00/1.00
CONTRACTOR/�S �j�-r ��cc APPLIANCES-RESIDENTIAL 4.00
akl r/LC G"AJ [p PHONE Ji"n �/ PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C:NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER QQ � II,,''�t�____ "
ocONJhlf�vF•(Z01,S`s1 LocISIGNS TRANS. 3.00
ADDRESS ENG. �^ /� SPECIAL CIRCUIT $,QO PERMIT VALIDATION
So"7�F D 'K Ly` S T. zlPrfS/3 EMP.METER OR POLE INS. 20.00
APPLICANT'S
AOOREss /� MOTORS SEE FEE SCR.
�� mZ3UAX&,)` 691B11, 5SScI SERVICE CHANGE 20.00 ,f f
'02 LICENSIiU CONTRACTORS UIiCLARA'fION !� V
v w I hereby affirm that I am licensed under provisions of Chapter 9
¢ Z vAi
w ¢ ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and 'BLDG. ELECT. PLG. MECH.
H H z Professions Cotle,�{I 1 my license is in full f -ore nd e fe . ❑
LD
z v, W License laa Q Liu Nuntbur _ S
w H [)are !V Contractor
¢ K E " UIL DING PERMIT
X Ix w¢ OWNER-BUILDER DECLARATION
O " MISC.- REF ER TOO INFORMATION
w g I hereby affirm that I am exempt from the Conlrmtor's License
LL a j Law for tiro following reason.(Sec.7031.5,Businessand Professions 10'80 _y;y q+.UATION g/FT.
I- - h PERMIT ISSUANCE
Se Code:Anycity or county which requiresune,prior
to is construct,alter, O ✓ V
Se
¢ ¢ 0 improve,demolish,or repair any sltueture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
m u PERMIT TO
requires the applicant For such permit to file a signed statement that TOTAL r
w he is licensed pursuant to the provisions of the Contractor's License
Hzr
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �� A �L.Q�
i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE U
¢ r o the basis for the alleged exemption.Any violation of Section 703 1.5 1 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(8500).):
❑ 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 OCG GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's Liccnsc Law docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 s0.Fr.FLOOR AREA TOTAL ACREAGE
himself or Through his own employees.provided that such improve-
( ments 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-EASYSTEM OVER 4 (EA) 2.00
huilder will have the burden of proving that he did nit build I,, . - ,
r hu- BUILDING USE
prove for purpose ofsale.). RES IND CON PR Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
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 docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts lou such projects with a coutrucmRs)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt orderSc ,B.&P.C.Iihr this reason WATER HEATER W/VENT- 6.00
_
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
W'ORKERS'COMPIiNSATION DECLARATION WATER TREATING EQUIP-5 00
I hereby affirm that I have a certificate of consent to ed-insure,
or a certificaW of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.0 I
Policy No. Compan y �_tt, rT! V�L�
O ❑ Pe�r1 fiedcopyi,herebyfurnished. RE RPRINK ENERGY Z fYCenificd 'op� �� 'led-with Illyy� dy inspection division. 24
F O Applicant�_.� MISC.- REFER TO ORD. Y E] N� Y [] NE]
CCN CERTIFICA'T'E OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LUC.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.Na. PLG.
C 0 (This section need not be completed if the permit is for one TOTAL Y N� Y N
Z) Z hundreddoIlmx(SI00)Orlass.)
' EI
U O 1 certify that in Ire pelf h' f the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued, 1 sh Bll not cm •roan in any mmnncr so as to
0 Or U become subject to the Wor r saline Laws of California.
°. Dat` Appl" m ALTER OR ADD TO MECH. 5.00 BUILDING
} 2 NOTICIi TO API'LICANL I alter makinF this Certificate of Ex-
F _ e..prion,you shoulA become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10/JOD1C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 73
1 hereby affirm that their, is a construction lending agency f r EXHAUST HOOD(WITH DUCT) 5.00
the perlormunce 0f the w k Inch Ibis Permit is issued(See. MICROFILM
3097,Civ.C.). /N7 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name_ HEATING UNIT(OVER 100,000 B.T.U.)9.50 C/
Lender's Address ELECTRIC 'G
I certify that I have read ibis application and state if,,,the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and late laws relating to building construction. and BOILER-COW(3 H.P,or 100,000 B.T.U.) 6.00
J hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)BEE FEE SCR. MECHANICAL _
.' abuse-me Ninned property for inspection pu0rosex
(We) agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against t. /sa'i/d JCity in consequence of the PERMIT ISSUANCE
ra H permi � MECH.CONT. LIC.NO. MECH.
To (0-0 TOTAL 3
uJoinure 01 ApplicanniCurfaractor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT N
INSPECTION DIVISION 16600
73
JOB INSPECTION RECORD
r W1 y-
11 b5 ��n9SfOtl� PERMIT EXPIRATION
JOBFADIDRIFISS�Iy � UNIT# _LOT# PERMIT EXPIRES IF WORK '
OWNER U✓ V (,VK/ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANC- OR 180 DAYS FROM
FOUNDATION NOTE:
UFER ALL GRADING AND.DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRMIT VALIDTON
CUPERTINO STANDARDS.
GARAGESLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PD •1 hl�z!f i�-L
UNDERGROUND /SLAB `
PLUMBING
ELECTRICAL - AUG 511988 GpQQp ISSUANCE DATE
MECHANICAL City OfClELLDDG� ELECT vL MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING I II IL-
INSULATION STORKS TYPE CONSTR
OCC GROUP HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE. SO ,T FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID .I
BUILDING USE
ROOF SHEATHING HEs IND CON PB o,l,,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH. SAN.#
PLUMBING ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING' ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO,
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ; Y "� ` "ED
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A-L U C.
INTERIOR SHEAR FIRE DEPT. Y ❑ -01 Y ❑ N
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH \ 7 BUILDING
INTERIOR LATH -' "- TEMPORARY APPROVALS BUILDING
SCRATCH COAT L 1 ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4595, ELECTRIC
IF—
LU ARRANGE
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - tN
cAL
IMPORTANT! CAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL I I,i✓
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
11,9111LDIN PROJECT IDENTIFICATION PERMITNUMBER
BUILDING APPLICATION & PERMIT 16073
TODRE{�
I t� ) MS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OwrvER'S J PLAN CHECK VALIDATION
NAME TY. ELECTRIC PERMIT FEE
a�- oNEa53 any
NAMERACTo.s / UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
ADDRESS
oRs / APPLIANCES-RESIDENTIAL 4.00
CONTRACTOR
vHONE PANELS 10.00 DATE OF APPLICATION'
ARCHITECT PLAN CHECK FEE P.C.NO.
ORPANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ABC..OR ENG. PERMIT VALIDATION
ADDRESS / SPECIALCIRCUIT 5.00
APPLICANT'S
Z11 TEMP.METER OR POLE INS. 20.00 AooBMOTORS SEE FEE SC
Ess
Q/1IA� SERVICE CHANGE 20.00 M/JQ
DL2
r o O LICENSED CONTRACTORS DECLARATION 8 OO
a o I hereby affirm that I am licensed under provisions of Chapter
2 w
m rt w (contmenCing with Section 7000)of Uivisiuv 3 or the Business and ISSUANCE DATE
DG. ELECT. MECH.
H y z Professions Code,and my license is in full force and effect U 11 PL El
BUILDING
- License Class Le.Number
a m r Date Contractor
- J
Z ¢ w a OWNER-BUILDER DECLARATION BUILDING PERMIT
w 3 n H I hereby affirm that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
H w o j Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter,La 4 10.00
0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
L Cl a, re'quire's the applicant for such permit to file a signed statement that TOTAL
n w m he is licensed pursuant In the provisions of the Contractor's Liunse PERMIT TO
z a
Law(Chapter9(commencing with Section 7000)of Division 3 Lithe
4 c Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
IS H m life basis for the allcgcd exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
ate _ by any applicant for a permit subjects lire applicant to a civil penalty gLTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S500).1:
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 400
their sole compensation,will do the work,and th .
e structure Is not OCG 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
properly who builds or intprove,I ICrCLII,slid who does Such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such Balm mvo
ments are not intended or offered for sale.ll',however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder GAS will have the burden of proving that he Aid not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I❑ ❑N ❑ o❑
❑ 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 ASSESSORSPARCEL NO.
and Professions Code:The Contractor's License Law docs nod apply
do an owner of properly who builds or improves thereon.unit who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contrac(ors)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sea •,B.&P.C.for thisreams WATER HEATER W/VENT 6.00
Owner Dale WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WORKS RS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent 10 sell-insure.
or a certificate of Workers Compensation Insurance,or a cerfified ZONING ENG.SITE NO.
copy theomf(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified Copy is hereby furnished' RE SPRINK ENERGY T-24
Z Z 0 Certified copy is filed with the city inspection division.
F 0 Applicant MISC.- REFER TO ORD. _ Y ❑ NE] Y [] NE]
2y CERT[FICA It:01:EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.c.
W > COMPENSATION INSURANCE PLG.coNTR. LIC.NO. PLG. I Y� NEI YE] N�
CL 0 1'1'his section need not be completed it the pennil is for one TOTAL
::) Z hundred dollars IS 100)or less.) -
U O 1 certify that in the performance of the work nor which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U 0 became subject to the Workeri Compensation Laws of California.
G. nuc npphcam ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE 'f0 APPLICAN''1': 11,after making this Cettiflcale of Ex.
♦- Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO IOPWC.F.M.) 4.00
CONSI'RUC'I'[ON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a canstructlon 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
Lenders Name
Lenders Address HEATI NG UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and slate that lire above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING inn
.run....ces and stale laws rel.ing to building construction, and
hereby authorize representatives of this city to enter .,an the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpose.
(We) agree to save, indemnify .,,it keep harmless file City of MISC.- REFER TO ORD.
upertill against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in,uny way accru• against Said C'y in consequence of the
ign�e,of A,permit. �'��-/ MECH.CONT. LIC.NO. MECH,
C(f� TOTAL TOTAL 0�
Signature of Applicant 'nntraclor � Uatc
OFFICE COPY