15174POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
./Q 7LJ ? , `, � _ UNIT# LOT#
JOB ADDRESS 1 ESS / _ /6) S"-
� E'S o -i
OWNER �G CONTRACTOR
PERMIT NUMBER
15174
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLEDIflSPECTION.
INSPECTION - DATE INSPECTOR.
INSPECTION RECORD
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
UFER
PR EGUNITE
ver�nur vnuu ,no N.
...it' _ ._ ••�• �-'-•
y
suANCE uAr[
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
11ji'j tupL'
Lk "t0 1-srr
Cjn -��10•�'' tVc�{-�'F,nL� O%l d S/rl ofl
40d In 7
8 3 W C5}GIC -'O�_Ws
UNDERGROUND/SLAB
PLUMBING,.
ELECTRICAL
MECHANICAL
a Lec �,
❑
PLG. MecR.'
❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- C1ti
UILDING PERMIT
INFORMATION
WOOD FLOOR
' PLUMBING
VALUATION
/
/ .c,c i�(•)
SIFT.
MECHANICAL.
ELECTRICAL-
� 11,11111I TO
VOb I�S/G/ TVB .
FRAMING
INSULATION
'
STORIES
TYPE CONSTR. ,
OCC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
1. ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SOFT FLOOR AREA
TOTAL ACREAGE
DIAPHRAGM
ROOF SHEATHING,
BUILDING USE
HES INO CON PB OW..
❑ ❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATEINSP.
- ROUGH
SAN.#
ns.ESSDHSPARCEL NO.
-
--TRACT
PLUMBING
ELECT. ENERGY
TUBS & SHOWER PAN
PLUMBING ENERGY
No
PARCEL NO
MECHANICAL
MECH.ENERGY
ELECTRICAL-
BUILDING ENERGY
Acc DATE
Acc, FILE -10
FRAMING
.ELECT: FINAL TEST
INSULATION-
PLUMBING - -
zoNlNc
Ervc.sITE rvo.
GAS TEST
GAS
MECHANICAL _
FiRE.PRINK
Y ❑ N
ENERGY T 2
Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR -
ELECTRICAL RELEASE
FLooD zoNE
Y❑ N❑.
ALuc.
Y❑ N❑
INTERIOR SHEAR
FIRE DEPT. -
SHEETROCK -
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
INTERIOR LATH , -
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC I
PLANCHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR.
MICROFILM
-
ARRANGE FOR INSPECTION BY PHONING 252-4505,
oo4� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. .
- SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. -
CONST. TAX
TOTAL
4077/
VtFICE COPY
46
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL-POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
'RDILDING
.. APPLICATION & PERMIT
BUILDING_ELECTRICAL- PLUMBING - MECHANICAL
.PERMIT NUMBER -,
-
1517 4
ADDRESS Q I�73 ES'rpq ra R
IOB��+ W
OWNER'SO �fD W OR,RS H15
"AME fg N171
fruits 4VISm
ISO_r'(/� r'1+�4 PRONE V V 6-5g9 2,
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION -
NACONME TRACTOR'S s�y�s
4��` 'UTLETS
AIJS4a-6 L&ACIIk4flx)6' LIC.NO. 11601 Tif;Z
-SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
DDRESCTons
AS IND GILrYIAN aVE
%DDRES
m 13a.1I C PRONE3_79 (01093
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
on
ENGINEER
LIC NO
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P,C. NO. -
- 1
_
SIGNS TRANS. 3.00
ADDRESS ENG.
ZIP
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
^
(U/\jye\r,-J
ISSUANCE GATE
BLDGELECT. PLG. MECH.
❑ ❑ 11License
BUILDING PERMIT
FORMATION
ATION $/FT-
PERMIT TO
I,(/Q UD p( f �V/y pcfZONE
TEMP. METER OR POLE INS. 20.00
ADDRESS rs'ilpJ1O fYLGA2lS
ADDRESS
10 16,13 W ESf T �l
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
' LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed lender provlsmn of Chapter 9
(commencing with $ 700of Division 3 of the Business and
Profession my l Code, and my licensee is in full lone and effect.. ect.
Class Lin Number
Date. Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that 1 ,o exempt from tire Contractors License
Law fornycfileitbellowing rountywhich retuirsypersit eland Professions
Codeimpro Any city or county which requirese permit toconstant,, olso
improve, demolish, or repair any structure, prior to its issuance, also
requires lie applicant for such permit to fill a Signed statement that
he is (Chapter
pursuant to the provisions of the)id
9(commencing DiContractor's License
of Division 3 of ole
Law (Chapter 9 f commencing with Section is exempt
Business and Professions Code) or that he is exempt actio 70 and
the basis for the alleged exemption. Any applicant
t maction 703L$
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (5500).1:
❑ 1, as owner of tiro property, or my employees with wages as
their Sole compensation, will do the work, and the structure is not
intruded or Offered for Sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not up Iy to an owner of
properly who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
mentsarcnotintendedoroffered for sale. Il', however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or an
prove for purpose ofsah.).
14 1, as ner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon, and who
contracts for such projects with a cuntructooso licensed pursuant In
the Contractor's License Law.
Clean❑ la exempgnoler Sec ,B.&P.C. for Osis
MISC.- REFER TO ORDJg"
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL ��1
QTY, PLUMBING PERMIT FEE
ALTER-DRAIN&VENT-WATER (EA.) 5.00
STORIES
TYPE CONSTR.
.
BACK FLOW PROTECTDEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA,CON D. 5.00
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
GAS - EA. SYSTEM - OVER 4 IEA.1 2.00
BUILDING USE
RES IND CON PB Omar
INDUSTRIAL WASTE INTER. 30.00
-
-
LAWN SPRINKLERS- 1 INC S V.e. 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO,
PARCEL NO.
WATER HEATER WIVENT 6.00
Owner ` •_Ya riIBR"
WATER SYSTEM 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure,
or a certificate of Workers' Compensation Insurance, or a certified
copy Ihereof(Sec. 3800, Lab.C.).
policy No. Company
ACC. DATE
ACE. FILE NO.
WATER TREATING EQUIP. 5.00
ZONING
-
ENG. SITE NO.
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the city inspection division.
Applicant
MISC.- REFER TO ORD.
FIRE SPRINK
Y0 NE
ENERGY T24
Y❑ N[:]
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Phis welion need not be completed it the permit is toy one
hundred dollurs (8100) or less.l
1 certify that in the performance of the work for which this per-
Hill is issued, I shall not employ' any person in any manner so as toFEE
become subject to the workers' Compensation Laws o(California.
Deo. Aliplica m
NOTICE 'I'O APPLICANT:ICANT:If, alter making thifal
is Ccrtce of Ex-
emption, you should become subject to the Worked Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for
the perlommnce of 11n work for which this permit is issued (Sec.
3097, Civ.C.).
Lenders Name
Lrndcrs Andress
PERMIT ISSUANCE 10.00
FLOOD ZONE
Y ❑ NE]
A.L. U. C.
Y [] N 0
PLG.CONTR. LIC, NO.
PLG.
TOTAL
QTY. MECHANICAL PERMIT
FEE SUMMARY
BUILDING
'
CrC 4L�
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10)=C.F.IVL) 4.00
PLAN CHECK
FEE
ta ✓
AIR HANDLING UNIT (OVER 10,000 C. EM.) 6.00
SEISMIC FEE
r q
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
ELECTRIC
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UN IT (OVER 100,000 B.T.U.) 9.50
1 certify that I have read this application and slate unit the above
loforn.tion a correct. I agree to comply with all city and county
ordinances end slide laws relating to building construction, and
representatives forms of this city to enter upon the
hereby authmentioned
alcove+nemioned property for inspection Purposes.
(We) agree to save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
ay any way accrue against Said City in consequence of the
ranofthispermit.
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER-COMP(3 H.P. or 100,0008.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
HANICAL
- MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
!CONST.TAX
ECH.CONT: LIC. NO.
MECH.
TOTAL
OTAL
q
9Q
Ssgna ure of Applicant/ ontractor Date?
OFFICE COPY