11591 J _ I
q POST THIS CARD NEAR FRONT OF BUILDING
I ��p I'l li M1lll NVAINEH
CITY OF CUPERTINO 11591
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS -/4 2 C4 -on, i7 L�,< UNIT# _LOT#
,/ PERMIT EXPIRES IF WORK
OWm+NER EiL LiCONTRACTOR /1 Tv IS NO! STARTED WITHIN
INSPECTIOW DATE I INSPECTOR 'rl;'^ .P;:INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ ANCE OR 180 DAYS FROM
UFER '
LASTCALLED INSPECTION.
PREGUNITE Ft nKUF VALI UA MON
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING F ..
ELECTRICAL
ISSUANCE IPLG.
MECHANICAL BLOC. EC1 PLG. NTcr,H,
El
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ING PERMIT
WOOD FLOOR
PLUMBING tr;T y1LUAlIU 74ORMATION S/FT
MECHANICAL
ELEC RICAL Elf�` PERMIT TO
FRAMING
$l Ulll[S IYI'C CONSiIi.
INSULATION
OCL' GROUP ICS UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
fl00F 5O FI,FLOOHAIIA TOTALACIIIACI.
DIAPHRAGM
BUIwING USE
IiLS INV 1,111 PIT unu.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PAHCTL NO.
PLUMBING
GAS TEST I IIACI NO. PARCEL NO.
MECHANICAL
ACC.DATE ACC FILE NO. -
ELECTRICAL 1D07/5;t 1 FINALS gi(,
INSP.
FRAMING Cr P pL SAN #
Nt 10NING ENG.SITE NO,
INSULATION PLUMBING
GAS
MECHANICAL ❑ N�COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGLATH—INTERIOR ELECTRICAL FLooO roar A.L.0 c.
LATH—EXTERIOR _ � FIRE DEPT. r ❑ N❑ Y ❑ N❑
SHEETROCK GRADE
FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR
TEMPORARY APPROVALS BUILDING
O REWALLS ELECTRIC PLAN CHECK
GAS FEE
.NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
UCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN.PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ' ' TOTAL
CALLING FOR FINAL INSPECTION.
APPUCANTS POSTING COPY
" POSTTHISCARD NEAR FRONTOF BUILDING
PFRNIIT NUMBER
CITY OF CUPERTINO 1591
INSPECTION DIVISION.
JOB INSPECTION RECORD ,
J )
' • %� I P � - /PERM-IT -
EXPIRATION
JOB ADDRESS �4 01011yUNITLOT#
PERMIT EXPIRES IF•WORK
OWNER I CONTRACTOR { IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
- LASTCALLED INSPECTION.
'
PREGUNITE _ PERMIT VALIDATION -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG. ELECT, 1. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMI -
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING _
MECHANICAL
ELECTRICAL PERMITTO ,
FRAMING � ,ill �
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED-
ROOF SO FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM. awl.Dmc USE
.RES IND CON PB DIN,,
APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST
' TRACT NO. PARCEL NO.
� -
I
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL - 0- -Y FINALS DATE INSP.
FRAMING SAN * -
ZONING ENG.SITE NO.
INSULATION "' � � PLUMBING
GAS
MECHANICAL II /� FIRE SPRINK 'ENERGY T 2
V�fl V
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING I min Y ❑ NE] El N❑
.BLOOD zoNE A.L.0 c.
LATH—INTERIOR ELECTRICAL l) v❑ N❑ v❑ N❑
LATH—EXTERIOR " b_' FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIORTEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK .
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
n
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN,PHONING.
Z .MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
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
s BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT
fr[DRESS r.
11591
101il F raItBUILDING -ELECTRICAL-PLUMBING -MECHANICAL
WN
PLAN CHE VALIDATION
NAME John Ra n
Ne_V PHONE rjU pg OTV ELECTRIC PERMIT FEE �G�7
CONTRACTORS G
NAME (uO ZC�r) � UTLETS-SWITCHES-RECEP 10.00/1.00 3L�
C, LI LIGHTING FIXTURES 10.00/1.00 7/4
nooaEss'oR/s^ KLiG.( PPLIANCES-RESIDENTIAL 4.00
GV _PANELS 10.60 DATE OF APPLICATION
onnCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
AARCH.OR DDRESS ENG. SPECIAL CIRCUIT 5,66 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH. ✓/( �
SERVICE CHANGE 20.00 9
w
02 LICENSED CONTRACTORS DECLARATION r/^re�
o a ng wSection )oon Business an
ur w
1 hereby affum that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing Si7000f Division 3 of the Busid
rR BL G. MECH.
F N Pr[fLsions Code se is in full fofrPe and effect. L,/H ,�.,r
z o ,_�or Llcen Cl ss'_{/-`'p Lia Numbere'L�I o a 1"y'!I
4 � w Date Cornractor �lJ DJry PIE
rt w st OWNER-BUILDER DECI. RATIO / A NFUkNI TRMIT
w N ION
I hereby affem that I am exempt from the Contractor's License MISC.- 'REFER TO ORD
.. o a Law for the following reason.(Sec.7031'.5,Businessand Professions PERMIT ISSUANCE 10.00 VAI lUATl N(s S/FT.
Code:Any city or county which requiresa Permit to construct,alter, 3 ylhy_-Hyilru Der ino
2 2¢ 0 improve,demolish,or repair any stricture,poor to its issuance,also ELEC.CONTR. LIC.NO. ELEC /!/f/
O ce requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO
z he is licensed pursuant en the provisions of the Contractor's License
i Law(ChapterProcssion, ode) r Section is 010)exempt therefrom
Pl"
- a the bass and he alleged
Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any applicant
of Section 7031.5 nulty STORIES TYPE CONSTR.
A , by any applicant lora permit dojcds S500R.liant macivil ptnulty ALTER-DRAIN -WATER (EA.) 5.00
of not mom than Five hundred Dollars(5500).):
❑ I,as owner of the property,or my employees with waVsm BACK FLOW PROTECT. DEVICE 4.00
their sole eampensalion,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sok (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law dues not apply to an owner of
t- property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
meats are not intendal or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
1 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 thut be did not build of im-
Prove for propose ofsale.). INDUSTRIAL WASTE INTER. 3066 RES IND CON Pe Our.,
0 I,as owner of the property,am exclusively contracting with , ❑ 0 ❑ 0 ❑
licensed contractors to construct the ponied(Sec. 7044,Businw LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of Property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contsactot(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No.
❑ I um exempt under Sea ,N.&P.C.for this WATER HEATER W/VENT 6.00
awn
Owner Date WATER SYSTEM 5.00 ACGDATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby infirm that 1 have a certificate of consent t0 self-insure, ZONING ENG.SITE NO.
or a certificate of Worked Compensation Insurance,or a certified
copy thereof(Sec.3800,tab.C.)./.4-. � �2
Policy No. Company � /QJ '-'&A_
O ❑ Ccrtif dcopy is her yfr mshcd. FIRE SPRINK ENERGY T$4
Z_ Z 0 Certif- any is rl (with 41 -city spe,fmr division. MISC.- REFER TO ORD.
O Applicant V N Y N
~ rn PERMIT ISSUANCE 10.00
� - Cl>RTI ICATF OF EXEMPTION PROM WORKERS' FLOOD ZONE A.L.U.C.
I
W > COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG.
CL 0 (This section need not be, completed if the permit is for one TOTAL v N v N
hundred dollars IS 100)or Tess.) -
U O 1 certify that in the pe,Vurm me of the work for which this Per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H Ioil is issued,I shall net employ any person in any manner so as to
U become subject to the Worked Compensation laws of California.
0. Date Applianl - OJ BUILDING
>- w NOTICE'10 APPLICANT: If,after making this Certificate of rix- ALTER OR ADD TO MECH. 5.00 -
F Z em pt ion,you should men me subject to the Workers'Core Nom ion APPLIANCE 5.00 PLAN CHECK
gc,isions of the Labor Code, you most fnrthwith Comply with FEE
U ssS h provisions or this peranit shall be deemed revoked. AIR HANDLING UNIT(TO 10 4,00
1 C.FM.
a CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER . 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITHDUCT) v 5.00
1he performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100, WB.T.U-) 6
Lender's Name HEATING UN IT 100,000 B 1' .50
Lender's Address ELECTRIC
I certify that 1 have mad this application and stale that the above VENTILATION FAN (SINGLQ% 4.00
information is Correct. I agree to comply with all city end county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COWI1 ,H.P.or 100,000B.T.U.) 6.00
V • hereby authorize representatives of this city to enter upon the BOILER-COMP (Osco 100,000 BTU)SEE FEE SCH. MECHANICAL /
ahove-mentioned property for inspection purposs. //�✓
(We) agree.to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
u vino aganst li bililies,judgments, costs and expcnus which PERMIT ISSUANCE 10,06 CONST.TAX
may any way a rue,agahgt acid City in consequence of the
grant gel is Pe t. MECH.CONT. LIC.NO. MECH.
- TOTAL /S+'U TOTAL /
SitninteoT Applica t/ on.actor Dae l'
OFFICE COPY