17356POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO-
INSPECTION DIVISION
JOB INSPECTION RECORD
p 'µ / \
JOB ADDRESS _/ 1 ��a�n ��� efy UNIT# LOT#
' //-- -
owNER1.� CONTRncroa :� �kLe
PERMIT NUMBER
��
{/ PERMIT EXPIRATION
`.moi' 1 ; I �.I J ,
PERMIT ,EXPIRES IF WORK
IS NOT'�$TAIR�EDr WI•THINr
180 DAYS OF PERMIT ISSU-
OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTVDN DATE I IWSPECT.OR
INSPECTION RECORD
FOUNDATIONANCE
NOTE:
GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THEAPPROVED PLANS AND CITY OF
CUPERTINO STANDARDS,
LIFERALL
PR EGUNITE
PEHMn VALIHATION }
_ IT
-r
Issunrvce DATE
GARAGESLA85
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' UNDERGROUND/SLAB
PLUMBING
MAY I I
- *
ELECTRICAL
MECHANICAL ' -
, .,
,BLO.G,
ELECT.
PLG. Ml CH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
j -�
/ _r'
l�
BUILDING PERMIT
INFORMATION
-
WOOD FLOOR
VALUATION
a33i 3P3 °D
sFT.
PLUMBING
'MECHANICAL
ELECTRICAL
,.� j� .
FEE MIT o
SSI Z:I WI
FRAMING } _ -
INSULATION .'
SiaHIES
,TYPECONSTH,
- -
-
OCC'GHOUP
HES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - '
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
S99� L l g5
'T.'��- n�.- Z�
y -
TOTAL PCFf PGE
DIAPHRAGM ,
ROOF SHEATHING
BUILDING USE
RES IND CON 'PB omP,
0 1:1 11 11
- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIG ED
FINALS DATE INSP.
' ROUGH -
SAN.# "'� I
nSBE550R5 P4 :CEL NO
- T-� �'-��'���
PLUMBING �' - ,.
ELECT. ENERGY
TUBS 8 SHOWER PAN
PLUMBING ENERGY
FACT NO.
PARCEL NO.
MECHANICAL iW-
MECH. ENERGY -
ELECTRICAL'
_
BUILDING ENERGY
ACC. GATE
ACC�FILE NO,
,
FRAMING cELECT:
FINAL TEST
INSULATION
PLUMBING
ZONING
-
ENG. SITE NO.
GAS TEST
GAS. -
'
-
MECHANICAL
FIRE SPHINK
Y ❑ ' "a
ENERGY T 24
Y "�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING -
E%TERIOR'SHEAR
ELECTRICAL RELEASE
FLOOD ZONE
�
Y "E]
A.L U c
i
Y ❑ � N0
INTERIOR SHEAR
FIRE DEPT. -
SHEET!1OCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUI EDING
BUILDING
,U�S'�•
INTER [OR LATH
TEMPORARY APPROVALS
CH
SCRAICOAT
ELECTRIC* "
-PLAN CHECK
FEE
'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY '� -
SEISMIC FEE
OCCUPAN_CY.OF BUILDING IS NOT PERMITTED ONTI L- BUI LDING FINAL IS SIGNED BY BUILDING,INSPECTOR.
MICROFILM
-�.-
ARRANGE FOR INSPECTION BY PHONING 252-4505,.
Iw-- ONE.WORKING DAY BEFORE REQUIRED INSPECTION.
ZO PLEASE GIVE JOB AbDRESS WHEN PHONING.
-SEE PERMIT FOR -EXPIRATION, DATE —' "
ELECTRIC
_
P�uMIBING.
MECHANICAL
CONST. TAX
62
IMPORTANT!''
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR.FINAL INSPECTION.
TOTAL
,OFFICE COPY' .4
„`;I4PP{IICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
140
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• BUILDING PROJECT IDENTIFICATION
-
APPLICATION & PERMIT
BUILDING-ELECTRICAL-PLUMBING-MECHANICALA-MECHANICAL
PERMIT NUMBER -
17,356
BUILDING -
ADZs
OWNER'S
NAME %
L.'IQr,
IrAPHONE
k A5 -s- I4lot
QTY. - ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION
CONTRA RS
NAME
S ll,, - LIG. No, 372763
Q UTLETS-SWITCHES -RECEP 10.00/1.00 3:
HTING FIXTURES 10.00/1.00 16,qqiJ
'CONTRACTOR'S -
ADDRESS Ce���"r_
Sq ryti. PHONE % `Ewe
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT..
OR
ENGINEER Sgj,...c�
�J -1 LIC. NO.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE C. NO.
-
-
SIGNS TRANS. 3.00
ARCH. OR ENG.
ADDRESS
" -S Qom- ZIP
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
� I -'x„ IS
( 7
`I ./�(�
"`e- (1 w4
EMP. METER OR POLE INS. 20.00 � -
APPLICANTS GV A,
ADDRRE�^�D SHevKOSO, Jk4e S27
MOTORS SEE FEE SCH.
SERVICE CHANGE/A��, 20.00
I.ICENSEUCON'I'RACI'ORSDECLARA'I'ION
1 OL N s
I hereby affirm that I in. Bansed under freshman of Chapter 9
(commencing wyb, Section 7000) of Division 3 of the Bosuns and
Prof ccsions Co dlj� ry licenx is in full for 'n
. bMAY
License I ss Lic. Number./ L
ISSUANCE DATE
1 If 1969
E.G.B
I ELECT.
PLG. '. MECH.
-®
Date Contracoul _
1Qf
'owNli-BUILDBR DEct.nRAT
I hereby affirm that 1 am exempt from the Contractor's License
Law for the fouowing'costa(Sec. 7031.5. Busir¢xsand Prufssicns
Code : Any cityorcounty which mryiresa permit ioconstrum,alter.
BUILDING PERMIT
INFORMATION
MISC. - - REFER TO ORD
VALUATION
$/FT.
PERMIT ISSUANCE 10.00
- �ze0
ELEC. CONTR. LIC, NO.
ELEC. _
TOTAL I
improve, demolish, or repair any itoncturc, prior 10 its ilaaanR, also
requires the applicant for such permit to file a signed statement that
he is levined punol nt Lo the prolof Hle COnlract0[s LICCnse
Law (Chapter 9(commencing with Sect ion 7000) of Division 3 of the'
q-3-4)2)SCID
q` F'
PERMIT TO
�FDh�L
Business and Professions Code) or that he is exempt therefrom and
QTY. PLUMBING PERMIT FEE
thebasis for the alleged exemption. Any violation of Section 703 LS
1
STORIES
TYPE CONSTR:
by any applicant lbr a permit subjects the applicant to a civil penalty
of not more than live hundred dOIWrs(S5001.):
"
ALTER -DRAIN -WATER IEA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compenmtien, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC.GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for to (Sec 71)74. [business and Professions
Code. The Contractor's License Law dors not apply to an owner of
FIXTURES - PER TRAP 5.00
-
GAS -EA. SYSTEM -1 INC. OUTLETS 6.00
Se, ETF
LIv._ aTA
_
TOTAL ACREAGE
property who builds or improves thereon, and who does such work
himself or through his own umployces, provided that .such improve-
menta are not intended or offered for Sale.11, however, the thrilling
or improvement is sold within one year of completion, the owner-
builder will have the burden olproving that he did not build or Im-
pluvefar purposeofsale.1. I"
0 I, as owner of the propertv. Pm exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
e,7 INC USE
RE IND CON PB Othn
❑
INDUSTRIAL WASTE INTER. 30.00
licensed contractors t0 construct the project (Sec. 7044, Business
and Prolessione Cale' The Contracmr s License Law dues not apply
10 an owner of property who build, or improves thereon. and who
FAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00contracts
ASSESSORS PARCELNO.
lV
'���_ /:.,_Z2
the Contract suchLicencctswith acuntractoHs) licensed punuanno
the Contractor's License'Law,
SEWER -SAN ITARV-STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
O Iamcxcmptundei Sec. ,B.&P.C. her this
'
WATER HEATER W/VENT 6.00
Owner Date _
-
WATER SYSTEM 5.00
ACC.OATE
ACC. FILE NO.
WORKHRS'COMPENSA'I' ION UTCL-ARATION
WATER TREATING EQUIP. 5.00
I hereby affirm that l have a evnificate of consent to sell -insure,
or a "Ttifc rs' Comp- tion Inver or a ecrti0nl
pee
s , 6
ZON WG'
ENG. SITE NO.
copy there Lah.C.l. (fyy/�, L/
Policy No._ ' mpanY-JI_L�'7�
-
FIRE SPRINK
Y[3 NEI
ENERGY LN
Y0 NEI
❑ CertBicd op ,Is emby lumi neJ.
LYCertifiud c t '- ,fled 111 mY ty �Iv^w,on�
Applicant �l f`- �
MISC.- REFER TO ORD.
CI>Rl'l I: fpOili%Ii MP ION IBUM WO KI?RS'
s. PERMIT ISSUANCE 10.00 j-,r�il
FLOOD ZONE
`A. L. u. c.
COMP NSATION NSURANCE
(Phis section nuW Errol k completed if the ril is for am,
pem
PLG.CONTR. LIC. NO.PLG
TOTAL Q�1 .(j
Y ❑ NE:]
V C:] N�
hundred lollurs IS 100) or less.)
I certify ihat in the performance of the work for which this per -FEE
miss
it is ued. I. shall oat employ any person in any Punier se as to
SUMMARY
BUILDING .'I�-.�J
C✓�
become subject to the Workers' Conspensalion Laws of California.
Dam Applicant -
ALTER OR ADD TO MECH. 5.00
N61'IC0, '1 O APPLICANT: If, after ..king this Certificate of Ex-
APPLIANCE 5.00
AIR HANDLING UNIT (TO 1O=C.F.M.) 4.00 '
PLAN CHECK
FEE
emption, you should tKcome subject to the Workeri Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permil shall be deemed resulted.
CONSTRUCTION LENDING AGENCY
AIR HANDLING UNIT(OVER 101000C.F.M.) 6,00
SEISMIC FEE
SS
I hereby off m Illus there is a cinstruction lending agency for
the performance of the week for which this permit is issued (Sec.
3097, Civ.C.).
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
HEATING UN IT(OVER 100,000 B.T.U.) 9.50
ELECTRIC
1 certify that 1 have read this application and state that the above
information is correct. I agree 10 comply with all city and county
ordinances and state laws relating In building _cconstruction, and
VENTILATION. FAN (SINGLE) 4.00
PLUMBING
BOILER-CC"(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter open the
abbye-mentioned properly far inspection purposes.
BOILER -COMP (Over 100,DDO BTUI SEEIFEE SCH.
MECHANICAL
(W) agree to suec,-indemnify and keep hamdus the City Of
No against liabiliti , judgments,. casts and expenses which
any way cc a ast Said City in consequence of the
Eingof is is p'nit
MISC. - s 0 EFER TO ORD.
PERMIT ISSUANCE 10.00 ,�
CONST. TAX
O�a
MECH. CONT. LIC. NO. MECH.
TOTAL
L
6/S
TOTAL
-
�3.,
re0 pin cit/ Onnaclo! ale
OFFICE COPY