16540 1
POST THIS CARD NEAR .FRONT OF BUILDING 70 PFUMIT NUMBEF♦•'.'
CITY OF CUPERTIN 16540
INSPECTION DIVISION
JOB INSPECTION RECO
PERMIT EXPIRATION
J(IH F /p vr�_cTF :1 .- r2d
nODHESS .. -_, .`_..__...... - _ ..__UN Il .--.— __L Ttt PERMIT EXPIRES IF WORK
HD ,^CIOR IS NOT STARTED WITHIN
_ _ INSPECTION DATE INSPECTORINSPECTION RECORD 180 DAYS OF PERMIT ISSU
P OI1N__DMl0N ANCE OR 180 DAYS FROM
NOTE: L•ASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR E(iUNI TE TO COMPLY WITH THE APPROVED PLANS AND CITY OF IYJO.RT NALIUAI ION
CUPERTINO STANDARDS.
GNIAGC St.nOti — -
P_OU_RNO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 11RIAR B �-
_ _ UNDERGROUND /SLAB
PLUMBING •yZ•-l` CI' City ul cupotqq-
F:LFCTR ICAL yL\ ISSUANCE DATE
MEC14ANICAL ULUG ELECT PLG. MEUI
i -- ❑ ❑ ❑
j DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I/— ' � BUILDING ER
/ IINFORMA?IONfs,i
WOOD FLOORLS
PLUnn BING D�Y b nA,ION �SIFT.
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I
MECHANICAL �p
F,LEC �.,�1• �f , �� Q� rEnnm.
F-- — V I )
RAMING �,_-5�- ��FT �•R`VU
INSULATION s, rots ry D
,.I
A.,, Uf.L (:,IO TIES ES UNITS
, Z� ,ti'i �n.tG t rl+.rya, '-h CIi 3
I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ✓�'/) �'r�''C )10 LIZ! r-),WTT-0enal"
SO Ir ILOONANEA TOTAL ACREAGf
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE /
DIAPHRAGM THE CONSTRUCTION TAX IS PAID O
ROOF SHEATHING !/, r 9VILUI NG USE
I, •p�. uEs IND ON PB Omr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN tIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.11 ASSESSORS PAUCE I.NO
PLUMIIING ELECF.ENERGY
I UIl:KSI I0WHI VANIUM.I NO. PAI c L No
PLUMBING ENERGY
MECIIAPJ ICAL MECH.ENERGY
' ELECTRICAL ncc Onrt, ncc FILE No
BUILDING ENERGY
I FRnMIN(] ELECT.FINAL TEST
INSULAOON PLUMBING ZONING ; ENG.SITE NO.
GAS TIS IGAS
I
MECHANICAL FINE SPRINK ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° El NO Y 0' NEIEXTERIOR SHEAR FLOOD ZONE A.L U.C.
_ _ _ ELECTRICAL RELEASE
INTERIOR SHE N1_ .......... 1.1__._,. FIRE DEPT. .E-`f �-1M Y❑ N❑ . ❑ :.. N❑
^.HEC IHOCK GRADE
eaF.�E-6UMMAIII''- �; ;r.
EXTERIOR I.AT11 BUILDING
IN n1.nIDR Ln FllTEMPORAR'T APPR ALS BUILDING S (r
SGRAICH COAT ELECTRIC PLAN CHECK
GAS FEE
flf-
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEDOCCUPANCY / SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• o0 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
u
CALLING FOR FINAL INSPECTION.
APPLICANTS POSTING COPY
POST THIS CARD NEAR-FRONT OF BUILID INGl A
\ RMI NUMBER
CITY OF CUPERTINO 4/6 . 16540
INSPECTION DIVISION c6D.
I' JOB INSPECTION RECORD / L
-7 , / •'-� �/ �J l
`-J JOB ADDR ES �aCO�J PERMIT EXPIRATION
UNITAc*oa PERMIT EXPIRES IF WO
RK
OWNER V4, CeLOT
tferRD
IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD - ... DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR,180 DAYS FROM
NOTE: - LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. nM•
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDvpT;�f M�R
UNDERGROUND /SLAB 5-1c),pO 5'ieL-All ,1u4,
PLUMBING C* of CUpow '-• i I�� ,..ri% <,;..
ELECTRICAL VW
'ISSUANCE PATE
MECHANICAL � �1O_I� /11o� � BLOC rLecT PLC, MECR.
o
1V7 GK.\r K '\ ❑ I ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNE - Q���g l �.5 ��NL BUILDING PERMIT
WOOD FLOORNM INFORMATION
PLUMBING - �N VALUATION oN ST .
3 coG
MECHANICAL G O✓ems /�?py� ` v,1i�y 1-,P% 11-17-
ELECTRICAL - PERMRT To
FRAMING I _ A J d 41
INSULATION - STORIES TYPE c NSTW.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . -
. SO FT FLOOR AREA TOT AIACREAGE
T ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID !7
ROOF SHEATHING _ R[s IND LoCON USE
0'1'•
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ -❑
ROUGH SAN.k
I�� I ASSESSORSPAHCELNO
-
y, //�� /1 57
PLUMBING ELECT.ENERGY TTG(P - I�- 0
TUBS&SHOWER PAN PLUMBING ENERGY TRACT No PARCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL ' BUILDING ENERGY ACC DATE AGC.PILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING - ZONING ENG.Si TE NO,
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZUNL ALUC
INTERIOR SHEAR FIRE DEPT. N❑ Y ❑ N❑
SHEETROCK GRADE
FEE SUMMARY
EXTERIOR LATH - ILDING -ZZ-
INTERIOR LATH MPORAR BUILDING -
SCRATCHCOAT - ELECTRIC PLAN CHECK
5 e4p_' -"'i
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY LSEISMIC FEEF
-
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
• MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
y� z PLEASE GIVE JOB ADDRESS WHEN PHONING.
�TJ
- SEE PERMIT FOR EXPIRATION DATE'- MECHANICAL•
IMPORTANT! CONST.TAX
y
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. ' � • u
OFFICE COPY :i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
rB BUI CCY NG PROJECT IDENTIFICATION PERnII16540
N6 5 4 0-
I;VILDING APPLICATION & PERMIT
ADDRESS Gw BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
H
OWNEn'$ N%*
�L 6•r -Wd)�APLAN CHECK VALIDATION
NAME W
TV. ELECTRIC PERMIT FEE
PHON �
� NoTORe'� - UTLETS-SWITCHES-RECEP 10.00/1.00
Fz'r-- L LIGHTING FIXTURES 10.00/1.00
CONTRACTOR S APPLIANCES-RESIDENTIAL 4.00 -
S PANELS 1000
PHOry . DATE OF APPLICATION
AR°wTe
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,C:NO.
ENGINEER���
�LIC,^.O.. /• Q SIGNS TRANS. 3.00
ADDRESS ENGtT/� �• SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Z,p
APPLIC
EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE .20.00
2 F
0
0oo LICENSED CON"TRACT'ORS DECLARATION '
a U U I hereby affirm that I am licensed under provisions of Chapter 9
2 w r'�
Z
(commencing with Section 7000)of Division 3 of the Business andMAR ;ISSUANCE DATE
.,V.r - LOG. ELECT. PLG. MECH.
D i Professions Co J my license is in full fop} •yy ..
z o m- Lice ]a,, Lic.N'umh 'j ClZ ICf � E
O of H Dale -3 •'� Gonlmctorr'Z"^1IA,xi City of Cupertino IL`l
SE y f J
¢ ¢ wa OWNER-BOLDER DECLARATION BUILDING PERMIT
a: 0a " MISC.- REFER TO ORD INFORMATION
w a- 1 hereby affirm that I mn exempt from the mv,,Contractor's
LLoj Law forthefollowingreuon.ch reuiresa.ermit tocnd Professions VALUATION $/FT.
r - PERMIT ISSUANCE 10.00
Cprovo,demolish,
Countywhiny structurep riot t oconsuance,lter,also - p� n^
¢ ¢¢ improve,dttno ish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 1,10 WO
¢ requires the applicant for such permit to file a signed statement that
ea m m he is licensed ulsuanl to the - TOTAL PERMIT TO
p provisions of the CDnlmctor's License
HZQLaw(Chapter 9(commencing with Section 7000)of Division 3o fth, ^I ` �
i o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE r`
¢ ,-m the basis for the allege)exemption.Any violation of Section 7031.5 STORIES TYPE CO TR.
dam _ by any applicant for a permit subjects Ute applicant to a civil penalty gLTER-DRAIN -WATER
of not more than live hundred dollars(5500).1'. (EA.) 5.00
❑ Las owner the property,of my employees with wages as
their sols;compensation,will do Ute work,and ye structure is not BACK FLOW PROTECT.DEVICE 4.00 OCC.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 dos not apply to an owner of
property win.build,Or Improve,thelenn,and who does such work FIXTURES-PER TRAP 5.00 $Q FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employes,provided that such improve- ,y
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 �
or improvement is sold within one year of completion,the owner- GAS EA.SYSTEM-OVER 4 IEA.) 2.00 o
builder will have the burden of proving that h -e did not build or im- BUILDING USE
prove for as owner of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ L u owner of the property,he exclusively contracting with ❑ ❑ O 0 0
licensed contractors tore C.mtutthe project(Sec.7044,Business LAWN SPR IN KLERS-1 INC5 V.B. 6.00 ASSESSORS PARCELNO.
and Profession'
Cole The Contract Ors License Law does not apply
to an owns of property s who ha contr improve,ensed p,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 'Z 269 - 1 •T_/15
contracts for such cense is with a conlmctor(s)licensed pursuant to :J eV/ V L.J
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00
❑ TRACT NO. PARCEL NO.
Pum tnempt under sec. ,B.&P.C.for uus
reason WATER HEATER W/VENT 6.00
Owner Date - WATER SYSTEM 5.00
ACC.OATE ACC.FILE NO.
woRKERs'compENsn'floN DHCLnftniiON WATER TREATING EQUIP. 5.00
1 hereby affirm for I have a certificate of consent to self-insure, -
or u certificate of Workers'Compensation InsuranCce,or a certified ZONING ENG.SITE NO.
copy thereof tree.3800.Lab.C.l. LV�
Policy er Company
0 L] Certified copy is hereby furnished. FIRE SPRINK ENERGY T"24
z Z Py(IS" Cerlift carry is filed w h th- �y , . tion "on.
F,p A pheanr F;y� tgYy�_e�"� MISC.- REFER TO ORD. y N� v LTC.a
CERTIFICATE OF li%IiMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.LC.
LU > COMPENSATION INSURANCIi PLG.CONTR. LIC.NO. pLG
CL O (This section need not be Completed if the permit is for one TOTAL v� N� Y� N�
Z hundred dollar,(S 100)or less.)
U O 1 testily that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY -
LL U mit is issued, I shall not empluy any person in any nmmnsr so as to
become subject to the Workers'Compensation Laws of California.
� y Dam Applicant ALTER OR ADD TO MECH. 500 BUILDING
} to emption,TO APPLIshould become
If,alter making this Certificate u Ex-se.ion r
F Z emvision you the Labor Code,
totheWorkers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions io the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoke). AIR HANDLING UNIT(TO 10pODQF.M.) 4.00 FEE
CONS'I'RUCfION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE. Gf SD
I hereby aRlrra that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) ,5.00 1
the performance of the k for which this permit is issued(SP" PLUMBING
MICROFILM
3097,Civ.C.). ING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Namc
Lender's Address I NG UN IT E R 100,000 B.T.U.)9.50 ELECTRIC
I certify that I habe read this application and state that the aboILATION FAN (SINGLE) 4.00
ordiinfonances n tourer. I agree to compty with all city and counR-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinanc- and rr tc Taws relatinx to building construction.hereby authorse representative, of this city to enter upon tabovo-mentioned property for inspection purposes. ER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save indemnify and keep harmless the City .- REFER TO ORD.apeina against liabilities,judgments', twin and expenses whiCONST.TAXmay in any way accrue against said City in consequence of tIT ISSUANCE 10.00LIC.NO. MECH
L7TOTAL TOTAL 983 0
urea Applicant/Cont,eros Dao
-- - OFFICE COPY