15344 POST THIS CARD NEAR FRONT OF BUILDING '
' PERMIT NUN18ER
CITY OF + CUPERTINOn
INSPECTION:DIVISION 1 5344
3t JOB INSPECTION RECORD
• I , PERMIT EXPIRATION
LJOB ADDRESS- .B e CI /C/ �7�'. UNIT# + LOT#
�7 - -
j� �+
PERMITEXPIRESIF WORK
.OWNER v!olrQiczS i k Q ,1CONTRACTOR �4 'J Q �,CE, .IS,NOT STARTED WITHIN
INSPECTION DATE INSPECTOR SPEC . ON RE ORD 180 DAYS OF PERMIT ISSU-
' FOUNDATION'- ''• -' - ANCE OR 180 DAYS FROM
" ,NOTE: LASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE ,. TO COMPLY WITH THE APPROVED PLANS AND CITY OF PENNITI I DXTION
CUPERTINO STANDARDS. ,
.GARAGE SLABS -
T -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
,��•-'• u� i.. ice`
UNDERGROUND /SLAB ` ! l
PLUM
A' o. 1 +
PLUMBING
Rb
B C/
- ELECTRICAL - - - , • .ISSUANCE DATE
MECHANICAL d IIIyEcr PLC. MECR
i - ❑ T71 ❑;. ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERp11T
INFORMATION
WOOD FLOOR vALUAnoN r sIPT.
PLUMBING - - '.
`• + MECHANICAL` - ` '• ,
ELECTRICAL - - " PERN1IT TO
' FRAMING
STORIES TYPE CONSTR,
INSULATION
OCC GROUP ' '•RES.UNITS
PLACE ND'SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF NOTE;NO FINAL INSP.SHALL BE MADE BEFORE so.Fr.FLOOR AREA: TOTAL ACREAGE
DIAPHRAGM'- .THE CONSTRUCTION TAX IS PAID.
-BUILDING USE
ROOF SHREs• wO- CON Pe - am..
APPLY�NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS + DATE INSP.,. ❑ - ❑ E.
. ❑ ❑
ASSESSOR SPARGELNO.
ROUGH . SAN.N .,.. , ..
PLUMBING ELECT.ENERGY '
TRACT,NO. WAR CEL NO
TUBS B SHOWER.PAN•. . . PLUMBING ENERGY' - •P "
MECHANICAL MECH.ENERGY
.ACC DATE ACQ,FILL NO
_ • ELECTRICAL ' - U^ BUILDING,ENERGY
FRAMING - - ELECT.FINAL TEST - –sf— ZONING
ENO.'SITE.NO.
.
i 'INSULATION - PLUMBING - -
GAS TEST '/ GAS
' MECHANICAL - EIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ❑Ir•"❑ [D "❑
ELECTRICAL RELEASE - vu000 zoNE A.L.0 c.
EXTERIOR SHEAR '
INTERIOR SHEAR ' .. _ FIRE DEPT, _ _ `'❑ . N❑ v ❑ . 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 '
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEO BY.BUILDING-INSPECTOR'.
- MICROFILM '
LU ARRANGE FOR INSPECTION BY PHONING,252-4505, ELECTRIC
ONE;WORKING'DAYBEFORE REQUIRED INSPECTION. PLUMBING*
Z "', PLEASE GIVE JOB ADDRESS WHEN PHONING. '
— SEE PERMIT FOR EXPIRATJON DATE MECHANICAL
IMPORTANT!, r coNST.,TAx
PLEASE READ REVERSE SIDE BEFORE TOTAL ..
GALLING FOR FINAL INSPECTION.
`y„ OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY'
BUI LDI NG'PROJECT I DENTI FICATION .PERMIT NUMBER „ y,
BUIUING ,��M SvRd6T - 'APPLICATION & PERMIT
ADDRESS 15 3 4 4'
's BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
k OWNER S/�� PLAN CHECK VALIDATION
NAME
LIC�VE RS Pf/a,6 QTY. ELECTRIC PERMIT FEE
PHONE 6-//9�/ 1 ••
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 b
A.SEYmcx4it LIC No. Z9 gS7 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S '
yy 37/-8on'� APPLIANCES-RESIDENTIAL 4;00
ADDRESS pn}d PJM AV PHONE.244- PANELS 10.00 DATEOFAPPLICATION '-
ARCHITECT PLAN CHECK FEE " P.C.NO.
OR - PANELS (OVER 200 AMP) 20.00 -
ENGINEER
' � �fl . LIC.No. SIGNS TRANS. 3.00
ARC OR ADDRESS ENG, SPECiIALCiIRCUIT 5.00 _ PERMIT VALIDATION
2 -V
ZIP TEMP.METER OR POLE INS. 20.00 t
AA9PLICADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE '- 20.00 fR1
O 0 o LICENSED CONTRACTORS DECLARATION _ tO
a v w 1 hereby affrm that I am licensed under provisions of Chapter') AI JUU ISSUANCE GATE I
s- (commencing with Section 7000)of Division 3 of the Business and
H rt BLDG. ELECT. PLG. MECH.
y i Professions Co 1�c,an I my license is in full fnr e e
o u- License Class.LS-/_Lic.Nunsber N c�� ty �,y gr
0 N r w Date�_)p - ag Contracwr - I`' O Er hb E-
a se s J - BUILDING PERMIT
¢ ¢o M ¢ OWNER-B UI LDHR DFCLA RA'PION INFORMATION
w ;LL E. I hereby affirm that I am exempt from the Contractor's License MISC.- REFER SO ORD
LLo j Law for the following reason.(See.70JL5,UusinessanJ Professions PERMIT ISSUANCE 10.00 �� VALUATION $/FT.
� - Code:Any city or county which requires a permit to construct,alter,
�'
Qta¢ 0 Improve,demolish,or repair any structure,prior to Its I1'sIIJOCe,also ELEC.COINED. ELEC. -A�/
u, w m u requires the applicant for such permit to file a signed statemLIC.NO.ent that TOTAL GiL/� PERMIT TO
he is licenmd pursuant to the provisions of the Contractor's License I I
F z i Law(Chaptere)(commencing with Section 70000of Division3ofthe
f 4 o Business and Professions Code)or that he isexempl therefrom and QTY. PLUMBING PERMIT FEE - -
F$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES IrYPE CONSTR.
T ; _ by any applicant for a permit subjects the applicant ins civil penalty ALTER-DRAIN -WATER (EA.)•5.00
of not more than five hundred dollars(55001.1:
t ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 - OCD.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or Offered for sale (Sec. 7044, Business and Professions - DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 -
Code:The Contractor's License Law does not apply to an Owner of
property who builds or improves Iheraon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
•• himself or through his own employees,provided that such improve.
meats are not intended or offered for sale.It,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner GAS EASYSTEM. 4 (EA) 200
builder will have the burden of proving that he did not build or im- - . . .
BUILDING USE
prove for purpose ol'mleJ. INDUSTRIAL'WASTE INTER. 3000 RES IND CON PB Other
.
❑ I,as owner of the property,am exclusively contracting with ❑ ❑� ❑ ❑ ❑
licensed contractors to constrtmt the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Profess'ians C_nde:The Contractor's License Law tines not apply
to an owner of property who builds or improves therron,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
conoids for such projects with J cootructor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO,
Cl I and exempt under Sec. ,IL&P.C.for fill, WATER HEATER W/VENT 6.00
reJ5o11
Owner Dam WATER SYSTEM 5.00 ACC.DATE ACG.FILE No.
WORK ERS'COMPHNSAPION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sell'-insum, ZONING-
or a certificate Of Workers'Compensation Insurance,or a certilieA ENG.SITE NO.
copy thereof(Sec.3800,Lab C.).
Policy No. Company
' O ❑ Cmaified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified ropy is riled with the city inspection division.
O Applicant MISC.- REFER TO ORO. y ❑ N❑ Y ❑ N❑
= rn PERMIT ISSUANCE 10.00
LU - CH RTI PICCOEPE IiXIiMPPION NSURANCE RRIi 125' FLOOD ZONE A.L.U.C.
W > ' COMPIiNSATION INSURANCE PLG.CONTR. LIG NO. PLG. ' ''
CL Z' (This seclion need not be completed if the penal is fnr one TOTAL Y❑ N❑ -YE]'' 'N❑
hundred dollars($100)or less,}
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEEFEE SUMMARY
W f- mit is issued,I shall not employ any person in any mannerso as to
O W beco c x iject�tq�the Worker. ompenwt' n Laws Ca limit,ia.
Datc£aclC_X-75.A licant BUILDING
'a RR ALTER OR ADD TO MECH. 5.00
} to NOTICF,'1'O APPLICANT: If,a ma ing Btis Cc Ific.1I of fix-
_ F 2 emption,you should become subject m he Workers'Compensation APPLIANCE _ 5.00 ' 'PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
CJ such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION I.IiNDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency far 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
Lender's Name HEATING UNIT(OVER 100,0008.T.U.19.50 �`'�
Lender's Address ELECTRIC
1 certify that I have read this application Jnd state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
•' ordinances and state laws relating to building construction, and BOILER=COMP(3 H.P.or 100,000 B.T.U.) 6.00.
hereby aulhorlee representatives of this city to enter Inion the BOILER-COMP Most,100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned property for inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
Cupertino against liabilities,.judgments, costs and expenses which PERMIT ISSUANCE 10.001CONST.TAX
ay in any way accrue against said City in consequence of the -
antingoflhispermiL MECH.CONT. - LIC.NO. MECH. -
o_% roTAL . TOTAL 2�
Signa o pleant/ ontm or Data
OFFICE COPY