16812 t POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
�;. CITY 01" CUPERTINO. 1681 `
INSPECTION DIVISION x,
JOB INSPECTION RECORD
PERMIT E%PIRATION
JOB ADDRESS 1_l b. 1 �R�^'�-L- I c` ' UNIT# � _LOT# '
+' `PERMIT•EXPIRES IF WORK .
OWNER ��" • COSTRA& R `--(�W' IS NOT,STARTED WITHIN
INSPECTION DATE INSPECTORINSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: - I'•" LAST CALLED 14PECTION.-
UFER ALL GRADIN&AND DRAINAGE SHALL BE INSTALLED
PREGUNITETO COMPLV WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS 19,E �If 39_14,c _ % vbz,
- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ' ' �•' ' "� , f
UNDERGROUND /SLAB
PLUMBING - - �� 0.2a.r'a• �1 t Ig;lfK�.
ELECTRICAL I 'i ssunNCEDATE',"
MECHANICAL , " cvv((, RLor. elecT. PSG. WEIR, _
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 4—y-- ��G(� L�A� BUILDING PERMIT
INFORMATION
` WOOD FLOOR ` • - CCM vASUATION -SIFT
PLUMBING -7
MECHANICAL - ° i•. Q�.0 x
ELECTRICAL
PERMIT TO
' � ,. :.- �.- . - - .- II
FRAMING. .
INSULATION STOHi Es TYPE CONSTH.
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED r,•. .
so Er rLnoR AREA TOTAL ACRPA,e ,
ROOF NOTE:NO FINAL INSP:`SHALL BE MADE BEFORE
`�,. DIAPHRAGM THE CONSTRUCTION TAXIS PAID
_ E BUILDING USE
ROOF SHEATHING . RES IND CON ,PB Om., '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN-SIGNED FINALS DATE INSP n❑ H❑_ El O
ROUGH SAN.# I4$ 4 E37 ssess< nRc LNo
PLUMBING ELECT.ENERGY , 'z " - 73157'' !7—. 'i_l,L+
TUBS&SHOWER PAN �'o •' PLUMBING ENERGY TRACT No. PARCEL No,
MECHAN ICAL' MECH.ENERGY "
Arc once nce.PaE No.
ELECTRICAL BUILDING ENERGY '
-FRAMING ELECT.FINAL TEST ZONING ENG.sire NO
INSULATION - ..Z O • PLUMBING
GAS TEST GAS`
' MECHANICAL - -. EIRESPRINK ENE RGV T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� NE]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUs
INTERIOR SHEAR FIRE DEPT. . `" 0 N Y ❑ N❑,
SHEETROCK - - GRADE ' FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - -TEMPORARY APPROVALS . 'BUILDING _OG
SCRATCH COAT ELECTRIC - PLAN CHECK' .
GAS - FEE , 'i
NO TAPE OR FrLASTER UNTIL ABOVE HAS BEEN SIGNEF OCCUPANCY SEISMICFEE"•'r, Q7
OCCUPANCKOF BUILDING IS NOT PERMITTED UNTI L BUILDING FINALISSIGNED BIKBUILDING INSPECTOR. :MICR'0'
ILM'
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC - ;, z,.o3
ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING ,g
`
o PLEASE GIVE JOB ADDRESS WHEN•PHONING. ° �
Z MECHANICALS ,Z,O3
- SEE'PERMIT FOR EXP.IRATION' DATE -
'. T
'.CONSTAX
IMPORTANT!
'PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINALANSPECTION.' , TOTAL 16,
OFFICE COPY.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
VUI LDI NG PROJECT I DENT]FICATI ON I - .PERMIT NUMBER
BUILDING U APPLICATION & PERMIT
;G ADOREB$_�-. 16 8-12
�7/3,/,�;y ,�� - BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWN'AS t" PLAN CHECK VALIDATION
NAME Y �1 CITY. ELECTRIC PERMIT FEE t l/"• PRUNE
HAMERAcrORs OUTLETS-SWITCHES-RECEP 10.00/1.00
06e LIC,No, LIGHTING FIXTURES- 10.00/1.00
CONTRACTOR'S
ADDRESS - PPLIANCES-RESIDENTIAL 4.00
CONFE
PHONE PANELS 10.00 DATE OF APPLICATION "
ARCRITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 ,
ENGINEER //��
�� uc.NO. SIGNS TRANS. 3.00 '
AR H.OR ENG. • - PERMIT VALIDATION
ADOC11RESsw�MI} SPECIALCIRCUIT 5.00
PA" --oall TEMP.METER OR POLE INS: 20.00
APPLICANTS
MOTORS SEE FEE SCH. I //
ADDRESS
SERVICE CHANGE 20.00
o s , LICENSED -J 74 k��LICENSED CONTRACTORS DGCLARATION - _
v I Icrehy affirm that I am Iicemsed under provisions of Chapter 9 ISSUANCE DATE
NZ w (commencingwith Section 7000)of Division 3 of the Rosiness'acd
G vAi MAR 31 BLDG. ELECT. PLG. -,MECH.
r N Z Professions Codcgtd my license is In tali fo n elle
Zo O e o License CI ss_�� Lia Number _
Q Y J Date _tT-Q/ Co1ltmCtOr city
- ciy If Cu . BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARA'(ION -
o a u INFORMATION
w ; I s- 11®rehy affiml That I ams exempt from the Contractor's License MISC.- REFER TO ORD
LL o j Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
_ PERMIT ISSUANCE 10.00'
Code:Any city or county which requirese permittocOnsuuct,alter•
� improve,demolish.or any structure,prior to its is6➢anCe,also ELEC.G❑NTR, LIC.NO. ELEC. IV
`
o u requires the applicant for such permit to file a signed statement that TOTAL
PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License
F Z i Business
(Chapter and
Professions
Code)orlli Section m e.coi(Diheiefrom and
Business and Professions Code)or tAn he is exempt therefrom and QTV. PLUMBING PERMIT FEE L.ES ✓I TYPE
.w F$ the basis for the alleged exemption.Any violation t Toarion 703L$ STORIES TYPE CONSTR.
n , by any applicant fora permit subjects the applicant toacivil penalty ALTER-DRAIN& VENT-WATER (EA.) 5,00
of not more than five hundred dollars(S500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole 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 thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale,If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 I /'_ lU
or improvement is sold within one year of completion,the owner- l0
builder will have the harden of proving that he did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of file RES IND CON PB Ono,,
INDUSTRIAL WASTE INTER. 30.00 ❑ O 0 ❑ 0
-
El 1,as owner of Ila p property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and ProfessionsCode:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
r, n a
_
contracts for such projects wi0a contractor(s)licensed pursuant to j ' _ - 0 [
tele Cmtrctor'sLicene Lw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tum exempt Holder
Sec.-,B.&P.C.I'or Ibis
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
w ACC.DATE ACC.FILE NO.
/Jw IiL,9'J MCC-a J1J0;LLPECLARATION WATER TREATING EQUIP. 5.00 '
l beech (f uthaRlR75v(u JLic(te of consent In self-inwre.
ar a certificate f Workers'Compms: ion Insurmce,or a cerlifiml ZONING ENG-SITE NO.
copy thereof( c.3600,Lim CJ.
Policy Nn. Company _
O ❑ Certified copy is hereby furnisher. FIRE SPRINK ENERGY T-24
Z Z �CertifiwI is filed will�I�yyre city inspection division.
O Applicant __.�/rG� - MISC.- REFER TO ORD. Y ❑ N E] Y ❑ N[]
~ m V' / PERMIT ISSUANCE '10.00
� - CIi R'17FICA'I'IiOP E%IiMI''I'ION FROM WORKERS' FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. [:]❑ ❑ ❑
1 0 (Thn section need not be completed if the permit is for one TOTAL Y N VN
D Z hundred dollars IS 1001 or less.)
U O 1certify that in the performance of the work tier which this per QTV. MECHANICAL PERMIT FEE FEE SUMMARY
IL H, mit is issued,I shall not employ any person in any numner so as to
O w becolnu subject to the Workers'Compunsallon Laws of Culiforniu.
Dale Applicant BUILDING
n ALTER OR ADD TO MECH. 5.00 ( 3
} N NO'I'l C14 TO APPLICANT: If,after making Ilii,Certificate of lix
F2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code; you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
Thereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance the work f r wpich t perm) Is i ed 1Sec. MICROFILM
3097, .CJ. 1 -=yam HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UNIT(OV ER 100,000 B.T.U.)9.50 �j
Lender's Aldress � ELECTRIC
I certify that l have read this application and state that the shove VENTILATION PAN (SINGLE) 4.00
information n and correct. I agree to comply with all oily county PLUMBING
ordinances /Z
and nate laws relating ni building construction,and n, and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above mentioned property for inspection purposes. BAILER-COMP (GVaf 100,000 BTU)SEE FEE SCH. MECHANIC L .12
(we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. . �zn
upertiao against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TA W2 M
ay in any way accrue against Said City in consequence of the VLA M
E �r. ([his pen q L MECH.CONT, LIC.NO. MECH.
,lT,®r^^ �/_���• TOTAL TOTAL J[) Ia
Signature of Applicant/Contractor Dale 0
OFFICE COPY