15915 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15915
INSPECTION DIVISION
JOB INSPECTION RECORD ,
PERMIT EXPIRATION
JOB ADDRESS c1!03� •'`I'VV(T� C0.) -I UNIT#' _LOT#
'^'T1�p�,I` - PERMIT EXPIRES IF WORK
OWNER CJI/( V-- CONTRACTOR /q/S LE IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECYION RECORD MO DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS,
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB '9^^� sec��°'-' -� L •' /_ .
PLUMBING - eRs389 4E�N>� n 1�� L'� trcu�c •� - rr
ELECTRICAL N01%i OT kc- e Gk �x ISSUANCE DATE
MECHANICAL V BLDG ELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR UATION sIFT.
PLUMBING J.2�- � ?
MECHANICAL �� `
ELECTRICAL PERmn TD 1
FRAMING
STORIES s rvaE CONS
TF
v,
i
a . _ •s--tie�1
DCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _3
50 Ft FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 7
DIAPHRAGM _ — J (l THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB OIL
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0` El El El
_ A551!$$UHSPAHC[l.NO
RCUGH SAN.# (Cf 3� a.-;-3 - 0,3,r
PLUMBING -2N� _; ELECT.ENERGY Z.,
TRACT No PARCEL NO
TUBS 8 SHOWER PAN ,jC _ ,7t, PLUMBING ENERGY mi MECHANICAL _2C/ ,j MECH.ENERGY
ELECTRICAL ,�12 BUILDING ENERGY Acc DATe ACC,FILL No.
FRAMING _ ELECT.FINAL TEST zow NG ENG,SITE NO.
INSULATION - PLUMBING
GAS TEST IIj'- _ GAS �,_1'.9'-t5u/
FIRE SPRINK ENERGYT-24 "
MECHANICAL - v ❑ NEI v ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 6--2!G- 'r
LOC
EXTERIOR SHEAR -� _ w. ELECTRICAL RELEASE FLOOD zoNE A-1
INTERIOR SHEAR a FIRE DEPT. Y[:] No Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING, 03.S -u
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
1 1- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Q 33
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 3,
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL 3/
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-'_`BVI LING PROJECT IDENTIFICATION PERMIT NUMBER
awAEG APPLICjjTION & PERMIT 15915
,2-102
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL C.
DWNEE S PLAN CHECK VALIDATION
NA}M�E/yx.J '1 CITY. ELECTRIC PERMIT FEE
^
V �. Z1 r 1\ 1/ a P.ONS-1`?-1P7
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME G / n
WS V(.-V LIC.No .3Z( 0 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S arOREss PPLIANCES-RESIDENTIAL 4.00
9�� �L II/EPHON �/� PANELS 10.00 DATE OF APPLICATION
ARCHITECT�nJ1 PANELS (OVER 200 AMP) 20,60 PLAN CHECK FEE P.C.iNO.
�`• ENGINEER 1 LIC.NO, SIGNS TRANS. 3.00
ARCH.OR EN1G. PERMIT VALIDATION
�34v Ao..ESs(/ ^� n 2 SPECIAL CIRCUIT 5.00
7 y 1. • (� ZIP EMP.METER OR POLE INS. 20.00 /7
APPLICANTS MOTORS SEE FEE SCH.
AOOREs
/ S (L7V1sx/ SERVICE CHANGE 20.00 p
w o o LICENSED CON'i RACTORS DECLARATION /�J���
G o u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
K w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
K
i 1'rrfcssinns Code. nd I IY license is in full fur'•un efic L ❑ ❑ ❑ ❑
z o u,--�•License lass Lic.Number G
9 z F ,Py Date - Contracto -
J
Q w a OWNER-BUILDER UECL A'I'ION BUILDING PERMIT
oa" MISC.- REFER TO ORD FORMATION
wLL H I hereby affirm that 1 am exempt lion tire Contractors License ION SIFT.
ra LL ci j Law for the following reason.(Sec.1031.5.Businessxnd Professions PERMIT ISSUANCE 10.00
io Code:Any city or county which requires a permit to construct,alter,
a ¢¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. OC N
ai O a: requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A w m ac he is licensed pursuant to tire provisions of the Contractor's License
rzi Low(Chapter9(commencingwith Section 7000)of Division 3 of the � (,f//-
- 4 Business and NVieslons Code)or mat he is exempt therefrom and QTY. PLUMBING PERMIT FEE
r Oo the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ;m by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER (EA.) 5.00 ' /
W not more than five hundred dollars(55000.):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.urvrTs
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 R- 3
Code:The Contractors License Law does not apply to an owner of
property who builds ar 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- GAS-EA.SVSTEM-l 6.00
menus are not intended or offered for sale.If,however,the building 2733
ca 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 on-proving that he did not build or im- RES IND CON Pe Omer
prove for purpose of sola). INDUSTRIAL WASTE INTER. .30.00 ❑ ❑ ❑ ❑
❑ I,as owner of the property,am exclusively contracting with
licensed contract.. In construct lire project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 AIUSORSPARCELNO.
and Professions Code The Contractor's License Law does not apply y �/
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 36a -a3''D30
contracts for such projects with a contmetor(s)licensed pursuant to
Tic Conra,ho's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I um exempt under Sec' ,BARC.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORK ERS'COM PENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cerlificalu of Consent to scIlhu"ure, ZONING
or a certifmate of Workers'Com pe lion Insurance,or a certified ENG.SITE NO.
q copy thereol'ISee 3800.Lub.C.).
Policy No. Company •
O ❑ Ccr llcd copy by Im'i hcd FIRE SPRINK ENERGY T-24
Z z ^ ❑ Cert fief co + I•d w' ly�uil nslly Y n division. MISC.- REFER TO ORD.
O Applicant / Y❑ N❑ Y ❑ N❑
Fm PERMIT ISSUANCE 10.00 FL000 zoNE A.L.u.c.
CC ch R'I' 11CKE 01'EXEh1 PTION FROM WORKERS'
Ui _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N E] V E] N[]d o (This section need not be completed if the permit is lir one TOTAL
0 Z hundred doll ars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL. H mis
LL. issued, I shall not employ any person in any manner so as to
O w he Lome subject 10 the Workers'Compcmation Lows of Calihi rnia.
Date - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING o�S
- N NOTICE'f0 APPLICANT: If, after making this CertifiCm1 of Ex-
F ? eruption,you should berome subject to the Workers'CompaLsation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall he deemed revoked.. AIR HANDLING UNIT(TO 10SWC.F.M.) 4.00 Q
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10D=WC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work Rn which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Oc.�j
Lender's Address
I certify that I have read this application and slue that the above VENTILATION FAN (SINGLE) 4.00 M, 3 3
• irdinancinn isstatecorrect. 1 agree to comply with all City and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 0 V
ordinances and stale laws relating m building construction, and
hereby euthora, representatives of this city be enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL 8o 33
above-mentioned property for inspection purposes.
(We) a•cc to save, indemnify and keep brmle. the City of MISC.- REFER TO ORD.
Cuperti gui sl liabilities,judgmm� Cosh and expenses which PERMIT ISSUANCE 10.00 CONST.TAX / �
may y ay ac rue a ains sa' Cit I consequence of the
BE of 1s per it MECH.CONT. LIC.NO. MECH.
�, -7- p TOTAL TOTAL �a 3 /
✓" g aturc of Applicant/Contractor Datc
OFFICE COPY