15194 I
- POST THIS CARD M,AR FRONT OF BUILDING
I'f:F MliNUMBER
CITY ')F- CWERTINO r , 1519
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
Mn nw LOT#
UIT# _
JOB ADDRESSILSL _
``/(� Yka n PERMIT EXPIRES IF WORK
owNtivl dq Cd,, o
CONraACTOR \q�1 p' tto, IS NOT STARTED WITHIN
INSPECTION DAT INSPECTOR INSPECTION hEcoRD 1180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION -(�O n .Q• NOTE: LAST CALLED INSPECTION.
UFER !�. 9 ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vnLmArioN
PR EGUNITE - CUPERTINO STANDARDS.
GARAGE SLABS - �QlL1QU..RZR41, 1-+�..7 '•"-'°
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,. .• / - ` -"'
UNDERGROUND /SLAB
PLUMBING
ELECTRICALISSUANCE GATE
MECHANICAL 8LOc ELEcr vLG. MecR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 0 DING PERMIT
BUIL
WOOD FLOOR \C)v �' INFORMATION
�1 v ALUAnuN SIFT.
PLUMBING /o mc�7 d-`g _ Ot CVQe _
i
MECHANICAL PERMIT TO
ELECTRICAL �/- I w�,i
FRAMING 2^ 7-" ✓� E l/�J VV -
srOI+IEs TYPE coNSTR •
INSULATION 2-C,f-- p�
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •�
la ri FLOORAREA TOTAInEEEAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE'
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID UI
LW / BUILDING USE
ROOF SHEATHING -{�•�—QA RES, IND CON Pa OPI �
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑11 EL
ASSESSORS PARCEL NO
ROUGH SAN.4
PLUMBING p� �j �,rj ELECT. NE GY
IRACI NO PARCEL NO
TUBS 8 OWER PANS - ' PLUMBING ENERGY
MECHANICAL MECH.ENERGY S n
ACC DATE ACC.FILE NO
ELECTRICAL, BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG SITE NO.
INSULATION - _�(�_ PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGYL2<
MECHANICAL v ❑ N❑ ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EL000<oNL nLuc.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. r N� v Ll N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH — '� BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING "
SCRATCH COAT ITT ELECTRIC Z PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE / .c.
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
' L
LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
? — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! "CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. '
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATIOIJ �'-'/ ,PERMIT NUMBER
aDILDINc APPLICATION & PERMI1_ 15194
ADDRESS
0e- Aria' t BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
. A'F I ftod ( PHONE q GTV ELECTRIC PERMIT FEE
a d
CONTRACTOR
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
�—�
NO. LIGHTING FIXTURES 10.00/1.00
LIC.
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION -
ARC1H'ITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ERiG�j l t. INC,No, W SIGNS TRANS. 3.00
ARCH OR ENG. SPECIAL CI RCU IT 5,00 PERMIT VALIDATION
Do s Ila,
Gf F ZtP EMP.METER OR POLE INS. 20.00 �\
APPuc Nrs MOTORS SEE FEE SCH. X/-Y
DDRES � JU`I"
SERVICE CHANGE 20.00
r O o LICENSED CONI ACTORS DECLARATION
Q U v I hereby affirm that I am licensed under provisionsof Chapter 9 ISSUANCE DATE
of a m (commencing with Section 7000)of Division 3 ol'tile Business laW BLDG. ELECT. PLG. MECH.
H y z Professions Code,Oq my license is in full force and effect r-r•t -
z D m - Liccnze'��C�{{{aaaggqs Lic.Nuhcr
Q y 4 Dale . ' Conmtractor
m 2 w a OWNER-BUILDER DECLARATION ` S BUILDING PERMIT
u REFER T D INFORMATION
s, ;u w I hereby el'finn that I am exmmpt from the Contractor's weric MISC.- vgLUATION SIFT.
H .. o j Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 1
Cade:A try city or co u my which Fell ui res a Perm it to construct,alte,, - �7 a.8-0
QQ Q Q improve,demol6h,or repair any structure.Prior to Its issuance.also ELEC.CONTR. LIC.NO. EL�p
- o e, requires the applicant for such permit to file a signed statement that t)PTYA'L � T� PERMIT TO
d w Cr he is licensed pursuant to lire provisions of the Contractor's License �M V =6 w
F z a Law(Chapter 9(commencing with Section 7000)of Division 3 Otthe X`) •Ll
F i o Business and Prates me,Code)or that hGm
e is exempt thereoand QTY. PLUMBING PERMIT C FEE
M H o the basis for lite alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
re
ate _ by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not mre othan five hundred dollars(55001-1:
❑ I,as owner of the property or my employe,,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,AREA,COND. 5.00 Q— 3
Code:The Contractor's License Law does riot apply to an owner of
property who builds or improves thereon,laid who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself orthroughintended
ownemployees,or edcovided ever.hat the
improve- GAS-EA.SYSTEM-1 INCAOUTLETS 6.00
meals are nor intended ar offered ee sale-If-however.the building d �P
or improvement is sold within ooc year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build orie-
1 prove filly purpose of sale.). INDUSTRIAL WASTE INTER- 30.00 RES IND CON PB Omer
/Y1 as owner of tile properly,am exclusively contracting with 9- ❑ ❑ ❑ ❑
licenud convectors to construct lire project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does riot apply
to an owner of property who builds or imprmcs thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts lot such projects with a emoractor(d)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's Lccuse Law. pTRACT NO. PARCEL NO.
❑ I axcmpt under ScG B.&P.C.fist h' WATER HEATER W/VENT 6.00 Ol�
ft.'0 la V
Owner • Dote - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WOKKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sell'-insure, 20NING ENG.SITE NO. .
nr a certificate of Workers'Compensation Insurance,or u certified
copy thereof(Sec-3800,Lab.C.I �'-) �(
Policy No. Company— IJ 1F�pd- •U-
Q ❑ fC��fliric 11 is hilly in S FIRE SPRINK ENERGY T29
Z Z Q/Cervfic d • Ci division' MISC.- REFER TO ORD.
O Applicant_ Y❑ N❑ Y ❑ N❑
X - CERTIFICATFOP EXEMPT ION PROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.0 A.
DJ COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG. ps 9,S' Y❑ N❑ Y❑ N❑
d 0 (Phis wetion need not be completed it the Permit is liter oil, TOTAL U J
Z hundred dollar,($100)or Icse)
U O 1 certify that in the performance of lhework for which this per DTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compeasat ion Laws of Calhornia.
n Dale ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
H Z eruption,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.IVL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.EM.) 6.00 SEISMIC FEE
I hereby effirnh that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of lire work for which this perhnit is issued(Sec. MICROFILM
LendeHEATING UNIT (TO 100,000 B.T.U.) 8.00's Name
S
LenderrName HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address S13
I certify tlhat l have read tlusappliestion and slate that the above VENTILATION FAN (SINGLE) 4.00 /-
m onnation is correct. I agree to comply with all city and county PLUMBING EJ
J
ordinances and state laws relating to training construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property tot inspection purposes.
1 (we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities.judgments, costs and expenses which CONST.TAX 0�
may 'ri any way accrue against sail City is Conscyuen-e `�
of the PERMIT ISSUANCE 48-BB
run g oI This permil.��_ MECH.COCONT. LLIC.NO. MECH. y.
•+I/Lr/y-.11 L I TOTAL OL� 7 TOTAL
SiR ature of Applicant/Contractor DID,
OFFICE COPY