15029 POST THIS CARD NEAR FRONT OF BUILDING
' PERMITNUMBER
CITY OF CUPERTINO
®29
INSPECTION DIVISION
JOB INSPECTION RECORD ,•� {r`
. PERMIT EXPIRATION
o2oL�3/ M�ec�y
JOB ADDR ESS UNIT#' LOT
- PERMIT EXPIRES IF WORK
OWNER CONTRACTOR (�{}/�-(C� �J/f IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
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 CIN OF PERMIT VMJUATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED c'TNz% i;IF� yaR-N m.),
UNDERGROUND /SLAB o1� w o►�I
PLUMBING Fj III i CR5LF 0 VND�TSbN AICD so'�1 -
ELECTRICAL C61,O:r�a•h1 S�b'� to 50} �p14G, ISSUANCE DAIS
RLUG ELECT PLG MECH
MECHANICAL
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR pAI INFORMATION
WATION $TFT.
PLUMBING i-s - gg qPw
w-Q-cD
MECHANICAL
ELECTRICAL- ��tt rA I`PeRMn o
FRAMING _ - �` {r•� y' VJ w
STORIES TYPE CONSnv
INSULATION -S_yy ck '/
4- 3
/ GROUP S N
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED H'Dc prs.=G o.cp_/ 15J� 4- 3
SIT II FLOOR AIIEA TOIALACHLAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE n
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 6 a
! +L RDIL U$E
ROOF SHEATHING Nes IND CON coN PR ou,..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS q_DATEINSP. '❑ ❑ ❑ ❑ ❑
ASSESSORS PAHCLL NO
ROUGH SAN.# / ' p
PLUMBING � � - _L,�, T3 ELECT.ENERGY
3�`-a o�
IHACI NO PARCEL NO
TUBE&SHOWER PAN — vf� PLUMBING ENERGYMLECTRI A L _Z c _ J' M ILDINGE NE 'RACC DATE ACC FILE NO
ELECTRICAL - BUILDING ENERGYFRAMING _ QELECT.FINAL TEST ZONING ENG SITE NO,
INSULATION APLUMBING
GAS TEST CJ^Rg-{� / GAS
FIRE SPRINK ENERGY L]G
�/ MECHANICAL N� v N�COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGFLooO zoNE ALU c
EXTERIOR SHEAR ELECTRICAL RELEAS
INTERIOR SHEAR FIRE DEPT. v E] N� ❑ N�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING 0/
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE-
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 0 /6
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-450ELECTRIC o
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING a
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. ny
17
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL Q('
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL a7'
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
ILDING PROJECT IDENTIFICATION PERMIT NUM BER
BUILDING APPLICATION & PERMIT ' 02 J
n n
�-�
ADDRESS / f •
.� DE5 D- BUILDING - ELECTRICAL-PLUMBING
-MECHANICAL
OWNER'5 PLAN CHECK VALIDATION
NAME
�� 5 Il - �ISK ZSS_46V ITV ELECT-;iI.,PERMIT FEE
v `R PHON W
corvrnacroRs
[ OUTLETS-SWITCHES-RECEP 10.00/1.00 /a
NOM ' I
�J A1'1�'L•Ci CZ �LSK-. uc No.S0Z955 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
X004-I
D PHONE�J�"{�{� PANELS 10.00 DATE OFEAPPLICATION
ARCHITECT PLAN CHECK FIEETE P.C.NO.
OB 'p�N PES
C PANELS (OVER 200 AMP) 20.00
ENGINEER ''((
uc.NO SIGNS TRANS. 3.00
PERMIT VALIDATION
ADDRESS 4 15 o Pj SPECIAL CIRCUIT 5.00
EMP.METER OR POLE INS. 20.00
APPLICANT'sI00q� ��NIL MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 -
w o) LICENSED CONTRACTORS DECLARATION
a to u I hereby aft inn that Lam licensed under provisions of Chapter 9 ISSUANCE DATE
m rt H (commencing with Snetlon 7000)of Division 3 W the Business and ELECT. PLG. MECH.
Z F N z
Professions CoJiyand my license is in full fo,[te,�uJ
o m- Lumns- lass_p-- Lic.Nu L+G9 7 .�
9 F Doe �J-$. -Content A _
a y, t Of' ft 1� iDING PERMIT
¢ ¢ w ¢ OWNER-BUILDER DE ARATION J
Ey a D REFER TO ORD INFORMATION
wS n I hereby affirm that I am exempt frons the Contractor's License MISC.-
�- VA �N
Huo J Law me following raason.(SY'..]031.5,Busincssand l'rul'cssions PERMIT ISSUANCE 10.00
Code:Any city Or CORMY which requires a permit to construct,alter,
IS av(Ely, improve,demolish,or repair any structure.prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC.- DLL requires the applicant for such permit to file a signed statement that TOTAL Q� ✓ PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License
FZQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe sr--'vim bU a�
Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ F $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e. , by any applicant for it permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.0
of not more than five hundred dollars IS500)J: -
V I,as owner of Ox property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not DGG.GROUP PES.UNITS
intended or offered Icor sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs 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 however,leve such improve-
himesayefo thr ugh hiss oroffered for employee,provi, Suhenlooing GAS-EA.SYSTEM-1INC.4OUTLETS 6.0006
or improvement is sold within one year of completion,Um owner- GAS-EA.SYSTEM-OVER 4(EA ) 2.00
builder will have the burden
of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with DQ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply `
to an owner of pmperly who builds or improves the con.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 31le'.2 oU -p
contracts for such projects with a contractods)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO.
❑ lam exempt under Set.-,B&P,C.for tills WATER HEATER W/VENT 6.00
Icason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORK ERS'COM PENSA FION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby aflinn that 1 have a certificulc of consent to sc11'-insure' ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(See.3800,LAC.).
policy No. Cm.Ioil ny_1AI&QSTK i4�
O ❑ Certified copy is hereby furnished. pL, FIRE SPRINK ENERGY T-24 r
Z Z Certified copy is filed th the nsp' ion division.
O 1t�it,llt,"�,.-- „`L MISC.- REFER TO ORD. Y❑ No Y ❑ N❑
Mrn C: FICA'PEOF IiXEMPT1ON PROM WORKERS' PERMIT ISSUANCE I FLOOD ZONE A.L.U.C.
LLI > COSIPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. 0
D- (this sedi<iIt need not he completed if the permit is for one TOTAL /O V[:] N❑ V C] N❑
D Z hundred dollmrs($100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mil is issued,I shall not employ any person in any manner so as to
V heconiesubject tothe Workcri Compensalion Laws of GJifornia.
i Datc ApplicantBUILDING
ALTER OR ADD TO MECH. 5.00
} m NOTICE TO APPLICANT: If,after making this Certificate of Fe-
Z cnrption,you should become subject to the Workcri Compensation APPLIANCE 5.00 PLAN CHECK
provlsiuns of the Labor Code, you noel forthwith comply will FEE
U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ;zU /b
1 hereby aflinn that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) B.00 MICROFILM
3097,Civ.C.). J/L7
Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRLener's Address
1 certily that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00information is correct. 1 agree to comply with all city and county PLUMBIordinnce and state laws relating to building construction. and BOILER-COMPl3H.P.or100,000B.T.U.) 6.00hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposesBOILER-COMP IOver 100,000 BTU)SEE FEE$CH. MECHA(We) agree to Savo, indemnity and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments', costs and expenses which CONST.ay in any way accent, against said City in consequence of the PERMIT ISSUANCE "of this penmit. MECH.CONT. LIC.NO. MECH.TOTAL �pAf B� TO
Si ore of Applicant/Contractor Date
OFFICE COPY
ELECTRIC SERVICE NOTICE P.G.BE COPY V'
BUILDING INSPECTOR'5 NOTICE
CITY OF CUPERTINO
/•� _ 22-
To 2"To
You are hereby authorized to Connect electrical service for
Owner or Tenant Y/ / /�/ /`/
A,
No.of Woes .Size of Wires Size of Switch
I _
Motor Load Voltage Phase
e Heohn9 Lood K.W. Voltage
I l'gM I10_New$erode Reconnect
No.of Meters Neat 120 Three Wire ' More service
No.of Add.Meters Power Three Phase Move Meter.
OO ELECTRICAL INSPECTOR p
9 IV
PG BE
CITY OF CUPERTINO - COPY
GAS SERVICE NOTICE
I I q 19
I-
I� To
' You are hereby authorized to connect the GAS service for
Owner or Tenont :1 A k1FS
At bi r—
New Service-
No
ervice No, of Meters
Reconnect
Move Service
No. of Add. Meters
je Move Meter
Oa
t PLUMBING INSPECTOR
i BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO D's",Coop
❑ Backflow Device y.(
Sanitary Permit No. � "l !U�' O
Sewer Connection r I
Plumbing Permit No.
Plumbing Final
Lot No.
Owner or Tenant
At 22 P 3 I EF� ceiC S 7Zp
Tract {
Date Connected �-7,�J
- 19—Date Final " i —9c 19
°• i>Jl4`7�
PLUMBING INSPECTOR
I
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
To —7 I I LTJ , 19
You are hereby authorized to Connect electrical service for
Owner or Tenant -,7f)"FS Sh��T
At I I�E�7- CE l�as e(n
No.of Wires Size of Wires Size of Switch
Motor Load Voltage Phase
Heating Load K.W.t- Voltage JIi
No.of Meters Lighir � I10_New Service Reconnect J
Hear 170__Three Wire Mme Service
No.of Add. Meters Power. Three Phase Move Merer
�• ELECTRICAL INSPECTOR
I
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date ...../..... ...1..�..... .. ......... 19............ a Building Permit No. {.So2... .
The Building Located at .. Z ..�3I.....
Ownedby ......v� ._ .XYJ.. q- .........................................
Has Been For Use As: .J-F
Com tete
Altered) ....... ....................................
.. ..................................................................... .... ...............................................................
.................................................................................................................................................
....................... ... ...................................................�..........,.C....................................................
.............................................................
PD-7 BUILDING INSPECTOR