15761 I POST THIS CARD NEAR FRONT OF BUILDING4. PERMIT NUMBER
CITY OF CUPERTINO 15761
INSPECTION DIVISION
JOB INSPECTION RECORD I
�i ,,((�� PERMIT EXPIRATION
/
JOB ADDRESS��_.p_Q 211f, UNIT 1# _LOTW
PERMIT EXPIRES IF WORK
OWNER S {Z 0 fill CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
LAST CALLED INSPECTION. .
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO S ANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED R ok6N F.�C-vt Pb'6 "mbI3
UNDERGROUND /SLAB of-+�`I `R> '� Z-co2Ro�rTTT L. r
PLUMBING
ELECTRICAL ^H' ILLKcT W 1 ISSUANCE DATE
ECH
MECHANICAL /.;aA7&r cto(kr / //DLL BLDG ELEcr LLc,. M
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED aG Z' Ot BUILDING PERMIT
-�-
WOOD FLOOR ^'�Y Co a•..- A'S INFORMATION VALUATION S/FT.
PLUMBING - LGar�
to
MECHANICAT
L
PEH M111i TO
ELECTRICAL _
FRAMING / / �o"d
st We
INSULATION �1}�9 �.Q Q sroHlGs rvPE cnNsnT
OCG GHOUL RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE so IT rLomT AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HES No CON PB oln„
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑ 0 ❑ 1:1
ASSESSOH5 PARCEL NO
ROUGH iln SAN,#
PLUMBING ELECT.ENERGY
TRACT No PARCEI_No
TUBS 4HOWE AN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
E LECTRICAL' tel/-fid' BUILDING ENERGY ACC DATE AC c FILE NO
FRAMINGELECT.FINAL TEST zoNlNc ENG SITE No.
INSULATION - 116 Go PLUMBING
GAS TEST GAS
MECHANICAL FIRESPRINK ENERGY TqG
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING V ❑ N[_
❑ I ❑ IN[j
EXTERIOR SHEAR ELECTRICAL RELEASE FLoou zuNE A.Luc
INTERIOR SHEAR FIRE DEPT. Y ❑ NE] I ❑ N❑�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH -/fr- BUILDING BUILDING
INTERIOR LATH TEMPORARY AP R .ALS
SCRATCH COAT ELECTRIC ti PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OFBUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC GI?
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
U, PLUMBING 6 db
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX C
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
PERMIT NUMBER
' BUILDING PROJECT APPLICATION & PERMIT
BDILDING -� 15761
AODflE:fOB� yl
BUILDING CAL
OWNER'S r(/ PLAN CHECK VAUDATIO
NAMME,, CITY. ELECTRIC PERMIT FEE
• 00 6-
CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.No. LIGHTING FIXTURES 10.00/1.00
CDDEs. oats APPLIANCES'RESIDENTIAL 4.00
CONTRAIE
PRONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTLAN CHECK FEE ECT PANELS (OVER 200 AMP) 20.00 7=
P.C.NO,
OR
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
ARCH.OR ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
to v u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSIMI DATE
(commencing wish Section 7000)of Division 3 of the Business andC,♦ EL PLG. MECH.
Fn Oz Professions Code,and my license is in full force and effect. f-yd Elz o L — License ClassLic.Number. LN
Q z w Date Contractor
TQ NG PE MIT
OWNER-BUILDER DECLARAION
o a " MISC.— REFER TO ORD INFORMATI N
X 3 N I hereby.1 Unit that I am exempt front the Commetor's License
LLoa Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE ye•�0 VALUATION $/FT.
L Code:Any city or county which requires a permit to co...unct,alter,
R¢se 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.
ELEC.
— DLL requires the applicant for such permit to file a signed sl alement that TOTAL _ PERMIT TO
' w$ he is licensed pursuant to the provisions of the Contractor's License
H z i
Law(Chapter 1)(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or HIM he is exempt therefrom and QTV. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 703 1.5
STORIES TYPE CONSTR.
w5;: by any applicant fora permIt subjects the applicant m a civil penally ALTER-DRAIN&VENT-WATER (EA.)
of not more than five hundred dollms(8500).):
- ❑ 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,AREA,COND. 5.00
Code:The Contractor's License Law docs not applyto an owner of
property who builds or improves thereon.and who does such work FIXTURES-PER TRAP 5-eG SQ FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedmoffered forsalu.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold willim one year of completion,to nwVCP GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
huilder will have the burden of proving that he did not build or int-
ProveOrpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PR Our.,
❑ 1,as owner of the 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 Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00
contracts for such project w th ntmetor(S)licensed pursuant to
the Contractor's SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ I am • ;B.& C.Ii this WATER HEATER W/VENT .6.00
cairn
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK Ii RS'COMPF.NSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby alfrm that I have a certificate of consent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is Filed with the city inspection Division. MISC.- REFER TO ORD.
O Applicant Y❑ N❑ Y ❑ N❑
MN C17R'I'IHCA'I E OF 1:X EM 11110 N I7RONI WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
QJ1 CONPI-NSATION INSURANCE: PLG.CONTR. LIC.NO. PLG. 3o .� Y❑ NE] V ❑ NF]
O (This section need not be completed if the permit is for one TOTAL
::) 2 hundred dollars IS 100)or IeSs.)
0 O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as to
V become subject to the Workers'Compensation Laws of California.
w Date Applicant BUILDING
a ALTER OR ADD TO MECH. 5.00 S3
} N NOTICE. you
APPLICANT. It,after to the
this Workers'
ompe of lix-
F 2 emptloo,you she L become Code,
you
m we Workers Ccomply inion APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, you mtrsl Iorthwith comply with FEE
U such provisions m this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00 p G
CONSTRUCT ION LENDING AGENCY AIRHANDLING UNITIOVER 10000C.F.M.) 6.00 SEISMIC FEE FT O
I hereby affirm 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.) 8.00 MICROFILM
y 3097,Civ.C.).
Lender's NI I, HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC /
Lenss
Lender's Address / .�.(
I cert it that l have read this application and state that tire above VENTILATION FAN (SINGLE) 4.00
. information n correct.I agree to comply with all city and county PLUMBING 30 0-0
ordinainformacestion
and state laws relating ro building l city action,nd co and BOILER-COMM H.P.or 100,000 B.T.U.) 6.00
hcrcby authorim representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU1SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) ogre• save, rade ify and keep harmless the City of MISC.- REFER TO ORD.
uPertino a ti ti dgm4n[s, costs and expenses which CONST.TAX
CUP i ny u a mst said City in cunsequ77,1_0
nc of the PERMIT ISSUANCE 10.00
m g 01 MECH.CONT. LIC.NO. MECH.
/� TOTAL TOTAL Qct 9�
igna PPPlicunt/ [mdor Dlde
OFFICE COPY -