15783 POST THIS CARD NEAR FRONT•OF,BUILDING ERn,iT NUMBER
y CITY OF CUPERTINO . , 1'5783
'INSPECTION DIVISION
JOB INSPECTION RECORD
. •• A
1 - PERMIT EXPIRATION
7
JOB ADDRESS: ` 6-K 0"O *Nr-l ' 2CJ ZSd F9 %✓�"Q UNIT# •'1COT# Li• ,
PERMIT EXPIRES IF WORK y
OWNER ..f} LL CONTRACTOR " f} �, -S IS NOT'STARTED WITHIN
INSPECTION DATE INSPECTOR "INSPECTION RECORDC �= T 180 DAYS OF PERMITISSU-
FOUNDATION• - ANCE OR 180 DAYS FROM
NOTE LASTCALLED INSPECTION.
UFER ALL GRADING.AND DRAINAGE SHALL BE INSTALLED
PREGUNITE -. TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRMn VALIDATION
- CUPERTINO STANDARDS.I
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - '"�„'�•-'f•i=i". ""”' ,
PLUMBING
ELECTRICAL,
- - ISSUANCE'6ATE.
ELECTPLG. MEC+
MECHANICAL SE - ❑- .11 ',
. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - " BUIL DING PERMIT
INFORMATION
•.WOOD FLOOR - .. VALUATION :SiET.
' 'PLUMBING :• • , - •�
MECHANICAL' ' -
- - ELECTRICAL - - - JV6PERn+n t i
FRAMING
- STORIES TYPE CONSTR,
INSULATION
r
--UCC.GROUP RES.UNITS
PLACE NO SUBFLOOR.UNTIL ABOVE HAS BEEN SIGNED
��•, ` t • - ' ' '� � FI.O(1N,PHE4 TOTAL PLRf PGf •
-ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID-
BUILDING USE
ROOF SHEATHING I+es iND. .CON PR o
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP:
n55E550R5 PARCEL NO.
RCUGH SAN.#
PLUMBING ELECT.ENERGY ' + -
• TRACT NO, PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY'
MECHANICAL' MECH.ENERGY,
.
• ELECTRICAL • ' � BUILDING ENERGY �1 ACC.1.DATE ACC,FILE NO.
FRAMING ,)Z ELECT.FINAL TEST ff=2�-S�,' ,
ZONING ENG.$ITE NO.-' '
INSUL'ATI - _ PLUMBING'
GA TEST-- GAS .
•FINE SPRINK ENERGY T']A
ar - 3.. MECHANICAL'. ?.Z�y� ,,Y [D N.❑ ND
COVE NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '
.:,FLOODZONE JA'LUF.
EXTERIOR SHEAR,- ELECTRICAL RELEASE
.INTERIOR SHEARFIRE DEPT. Y Q N� • ,Y;L No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - NG ",
' • .INTERIOR LATH !TEMPORARY AP,.PROVALS'.. �
• SCRATCH COAT ELECTRIC PLAN CHECK -
t, /"FEE
GAS,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY y ' SEISMIC FEE , '�Q.•
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC y
LIU6 ONE WORKING DAY BEFORE' REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
z - MECHANICAL '
=-SEE PERMIT FOR EXPIRATION DATE
IMPORTANT!,
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE- TOTAL a
CALLING FOR FINAL INSPECTION:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES T USE BALL POINT PEN ONLY`
_ .BUILDING PROJECT IDENTIFICATION -
\ / ' It9 µ APPLICATION & PERMIT
PERMIT NUMBER
BUILDING
AEs , - ELECTRICAL-PLUMBING-MECHANICAL [7 p•
�
� C! v/0
OWNERS
PLAN CHECK VALIDATION _
`s NAME V r QTY. ELECTRIC PERMIT FEE j 1
/T PHONE
NAMER"cT°Rs uUTLETS-SWITCHES-RECEP 10.00/1.00
c..D.Jp B LIGHTING FIXTURES 10.00/1.00
r:DNT Acr°ns.• • APPLIANCES-RESIDENTIAL 4.00 - -
DDREss L . '
Q IPANELS;, 10.00 DATE OF APPLICATION h•
ARCHITECT PLAN CHECK FEE tP.C.NO. ,
OR PANELS (OVER 200 AMP) - 20.00 -
ENGINEER ,
LIC.NO. . SIGNS TRANS. 3.00'
AARCH.OR DDRESS ENG, �. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. ._ 20.00 �a _
APPLICANT .
ADDRESS - MOTORS SEE FEE SCH. CJS!
SERVICE CHANGE 20.00
o o LICENSI>1)CONTIO
RACTORS DECLARATION 7//
a v I hereby affirm that'I am licensed under provisions of Chapter 9 ISSUANCE DATE
y rt m commencing will)Section 7000)of Division 3 of the Business and - RLDG. ELECT. PLG. MECH.
Hy,z L Lossions Co�{e��p*j�yy..L is in full lorcy� fyt�� -
z o w - Lianm Class_/-e�/ 1L'�Lic.Number_!_ I60L ❑ ❑ '❑
oz w Date '(�-/.)[_�: Contrador_T/}_'.
UILDING PERMIT
¢o i OWNER-BUILDER Dec LA RKf10N INFORMATION
w ; LL y. I hereby alfirm that 1 am exempt from the Contractor's License MISC.=- REFER TO ORD VALUATION
S/FT.
H Loa Law ti..the following reason.(Sec.7031'.5,tlusinrss and Rrofcssiuns PERMIT ISSUANCE .+ 10.00
Code:Any city or county which requires a permit m const nreL al ler, /A-(1
. �.p ¢ 0 improve,demolish,or repnir any,structure,prior to its issuance,also ELEC.LONTR. LIC.NO. - TE LEC.
-D M requires the applicant for such permit.to file a signed statement that TOTAL PERMIT T
E
m lie is licensed pursuant to the provisions of the Contnuctor's License
H' aLaw(Cbaptcr9(conuncmeingwlthSedion70001o1'Divisio13el'the ' �F}Tq-iep�/l7f �R
Nosiness and Profession Code)or that he is exempt therefrom and QTY. r PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
p3 _ by any applicant for a permit%objects the applicant to a civil penalty ALTER-DRAIN&.VENT-WATER (EA.) 5.00
of not more than live hundred dollars(5500).):
❑ I,as owner of Ibc property,or my employees with wages as BACK F LOW'PROTECT. DEVICE 4.00 Dee.GROUP RES.UNITS
their sole compensation,will do the work,and the sl ructure is not
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CONIC. 5.00 -
•dw., Code:The Contrumor's License Law docs not apply to an owner of -
pe y w' D S0.FT,FLOOR AREA TOTAL ACREAGE
-
property Who buildse, improves FIXTURES-PER TRAP '5.00
i hinurlf re of intended
own employees,provided that such im Drove. h
mean an not imm�ded w toffendhin one year
of co mpleter,tthe o ding GAS-EA.SYSTEM-1 INC.'4 OUTLETS _6.00 • ,
,. or improvement Will have
is sold within one year of lie didtio t the owner GAS-EA;SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
u r builder will have the burden of proving Ilett he did not build or im-
RES IND `CON PB 011ier
prove fors owner of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ;�
❑ L as owner of the construct
petty.and exclusively contracting ins with
licensed contractors to construct the project La does Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions Cade:Ted Con tractor's License Law Roue not apply `
to antr owner of property who builds t r improves msec PLIand who LAWN SPRINKLERS-OVER 5(EAS) 1.00
contracts for such projects with a cnnlmdartsl licensed pars ant to
the Contractor's Licenu Law. I SEWER-SANITARY-STORM EA:200ft/10.00 - TRACT No. PARCEL No. .
❑ lam exempt under Sec. ,ITAP.C.for this WATER HEATER W/VENT' -6.00 -
ReasRo
Owner Date - WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WORK IS RS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate ofconent to self-insure,
ZONING ' ENG.SITE NO.
or a certify pfX'yrf.ykyL ompensalion Insurance,or:I certified
copy t �qI/ 66yyEC 77ll0D((YYEEab�,C.)..p UNC
'V Policy No. Colnpany Y 707
-
O ❑ Cerliliedcopyisllerebyfufnished FIRESPRINK ENERGYT24
Z Z T('Cdrtifi y is II` uh Ili city impcdt- di MISC.- REFER TO ORD. ❑
Q APPlicon (��fd Y N v N
X h iR'I'IFICA'I'F,OF Ii KliNll'TION PROM WORKERS• PERMIT ISSUANCE • - 10.00 FLOOOZONE A.L.U.C.
LU �_ CONIPENSATION INSURANCE „ PLG.CONTR. a LIC.NO. PLG.
d I'I'his section nerd not be complclSd it it,, permit ix for one - 'TOTAL Y❑ N Y ❑ N❑.
Z hundred dollars IS 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 mit is word,I shallnotemploy any person in any manner so as to
U become subject to the Workeri Compensation Laws of California.
U y Dom Apphcaut ALTER OR ADD TO MECH( 5.00 BUILDING
} N NOTICE'10 APPLICANT: If,after making Ibis Certificate of Ex.
Z emption,you should bcconhe subject to the Workcrs'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you nmM farthwilh cmuply Will, FEE
U_ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.)i 4.00
coNSTRUCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE xf�
I hereby affirin that there is a consvuctiun leedins agency for EXHAUST HOOD.(WITH DUCT) 1 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Chv.C.). - 'HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC '
Lender's Address
I certify ihat 1 Imvc read this application and state that the aboveVENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
y ordinances and stale Inns relating to hiilding construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
t heheby nmlhon'o represematives of this city In enter upon the BOILER-COMP(CIVIL,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property ler inspection purposes.
(We) agree to save. indemnify and keep harmless the City of MISC.- REFER TO ORD. \ - -
upertirm against liabilities,judgments. Costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX -
may in any way accrue Ig ins said Cily.in consequence of the '
rami of iK-pe MECH.CONT. LIC.NO. MECH.
TOTAL
7=/y' TOTAL " JS
literature of App hcant/Contractor Dare I
OFFICE COPY