15774 POST THIS,CARb 'NE'AR FRONT OF'BUILDING PERn+Ir Nu xev
CITY:. Ql •�CUPERTINO 1 A
INSPECTION DIVISION
JOB INSPECTION RECORD
•. - IO fJ / QRA-�/s-c= '�iC.�6 �� _ PERMIT EXPIRATION
JOB ADDRESS J UNIT# LOT W4
_/7 - - PERMIT EXPIRES IF WORK"'
OWNER v"e-7 vt �-.S. CONTRACTOR % 7�T
C4_3 IS NOT STARTED WITHIN
C
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT iSSU
FOUNDATION* ANCE OR 180 DAYS.FROM i
NOTE:, LAST CALLED INSPECTION.
1 UFER ''ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
. . F; PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS" P •,' A '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED • . - -�_
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE LATE
RIUG. ELECT. - PLG. A+EOI
,N MECHANICAL, 1 i _ ❑ ❑ ❑ `•
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
1 ' INFORMATION
• WOOD FLOOR - - vn wnnoN .siF T.
PLUMBING
MECHANICAL -- OVA-
ELECTRICAL /,/•PENnmr
FRAMING_ - r - ,
STORIES TVP
E CONSTR.
' INSULATION •
UCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE . SO IT.FLooN AREn TOTAL ACRenuL
DIAPHRAGM• THE CONSTRUCTION TAX IS PAID � BUILDING use ..
ROOF SHEATHING'. Nes Irvo CON PR om—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El 0 ' .0 . ❑- '
ASSESSORS PALACE L N0;_
ROUGH '0. SA'N.a._
PLUMBING- 'ELECT.ENERGY
'- TRACT NO. PARCEL NO,
TUBS&SHOWER.PAN a PLUMBING ENERGY,
MECHANICAL- 1• - 'MECH.ENERGY,
- ACC.OATS ACC.FILE NO,
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST zoNlrvc ENG.SITE No.
-- INSULATION- PLUMBING ,I
GAS TEST GAS
FIRE SPRINK - ENERGv T.}n
• MECHANICAL - ❑ N� ,s E) mQ
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _
FLOOD ZONE A,E U.C.
EXTERIOR SHEAR '^L d ELECTRICAL RELEASE - Y[j •N� .� ❑ _N❑
INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE "-• FEE SUMMARY
EXTERIOR LATH - -Sf„ BUILDING
BUILDING
.INTERIOR LATH' sTEMPORARY AP
SCRATCH COAT - � ELECTRIC _ PLAN CHECK
GAS 7 FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY,BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
w 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 REV ERSESIDEBEFORE TOTAL a
CALLING FOR FINAL•INSPECTION.
OFFICE COPY
' I
APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION " PERMITNUMBER
• BUILDING APPLICATION & PERMIT
ADOREss ' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1577-4
3 e e- lawe
OWNER'S V I - IPLAN CHECK VALIDATION
NAMEOTY. ELECTRIC PERMIT FEE
U V _ •C m10NE. -f
CONTRACTOR'S
NAME UTLETS;SWITCHES-RECEP 10.0011.00
-fLQs to Ut.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS SIp lam- - APPLIANCES'-'RESIDENTIAL "4.00
PDDRE55r /1 y��AI p/
.. 'Z S.COrovder cls , PRONE 3' -oS PANELS 10.00 DATE OF APPLICATION .
ARCHITECT PANELS (OVER ZOO AMPI 20.00 PLAN CHECK FEE P.C.NO.
PNGINEEfl- UTRANS. '
C.NO. SIGNS TRANS. ' ' 3.00
AARR.08 DDRESS ENG. - SPECIALCIRCUIT 'S.DD PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. _ 20.00
APPLICANT'SI
- . - MOTORS • '' SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
00o LICENSED CONT RACTORSDECLARATION
a v U I hereby affirm that 1 am licensed under provisions of Chapter 9 - ISSUANCE.DATE i
w (commencing with Sermon 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
Hz Puflesslons Code and 1I99yy II ensu is in full forc'�e'a'1II)it}•ffSy•,c,t ` -
z o m - License Class_(1,..La1.�Lic.Number_�1-'d7t�-�- ❑ ❑ r�
Dmc Contractor_
0 Z o �i��
< x f ��/r/��- `'�? BUILDING PERMIT
R w ¢ OWNER-BUILDER DECLARATION INFORMATION
AOA " MISC.- - -REFER TO ORD '
w 3 u m I hereby al firm that I am exempt from the Contractors License I vALUATIOry $/FT..
w• LL O j Law for the following reason.(Sec.]031.5,Businc,o and Professions PERMIT ISSUANCE - - 10.00
Cade:Any cityor county which rcyuires a pcnnn to construct,ulaq
R 2 Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. .. '
- 0 : reyuir pp perm signed ELEC.
es thea !leant for such t to filo a ei•I J sLdvmunl that - TOTAL
a' w p lie Is licensed pursuant to tire'provisions of file Contractor's License' PERMIT TO
Hz>0 Law(Chapter 9(mmmencingwith Seciion 70000of Division 3 ofthe �
a - Business and 1'mfcssions Code)or Him he is exempt llcrefrom and QTY. . PLUMBING PERMIT FEE
o the basis for Ore alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR.
d ;W by any applicant fora permit subjects the applicant tort civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of nut more than five Imndred dollars(5500)):
❑ 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 lire 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 does not apply to an owner of '
property who builds or improves thereon,and who does such work - F IXTURES-PER TRAP 5.00 SO,FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
mans'aro not intcnded'or offered hor sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS-6.00 ,
Or improvement is sold within one year of completion,the owner-
dill
wner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE -"
builder will have the burden of proving that he Jid net builder or int- RES IND CON PB Other
Pmveforpurposeol'sale). - INDUSTRIAL WASTE INTER. t 30.00
❑ 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 properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
conducts for such projects will a contract.G )licensed pursuant to - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
Ole Contractor's License Law. ..
❑ Iamexemptunderser. .B.&P.C.forthi, WATER HEATER W/VENT. 6.00 -
reason
Owner Dale WATER SYSTEM ,5.00 ACG DATE ACC.FILE NO,
WORK ERS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby infirm than 1 have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate f Workers'Compensation Insurance,or aieJ
copy there I i .ab '
Policy Nr( a9_a,L�Prp
O ❑ Ccrlilied copy is hcrcby'fumishcd. - . - .. FIRE SPRINK ENERGY T-24
Z Z ((�{//Certil led spy is lilyy(�11 wltli the ily X,on division.
O AplSlicam �-'G�j �Lp i�L��s MISC.- REFER TO ORD. - Y❑ No v❑ N❑
L2 /7r='+'T PERMIT ISSUANCE - 10.00 FLooD ZONE A.L.u.c.
CC � CERTIPICA-1'1>OF IKEAIPFION FROM RKFRS'
_ COh1PFNSAI'ION INSURANCE PLG.CONTR. LIC.NO. PLG..
d 0 ('flus section need not be completed if the permit is for one TOTAL Y❑' N❑ Y [:] N❑
::) Z hundred tr ials(S100)or less)
0.0 ' I certify that in lire perRnmmu'e ol'tire work or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued.I shall not employ any person in any manner m as to
U become suhjcet to lire Walken Compensunion Laws of California.
O w Dart' Applicant BUILDING '
a ALTER OR ADD TO MECH., 5.00
} So NO1'ICF 1'0 APPLICANT: If,after making this Certificate of Ex-
? eruption,you should beannu subject to the Workers'Colnpensallon 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 1Q000C.F.M.) 4.00 I
CONSTRUCT ION LENDING AGENCY ` - AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE ,.
I hereby affirm that there is a conUrUCtiOn lending agency for . EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issue)(Sec HEATING UNIT(TO 100,000 B.T.U.) .Gr66
LenderrNamMICROFILM .
3097.
- - ',Name
Lender's Address HEATING UNIT(OVER 100,0008.T.U.)9.50 ELECTRIC e
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 !
information is correct. I agree to comply with all city and c itullyPLUMBING
••I ordinances and ,late laws relating to building construction, and BOILER-CQMP(3H.P.'or100,000B.T.U.) •6.60 .490
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over IOQOOO BTU)SEE FEESCH. '.MECHANICAL
,boor-mentioned property for inspection purposes.
(We) agree m save, indemnify sad keep harmless lire City of MISC.- REFER TO ORD.
uPenmr, against liabilities,judgnuents, costsand expanses which '• CONST.TAX
may in any way accrue against said City in consequence of the I PERMIT ISSUANCE 10A0
ranting ispermit. MECH.CONT. LIC.NO. MECH.
7/ TOTAL' TOTAL
Sig ofAppli tr
t onactor Date -
OFFICE COPY' `