16809POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
I .
1 r! / /�_
JOB ADDRESS ( —I ' (% �� LkP VLJ '�_�VNIT# _LOT#
' w' c+ c -
'OWNER O V �V CONTRACTOR J •�! j, ,1 C(i •�
PERMIT NUMBER
96809
I
PEAM�I7/T�(6XPIRATION -
X 1 `
ERMIT' XPIRES IF WORK ;
I NOT STARTED WITHIN
80 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS'FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
LIFER
PREGUNITE - '
PERMIT VAI.m ATION
LC
/'�_�,�•
ISSUANCE DarF.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICALBLDG
E ECT
1[\
PLG. ME.CH
❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
,.. '
BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION,
$JET.
PLUMBING �
-. -
MECHANICAL�L.^W
ELECTRICAL -
PAID
}iPERMIT To
z -S Il I l6{') C K
FRAMING
INSULATION - -
STORIES
TYPE CONS I R.
-
C411Y Of Cupertino
OCC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS,PAID
-
s° FT. FLOpR AREA
DOTAL ACRE.AGE
DIAPHRAGM
ROOF SHEATHING
BUILDING USE
RES IND • CON PB OR —
❑ ❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SAN.#
ASSESSORS PARCEL NO
PLUMBING
ELECT, ENERGY
TUBI g SHOWER PAN
PLUMBING ENERGY
TRACT NO
PARCEL NO
� 2:
MECHANICAL
MECH.ENERGY
ELECTRICAL
BUILDING ENERGY
ACC DATE
ACC. PILE NO
FRAMING
ELECT. FINAL TEST
INSULATION'
PLUMBING
ZONING
ENG, sIrE No.
GAS TEST
GAS
' •
MECHANICAL
FIRE SPRINK
Y ❑ "❑
ENERGY L]4
' ° ❑ "❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL E
FLOOD ZONE.
❑ "❑
. -A.L U. C.
Yo No
INTERIOR SHEAR
-
FIRE DEPT. T.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
00
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
}
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505,
H ONE WORKING DAY BEFORE REQUIRED INSPECTION.
o PLEASE GIVE JOB ADDRESS WHEN PHONING. :
— SEE PERMIT FOR EXPIRATION.DATE —
ELECTRIC
Z•`
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.I.
TOTAL
TJ
OFFICE COPY
Zz
P:O
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ao
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROjECT 1 DENTI FICATION
APPLICATION & PERMIT
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
l PERMIT NUMBER
�: 16809
,
BUILDING�O 3Cj �� nevi ll� (zt•
ADDREss
.t1
OWNERS -
NAME' - /I'
/-e-O v"M Ck ` 4 HONE Z15 -0
DTV. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
CONTRACTORS
NAM �
OUTLETS-SWITCHES•RECEP 10,00/1.00
LIGHTING FIXTURES 10.00/1.00
q' t�✓LS'C LIc.NO. O .5
.
DATE OF APPLICATION
CONTRACTORS
TORS R�
1130 RebBG
CC�,
p I Gs^ PHONE z 5
PPLIANCES- RESIDENTIAL 4.00
PANELS 10,00
ARCHITECTPLAN
DR 1ZoWA -D BFl-iCNAp
ENGINEER ,ww
l dol. uc �No.3T
PANELS (OVER 200 AMP) - 20.00
CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ENG. lye SLp�Ntq 'D
ADDRESS GG ` ps
C ZIP /SOig
SPECIAL CIRCUIT, 5.00
TEMP. METER OR POLE INS. 20.00
PERMIT VALIDATION
/ •� ^�+
i ` 6
ADDRESS
ADORPPLICESWra (13o Rebecccaf�C�
MOTORS SEE FEE SEH.
SERVICE CHANGE ?' 20.00
LICENSED CONTRACTORS DECLARATION
-j. T' `
1 hereby affum that I am licensed under provisions of ch.ptS, 9p
(commencing with Section 7000) of Division 3 of the Business and
License Co CnA • nJ my license is in full fort • •fit 6
^
License Class Lic.Number 'T
ISSUANCE DATE
B G. ELECT. PLG. H.
y u ❑ ❑
Date (.'011traetOr
DING PERMIT
BUILORMATION
INFORMATION
OWNER -BUILDER DECLA ATION
License
I hereby utire ollo ,ihul I sial exempt from the Business
reason, (Sec.uires a permit tocnstrofeseions
Cod (o Any a permit to consu a cealter,
Code: Any city or county which structure,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he Is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9(commenuingwith Section 7000)olDlvislon3 ofllte
Rosiness and Professions Code) or that he is exempt therefrom and
MISC.- REFER
PERMIT ISSUANCE 1 'tire
ELEC. CONTR. LIC. NO.
h?MIeAN'� SOi 7 TOTAL 2�) V
CITY. PLUMBING PERMIT FEE
VALUATION
$/FTLaw.
PERMIT -TO
the basis for the allege) exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penally
of not mom than five hundred dollars ($500),):
STORIES
TYPE CONSTR.
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
FIXTURES - PER TRAP 5.00.
GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
SO. FT. FLOOR AREA
TOTALACREAGE
property who builds or improves thereon, and who docs such work
himself or through his own employees, provided that such improve-
mentsarenotintendedor offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
Prove for purpose of sale.).
❑ I, as owner of lirm
e pperty,.aln exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Core;
❑ ❑ ❑ ❑ ❑
WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, bodiless
and Professions Code: The Contractor's License Law does not apply
m an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS- 1 INC 5 V.B. . 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL N0.
contracts far such projects with a contractor(s) licensed pursuant to
lite Contractor's License Law.
O 1 and exempt under Sec. , BAP.C. hu this
Person
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO,
WATER HEATER W/VENT 6.00
Owner Dam
WATER SYSTEM5.00
ACC. DATE
ACC. FILE NO.
WORKERS'COMPENSA'I' ION DECLARATION
WATER TR EATING EDU 5.00
I hereby affirm that I have a certificate of consent to sell' -insure.
or a certificate of Workers' Compensation Insurance, or a certified
-
ZONING
ENG. SITE N0.
`JWWW
copy thereof (Sec. 3800, Lub.C.).
Policy No. Company
_ ❑ CetliBed Copy Is hereby fu rished'
❑ Certified copy Is tiled with the clly inspection diki'li n.
Applicant
MISC. - E RD.
FIRE SPRINK
Y ❑ N❑
ENERGY T-24
Y ❑ N❑
CERTIFICATE OF EXEMPT' ION FROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
COMPENSATION INSURANCE
(This welt....need not be completed if the permit is for one
PLG. CONTR. - LIC. NO.
_
PLC.
TOTAL
Y ❑ No
Y ❑ IN
honored dollars IS 1001H, less.)
-
1 certify that in the performance of the work for which this per-
mit is issue I shall not employ ny arson in n nncr Ott ns In
beton Ic Workers' C ml srlia S Fxf' li'su.
Dutc Applicam g
NOTICE 'I APPLICANT': If, ter making this Ccrtificatu of
OTY. MECHANICAL PERMIT FEE
.
FEE SUMMARY
BUILDING
OV
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
PLAN CHECK
FEE
o `r
empiton, you should hecome s jecl to the Workers' Compensation
provisions or the Labor Code, you mull foNhwilh comply with
such provisions or this permit shall he deemed revoked.
AIR HANDLING UNIT (OVER 10=11EM.) 6.00
SEISMIC FEE
' SO
CONSTRUCT ION LENDING AGENCY
I hereby affirm Thal there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
lire performance of the work for which this permit is issued (Sec.
3097, Cw.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Nanta
Lender's Address -
HEATING UNIT (OVER 100,000 B.T.U.)
ELECTRIC
/ZF r6
VENTILATION FAN (SINGLE) 4.00
1 certify that I have read this application and slate that the above
information is correct. I agree to comply with all city and County
ordinances and state laws relating to building construction, and
hereby out ho.lre representatives of this city, to enter upon the
above-mentioned property for inspection purposes.
PLUMBING
BOILER- COW (3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
(We) agree to Save, indemnify and keep harmless the City of
MISC. - REFER TO ORD.
upert o ago'plat liabilities,juJgl encs, costs and expenses which
may in any y accrue aa' aid C' -of the
rand of tl i' creel[.
PERMIT ISSUANCE 10.00
CONST. TAX
H. CONT. LIC. NO. MECH.
fA TOTAL
v
TOTAL
72e
Sign ore of Applida t/Commctor Uale
OFFICE COPY'