15889&i
4'
POST THIS CARD NEAR FRONT OF -BUILDING
CITY' OF 'CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD. '
JOB ADDRESS -/L4?fi�:500IA16i C✓
_ UNIT# � COT
' owrvEa ', CONTRACTOR.
PERMIT NUMBER
15889
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
ISNOT STARTED WITHIN ;
180DAYSOF PERMIT ISSU-•I.
ANCE OR 180 DAYS FROM
LAST CALLED 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.
UFER
PREGUNITE..
PERMIT VALIDATION ,
py�j
.'al `•�, /+
ISSUANCE DATE
GARAGE SCABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
3
1
UNDERGROUND /SLAB,
PLUMBING'
:{ 23 1989 -
ELECTRICAL
MECHANICAL
wilz UL uummaBLDG
ELEcr. I
PLc. MECR..
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING FERMIT
INFORMATION
' WOOD FLOOR
VALUATION
PLUMBING •
MECHANICAL
ELECTRICAL
I, - PERMIT TO
FRAMING
.INSULATION
�;,'
srORIEs
Tvve CONSTR.
-
OCC, GROUP
R-3
RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE. CONSTRUCTION TAX IS PAID
50 FT. FLOOR AREA
TOTAL ACREAGE
DIAPHRAGM
ROOF SHEATHING'INo
ILD NN,7EPa um„�
Res `
� 6 ❑ '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SAN
ASSESSORS PARCEL NO
3 J'a I
PLUMBING c_j '10
ELECT. ENERGY
TUBS & SHOWER PAN
PLUMBING ENERGY
TR.ACT.NO.
PARCEL NO
MECHANICAL"_
MECH. ENERGY
ELECTRICAL-
BUILDING ENERGY -
.DATE
ACC. FILE NO
FRAMING', >h Z2
ELECT. FINAL TEST
INSULATION' ,'
PLUMBING '- -
ZONING
ENG. SITE NO.
GAS TEST
GAS
MECHANICAL
FIRE SPRINK
Y N
ENERGY TPG
° ❑ N0'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR �
ELECTRICAL RELEASE
F LOOD ZUNE
v'� N❑
A.L U.c.
° ❑ ND:
INTERIOR SHEAR
FIRE DEPT.'
SHEETROCL
GRADE
FEE SUMMARY
EXTERIOR CATH 2L S
BUILDING°
BUILDING
91600
INTERIOR LATH..
TEMPORARY APPflOVALS -
SCRATCH COAT'
ELECTRIC -
,.
PLAN CHECK
SE SMTIC E
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY . •
OCCUPANCYOF BUI LDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
12 63
ARRANGE FOR INSPECTION BY PHONING 252-4505;
F ONE WORKING DAY BEFORE REQUIRED INSPECTION..
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE,PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
lad
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE.
CALLING FOR FINAL INSPECTION.
TOTAL
1
513 79
OFFICE COPY
A IPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITYO �CUPERTINO RUILDING-ELECTRICAL
'IIUIt.,ING DIVISION APPLICATION/PERMIT PLUMBING - MEGILANICAL
BUILDING. PROJECT IDENTIFICATION
PERMITNO. O J.1 Z
BUILDITApDRESS LAC z SP�.�N� CT.
II II 377 61 5D,I1,G�Ip[C''
SANITARY NO.
APPLICATION SUBMI' DATE
-zc{6
V
OWNER'.N M:,�f 1.
1W..
��p}C L� -�
1V�
AAMF
.( Q -/'/
CNTRA^1�,g //11 '-1 �/lIC. LN N�r/7//
1'Y
NIC
❑
CONTROL.
RCIETECURNGINEER: LIC NO:
Ap I
ave rin s 81 vd .
CONTACT. PHONE:
MAKT7 r K 0 11 / D
M1' f1Y �R M1^
❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PERMIT INFO
BLDG ELECT PLO MECH
❑ ❑ ❑
LICENSEDCONTRACTORS
SED
underSDECLsol'CaN
I hereby E.d` Nat 1 am licensed under pd inch ns of Chapter 9 (commencing
' with Seaion]tKK))ofDivision3ofthe Busineu and Profe siO C rimy licemeis
? i (
n full force end e
� License Class Lica � �
1 Dam—rrraxr
ECEITFCCom
j DECLARATION
understand my plum shall he need ns public records
'
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL:
❑'.FOWL C:) KITCHEN REMODEL.
[]ADDITION ❑PLUMBING RE -PIPE
[_1 MULTI -UNIT ❑STRUCTURAL
MODIFICATION
El INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
❑BATH REM DE EMOLITIMP
[]OTHER A`II—
PERMIT ISSUANCE.
APPLIANCES - RESIDENTIAL
PANELS
UPI 02W AMPS
LittnaeJ Professional -
OWNER -BUILDER a.a LOCR DE CLARATION
o far the
I hereby u(Urm on Into exempt tram the eadoncmrs License city
whichfollowingliresaaTato construBusinessmpr and Profdeonsh.ormair an orcounry
3 which requires a permit to bun9wa, alter, improve, h peornit 1 or repair any structure
1 primmslits ce uedprosamqulresimmki m.1'for statin hnfo file.ammmem
Lou,Inca lCltapmr9
. (cothaheislicensed pursuant to N) of provisionsof the eBusin ss and
ingwithheefromadhe Division of the Business andon.Ayviol odc)or
Professions
fee, he
that i. is exempt therefrom and the basis for the alleged exemption. Any violation of
subjects the applicunsmucivil penalty of
Section]011.3ve any hundred dollars
not mart on.woe five t h prop, dollars y ci X).
C] Las the aoraf the pmpenyar is anplended wllhwages red frlale(See. csnnpeusines,
will do the work, and the he Co era nor Intendede Law do for sale Iger. 7044, weer of
Code: The C e, (Immor License Luo does not apply toanowner of
i and Pty who
property who hoilds or improves thereon, and who dots such work himself or through
his own employees, provided that such improvements arc not intended or offered for
sale. If, however. the building or improvement is sold within core year of completion, the
ownerbuilder will have the burden of proving that he did not build or impmve for pup
poseafsale).
❑ h us owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. ]014, Business and Professions Code:) The Contractor'. Li-
cense Law does not apply to an owner of pmpetty, who builds or improves thereon,and
who contracts for such pmjwts with a contradon s) licensed pursuant to the Cransto isb�Y
License Law.
❑ Iron exempt under Sec. ,B& P C for chis renson
2o1-l"AMPS
OVER ]"AMPS
SIGNS ELECIRICAI.
SPECIAL CIRCUIT/MISC.
TEMP. METER OR POLEINST.
COMMERCIAL:
❑ NEW BLDG/ADDITION ❑ DEMOLITION
❑TENANT ❑FOODSERVICE
IMPROVEMENT
❑OTHER
POWER DEVICES
SWIMMING IK)QI. ELIiCb'RIC
OUThF,TS-SWI)'CI1F,5-FIXTUR
NEW RESIDENTIAL HLECTR Tr
_
SQ. PI'. FLOOR AREA
`
A n ��
21 1996
1.7.7b
-
S/SQ. FT.
TOTAL:
QTY PLUMBING PERMIT
PERMIT ISSUANCE
ALTER - DRAIN&VENT- A)
Owner Data
VALUATION
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following deelmadi a s:
❑ I have and will maintain a Certificate ofconsenl to self-insum for Workers Compete
safion, as provided for by Section 3100 Of the Labor Code, for the performance of the
4forwhich this it is issued.
war perm
have and will maintain Workers Compensation Insurance, as required by Section
31X1 of the Labor Code, for the performance of the work for which this Permit is pissued.
Ca Worker C m e s li 'e carier and Policy nMyq�jy 52"L
Carrier._ PIONY Na: WORK
CE TIFIC O GF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tax section need not Mmmp4mv) if fire permit is for one hundred dollars IS I IN1)
or less.)
I unady that in the performance ofthe work for which this permit i9 issued, l.shull
not employ any person in any manner so es uLiiea.ampp cubjypt/o the Workers' Cmnpen-
nation Laws of Ca��,ifomia. Dyyy��s Ti�' S//� N' L
Applicwt �s-%�: aft ky.e.v - _
BACK FLOW PROTECT. DEVICE e
DRAINS- FLOOR, ROOF, AREA. COND.
STORIES
OCC. GROUP
TYPE CONSTRUCTION
APN
FIXTURES -PER TRAP
GAS - EA. SYSTEM -I INC. 4 OUTLETS
GAS - EA. SYSTEM -OVER
GREASFJINDUSTRL WASTE INTERCEPTOR
BUILDINGDIVISION FEES
GREASETRAI' °
PLANCHBCK PEP.
SEWER - SANITARY - STORM EA. 200 FT.
ENERGY FEE
WATER HEATER WHEN UHLECIR
GRADING FEE
NOTICE. TO TJPLICANT fer making this Certificate of Exemption, you ahould
become objW ro the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this perm,shall be dcemell revoked
CONSTRUCTION LENDING AGENCY
I hereby affirm that there isuconswaion lending agency forthe performance of
the work far which this .it Is issued (Seo. 3097. Civ, C.)
Lcnde'a Name
WATER SYSTEWIRZATING
WATER SERVICE
SOILS FEE
PAID
Data Receipt#
NEW RESIDENTIAL PLMB. SQ. FT.
TOTAL:
Lender's Address
1 cmify that l have reed this application and slide that the above information i9
corrcm l Ogren or comply with Ucity and county ordinances and smte lawsmi.ingm
building conswction, and hereby authorize representatives of this city m enter upon the
ahsne-mentioned property, for inspection purposes.
(We) agree m save, indemnify and keep harmlem Ne City of Cupertino against
Iiabilitusjudgments. costs and expenses which may in any way accrue against said City
uquNT o gree g o
in con of fin of Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1. NON -POINT
SOURCE REGULATIONS. �/ //1� q
C('I�f/a
Sill neat Apylic onvacfor Y (/Dum1 V
A7ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant sloe or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Salary
Code. Section 25532(a)^
❑Yea IN.
WilData
mil hazardous air contaminants as defined by the Bay Area Air Qualify Mvnegcnrcm
zooms air cicant or ntaminants a definedding by the nt Bay Cea Air Qgalityl of Manawhichgement
District?
❑Yea ❑No
I have read the hazardous materials requirement under Chapter 595 of (he Cult-
Luria health & Safety Code, Sect ho, 25505, 25533 and 25534. 1 undeamnd that If tbo
huildingdoes not currently have.tea.m.thmll islny mspansibilhy fortify the nccupant
of the royulrements which must he met pfiar 1n issuance of a Cerific.m of Occupancy.
TOTAL:
BUILDING PEE
QTY. MECIIANICALPERMIT FEE
SEISMIC FEE
PERMIT ISSUANCE
ELECTRIC FEE
ALTERORADDTOMECH.
PLUMBINGFEE
AIR HANDLING UNIT (TO 10,1X10 CFM)
MECHANICAL FEE
AIR HANDLING UNIT (OVER IO,OIXI CM)
CONSTRUCTION TAX
EXHAUST HOOD(WIDUCT7
HOUSING MITIGA'ITON FEE
HEATING UNI T(TO I4),000 BTU)
I HEATING UNIT (OVER 100.000 BTU)
PAID
Receipt M
VENTILATION PAN (SINGLE RESID)
BOILER-COMPOHPOR100,000BTU)
TOTAL.
BOILER - COMP (OVER 109,W0 BTU)
AIR CONDITION12H
ISSUANCE DATE
ISSUED BY:
NEW RESIDENTIAL. MECH. SQ. FT.
_
(Iwner nr authorize) agent Dam
TOTAL:
OFFICE