16365 POST THIS CARD NEAR FRONT OF BUILDING
_ PERMIT NUMBER
CITY OF CUPERTINO 16365
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION .w
JOB ADDRESS /0`1`0 / 7�L. --^I UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER F{-M` CONTRACTOR IS NOT STARTED WITHIN
INSPECTION SPECTOR-FAAN1 biSn+ NSP.ECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM,
FOUNDATION - NOTE: , li. LASTCALLED INSPECTION.
OF ER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
,TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE .CUPFRTINO ST NO R S.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS:BEEN,SIONE
UNDERGROUND /SLAB ti
PLUMBING - AS�e^^�• "jamTFL, z� O
ELECTRICAL �{JY/L Ls3F�/(!-a' l,"T ISSUANCE DATE
ELECT PLG MECH
MECHANICAL ' pG,�Dra f /P/&-k^!� E , Q 0 D
�
�
\DO NOT POUR FLOOR UNTIL ABOVE HAVREEN SIGNED f tU 47E0 4, uE V Domflzw") Ot C ? ';BG PER
UN ORMATIONTI
WOOD FLOOR OE�T� (UU�R_ Y-EfP 1V1 VALUATION SIFT.
PLUMBING - /-9
MECHANICAL 4 PERMIT TO
ELECTRICAL
_ A � J/7,
FRAMING
$TORIES TYPE CONSTR
INSULATION
Oa* - OCC GROUP RES UNITS _
PLACE NOSUBFLOORU ABOVE:HASBEE SIONEp' TR T SO ITFLORRAREA TOTALACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
61APHRAGM - THE CONSTRUCTION TAXIS PAID euaDlNc USE
ROOF SHEATHING A - A, RES IND CON PB 3.A..
APPLY NO ROOFING UNTIL ABOVE'HAS BEE ZONED ; ' :• .FINALS :�I, .,,,DATW' . INSP•'•'
ASSESSORSPARCELNO
ROUGH " SAN.#
PLUMBING ELECT.ENERGY TRACTNO PARCELNO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY ACC.DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING /O— Ef/' ELECT.FINAL TEST zoNlNc ENG.SITE NO,
INSULATION - EL� PLUMBING -
GAS TEST GAS -'
FIRE SPRINK ENERGY i:i
MECHANICAL - V L N� L NCD
COVER NO WORK UNTIL AS VE HAS BEEN SIGNED HEATING FLOOD ZONE A L c
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. I NL , --I
No
SHEETROCK RADE --f EE SUMMARY
EXTERIOR LATH U' BUILDING BUILDING �(J'g
INTERIOR LATH TEMPORARY APPROVALS
ELECTRIC PLAN CHECK
SCRATCH COAT FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY
SEISMIC FEE 7s
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED�Y BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONIN 252-4505, ELECTRICO
�� ONE WORKING DAY BEFORE REQUIRED I N. jPLUMBING c°tJ
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
1�J Z .'J. �'P , 51MECHANICAL S a
-SES PERMIT ffOR EXPIRATION DATE_-d l'
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL �0 f{
CALLING FOR FINAL INSPECTION.
APPLICANTS POSTING COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO , 16365
INSPECTION DIVISION
JOB INSPECTION RECORD
,PERMIT EXPIRATION
JOB ADDRESS 'fD/_ f".f UNIT# _LOT# d
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM,
NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
,CUPERTINO STANDARDS.
GARAGE SLABS ' ' � �. � '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
. UNDERGROUND /SLAB �`•p"
PLUMBING 19aa ' 7 -
ELECTRICAL Iss NCE unnt �
MECHANICAL RL Vp PLG. MECH
°T z 2
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION
MECHANICAL o1,.C'ar�'-0 I`.t
ELECTRICAL - ,[f�/PERn+lr
FRAMING '� r•1 `J/ 7 ;, `
INSULATION STORIES TYPE CONSTR
' OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
� ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $O IT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING res irv0 CON PB -
APPLY NO ROOFING UNTIL A80VE HAS BEEN SIGNED FINALS DATE INSP. El ❑ '0 0 ❑
ROUGH sAN.k
ASSESSORS PARCEL NO.
,
PLUMBING ELECT.ENERGY -
_
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO .
MECHANICAL _ MECH.ENERGY
ELECTRICAL BUILDING ENERGY ,ACC DATE ACC FILE NO
FRAMING n-• ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
_ GAS TEST GAS
MECHANICAL EIRE SPRINK ,ENERGY T.24
F COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "Q Y "o
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUC. '
INTERIOR SHEAR FIRE DEPT, Y❑ N❑ T•❑ N❑
SHEETROCK 1/' B GRADE FEESUMMARY
EXTERIOR LATH. BUILDING
INTERIOR LATH . TEMPORARY APPROVALS BUILDING
SCRATCH COAT c ELECTRIC 'PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE {'
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
'�"�+= Q
ARRANGE FOR INSPECTION BY PHONING 252-4505ELECTRIC
, �:
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING .
o� PLEASE GIVEJOB ADDRESSWHEN PHONING.
-z-
- SEE PERMIT FOR EXPIRATION DATE - MECHANICALSa
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
'APPLICANTFI'O FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
f; BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
• - BUILDING1. /� APPLICATION & PERMIT
ADDRESS (04.0 I pA Me Tree �.. � 16365
1'C• BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
OWNEF'S PLAN CHECK VALIDATION
/ NAME T..._..,. l Lbw OTY. ELECTRIC PERMIT FEE ,/,q
GJ�•��� PHONE / 60
`
CONTRACTORS Z UTLETS-SWITCHES-RECEP 10.00/1.00 ja
NAME
uc.No: NIGH FIXTURES 10.00/1.00
ADDRESS cons - I - APPLIANCES-RESIDENTIAL A.GGR IT,
1 PHONE PANELS 10,00
GATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.N0.
.--� OR /A'�i0(nr5 PANELS (OVER 200 AMP) 20.00
NGINEER
LIC.NO, G O SIGNS TRANS. 3.00
ARCH,OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
IS836tuaik pnPe
zIP o EMP.METER OR POLE INS. - 20.00
ADDRESS rs - MOTORS SEE FEE SCH.
APPLICA
SERVICE CHANGE 20.00
wo O - LICENSED CONTRACTORS DECLARATION 7/V
' a cur I hereby affirm that I am licensed under provisions of Chapter 9 CE DATE
w a w (commencing with Section 7000)of Division 3 of the Business and G. ELECT. P�7LqG`. MECH.
r z Professions Code,and my license is in full force and effect. - PLG
400
O z w w License Class Lie.Number
Date Contractor p;
a r - V BUILDING PERMIT
to ¢ w ¢ OWNER-BUILDER DECLARATION
o a INFORMATION
w3 n 1 hereby affirm that 1 am exempt from tire Contractors License MISC.— REFER TO ORD
uo¢ Law for the following reason.(See.7031.5.Business and Professions VALUATION $/FT.
PERMIT ISSUANCE a0
> Code:Any cityor county which reyuiresa permit to construct,alter, ✓
2 X ¢0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u w m
as he is licensed pursuant to the provisions of the Contractor's License
HZ > Law(Chapter 9(commencing with Section 7000)ofDivision3ofthe -�l��7ee.J
x o Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
I w H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more(lion five hundred dollars($500).): -
❑ 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 Prafces Des DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cole:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP BO.FT.FLOOR AREA TOTAL ACR EAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1INC.40UTLETS 6.00
ents are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM•OVER 4 IEA) 200 BUILDING USE
builder will h . . . .
ave Ole,burden of proving that he did not build or im-
prove for purpose of sale.). INDUSTRIAL WASTE INTER, 30.00 RES IND CON PB OmerRE ❑ ❑
I,as owner of the property,am exclusively contracting with
f c ed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1.INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and 0 rasions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereom and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forsuch projects with a contmctods)licensed pursuant to SEWER-SAN V-STORM EA.200ft/16.00
the Contractors License Law. TRACT NO. PARCEL NO.
.❑ 1 a exempt under Sec..,e.&P.C.for this WATER HEATER W/VENT •6.00
reason —
Owner pate WATER SYSTEM 5.00 Fr
ACC.OATE ACG FILE NO,
WORK ERS'COM ENSATION DECLARATION WATER TREATING EQUIP. 5,00
1 hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,Or a,certified I ZONING ENG.SITE NO.
copy thereof(Sec 3800,Lab C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY L24
Z Z ❑ Certified copy is filed with the city inspection division.
pyo Applicant MISC.- REFER TO ORD. Y[] NE] Y ❑ N[D
CC y ..' CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE I — FLOOD ZONE A.L.U.C.
LLJ - COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG.
d O (This section need not he complete) if the permit is for one TOTAL V� Y E] N� Y 0 N�
Z . hundred dollars(5100)or less.)
L) O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
UL I- mit is issued,I shall not employ any person in any manner so as to
Q W become subject to the Workers'Compensation Laws of California.
y Date Applicant 1 ALTER OR ADD TO MECH. 5.00 BUILDING ad✓
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex. -/
F. ? emption,you should become subject to the Workers'Compensation 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 ITO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.FM.) 6.00 SEISMIC FEE ]A
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) ...GeBB
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.Ch HEATING UNIT(TO 100,000 B.T.U.) 8,00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and state Thal the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COW 13 H.P.or 100,000 B.T.U.) O.DO PLUMBING
ordinances and state laws relating to building,construction, and
above-hereby authentioriu representatives of This city To enter upon the BOILER-COMP (Over 100,0008TU)SEE FEE SCH. MECHANICAL Sv
above-mentioned property for inspection purposes,to
(We) agree to save, indemnify and keep harmless The City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses whichCONST.TAX
may in any way accrue against Said City in consequence of the PERMIT ISSUANCE
Canting of this permit. MECH.CONT. LIC.NO. MECH.
')`Signatnre OfA I Otr'aCTOr Q � - TOTAL / /S� TOTAL 3,2,0Date I
`�
OFFICE COPY
Citsf of Cwpertf"a
10300 Torre Avenue P.O. Box 580
Cupertino. California 95014 Cupertino,California 95015
Telephone: (408) 252.4505
DEPARTMENT OF PLANNING AND DEVELOPMENT
APPLICATION FOR USE OF ALTERNATE
MATERIAL,
METHOD OF CONSTRUCTION OR MODIFICATION OF CODE
Address of where work will be done:
10401 P Qu w 'C- T t2-e�: L-a N'C
The undersigned hereby requests the following:
Use of alternate material
OW." Use of alternate method of construction
Modification of Code
(See USC Section 105, 106 and 107; UFC 2.301)
Codes affected:
Building Electrical
Mechanical Fire
Other —
A of specific section involved:
1'wR "ftad r{ ,-Jl( ROof CUof.Q r'28N;rjt 3 : 12 r;hvt\
Brief description o! request 1/
1'2y hotir z how h« 1.1 : IZ Kt-v \ fq� -V-1\A rvVf 1 wo�td I 're co pw�
MQtr,Q t \Qs +o-o- 1'�, roof
Applicant ' s Name: CNAT,�c3 - CI-1q1 () IJ
Address: k0 'Lf 01 NRUnIEr- LAJ
CIA P'6R 7t tiZIP O
'J yi:w. •... ..
Telephone: (A/C 4og ) q q I =L13 '+2,
r�
The Building and Fire Official must evaluate. information that the
material, method of work and/or modification is equal to the Code
in strength, effect, fire-resistance, durability, safety, etc.
Please supply such information to support your request. Use
additional paper if necessary.
1 . Suitability
2. Strength
3. Effectiveness
4. Fire resistance
5. Durability
6. Safety
Additional evidence or proof:
Date: Signature
• • a a
Is a '• Is a • a • s a a a a • a a • .a asa • • a a a • a • r
The above application and material has been reviewed and:
W
C7 PR-i�L
Fire Marshal: Date
Building OfficialT � � {�- � r
V ���'.:�1 "'tr..� .; Date