18762 POST THIS.CARID NEA'R`.FRONTOF BUILDING 4
R
' - '.' PERMIT NUMBE '
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.* -CITY: F -CU�PERTINO 1� 1 $76 .
T p INSPECTION:DIVISION a y^`; r
JOB,'INSPECTION RECORD a -
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II ' ,
'r PERMIT.EXPIRATION
JOB ADDR ESS/ 'UNIT# AT
•� ,; PERMIT,EXPIRESyIF WORK
owNER':1 - '�.-coNTHACTaR A IS '.NOT STARTED WITHIN w'
INSPECTION DATE" I INSPECTOR .INSP CTI RECORD - 180•DAYSOF,,PERMITISSU-
ANCE OR 1BO DAYS FROM
FOUNDATION NOTE ` �'i LASTCALLED INSPECTION. '
'• UFER• ' - % ;' . 'i ,. ALL.GRADING AND DRAINAGE SHALL BE INSTALLED', ; - '-+A
. ,PREGUNITE - +�,; TOCOMPLVWITHTHE PLANSAND CITY OF , renn, v uunnUN
CUPERTINO STANDARD Ava
GARAGE SLABSr - i • 1 IIA/ �.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED nr.; � 1JC7J �`•, '
UNDERGROUND /SLAB" � f �
'
PLUMBING% a -"' 1 U
0(QUD
. ELECTRICAL ^ '"� -"' , " ISSUANCE DATE' 1
MECHANICAL. " - .BLUE.. I ELECT, I PLG MECHrj z
DO•NOT POUR FLOOR UNTIL ABOVUHAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR .� ' . INFORMATION i
`w1 VALUATION ( - $/FT.
PLUMBING '141 -
i: MECHANICAL
,F.NMII; o
ELECTRICAL 'm
FRAMING -
5TORIFS TYPE CONSTH.
'INSULATION ti ' '`p "
I '
UIX.,GHOUI �'RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE NO FINALINSP.SHALL BEMADE BEFORE
so.r-r.F�ooR,AHeA TO IAL
DIAPHRAGM ,• THE CONSTRUCTION'TAXIS PAID. , >
.. RUII DINE USE
ROOF-SHEATHING" -°'. "1 ,. i EES .INU EON'. PB
`�APPL`Y*N O;ROOF,ING:UNTIL'°ABOVE H'AS7BEEN SIGNEWr ?,y$�';FINALS,.C' °"ai,;s ,.DATE?� „'INSP:: " •- ❑ ❑ ❑ ^❑ ' ❑�'`
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ROUGH-, a SAWN a I I�37�,.
PLUMBING y' - ELECT.'ENERGY;'` - '
IHACI.NO.-, PARCEL NO _ 4
TUBS&SHOWER PAN ' - - ",PLUMBING,ENERGY
MECHANICAL', F 'MECH>ENERGY :%.
ELECTRICAL ' ACC.DATE -ACC FILE NO
-
., • BUILDING..ENERGY ".r
FRAMING a$ ELECT.'FINAC TEST':` _ ' -
INSULAT,ION -•... .� PLUMBING `..• ..'. .,� i-'ZONING ENE:.SITE NO. _"
GAS TEST - GAS. "' "
81HE SPHINK F.NEHGY T 24
MECHANICAL w'' -
COVER NO WORK UNTIL ABOVE HAS-BEEN SIGNED HEATING ` ❑;; N❑' Y (] N❑',"
EXTERIOR SHEAR• `c .r ELECTRICAL RELEASE PL000mNE AL.0 c.
' •'.'e
INTERIOR SHEAR i - -k :: :FIRE DEPT. -.v❑ N❑ v"❑ N❑.
-, SHE ETROCK }• a. »' GRADE" - FEE SUMMARY
r ' EXTERIOR LATH 4 BUILDING -
" .IN,TERIOR LATH. „- TEMPORARY PPROV C,91 BUILOwG
-. 'SCRATCH COAT. " ELECTRIC - ,I `` .� PIAN,CHECK
GAS. F., t` :8. FEE
NO TAPE-OR PLASTER.UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ,; '• - SEISMIC FEE "Tf
OCCUPANCY OF'BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BVBUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY.PHON'ING 2524505 ELECTRic ,
I"'— ONE'WORKING.DAY BEFORE REQUIRED,JNSPECTIOIN PLUMBING
C�' - PLEASE GIVE JOB ADDRESS,WHEN PHONING
Z'
�. , MECHANICAL-'
SEE-PERMIT FOR, E,XPIRATIO,N DATE
IMPORTANTI conlsT TAX
, .
PLEASE READ REVERSESIDEBEFORE ;��, `z"°�-;'• ,
CALLING FOR.FINAC.INSPECTION' TOTAL
-'OFFICE COPY,'-
x
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —' *USE BALL POINT PEN ONLY.
BU LDING PROJECT IDENTIFICATION .PERMITNUMBER•
B tH.G t IAPPLICATION & PERMIT
ADDRESS
OWNER'S I_
D p� 18:762
'� , BUILDING—EtECTRICAL—,PLUMBING-MECHANICAL - ,it '
PLAN CHECK VALIDATION
NPME �7 N' _�-
)/ J fZA"D*N. Z� 7OTV ELECTRIC PERMIT FEE ' s�
•. VIGIL orvE .., � '" - � � I �
CONTRACTOR'S r
n,gmE 'OUTL'ETS-SWITCHES-RECEP 10:00/1.00
C�nSjaxcTuaa e6/5
UC.NO."M�(.4 ILIGHTING FIXTURES 10.00/1.00 ✓ .�^ �',
CONTRACTOR'S `
ADDRESS - APPLIANCES-RESIDENTIAL 4:00
'7 XM-y.'fdGIp C.(, �I��PNONE PANELS 10.00 r 'DATE OF APPLICATION Y
0gcHREcr�ou Lo A.rL"("C�Tf PANELS (OVER 200 AMP) , 20.00 PLAN CRECK FEE P.C.No.
�) ENGINEER `
LIC No' —2.76 j SIGNS TRANS: 3.00
ARCH.OR ENG. S"S �I , PERMIT VALIDATION
-
ADDRESS ,• (o5* SPECIALCIRCUIT 5.00 y... ( p
➢P/r�I(� EMP. METER OR POL INS. , �_.
APPLICANT'$Z�� r
ADUREss SJt+ „` �V/ $rt MOTORS - SEE FEE SCH. -
�[Y7 _ SERVICE CHANGE COX CIIWW
0 0 o LICENSED CONTRACTORS DECLARATION \.
SE
u 1 hereby a(Enn that I am licensed under provisions of Chapter 9 ISSUANCE DATE -
m a m Icommemmrg with Section 70001 of Division 3 of the Business and BLDG. ELECT. .PLG. MCH.
'r w :z ProfessionsCmle,u 1 my license is in full fnrou;uW,effe ❑ .❑ ❑
z o w Liconsu C ass Lic.Nuau,,p Y'/'a D 4r
o m r Dote�9.�C�—_CmitructoK.i/h£�LK�1 ,
y s 'ri.1uLM -
E E w OWNER-BUILUIiR DECLARATION BUILDING PERMIT
sa
E
;LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD INFORMATION
u 04 Law mi-the following reason.(Seo.7031.5,Business and Proessions VALUATION $/FT.
Code:An '1 or Count - PERMIT ISSUANCE ,1 ' 10.00
mj YCIY Ywhich requiresupennit to conslRmt ulltq /
w 4 Q improve,demolish,or repair any structure,prior to its issuance,also ELEC CONTR. LIC.NO, ELEC. .,
O E requires the applicant for such permit to file a signed statement that TOTAL "
a. m m va he is licensed pursuant to the provisions of the Contractor's License PERMIT TO /
¢ Law(Chapter 9(commencing with Section 7000)of Division 3 of the
i O Business eod Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE'. �I��-CC��
E,rm (ha basis for the alleged exemption.Any violation of Seclio,7031.5 - 1
1 STORIES' - TYPE CONSTR.
i 3 by any applicant(ora permit suoJects the applicant too civil Oenolty
-
of not more than fivchundred donors(85001.): . ALTER-DRAIN& VENT-WATER (EA.) 5.00 .
❑ 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 Professions - DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Low dots not apply loan owner of
• prnpen,who hnilds ur Impro VCE'tlwi,.L,and who d..,uch work FIXTURES-PER TRAP , 5.00 SDFTFLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- . , -
mcntsice Get intended oroffered for sale.If,however,the building GAS EA.SYSTEM-1'I NC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EASYSTEM OVER 4 (EA.) . 2.00
builder will have the burden of proving that he did not build o , -r int- BUILDING USE
prove for purpom of Sale). INDUSTRIAL WASTE INTER - 3000 RES - 'IND CON PB, Omar
In 1,as owner of the properly,am exelntr
sively cona . .
cting with E:] [:] [j ❑' ❑
licensed contractors to construct the project ISee..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 property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 ,
contracts forsuth projectswith'it contractor(s)licensed purstent to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. - TRACT NO. PARCEL No.
❑ lam exmnpl under Sec. ,B.&I'.C.for tlli5 WATER HEATER W/VENT . 6.00 ' `
reason
Owner Date WATER SYSTEM 5.00 Ace.DnrE ACC.FILE N0.
WORKS RS'COMPENSA'IION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that 1 have a certificam of consent to sclhinsure,
Or u certificate of Workers'Compensation Insu_ranec,or it certified ZONING ENG.SITE NO.'
Copy thegtol;,(Sy ,gjlp,Lab,C.I
PoliNo V hmPunY AT_F w� - ' -
O Y ,Cetlife copy ereby furished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certif copy is filed with f R inspectio", visual. -
F Oh nnPlic'm /Ar+tin—_ + MISC.- .. REFER TO ORD. Y ❑ mo Y ❑ No
� y CERT, E OF'Ex1ih1PTION PROM WORKERS' PERMIT ISSUANCE '10.00 `a,• •FLOOD ZONE A.L.u.C. '
LL > - CO.MPF;NSATION INSURANCE: PLG.CONTR, LIG NO. - PLG:
Q This Section metal not be Completed if the pe nn it is for one TOTAL Y❑ N❑ v E] NQ.
hundred d011ars(S 100).dell.)
U O - 1 certify thm,in the performance of the work for which this per- CITY. MECHANICAL PERMIT - FEE FEE SUMMARY`
LL U it is issued',I shall not employ any person in any mannal'sa as In
become subject to the Worker,Conipensut ion Laws of Calitbrnia.
O 11. Date ApplicantALTER OR ADD TO MECH. 15.00 BUILDING I �7 fib'
>_ EC NOTICE TO APPLICANT: If,atter making this Certificate of Iix-
F. Z vitiation,you should become subject to the Workers'Compensation APPLIANCE _ 5,00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C.) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVER IO GRM.16.00SEISMIC FEE 1 70
I hereby affirm that there is I, construction lending agency torr EXHAUST HOOD (WITH DUC
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ..). HEATING UNIT(TO 100,000 .T:U.) B.00
lx,,dcr's Nome HEATING UNIT(OVER 100,000 B.T.U.)9.5
Lsnder's Address ELECTRIC
I certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) - 4.0p
information is city c
correct I agree to comply with all and county 'PLUMBING
ordinances and state laws relating to building l city an ion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.), 6. 0-
hereby outhmirc repre,CNotive, of this city (n,enter upon the
above mentioned property for inspection purposes. BOILER-COMP Iovar i0Q000 BTU)SEE FEE S MECHANICAL' "
(We) agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORN. -
Cuperlimo against liabilities,judgments, costs and expenses which PERMIT ISSUANCE '1n OCONST:TAX .
o in any way accrue against said City in consequence of the
r' ng Oft s Pcimit. MECH:CONT: LIC.NO. MECH.
,.7 t TOTAL' TOTAL
7cfi'ui io— 1 l- `
I rot of App' en[/Contractor Date It
OFFICE COPY