15212 POSTTHISiCARD NEAR PROI"cOF BUILDING PEHM,T NUMBER
CITY OF ' CUPERTIND 15212
INSPECTION DIVISION
d JOB INSPECTION_ RECORD
•1+ r - r PERMIT EXPIRATION
^-•r JOB ADDRESS JOS g S'cI'9�/ sYL��OdB LIN
IT# LOT# u
PERMIT EXPIRES IF WORK
DINNER fJ CONTRACTOR !.T.�Hlrx cS/ - IS NOT STARTED-WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RE ORD 180.DAYS OF PERMIT ISSU-
FOUNDATION 12- -m C• NOTE: - ANCE'_OR 180 DAYS FROM
LIFER Z--- - G` ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. ;
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vALIDATIoN
GARAGE SLABS- CUPERTINO STANDARDS.'
- -
1 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
a3 Pe� R� Fib Crz
UNDERGROUND /SLAB < �'
PLUMBING - - ` ell
ELECTRICAL `S` 4ElA��AtTn
Qt Q_ 1� a-}'—B l.\ , ISSUANCE DATE.
MECHANICAL BLDG ELIECT I PEG. - MECR
. _ . . El ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' ' - BUILDING PERMIT
' -WOOD FLOOR P` INFORMATION
PLUMBING _ '�- ,_ M. I0UATION SOFT,
MECHANICALIN
0'7.O-A'O
.ELECTRICAL - 1 - ,���p[+ PERnxi IT�TTO
FRAMING ��I _ Cope T; �1 kP�
INSULATION _ - STORIES ,'TYPE CONSTR.
OCC GROUP RES UNITS
i'P,L+ACElNO"SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED'-3: '
/w ROOF- - NOTE:NO FINAL INSP.SHALL BE MAGE BEFORE SO FT FLOOR ARhA TOTAL ACREAGE
- 3SV
DIAPHRAGM � THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING - c BUILDING USE
Rf5 IND CON 'PB
FINALS DATE INSPOm.
"'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ ❑
- ROUGH SAN'.k D sE� GRS PAR EI.NO
PLUMBING _o -g= ELECT.ENERGY 3 '- 02 �O
TUBS&SHOWER PAN _ TRACT NO PARCEL No
T� PLUMBING ENERGY ,
MECHANICAL 3 - 7;iki MECH.ENERGY
„ ELECTRICAL BUILDING ENERGY ACC.DATE ACC ERE NO
FRAMING ELECT.FINAL TEST '
INSULATION PLUMBING ZONING ENG.SITE NO. .
GAS TEST a GAS
MECHANICAL EwesPR l Nrc ENel+cv r7a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING CC Y ❑ "❑ ❑ "❑
SINTEAqOR
EARWHASS
ELECTRICAL RELEASE G FI.DOU ZONE A.I.U.C.
EAR - FIRE DEPT. Y❑ N❑ Y L "❑GRADE -
FEESUMMARY
THBUILDING
THTEMPORARY APPROVALS BUILDING3 4*�•TELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UOCCUPANCY, - SEISMIC FEE 6
OCCUPANCY OF BUILDING IS NOTPERMITTEO UNTIL BUILDINGFINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
i
ARRANGE FOR INSPECTION'BY PHONING 252-4505, ELECTRIC d/
p� _ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
fe l Z -
— SEE PERMIT FOR EXPIRATION DATE — ' MECHANICAL O S� .
'. IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
1 - CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
I - -►
APPLICANT TO FILL IN INFORMATION WtTHIN ED LINES ; USE BALL POINT PEN ONLY
• BUILDING PROJECT IDENTIFICATION _ . - •1 - PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADflBUILDING - ELECTRICAL-PLUMBING-MECHANICAL [GS ,
1 2
OWNER'S PLAN CHECK VALIDATION
X. NAME �'�h V S OTV., ELECTRIC PERMIT FEE
7 PNONE
tDNTflacTofl s•
NAFOUTLETS-SWITCHES-RECEP 10.00/1,00 1
-.•. �/
��.arE,EES
",N.45621 S5 LIGHTING FIXTURES 10.00/1.00
ADORBacroRs 1a� _ APPLIANCES-RESIDENTIAL 4.00
ADDRESS GBNI CG PRONEJSC- 5 PANELS 10.00 DATE OF APPLICATION
ARCHITECZDAawG. `-' PLAN CHECK FEE P.C:NO.
9. OR r7I IHl..MV V'�r PANELS (OVER 200 AMP) 20.00
ENGINEER SI
Bac.No, SIGNS TRANS. 3.00
ARCR.On ENG. PERMIT VALIDATION
ADDRESS �S Gab 5, SPECIAL CIRCUIT 5.00
Tj' We i EMP.METER OR POLE INS. 20.00
APPLICANT
ADDRESS MOTORS SEE FEE SCH.
•7--
(,� p l SERVICE CHANGE 20.00
o o '• LICENSED CON'T'RACTORS DECLARATION
a u w I heneby affirm that I nm licensed antler provisions of Chapter 9 ISSUANCE PATE
y (commencing with Section 7000)of Division 3 o'the Business and¢ d g BLDG. ELECT. PLG. MECH.
m i Professions s and my license is in full Gyyyy•un��-J yyyjjjjjf yyyyyysrr.
z o a-- License Class. Lit.Number20ZY ST.-I_ rX
juw
Date' _ _s�.p Cnntruc�t�$J,/(Rrr1.Ar_- y^_��/4e�
F J GC
p�P.1 BUILDING PERMIT
¢ a w affirm
Hitt I am exempt
t ATION UO' INFORMATION
w S.0 4 I hereby affirm that I reaso exempt from the Contractor's License MISC.- REFER TO
m VALUATION
$/FT.
FUO J CodLawe:Any city
following' which
requitc. es apemit to construct,
Professions PERMIT ISSUANCE J"a-
improve,
'..^
Code: dro y or coumy whlcb rcgvilme P rior t o consuanc , ,so Cf 1NY„F AmsSe ¢G Demolish,or repair any zlnmlure,prior to its issuanac,also ELEC.CONTR. LIC.NO. ELEC. zV O v V
I^ O u requires the applicant far such permit to file a signed statement that TOTAL
e. w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
F z
Law(Chapter9,(commencing with Section 7000)of Division 3 ofthe
i o • Business.,,it Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
II rc 1_ j the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
s ; _ by any applicant for hundred
dollars the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 � S /Val
of not more than five hundred dollars($500).1:
❑ 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 uttered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to on owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 so.PT.FLOOR AREA TOTAL ACREAGE
Itimself Or through his own employees,provided that such improve-
mn /
h emsare not intended or offered for sale.IL however.the building GAS-EA.SYSTEM-1 6.00 .J
or improvement is sold within one year of conmetion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or m BUILDING USE
E IND CON PB Other
Prove fors owner of the p INDUSTRIAL WASTE INTER. 30.00 E ❑ ❑ 0
' O d as owner of the properly,he exclusively,7044,tins with
licensed contractors to COFIstrUCt Cmun the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 8.00 ASSESSORS PARCEL NO.
and Professions Code'the who
builds ,License s th docs not apply p
to tr owner of h projects
who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �0
contacts for such projects with a contracmr(sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Con exempt
License Luw. TRACT NO. PARC N0.
El I aam m eexempt under sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC FILE No.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby infirm that I have a certificate ofcoment to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,La b.C'(I'.J A-4-e
Policy No. Company
❑ Certified copy is hereby FIRE SPR furnished. WK. ENERGY T2
Z 2 7fp Certified copy is tiles d�wilh tl city 'nspection division. MISC.- REFER TO ORD. Y N V N
p pplica O 0_ E]
N 'KATE 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 3668 �� I FLOOD ZONE A.L.U.C.
LU - COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG
0 (phis section need not be completed if the peimit is for one TOTAL 0�S� V❑. N[] V �. NF]
hundred dollars(Stool car Ito.)
L) O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H rill is issued,1 shall not employ any person in any manner so as to
U become subject to the Worker,Compensation Laws of California.
i Uam - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING. l3 O�
} M NOTICE TO APPLICANT: If,after making this Certificate of fix- T
? , emptlon,you should become suhject to the Worker,Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such Provisions or this Permit still]]he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 -
CONSTRUCTION LENDING AGIiNCY AIR HANDLING UNIT(OVER10=C.EM.) 6.00 SEISMIC FEE ad 3
I hereby affirm that there is a constrrmtion lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the 3097,performance
Gv C ante of the work I'or which this permit is issued(SeMICROFILM UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Nome
Lender,Address ELECTRIC HEATING UNIT(OVER 100,000 B.T.U.)9.50 / $`3
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - JJ
information is correct. 1 agree m comply with auu
ll city and cnty PLUMBING SJ
ordinances and state laws relating to building construction, and BOILER-CCNv1P 13 H.P.or 100,000 B.T.U.1 6.00 . O
hereby authorendonlm representatives ec this city to enter upon the BOILER-COMP (Ova,100,000 BTU)SEE FEE SCH. MECHANICAL O 3
above-mentioned property for inspection purposes. S
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said .ity In consequence of the PERMIT ISSUANCE 44-00
Df this permit. MECH.CONT. LIC.NO. MECH.
TorAL`C7/S 3 TOTAL �O
igna eof Applicant/Contractor Date 9
OFFICE COPY
�e*QM A
fo�
a CITY®F CUPEI TING
i CERTIFICATE OF~ COMPLETION `-('
BUILDING INSPE'CTOR'S OFFICE
Date ...1.... ......41-�....-......T., 19.........C..,., Building Permit nNo.
The Building Located at ... ........................
Owned by ---- J.. ...... ........................a...................................................
p . } � •c .
( mpleted LL
Has Been eyed) For Use As:�?FDW ..................................................... i
.............................................................................................................................................
t .
_...............................
I'll
.. ..r .a....._.C......._...._.......................--.-.
'os.........................................
PD-7 BUILDING INSPECTOR
� r