16620 POST THIS, CARD NEAR FRONT OF BUILDING
+ .. PFRMIT NUMBER,
CITY 'OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTIONRECORDu '. ,
• 4 `/ I{'�'\` ., e ,PERMIT EXPIRATION
JOB ADDRESS ' Id `' � SL'e �I�� �" k1NIT.# _LOT#
�y� - - PERMIT EXPIRES IF WORK,
"OWNER .� blr S'C'<< ( CONTRACTOR �, S IS NOT STARTED WITHIN '.
INSPECTION • DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION Jr!- NOTE: - " A LASTCALLED INSPECTION..
'UFER, - -Q [J, ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
PREGUNITE - TO COMPLY WITH THEAPPROVED PLANS AND CITY OF
GARAGE SLABS- :PEBn+Ir vnuunn oN
CUPERTI NO STANDARDS.
' '�' ` � - � '¢A � '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '.•.
- UNDERGROUND /SLAB - `
PLUMBING FU WBlwu!4 . , .`�E7 _ "c�'TtvI.e-
+ + ELECTRICAL` + '• ISSUANCE DATE k
MECHANICAL - - _ BLDG I ELECT 'Lu. .m�cp,•
Lr{il �r}Jt dL-h rL7TJi
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT c
k . • INFORMATION.
WOOD FLOOR'
_ .VALUATION, $/FT.
PLUMBING
MECHANICAL 1_' ✓ -
ELECTRICAL - PEHAurro
I FRAMING • - 0 `"^�
FAQ
` INSULATION .. /•. - - STORIES TYPE CON57
I
—
OCC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
5 fT ;LOU HEA •rqi�.I, +E
ROOF. NOTENO FINAL INSP.SHALL BE MADE BEFORE
THE CONSTRUCTION TAX ISPAI D -
DIAPHRAGM . . I I -
p
BUILDINGUSE
ROOF SHEATHING 3'ZfJ Cj Res IND. . CON Ptd on,.•.
APPLY NO ROOFING UNTIL ABOVE HAS'BEEN SIGNED'' FINALS .'DATE, - INSP: ❑ 1:1 ❑ ❑ El`'
ASSESSORS PARCEL NO
ROUGH SAN 1149CO. f5
55/ ^ D8_-
PLUMBING. e. //- ELECT.ENERGY, / ,-
TUBS&SHOWER PAN PLUMBING ENERGY rRncT No. PAR ,L No
MECHANICAL MECH.ENERGY ADD DATE ACC,FI LE NO
ELECTRICAL :% . BUILDING ENERGY
-omFRAMING .l.r.-, - ELECT.FINAL TEST ZONING - ENG.sITENO• ,
'INSULATION ,'Z PLUMBING': _ - ti .
GAS TEST GAS - -
- r¢a
MECHANICAL . FINE SPRINK �ENEacv
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ,` ❑ "❑
ELaoD ZONE A.L.u.c.
" EXTERIOR SHEAR „�,8(� (� � ETRICAL RELEASE %�: - a •�
INTERIOR SHEAR FIRELECDEPT. Y N❑ °,L7"'.I,
SHEETROCK - l UIBd, T IGRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARYAPRROVALS ' .BUILDING v00�
SCRATCH COAT - ELECTRIC PLAN CHECK -
.. GAS _ ..T
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE /
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM .y
ARRANGE FOR INSPECTION BY PHONING 252-4505, : ELECTRIC 0
s o� GIVE JOB ONE WORKING DAY BEFORE REQUIRED'IN$PECTION. PLUMBING
PLEASE ADDRESS WHEN PHON'ING'.
Z • ' ,, - 'MECHANICAL .
- SEE PERMIT:FOR EXPIRATION DATEqql L2
IMPORTANT! CONST.TAX "
PLEASE READ REVERSE SIDE BEFORE ,
CALLING FOR FINAL 'INSPECTION. TOTAL / , ,
4 OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT IDENTIFICATION -PERMIT NUMBER
aD,L° v 26 APPLICATION & PERMIT
ADD as rcerli c Blvd { 1 nh ^/
/0 i .upe4 i n0, �a I 1 0ornl a BUILDING - ELECTRICAL-PLUMBING MECHANICAL ,1 V�•L.I O
OWNER'S - PLAN CHECK VALIDATION
NAME Terry Brown Construction/ TY. ELECTRIC PERMIT FEE
Jim Sisk Llevelopmen�,D1E08-996-372
Is=..0`feRsrry tI o�:n Construction OUTLETS-SWITCHES-RECEP 10.00/1.00
NAMF r
J h 1314 LnnLIGHTING FIXTURES 10.00/1.00
'
AODR ESS TM21 Granada Ave. Z APPLIANCES-RESIDENTIAL 4.00
Cup,,sirtinn 95014 F PANELS 10.00 DATE OF APPLICATION I-
aragon Oesi gn Group PLAN CHECK FEE P.C.NO.
BR PANELS (OVER 200 AMP) 20,00 .�>
c ra«eFn
LICNO. SIGNS TRANS. 3.00
AARCHDDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
65 -Alberto Way, Suite B
Los Gatoo.- CA 99;012 ZIP TEMP.METER OR POLE INS. 20.00
AS0060 Pasadena Ave MOTORS SEE FEE SCH.
ADDRESS
SLIpertino, CA 95014 ISERVICE CHANGE 20.00
0 0 0 LICENSED CONTRACTORS DECLARATION
a u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N<`m (commencing with Section 7000)of Division 3 of the Business and e_ 'B� ELECT. PLG. MECH.
y z Professions Cnde J my license is in full fore n Alae t. ��1(
z o m - License Class Lic.Number LL
o z F D Uolc_�� Z -- Contractor ,p' asi PupQQ
< x V '•W{I -- BUILDING PERMIT
Q wDIiR UECLA ATIO OLA
S o A INFORMATION
F. g I- 1 hereby affirm that I am exempt from the Cont .u'ense MISC.- REFER TO ORD VALUATION
.. o< Law for the following reason.(Sec.7031.5,Busi res d Professions S/FT.
PERMIT ISSUANCE 10.00 2tD�. QO
� w> Code:Any city or county my wharty structure pcnnil rots issuan e,also
0-3 `1
Ie a improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC.N0. ELEC. {� V
rc O u requires the applicant for such permit to lite a signed statement that TOTAL , D PERMIT TO
n w m he Is licensedpursuant to the provisions of the Contractor's License
z a Law(Chapter 9(commencing with Section 7000)nf Division 3 oflhe
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE VV
R 1- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.'
rc ; by any applicant fora permit subjects theapplicanl to a civil penalty
of not more than live lmndred colla',(5500).), ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,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 Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA �rorAL,g�BEAyE
himself or through his own employees,provided that such improve- 5- TA !y3
mems are not intended or olfared for sale.if,mhoweveu the building GAS-EA.SYSTEM-11NC.40UTLETS 6,00 `l " (
or improvement is sold within one year of completion, the owner- p�
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON - PB Other
❑ I,as owner of the property,am exclusively contracting with . .
❑ ❑ ❑ ❑ ❑
l"I'lled contractors to cmRtnml the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6:00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply -�
to an owner of property who builds or improves thereon,and who to LAWN SPRINKLERS-OVER 5(EA.) 1.00 357
he Cor(J�
ttracts forsuchprnje with licensed pursuant SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO. PARC9L N0.
the otracrois License Law.
❑ Inam exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 . ACC.DATE ACC.FILE NO.
'IA/I 1j4��R I:RSCCfJ]'Cy�7�P'T�(�$,�.p1� DL'[fRATION WATER TREATING EQUIP. 5.00
I"M1clbs-'Etk�a' 1 rl8v!Awl Bate or t(�ownt to self-tnsone. g21(� ZONING
m a certificate of orkers'Compensation Insurance,or a cenlit'icd ENG.SITE N0,
copy lhcrm%1'fSu 18Compan C.1.,/',p„Aloe
D -
Policy Nrt Company
_f��-L�L..LLKK(( 1
Q ❑ CertlfmJcopy is hereby11dfurnishcd.
Z 2 .�/�rtifi is file) Th the city inspection Division. FIRE SPRINK ENERGY T-24
O A�cant MISC.- REFER TO ORD. v ❑ N❑ I Y N❑
y CCRT1 b'M)(1:. ION -ROM 1 f1ItK I,RS' PERMIT ISSUANCE 10.00 UQ FLOOD ZONE A.L.U.C.
L CIMPGNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. (,�
(This sect: n need not be completed if the permit is.for unc TOTAL IF le I V Y❑ N❑ Y❑ N❑
hundred dollars(S 100)or Tess.)
U O 1 certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
UJ
Dale - Applicant BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 J
1- ? enation,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will% FEE
U such provisions er this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00GRM.) 6.00 tELEECTRIC
FEE- rL(
1 hereby affirm that there is a construction[cutting agency for EXHAUST HOOD(WITH DUCT) _ 5.00
the performance of the work for which this permit is issued(Sec. ILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.509
Lcndor's Address fJ�
Icertify rhos l hove read this application and slate that tiro above VENTILATION FAN (SINGLE)' 4.00 _
information is correct.1 agree to comply with all city and county NG
ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 tJ
hereby authorize representatives of this oily to enter upon lire BOILER-COMP (Over 100.000BTU)SEE FEESCH. NICAL �D
above-mentioned property for inspection purposes
(We)'agree to save, indemnify and keep harmless [I a Cit of MISC.- REFER TO ORD. Za
Cupertino I liabilities,ju gments, cost and I CONST.TAX ?
my in y w' cruej�ytu PERMIT ISSUANCE 10.00 �e J
CH.CONT. LIC.NO. TOTAL
2�
amre ofA plicant/Contrnctar Dale ME CH. TOTAL /S
OFFICE COPY