15679 T
=> •� POST THIS CARD NEAR FRONT OF BUILDING' PERMIT NUMBER'
= : CITE' OF CUPERTINO 15679
i� INSPECTION DIVISION . +
`\71 JOB INSPECTION RECORD /
PERMI•PEXPI RATION
JOB ADDRESS SEVE-V SbA/4/�' 2'-- UNIT# LOT Sk
OWNER. , (r/COU ,• PERMIT EXPIRES IF WORK
� CONTRACTOR /ic:aF T/"w P OO LJ IS NOT 'STARTEO•WITHIN
INSPECTION DATE INSPECTOR .INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 160 DAYS FROM
FOUNDATION NOTE: '
UFER ALL GRADING-AND DRAINAGE SHALL BE INSTALLED' LASTCALLED 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
UNDERGROUNDISLAB T low OKooL [
PLUMBING1-7
ELECTRICAL EO L®� PSS IS6j5 ISSUANCE UATE
MECHANICAL . nnBL'Dr.. I ELECT. yPLG. I b4ECH.I
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
WOOD FLOOR Pv 0 INFORMATION
- VALUATION S/FT.
PLUMBING
• MECHANICAL
ELECTRICAL • PERMIT TO .�
hV/et/c//v6-Td vL
FRAMING '
INSULATION , STORIESel TYPE CONSTR.
t"u"re
OCC.GROUP RES UNITS
- t
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
/ SO.FT:FLOOR AREA TOTAL ACREAGE
'ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
KURU W USE
ROOF SHEATHING , ._ ' ;• ', " •. .• Tres IND conN PS o1I1..
,.APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ '
- n55ESSONPARCEL NO
ROUGH. SANK
PLUMBING - ELECT.ENERGY '
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY _
;MECHANICAL I MECH.ENERGY
ACC DATE ACL.PILE NO
• 'ELECTRICAL BUILDING ENERGY
FRAMING / ELECT.FINAL TEST
- - ZONING ENG,SITE NO. .,
INSULATION PLUMBING
GAS TEST GAS'
MECHANICAL FIRE SPRINK ENERGY T•PA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r "� Y "❑
EXTERIOR SHEAR ELECTRICAL RELEASE fir
FLOOD ZONE A.L.U.C.r[:] "� Y � N❑
.+` INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
•• EXTERIOR LATH BUILDING '"I BUILDING s.frrn
INTERIOR LATH TEMPORARY APPROVAL
SCRATCH COAT 1BECLRIC PLAN CHECK
' GAS
'1 NO TAPE OR PLASTER UNTIL ABOVE HAS.BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING,FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
.LU ARRANGE FOR INSPECTION BY PHONING 252-4505, . + ' ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING d
PLEASE GIVE JOB ADDRESS WHEN PHONING.
zf - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL DIT�
IMPORTANT! CONST.TAX.. ..
' PLEASE READ REVERSE SIDE BEFORE TOTAL
'T ` CALLING FOR FINAL INSPECTION,
OFFICE COPY
ICANT45 FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
• ti 11 DING PROJECT I DENT[FICATION - :PERMITNUMBER
-�lSa11:.ING APP, CATION & PERMIT 15679
woOREEB':.
�SFYL r✓S= Q /.�/(r'+C�� BUILDING-ELE 'RICAL-PLUMBING-MECHANICAL
EPs PLAN CHECK VALIDATION
a�.y.'�G d/1 �{ GRlkw OTY ELECTRIC PERMIT FEE u-3
IF' 1 76 VOW \r�LX C4 PHONE • <�G 7`
CONTRACTOR UT LETS•
Fe SWITCHES•RECEP 10.00/1.00 .
14
"h/1If1� FOOLS Llc.xo.2 O LIGHTI NG FIXTURES 10.00/1.00
moo ass ORS ��{A A 7 CA PPLIANCES-RESIDENTIAL 4.00
'p AA .s\U. IA sCGv NF;D PANELS 10.00 DATE OF APPI:ICATION I
ARCHITECT PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE .C.NO.
DR ALV#u ST k Ae6e.r%A4"
ENGINEER
-LIC.No. Z ` .SIGNS TRANS. 3.00
'ARCH•.OR ENG. SPECIAL CIRCUIT 5.00 •PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 /
ADDRESS (Q
ADDRESS S "O/VIO a MOTORS SEE FEE SCH.
ppyy
LD AL•t'd a CA, -0,4kO3 ISERVICE CHANGE 20.00
°w
00 LICENSED CONTRACTORS DECLARATION
<i u~.0 I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCEMATE
(so[
with Section 70001 of Division 3 of the Business and
<c G. ELECT. PLG. MECH.
r< Professions Cor a license is in full 1'orgc nit e_ffe
Z o w z Licence lass__ Lis:.Number{
O w F w• Date�Z - IN_Contractor
<x 'ILDING
PERMIT
¢¢d OWNER-BUILDER DECLARATION POOLS G INFORMATION
o's I- I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
O1Molawforthe following reason.ISec.703 uires a.Businessand Professions
PERMIT ISSUANCE .}ggB. v N II/FT.
� Le� Code:Any mulish (it ntyrep drany structesa Permit toconstruct.altar, QCO
C< idllsnrve,demuliSlr,rrr repair.any structure,prior In its irsuanee,also ELEC.CONTR. LIC.NO. ELEC.
w -O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
'N$ be is Iicemed Formant to the provisions of the Contractors License
_ii Iaw(Chnptar9(commencingwilh Section 7000)ofDivision 3 of the rS LV/aL•/�C(/N ' QL
4 c Business and Professions Code)or that he is excmpl therefrom and OTY. PLUMBING PERMIT FEE
¢r the hasis for the alleged exemption.Any violation ufSection 7031.5 STORIES TYPE CONSTR.
.w by any applicant far a permit subjects the applicant to a civil penalty ALTER-DRAIN'&VENT-WATER (EA.) 5.00 [��
of not more than live hundred doll..($5001.): cuN/Ze
O I,as owner of the property,OF my employees with wall's"s BACK FLOW PROTECT.DEVICE 4.00 �•
their Sole compensation,will do the work,and the structure Is not y .GROUP RES.UNITS
•L intended or offered for alc(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Coninetoes License Law does not apply to an owner of
property who builds or improve,them-on,and who dosuch work FIXTURES-PER TRAP 5:00 • SO.FT.FLOOR AREA TOTAL ACREAGE
1� n hrees
imself•or through his own employees,provider)that such improve.
menta am not intended or offered for ale.If.however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 L--
or improvement is mid within one year of completion,the owns,
builder will have the burden of proving That he didnot build or ice- GAS-EA.SYSTEM-OVER 4(EA.) - 2.00 BUILDING USE
Prove for purpose of ale.). I NDUSTR IA L WASTE INTER. 30.00 RES INo WN PB Other
O, 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to canstruct the'pmject(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.aml Professions lode: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 for such Projects with.cuntmetons)licensed pursuant to SEWER-SANITARY-STORM EA.200It/10.00
the Contractor s License Law. TRACT NO. PARCEL NO.
0 l am exempt under Sec. ,B.&P.C.for this
M.San WATER HEATER W/VENT 6.00 +
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I'hemby affirm that I have a certificate of consent to self-insure, TONING ENG.SITE NO.
- or a certificate n!Workers'Compensation'Insurance.or a certified
copy tllenofl5ec.3800,Lah.C.1r. ^ '
Policy N6.
Cn hereby
yJUA'�.QZaI. L
O D Certifiedlmd copy ishercby fu I the FIRE SPRINK ENERGY T-?d
_Z Z P Certified ropy is fi J wi h the city igspection division.
AbpBcamL'.1t _ - MISC.- REFER TO ORD. v❑ N❑ v.❑ N❑
1Lm CER ICA'TEOOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE "a-GO FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE, PLG.CONTR. LIC:NO. OGO �O ('This secticin need not be completed if the permit is for one TOTAL pY❑ No YC] N[]1
v:) Z hundred doll..(5100)or less.)
/U O I cenify that in the performance of the work for which this per, CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL mil is issued,I shall not employ any'peron in any manner an as to
Oa hecome subject to the Wurkcra'Cnmperuatinn lawx of California.
Dale Applicant ALTER OR ADD TO MECH." 5.00 BUILDING
} m NOTICE TO AP ICA If,alter making this Certificate of I.
Z amption,you should become abject Io the Workers CGmpenemn"' APPLIANCE 5.00 PLAN CHECK
provisions of the Lds C.
you must forthwith comply with FEE
U such provisions or this permit.11.11 be deemed revoked. AIR HANDLING UNIT ITO 10p000.F.NL) 4.00
. : CONS'T'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1017WC.F.M.) 6.00 SEISMIC FEE 0
I hereby affirm that there is.construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is Issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 '7
limiters Name HEATING UNIT,(OVER 100,000B.T.11.19:60 (s.' ELECTRIC c3R •--
Lenders Address
Icertify that have mail this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I ague to comply with all city and county BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING dQ
/
hereby
ordinances and stat' laws atisretailing to is building mnater upon
and
'hereby authorize representatives of this airy to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)BEE FEE SCH. MECHANICAL
�- (We) agree to ave, indemnify and keep Ilamlless the City sof MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,casts and expenses which CONST.TAX
may in any way accrue against ald City in consequence of the PERMIT ISSUANCE 4B:m --
'rlgOfthis Permit w MECH.CONT. LIC.NO. MECH.
C TOTAL a TOTAL
l�(V' a199UM of Applicant Contractor Date.
- - OFFICE COPY