16937�l
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY -OE CUPERTINO
16937 I
_ "
INSPECTION DIVISION'
JOB INSPECTION RECORD
- ^
PERMIT EXPIRATION
1
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JOB ADDRESS UNIT# -_LOT#
' -
PERMIT EXPIRES IF WORK
OWNER � `E-tJ 4J CONTRACTOR -
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU"
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION - DATE INSP CTOR
- INSPECTION RECORD
FOUNDATION — i
NOTE:
UFER —
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
PREGUNITE,
'i",MIT VALITI N
CUPERTINO STANDARDS....�Q—�
•TO, pr-
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
''UNDERGROUND/SLAB
ISSUANCE DATE
PLUMBING
ELECTRICAL-
MECHANICAL
RLOc
�L
€Lec i,
Pic, nnecnr
�y
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD FLOOR
UATION- a
SIFT.
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
�'✓ W '�
FRAMING
INSULATION
91OR IES
TYPE. CONSTIi.
UCC. GROUP
qE5 UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SO FT. FLOOR AREA
TOTAL ACREAGE
DIAPHRAGM
ROOF SHEATHING
Rw LOIUSE,
AlES IND COON . PB On„",
❑ 13 0 El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SAN.#
ASSESSOR$ PARCE I. NOC.
PLUMBING -111&6
ELECT. ENERGY o —
TUBS 8 SHOWER PAN
PLUMBING ENERGY. (3^'
TRACINU,
PARCEL NO
MECHANICAL
MECH. ENERGY
ELECTRICAL
BUILDING ENERGY
ACC DATE
ACC. FILE No
".
FRAMING W2
ELECT, FINAL TEST 6
INSULATION C�-Z'Z
PLUMBING _
roNlNc
eNc. sire No.
-
GAS TEST - , _
GAS
MECHANICAL
FIRE.SPRINK
Y[:] N
ENERGY T 24
Y[ 'NE:l
-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE .. a
iv_
FLOOZONE
L D
❑ NE]
ALUC 11
I""
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK, _
GRADE,
FE SUMMARY
EXTERIOR LATH
BUILDING^7
BUILDING
43
INTERIOR- LATH
TEMPORARY APPROVALS
/•car
SCRATCH COAT —
ELECTRIC -
-
PLAN CHECK
FEE
-
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SICNEO
OCCUPANCY
SEISMIC FEE
f �'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
_
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
G9G�
�� ONE'WORKING DAY, BEFORE'REQUIRED INSPECTION..
PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
�y CB�
Eq
Z
=SEE PERMIT FOR EXPIRATION DATE _ •'
CONST. TAX
IMPORTANT!
TOTAL
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR.FINAL INSPECTION.
OFFICE COPY,
CITY OF CUPERTINO
CERTIFICATE OF
COMPLETION
r'f ) 3!
fI
BUILDING INSPECTOR'S OFFICE
i
_ Q
Date .........1... ..I:. �................ 19.8T..
1..� 3�
Building Permit No. -................
I
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The Building Located at ......�._4a _S ........
.
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Ownedby ...: i.....Q, .........� ...............................................................
.
'
omp ete �
Has Been For Use As: .........:........
T1�.
�..................
.............................
..................................................................................................................................................
.................................................................................................................................................
PD -7
BUILDING I SPECTOR
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AP LICANT TO FILL IN -INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
JB UI LDI NG PROJECT I DENTI FICAT.ION A
-
. APPLICATION & PERMIT. -
BUILDING - ELECTRICAL- PLUMBING=MECHANICAL
PERMIT NUMBER
`"'
16937
Ho'
ADDRESS
50. TLrUl (A.STr wy1 IERkjpb
OWNER'S
NAME
p M-372
fWiIJ NToNP
-
DTV.. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
.
60CONTR� b
60.
DATE OF APPLICATION
CONTRACTORS
LIC. No. ,�j T6 !i
OUTLETS -SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
ADURE CTOR's
Z//Yl -j rvgrA 4 i/` PHONE 9/(J --?7Z7-
APPLIANCES - RESIDENTIAL 4.00
PANELS ,i � 10:00
ARCHITECT
ENGINEER
I CAW 1huc. uo.G /AYS
k
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
-
SIGNS TRANS. 3.00
ARCH. ORENG.
AD .Ess
11991 ,A AV)4 nP 951 'Z
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
2--[P.- CDC
p�
TEMP. METER OR POLE INS. 20.00
APPLICANT'S -
ADDRESS
Z/72/ 6RAYADA 4PE CitA
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
419 l• a OZS
V41
I hereby affirm that I nm licensed under provisions.1Chapter 9
(commencing with Section 7000) of Division,3 of the Business and
Professions Code, an ry license is In full f orce' n cffee .y Z
License Clss Lie. Number_ Z
ah�
ISSUANCE DATE
BLDGELECT. PLG. MECH.
. ,
x�
IYI-Q'
D ateContractor a ✓A%�
PERMIT
INFORMATION
OWNER -BUILDER DECLARATIONBUILDING
I hereby affirm that I on exempt from the Contractor's License
Law for the following reason, (Sec, 7031.5, Businessund Professions
Code: Any City or county which requires permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
MISC. - REFER TO ORD
PERMIT ISSUANCE 10.00 , r`�
vALunTIgN�ro $/FT.
1
ELEC. CONTR. - LIC. NO. ELEC.
requires the. applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
TOTAL • 7
PERMIT TO
Law (Chapter 9 (commencing with Section 700() of Division 3 of the
S'
Business and Professions Code) or that he is exempt therefrom and
QTY. PLUMBING PERMIT FEE
D
the basis for the alleged exemption. Any violation bf Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
Of not more than five hundred dollars ($500).):
STORIES
TVPECONSTR.
-
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACKFLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: Out Contractors License Law does not apply to an owner of
FIXTURES - PER TRAP - 5.00
GAS- EA. SYSTEM- 1 INC. 4 OUTLETS 6,00
SO. FT. FLOOR AREA
Z �j
a
TOTAL ACREAGE
property who builds or Improves thereon, and who does such work
himself or III roagh his own employees. provided that such impmve-
ments are not intended or offered for sale If, however, the building.
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not'build or im_
prove for purpose of the,
❑ I, as owner of the property, am exclusively contract Tug with
.
GAS - EASYSTEM -OVER 4 IEA.1 2.00
BUILDING USE
E IND CON PB Diner
11 ❑ ❑
INDUSTRIAL WASTE INTER. '30.00
licensed contractors to construct the phnjcet (Seo. 7044, Business
and Professions Code:'1'he Contractor's License Law does rut apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 IEA.) 1.00
ASSESSORS PARCEL NO,
contracts for such projects with a conlractrius) licensed pursuant to
the Contractor's License Law,
❑ l am exempt under Sec ,B,&P.C. for this
reason
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCELNO.
WATER HEATER WIVENT 6.00
Owner - [)ate
WATER SYSTEM - 5.00
ACC. DATE
ACC. FILE NO,
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self-insure.n
or a certificate of Workers' Compensation Insurance, or a certified
0i L02 S 4
` `+
ZONING
ENG. SITE N0.
eof (Sec. 3800, Lab P;my ).`��dUT /A06AN/%y
Policy N Company 7.
rt (!'
FIRE gPRINK
y� N�
ENERGYT24
v� N0
edified copy is hereby famislhed.
❑ Caitiff 01 win, the city i s on o
plicant Ws/ CoA/ %`�uA stir
WF�8- 67 �
C:RTIFI A7 E OF FXEMP'ION PROM WORKERS'
COMPENSATION INSURANCE
Prins section need not be completed.if the pertain is for one
'
MISC. REFER TO ORD.
PERMIT ISSUA 10.00 CQ7
FLOOD20NE
❑ V N❑
A.L.UC.
❑ Y N El
PLG. CONT.. IC. NO. PLG.pp �My
TOTAL 6-O 1l 5
hundred dollurs(5100) or less,) -
I certify that in the performance of the work for which this per-.
mit is issued, I shall not employ any person in any manner so as to
-
DTV. MECHANICAL PERMIT FEE
FEE SUMMARY
beconhe snhject to the Workers' Compensation Laws of California.
Irate Applicant
[)areNOTICE TO APPLICANT': If, after making this Certificate of rix-
BUILDING
a
ALTER OR ADD TO MECH. 5. 00
APPLIANCE 5.00
PLAN CHECK
FEE
eruption, you Should become subject to the Workers' Compensation
provisions of the Labor Code, you.must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00
AIR HANDLING UNIT (OVER I0,000C.F.M.) 6.00
SEISMIC FEE
vx, `(�,
CONSTRUCTION LENDING AGENCY
I hereby uRiun that there is a construction lending agency for
the performance of the work for which this permit is Issued (Sea
3097, Civ.C.).
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
,
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
HEATING UNIT 100,000 B.T.U.)9.50
ELECTRIC
v l
I certify that I have read this application and state that the Shove
information is correct. I agree to comply with all city and -county
ordinances and state laws relating to building construction; and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
- -
G Pd
1
BOILER- COMPH.P.or100,000B.T.U.) 6.00
hereby authorin•.MPMSent2tives of this city to enter upon the
above-mentioned property for inspection purposes.
g01 LER•C MP (Over 10,000 BTUI SEE FEE SCH.
MECHANICAL
(We) agree to save, indemnify and keep harmless the City of
upe;.dam againliabilities, judgments, costs and expenses which
may in an wayaccrue against said Ci[ in cense uence of the
�gmnting of this permit.
�Z_ 7 9le?
MISC. EFER TO ORD. qs
PERMIT ISSUANCE 10.00 �La�
CONST. TAX
1
MECH. CONT. LIC. NO. MECH,
OT/ALQ Q5
a^ a
TOTAL
Ir� QQ
I ! UO
Signatureof AppRcn oatr17or Date
OFFICE COPY