15291 POSTTHISCARD'NEAR FRONTOF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15291
INSPECTION DIVISION
JOB INSPECTION RECORD
_ r ,PERMIT EXPIRATION
JOB ADDRESS (Q�a tel' S��f''U-s' CD,-VKa 11CLNIT# _LOT# PERMIT EXPIRES IF-WORK
OWNER LUU Cd .
CONTRACTOR IS NOT STARTED WITHIN "
IN$PECTION E,:D*lTEINSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
.NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE,SHALL BE INSTALLED
PREGUNITE - "' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATIONCUPERTINO STANDARDS.GARAGE SLABS � '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL • P, IssunrvcE DATE
MECHANICAL ELECT. PLG METH.
oEl SETH
00 NOT POUR FLOOR UNTIL ABOVEHA$;BEEN SIGNED 1 ILOING PERMIT
WOOD FLOOR OVe� INFORMATION
VALUATION
-
PLUMBING �, SIFT,
MECHANICAL
ELECzc
TRICALMEENSIGNED
-c�• ERMIT//To /
FRAMING - 'JUT R.�y z-/vc ""
INSULATION STUHIES TYPECONSTHUCG GROUP RES UNITS
PLACE NO SU - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' so FT FLoaI+AREA mrAL ACREAGE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF BHErTHING - RES IND CON PB all-
APPLV,N)ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ns0ssoH❑nRc❑EL No ❑
\ ROUGH SAN.#
PLUMBING \ ELECT.ENERGY
TUBS B SHOVER PAN PLUMBING ENERGY TRACTNo. PAH CELND
MECHANIC6L ' MECH.ENERGY
ELECTRICAL ACC.UATF ACC FILE NO.
BUILDING ENERGY .
FRAMING I _ � e1 ELECT.FINAL TEST
INSULATIONZONING ENG.SI Tp NO.
PLUMBING
GAS TEST 4 GAS
V MECHANICAL FIRE SPRwrc ENERGY T.za
COVER NO ORK UNTIL ABOVE HAS BEEN SIGNED HEATIN ` E] NE] E] NE]
EXTERIOR SHIARELECTRI L 1`1111 ZONE A.L.U.0
INTERIOR SHEAR Y❑ N❑ ❑ N❑
FIRE DEPT.
SHEETROCK 'I _ GRADEg&t FEE SUMMARY
EXTERIOR LATH, BUIL
INTERIOR LATH BUILDINGTEMPORARY'APPF , s-S- D
SCRATCH COATELECTRIC PLAN CHECK
' GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE If 41"-
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 6
� 4" H ONE WORKING DAY BEFORE REQUIRED-INSPECTION: .PLUMBING
00 PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
•IMPORTANT! coNsr.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. /
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
Ed SG APPLICATION & PERMIT 15291 Ad HESS I J 9 I
BUILDING - ELECTRICAL-PLUMBING -MECHANICAL [�(]q
OWNER'S
NAME DPLAN CHECK VA TION
L/� {J ,x Q/ - TV. ELECTRIC PERMIT FEE
ou ARLf A PHONE 92el-7 Y
NAMEnac*oRs 3 OUTLETS-SWITCHES-RECEP 10.00/1,00 77
uc.No. LIGHTING FIXTURES- '10,00/1.00 ,Sa
CONTRACTORS
ADDREPPLIANCES-RESIDENTIAL 4.00 '
CON
PHONE PANELS 10.00DATE'OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.'NO.
OR PANELS (OVER 200 AMP) 20.00
ENctNEE1,5,C,� 72
f 'p� o. SIGNS TRANS. 3.00
nooABoss eNa. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
-O- 7X JAocf ?�, EMP.METER OR POLE INS. 20,00
APPLICANTS
AUERORESSMOTORS SEE FEE SCH.
SS /,•�W"�
rJLtM� SERVICE CHANGE 20.00 /
woo LICENSED CONTRACTORS DECLARATION UUU �,/
a in w 1 hereby affirm IhaLl am Iicenscd under provisions of Chapter 9 �11.10 IS(((SUANCE DATE
< (co
H v6i mmencing with Section 7000)of Division 3 of fire Buness and BLDG. ELECT. PLG. MECH.
r N z Professions Code,and my license is In full force and effect 4 ❑ ❑
License Class Lic.Number
O o H w Dalc Contractor L�`s
v s S BU L NG PERMIT
¢ ¢w 4 OWNER-BUILDER DECLARATION RMATION
K n m I hereby affirm that I um exempt from the Contractor's License MISC.- REFER TO ORD Iff
o a Law far the following reagon.(Sec 7031.5,Business and Professions PERMIT ISSUANCE 1 ALUATION $/FT.
Code:Anycity orcounly which requires a permit to construct,alter. �a0
a 2 ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO. ELEC.
O¢ requires the applicant Her such permit to file a signed statement that - TOTAL /lp
A W m" he is licensed pursuant to the provisions of the Contractor's License / PERMIT TO
a, Law(Cboptet9(commencingwith Section 7000)of Division 3 oftheCf /Czr
4 O Business and Professions Code)or that Ile is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars 15500).):
❑, 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 Contructor's License Law docs not apply loan owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP -5.00 SO,FT.FLOOR AREA TOTALACREAGE
meatsl're through his own employees,provided(hal such improve.building
meats are not intended or offered lbr sale.if,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS'6,00
or improvement is Sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) -2.00
builder will have the burden of proving that he did not build or im. BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB Omer
I,as owner of the properly,ant exclusively conivacting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'lie Contractor's License law does not apply '
to an owner of property who builds or improves(hereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a centurions)licensed pursuant to
the Contr ctor's La se Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. -
❑ t u n exempt s der5ee.`_ ,L&P.C.for this WATER HEATER W/VENT 6.00
oWat , / I rA Li-ck
P" " WATER SYSTEM 5.00 ACC.DATE' ACC.FILE NO.
W'ORKIiRS'COMPENSATION UGCLA TION WATER TREATING EQUIP. 5.00
1 hereby affirm (hal I have a caRiticme of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. -
Policy No. Cnntpmty - -
O ❑.Certified copy is hereby famished. FIRE SPRINK ENERGY T.24
Z 2 ❑ Certified copy is filed with Ne city inspection division.
I" O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
r'
CrN CEISSUANCE 70.00
RTIFICA'I 1:Oh'EXli M PI ION FROM WORKS RS' PERMIT FLOODZONE A.L.u.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0. Z ('Phis section need not be completed if the permit is for one - TOTAL Y F] N❑ Y[:] N❑
hundred dollars IS 100)or IeSS,
U O I certify that in the performance ol'the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I stall not employ any person in any ounmer so as to
O W become subject to the Workers'Compensation Laws of California. _
a Date Applicant ALTER OR ADD TO MECH. _ - 5.00 BUILDING
} W NO]ICH TO APPLICANT: If,after nwking this Certificate of Ex.
H ?
emptier,you should become subject In the Workers'Cornpebsmion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=CF.W 4.00 -
'�' CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10JX10CF.M.) 6.00 SEISMIC FEE 0�
I hereby affirm that there is r hick thii p lending agency for EXHAUST HOOD(WITH DUCT) ,5.00
the .Civ .). of Ihu work for which this permit is issued(Sec. MICROFILM
3o97,Civ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Nina Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC 6
I certify Bat I have read this applicat ion and ,are Ilett the above .VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.Of 100,0006.T.U.).•6.00 PLUMBING
(: ordinances and stale laws relating 4t building conslruclion, and
hereby authorize representatives of this city m enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
s
hereby
above-mentioned property for inspection this
purposes:
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
up lino against liabilities,judgments, costs and expenses which - CONST.TAX
a any way ace Ie against said City in consequence of the PERMIT ISSUANCE 10.00
a ting of lhi aril f. MECH.CONT, LIC.NO, MECH.
TOTAL TOTAL 7/ 'lz
$IgnaIt of Applicant/Contractor Datc
OFFICE COPY