18600POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO -
INSPECTION DIVISION
n r�O ' ,IOBGINSP,ECTION RECORD
f�jot5 /�ll� R
JOB ADDRESS 'r Ww�, 1��T .�'v�- t'�_ N T# _LOT#
• -
OWNS UC,A CONTRACT
PERMIT NUMBER
$60�
I' PER IT EXPIRATION
ERMIT. EXPIRES IF WORK
I NOT STARTED WITHIN
IUU,DAYSOF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION
DATE
INSPECTOR
INSPECTION R ORD
FOUNDATION
. I-(, ,.
-
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
^ •
UFER
P` . �(U
PREGUNITE
PERMIT VALIDATION
r�
;. 'Cfw
DEG .,
�jI•
elf, Oil . vE.!"`•^'..
GARAGE SLABS
q
T
POUR NO CONCRETE UNTIL ABOVE HAS BEEN
SIGNED
0 e ape t,1/ yt �+' YTPF�C
�v
UNDERGROUND /SLAB
PLUMBING
u U4 , V
CR.
- •1 AA - eFl
DES ). ^A '��p7
ELECTRICAL
MECHANICAL'
Olt! nP Mmortinn
aLOG. ELECT
. � ❑.
G.• M CH
� ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
' �QsT 'F!pp2 � ,1 C�C�a
ff
!" INFORMATION BUNG PERMIT
CwALUATIONI;-
WOOD FLOOR
- $ /FT.
PLUMBING
, OU &
MECHANICAL
ELECTRICAL
�// M T.Z �pUf. wc�'�
Pt;RM TTU •t:.w
/',.I"I�II. ;, •� ..
FRAMING
INSULATION
•, o IES
TYPE consrR.
UCC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
$O, FT FLOOR AREA
,
•Iit ��--
TOTAL ACREAGE
,
DIAPHRAGM
ROOF SHEATHING
—1—
BUILDING USE
RES IND CON Pa 0"."
❑ ❑ El ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN' 1GNED
FINALS
DATE INSP.
-
'
ROUGH
SAN.p
ASSESSORS PARCEL NO
PLUMBING
ELECT. ENERGY
TUBS . &SHOWER PAN
-�
PLUMBING ENERGY
TRACT NO
PARCEL NO
MECHANICAL"
MECH. ENERGY
ELECTRICAL
-
BUILDING ENERGY
ACC GATE
ncc. FILE NO
FRAMING -
ELECT. FINAL TEST
INSULATION.
- -
]MECHANICAL
PLUMBING
ZONING
ENG. SITE NO.
"
GAS TEST
GAS
- �
FIRE'SPRINK
• Y ❑ NO
ENERGY.T•34
Y ❑ NO
' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING -
EXTERIOR SHEAR �
ELECTRICAL RELEASE
FLOOOZONE
Y❑. N❑
A L.0 C,
.
Y N❑
INTERIOR SHEAR
FIRE DEPT.
-
SHEETROCK
GRADE
FEE SUMMARY `
EXTERIOR LATH'
-
BUILDING
L
BUILDING
INTERIOR, LATH
TEMPORARY APPROVALS
SCRATCH COAT
-
ELECTRIC -
PLAN CHECK
FEE
- -
"
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY
SEISMIC FEE
+ i
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252 -4505,
0� ONE WORKING DAY BEFORE REQUIRED INSPECTION`
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
—SEE PERMIT FOR EXPIRATION DATE —
MICROFILM -
ELECTRIC
PwMBINc
MECHANICAL
coNST: Tnx
i
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
-TOTAL
1
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OFFICE COPY
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
11 BUI LDI NG PROJECT I DENTI FICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL - PLUMBING - MECHANICAL
PERMIT NUMBER
18600
BUILDING
ADDRESS
0 CC Cl u.
OwNERM
NAME
L.v � -nl
L+{ j� �S PNONE
OTV.
ELECTRIC PERMIT
FEE
PLAN CHECK VALIDATION
1,- 83
I_ I{�_
1rVf JV1LIU ,J
Aa
NAME 4 1s+° 71p�. I 1
UTLETS - SWITCHES - PIECED 10.00 /1.00
LIC.N .
LIGHTING FIXTURES 10.00 /1.00
C N1
ADDRE eTOR's a
APPLIANCES - RESIDENTIAL. 4.00
PION S-
PANELS 10.00
DATE OF APPLICATION
ogcRrrecT
ENGINEER �4S ct. i]2A
LIC. NO. CC�O JJII
PANELS (OVER 200 AMP) 20,00
PLAN CHECK FEE P.C. NO."
SIGNS TRANS. 3,00
ARCH OR ADDRESS ENG. (
1 Z.1� l..tyCd -V pJI: , •.1 nP`I'IZ1
SPECIAL CIRCUIT - 5.00
-
(p.�RM�IT VVAALI /q.9�(,ONQ,,
V `^ T�"� `�� • "
DCft ,t }I
TEMP. METER OR POLE INS. 20.00
APPLICANTS
ADDRDDRESS SS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
�ir1 �f
LICENSED CONI RACTORS DECLARATION
nFC I
I hereby affirm that I am licensed under provisions of Chupler'J
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Class Lie, Number
Dale Commetor
�Ir.�d�no
ISSUANCE DATE
BLDG. ELECT. PLO. - MECH.
❑ ❑ ❑
Ifi/ nF !:!merfinr►
OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason, (See.laims a,enninessand Professions
Code: Any city or county which requirese p riot to construct, alter,
improve, demolish, nr repair any ..redo lipriortoits nsuuance, also
heq is lic Ilse d Pursuant for such penult 10 f the signed actor's i that
he is licensed pursuant to the provisions of the ) ofDivision License
Law (Chapter 9(wmmotCode)ithSection 7s exempt nd
Business and Professions Code) or that he is exempt therefrom and
BUILDING PERMIT
INFORMATION
MISC.- REFER TO ORD
PERMIT ISSUANCE 10.00
_ ygC4q
ij -J CJ(0
�® LIEHM
5 /FT.
X23 8
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL
PER MIT40 /tea -
T A
I /'1
OTY.
PLUMBING PERMIT
FEE
by any applicant for a Permit subjects the applicant to a civil penalty
by basis for the alleged exemption. Any violation t to a cion malty
of not more than five handfed ):
(my
STORIES
TYPE CONSTR.
11
V -0
ALTER- DRAIN &VENT -WATER (EA.) 5.00
c).
❑ 1, as owner at the properly, or my , and th es with wages as
property, r
[heir sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCc. GROUP
REST. UNITS
DRAINS - FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Cade: The Contractor's License Law does not apply to an owner of
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM -1INC. 4 OUTLETS 6,00
property who builds or IHiproves thereon, and who does such work
himself or through his own employees, provided that such improve-
meats are not intended or offered for sale. l f, however, the budding
or improvement is sold within one year of completion; the owner-
builder will have the burden ofproving that he did not build or no-
prove 1, as owner of tireJ.
❑ as owner of the property, am exclusively contracting with
SO. FT: FLOOR AREA
TOTAL ACflE
G � rA � AE
23:Co L
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
PIES IND CON PB that
❑ ,❑ ❑ El El
INDUSTRIAL WASTE INTER. 30.00
d
licensed contractors od : construct the project (See. 7044, Business
and Professions Code: The Contractor's Iimprov Law does not apply
pply
to ntr owner of property who builds who
improvesensed
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS -OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
to pursuant sua
contracts for rUdi cruse L wiNl a contrumorl sl licensed pursualra In
h projects
the 1 tractor's License Law.
❑ lam exempt under See ,B. &1'.C. I'or this
reason
SEWER- SANITARY - STORM. EA. 200ft /10.00
TRACT NO.
PARCEL NO. -
WATER HEATER W /VENT 6.00
Owner Dale
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE No.
WORKGRS'COMPHNSA'I'ION DECLARATION
WATER TREATING EQUIP. 5.00
I hereby affirm that I have o curtifcale ol'cansCut to self - insure,
. ZONING
ENG. SITE N0.
or a certificate of Workers' Compensation Insurance, or a c'crtified
copy If 5 ripl�d:
Percy I@�i LCd�lrl iQI J (Sfi T~�
,
to pY✓is
❑ Car iledcopy ¢hereby furor ed.
❑ Certified copy is Bled with the city inspection division.
Applicant
MISC. • REFER TO ORD.
FIRESPRINK
Y ❑ N �
ENERGY T24
Y ❑: IN
C Ii RT1171CAT E 017 EX BM PTI ON PROM WORKERS'
COMPFNSATION INSURANCE
(This section need Rot be completed if the permit is lot one
PERMIT ISSUANCE 10.00
FLOOD ZONE
Y N
': A.L.U.C.
Y ❑ N
PLO. CONTR. LIC. NO.
PLG.
TOTAL
hundred dollar, ($ 100) or less.) -
I certify that in the performance of the work for which this per-
mil is issued. I shall not employ any person in any manner so as to
OTY.
MECHANICAL PERMIT
FEE
FEE SUMMARY
BUILDING
�y
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, alto making this Cerliflcmc of Ex-
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
PLAN CHECK
FEE
'
emption, you should become subject to The Workers' Compensation
provisions el the Labor Code, you must forthwith Lromply with
such provisions or [his permit shall be deemed revoked
AIR HANDLING UNIT (OVER 10DWC.F.M.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address-
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
I certify that l have read this appiieafon and slate that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
onfinabees and state laws relating to building. construction, and
PLUMBING
g01LER- COMPI3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEESCH.
MECHANICAL
hereby authorize
hereby authorize representatives of this city to enter upon [he
property representatives i purposes. to '
' (We) agree to save, indemnify and keep harmless the City of
misc.- REFER TO ORD.
apertino against liabilities, judgments, costs and expenses which
ay in any ay accrue against said City in consequence of tiro
PERMIT ISSUANCE 10.00
CONST. TAX
aunt oft
_ , VIR
MECH.CONT. LIC. NO. MECH.
TOTAL
TOTAL
t/
�IZTQl
Signa[ur pp Ica t /Contra - o Date
OFFICE COPY