14796 POST'' " IS CARD NEAR F',RONT OFEBUILDING E;
•' PERMIT NUMBER $
:CITY OF: -CUPERTINOs: .
" INSPECTION DIVISION, 4796
JOB INSPECTION RECORD
• E
per/ ..'T^ (. � ''PERMIT EXPIRATION '
JOB ADDRESS—1- C ` 3'6 J , CJ '�'- —vt k,IT#' "LOT# A I �I
'WR IT EXPI SIF WORK
owNt:R 22C' ` (� 'coNTRAcroR 9IS NOT`�STARTED WITHIN'hl
INSPECTION ' DATE INSPECTOR INSPECTION RE ORD, 180 DAYS OF PERMIT ISSU 'j'
- - , ANCE ORABO DAYS FROM
FOUNDATION
_ NOTE: • LASTCALLED INSPECTION. `
. 'UFER - > d.. ALL GRADING AND DRAINAGE SHALL BE INSTALLED � I
PREGUNITE ' TO COMPLY WITH THE APPROVED PLANS-AND'CITY OF. , I'Di MIT VAm°ATION' 'i
b-
-' - CUPERTINO STANDARDS.
GARAGESLABS,•-' '{
-POUR NO CONCRETE UNTIL ABOVE-HAS.BEEN SIGNED
„'UNDERGROUND/SLABis?_
' PLUMBING' + 2 1411
ELECTRICAL ISSUANCE DATE
MECHANICAL
- BLD .ELECT. PLG. MEC� _ � G• Rt �q j
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
•
WOOD:ELOOR- ., INFORMATION'
ON''
. :'.
II- VALUATION 'SIFT. "
• - .: PLUMBING " . • ! - `• I
' MECHANICAL y"T 7111,
P PAID
,.3 � • � .
ELECTRICAL - PeHMn TD
OCT IA 198e
FRAMING > '-' eL {
r
INSULATION' STORIES - TYPE CONSTR.
' , � - � - +
. City of Cuper inD
• - .. , . // G OCC.GROUv RES UNITS -
-PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED r' / •.,.
• SO,Ii VICI°RABfA .TO`TALACREACE j
RODE' 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -
�, DIAPHRAGM ,THE CONSTRUCTION TAX IS;PAID,, • ' r
BUILDING USE
ROORSHEATHING . '- - a •' ' Hes IND CON. ' PB o
I i
APPLY NOROOFING,UNTIL-,ABOVE"HAS BEEN SIGNED FINALS ,,.,.0 w, DATE Al ;INSP.,,.,
ASSESSORS PARCEL NO.
ROUGH SAN:#!` '. .
PLUMBING, - ,ELECT.ENERGY' - - - -
TRACT NO PARCEL NO .I
TUBS&SHOWER PAN - ' . + PLUMBING ENERGY.
MECHANICAL MECR.ENERGY,'
ELECTRICAL - ACC DATE, ' ACC FILENO.
' +• 1' ' - BUILDING ENERGY'
. FRAMING' - - ELECT.-FINAL•TEST " - I i
INSULATION— PLUMBING' -+ : ZONING. ' ENO.SITE No. j
' 7
GAS TEST a GAS . r - -
VIRESPRWK „' ENERGY Tpa
MECHANICAL
. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING,' " ' N
EXTERIOR,SHEAR t ELECTRICAL RELEASE ci.°°°?°Ne A.L.u,c.
INTERIOR SHEAR' FIRE DEPT. + Y0 NQ; Y_2- N0
SHEETROCK. ' GRADE. - FEE SUMMARY "
EXTERIOR LATH ' BUILDING BUILDING * ,
INTERIOR LATH TEMPORARY APPROVALS ,
SCRATCH,COAT ELECTRIC ' PLAN CHECK
' . GAS . .. -
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY: - 'SEISMICF,EE.'
OCCUPANCYOF.BUILDING ISNOTPERMITTED UNTIL BUILDING FINAGISSIGNED BY BUILDING INSPECTOR'. T'
T " MICROFILM,
ARRANGE'FOR .INSPECTION BY PHONING:252.4505 ELECTRIC
F ONE WORKING•DAY'BEFORE'REQUIRED INSPECTION PLUMBING
o� PLEASE GIVE'JOB ADDRESS WHEN PHONING
• Z r ! - I '• r _MECHANICAL
-!
SEE PERMIT FOR EXPIRATION, DATE
' - CONST.TAX
IMPORTANTI I
PLEASE READ REVERSE SIDE BEFORE £ 3� TOTAL.
CALLING FOR FINALINSPECTION,
OFFICE'COPY
�/JJ�/I4t�GCfL`/YNTITOfL`G IN INFORMATION WITHIN RED LINES'- L `P019VT PEN-ONLY '
�y a
•'BUILDING PROJECT IDENTIFICATION I ..PERMIT rvuMBER �.,
UILDING APPLICATION & PERMIT
AOOREss. BUILDING—ELECTRICAL-PLUMBING— [A�f MECHANICAL t, 1 .479'6
Er, PLAN CHECK VALIDATION
- OTV. . 'ELECTRIC PERMIT - 'FEE'-I
PNGNE
CONTRAL 5
NOUTLETS-SWITCHES-RECEP' 10.00/1.00At
�
uc.No �le LIGHTING FIXTURES, 10.0.0/1-.00 ,l Q r r
C- NTR C 's - - APPLIANCES,-RESIDENTIAL' 4.00. '.
//s
ONE ` . PANELS'' 10.00 :-DATE OF APPLICATION
ARCHI EC n u +PLAN CHECK.FEE P.C.NO,
PANELS OVER 200 AMP)' 20.00
OR . ( —
ENGINEER u -
c.No. SIGNS TRANS. - 3.00 - '
ARCN.OR ENG. .PERMIT VALIDATION
I•
A R SPECIAL CIRCUIT . 5.00 ,
DD Ess
ZIP, t EMP.METER OR POLE INS. ,20.00
APPLICANT'S
t D MOTORS - '� SEE.FEE SCH.
" r
SERVICE CHANGE 20.00,='
Foorz LICENSED CONTRACTORS DECLARATION _w
O I beech Pmt t u t
- ¢ U hereby it nlicensed unision3 f(he ofChess and p.; . ISSUANCEDATE"
yz'+' (aemmencing wish Se/'tion]000)of Division 7 Of the Business and
¢ H BLOG.� ELECT. ` PLG.. -MECH.
H z Professions Cylys a}y,�r(1nn se is in full force n e ec
Z i o License CI as4�¢G� Lic.Number �' _ Iq, ,•--t • ❑ ❑ '..❑"• '.� .
9 r,In Dxte Cmrtractnr
r
f J'
a PERMIT
x BUILDING E
Ic to a OWNER-BUILDER DECLARATI N CI
F. O w u _ - INFORMATION ,
a oa _ ^+
MISC. - - REFER TO ORD
w'g o N I hereby affirm thin i ant exempt Gum the mess nctor s License ,
LL o ¢--. Law for the following rwson.(Sec.703 L5,Business and Professions PERMIT ISSUANCE - 10.00 VALUATION,' $/FL .
' gym Code:.Any city or county which requiresa permit toconslrucl,altm, 1
Qimprove,demolish rr:repair any structure,prior Jo its issuance,_Sho ELEC.CONTH. 'LIC. ELEC y-
u —O Itre requiresfile applicant for such permit to file a signed statement that _ TOTAL ,
he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Fza
taw(Chapter 9(commencing with Section 7000)of Division 3 offle )
sic Business and Professions Code)or that he is exempt therefrom and DTV. r PLUMBING PERMIT FEE'' -
¢ the basis for the alleged exemption.Any violation of Section 7031.5 _ - STORIES TYPE CONSTR.
- d3 by any applicant for a permit subjects the applicant to a civil Penalty ALTER-DRAIN -WATER (EA.) 5.00
+ ofum more than rise hundred dollars(5500).1:; - y
• ❑ I,as owner,of the property,ol'my employees with wagesus BACK FLOW PROTECT. DEVICE 4.00 ' t
their Sol,compensation,will do the work,and the structure is not OCC.GROUP RES:UNITS
intended or offered for sale (Sec:7044, Business and ProNssions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ".
« Code:The Contractor's License Law dues not apply to an'owner of -
• properly who builds or Buprnves thereon,and who does such work FIXTURES-,PER TRAP. -' 5,00W.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own.employees,provided that such euprovo-
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
m impruvemenl is sold within one year of cant pletlnn, IIIc owner GAS EA.SYSTEM-OVER 4 IEA.), 2.00 BUILDING USE
builder will have the harden Of proving that he did not build or ire
Prove for purpose ofsac).' ' ' INTER ' - RES IND CON PB Om.,
❑ 1,as owner of the properly,am INDUSTRIAL WASTE.INTER. 30.00 exclusively contracting with - ❑ ❑, Cl ❑ ❑
licensed contractors to construct the project(Sec.7044,BusinessLAWN SPRINKLERS- 1 INC 5 V.B. ' ,6.00 AssESSORS PARCEL NO.
and Professiohs Code:The Contractor's License Law does not apply
In an owner OI'Property who Iwilds or improves thereon.and who LAWN SPRINKLER4yOVER 5;(EA.)_ 1.00
confirms,for such projects with a contractoRs)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00 ,
the Comacto�i License Law. t - _ TRACT NO.'. PARCEL NO.
❑.•I um exempt under Sec." •,1i.&ItC.Inr this WATER HEATER W/VENT' r .. 6.00
reason
Owner . Date WATER SYSTEM 5:00 ACC.DATE 'ACC.FILE NO.
WORKl IIS-COMPf NS11 ION UECIARA PION d WATER TREATING EQUIP. 5.00
I hereby affirm that I have tlfl t e of consent t scllnrs m,� - -
r ircertificate, f Workers:Compensation Insur ntt,or a ectlifiedt'y, ZONING ENG.SITE,NO.
copy"
r c Lah.��1� -
1 ollcY 7fl►� Ic,vb y -aal7slts]',y�'[' S
t' ❑ Certified copy is hereby furnish J. - FIRE SPRINK •ENERGY20
Z Z
Certified lilt h til �inspLclim
.� _ MISC- REFER TO ORD.
O PP muni _ V ❑.' N❑ Y N❑
y '0 AI� PERMIT ISSUANCE.'
. •CI:RTIIJCAIEOI'EXhh1I'IION FROM WORKERS''' FLOOD ZONE A.L.U.C.
LU .✓ .- " COMPI:NSAI'ION INSURANCE PLG,CCNTR. LIC.NO. PLG. '
1''O ("Phis="sectiein acednorbe cmnpleted if the permit is for one TOTAL- Y❑ N❑ W❑, N❑
+ Z) Z' hundred dollars IS 100)orless.) +
U O I certify mut in the performance of tire work for whist Otis par- PTV. MECHANICAL PERMIT FEE FEE SUMMARY'
'U f' II, Is iorucd/I shall not employ.any person in any manner so ars to . ,
`U w• become subject to the Workers'Compensation Laws of California.
Date s Applicant BUILDING
CL ALTER'OR ADD TO MECH. t 5.00
} 0 NO1'ICI?TO APPLICANT: If,after making this Certifchte of Ex-
emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you In est B"thwim comply'will FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10000C.F.M.) 4.00 ''
CONSTRUCTION 16 LENDINGAGENCY AIR HANDLING UNIT(OVER 10,000GFM.) 6.00 SEISMIC FEE
` r I hereby aflirm.lhat 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. MICROFILM
3097,Civ.C.): - HEATING UN IT'ITO 100,000 B.T.U.) 8.00
' Lender's Name ' HEATI NG UN IT(OVER�l 00,000 B.T.U.)9.50
Lender's Address ' 'ELECTRIC
I certify that I have read this application and slam that ilm above VENTILATION.FAN (SINGLE) .00
`,• information is correct. I agree to comply with all city and county g01LER-WA'1P(3 H.P or 0,000 B.T.U.) ,00 PLUMBING' 14:udiriances and sbiteilaws relating to bilding construction, andhereby aulhorizc represenlatives of thin city Io enter:upon til° BOILER-COMP1 ,0110 BTUI SEEF ,mssMECHANICALfi
above-mentioned properly for inspection purpoxs.- I*. _ e
(We) agree to save, indemnify and keep harmless the City of MISC.-,- a REFER TO ORD. -/
lraay
n anyupertino against liabilities,judgments, costs anekpenses which CONST.TAX
iway accrue-against said City in consequence of the pERMITISSUANCE'
ntingof tl it. MECH.CONT. LIC.NO. ME H.
TOTAL gnature of plica t/Contractor - -
a /
OFFICE COPY, J