16970 ;POST THIS CARD NEAR FRONT OF BUILDING
e
PERMIT NUhiBEF '
CITY :OFA CUPERTINO y ,16970 z
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INSPECTION.DIVISION ,
JOB INSPECTION RECORD
• SOB ADDRESS T (—(—.L S w_� - GUNIT# } LOT
FERMIS EXPIRATION J.
A .n PERMIT EXPIRES IF WORK
OWNER .L �(: U -�/�.(b: .. coNTRncTOR L � - ISNOT •STARTED-WITHIN
INSPECTION DATE- INSPECTOR •I SP CTIONJECORD ` 180 DAYS OF PERMIT ISSu=y
FOUNDATION .:Y NOTE - '"'i` -.ANCE OR 180 DAYS FROM
"LASTCALLED INSPECTION. ;
LIFER . ALL' GRADING AND DRAINAGE•SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF rta+Mlr vnL.iunn ON
- > .PREGONITE 'r r� i 'r ' 3, .... °i •i. Y T 1 '
' CUPERTI N0 STANDARDS'.'
GARAGE'SLABS 'r 'x ..1' ' �''� .1 J .. f[ .k'`kr. •i1': .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB •,. , . _ q - itin �a
PLUMBING
ELECTRICAL S - ISSUANCE DATE'
MECHANICAL' ELECT PLG. mLCH_I
DO NOT POUR FLOOR_UNTIL ABOVE HAS BEEN SIGNED' : - BUILDING PERMIT
" WOOD FLOOR '
INFORMATION 'I
VALUATION $/FT. : -
• 'PLUMBING . - . . ' '•, _ - . - � ,'i
MECHANICAL .
ELECTPERlIL TO
RICAL` •a/r-
FRAMING 'r � A ���'
-STORIESTYPE CONSTR..
:INSULATION _
- ••DCO,GROUP., RES.UNITS
PLACE NO.SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
- I EI+FLC.II ARTA TOTAL.nGLEACE 1r
- •.ROOF 'NOTE:NO FINAL INSP.SHALL BE.MADE BEFORE
THE CONSTRUCTION TAXPAID
'. . ..:. IS It
DIAPHRAGM ^s i
.. .. I f1011-0OC USE
14 ROOFSHEATHING .HES - IND CON PH, O, .:
ir" APPLY-NO ROOFING UNTILABOVE HAS BEEN SIGNED- ,,FINALS -„DATE.,,., , INSP. -�
_ - Tr'W'"" nSSE650R5 Pn RCF,L NO,
ROUGH -SAN.# _
` PLUMBING - .ELECT,.ENERGY: -
a• _" , TUBS 8 SHOWER PAN' PLUMBING ENERGY - c "'"cT NO'• •PARCEL Nn. .i
y
7. J MECHANICAL _ MECH.ENERGY . -
> ELECTRICAL ". BUILDING ENERGY' Acc,DATE I - ncc FILE NOr
FRAMING ' ^ j ;•� .' • - ELECT.FINAL TEST
ZONING, • ENG:SITE,NO,
'INSULATION ' r - PLUMBING '
.. .,
GAS TEST ..: GAS _
. , MECHANICAL " ' FIRESPRINK " ENERGY T7A I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED- HEATING - rl Y "O 1,E] "
•' -
EXTERIOR SHEAR ELECTRICAL RELEASE % FLOOD ZONE iAIL,U C. I
INTERIOR 'SHEARFIRE DEPT. Y.O "� 1sIL N❑
SHEETROCK . GRADE - FEE SUMMARY_77—EXTERIOR LATH ' BUILDINGr -BUILDING - >�
INTERIOR LATH.- d TEMPORARY APPROVALS `
SCRATCH COAT: -: ELECTRIC PLAN CHECK
GAS .FEE
�.,. NO TAPE OR PLASTER UNTIL'ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING,IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
11
;A'RRANGE FOR INSPECTION BY PHONING 252-4505, '- ELECTRIC
o�, ONE'WORKING DA'Y'BEFORE REQUIRED INSPECTION PLUMBING ,
PLEASE GIVE JOB-ADDRESS WHEN PHONING.
r Z _ MECHANICAL
SEE PERMIT FOR EXPIRATION'DATE
CONST.TAX
.IMPORTANT! ,
a " PLEASE READ REVERSE SIDE BEF.ORE TOTAL �
".
CALLING,FOR FINAL INSPECTION', 3/'70
„
OFFICE COPY
(APPLICANT TO FILL IN INFORMATION WITHIN,REb�LINES - LISE'BALL, POINT PEN ONLY
. PERMITNUMBER
'BUILDING PROJECT I DENTLFICATI ON" - APPLICATION & PERMIT
ADDRESS BUILDING - ELECTRICAL-'PLUMBING-'MECHANICAL '
OWNED
's !J PLAN CHECK VALIDATION
" NAME )"ICIa - O STY. '1- ^ ' ELECTRIC PERMIT , ' - . . FEE 1 '
coANTDAcroRs
NME UTLETS-SWITCHES'-RECEP 10.00/1.00
w ,
LIGHTING FIXTURES- d 10.00/1.00 '
CONTRACTORS 7 E574-1. APPLIANCES-RESIDENTIAL' -"r'' 4.00
ADDRESS .
0 A eA
PANELS - 10.00 DATE OF APPLICATION
ARCHITECT
OR PANELS.(OVER,200 AMN. 20.00 r� PLAN CHECK
OR FEE P.C.NO.
-
' ENGINEER 1E , ..
- ' LIC.ND.. - SIGNS TRANS. 3.00 -
ADDRESSErvG. - 5.00 - PERMIT VALIDATION
-' AooDEss - � SPECIAL CIRCUIT
zip TEMP.METER OR POLE INS. 20.00- ` - [
APPLICANT sMOTORS ' 'SEE FEE'SCH:
ADDRESS ^ Y
SERVICE CHANGE '.20.00 /a
�•oo " LIU,NSEU COMPRACTORS DECLARATIONbEG
¢ v w I hereby oth m that 1 am,l¢en' d InderprovisionslofChapter9 - ',s. ISSUANCE DATE' V, '
r Q,a (commencing-with Section 7000)*of Division 3 of the Business and B OC. ELECT PLG- - MECH. ,
H 0 0 1 rofessions Co,1�Rd my license¢m fI II fore p{�• c
O 0 '0 h,c,n,,Cla s��r7 1__ Lic NI ober ( r ❑ •❑ ❑
H 11atc �/�fContrvunr. (f�
R .,4t BUILDING PERMIT `s - 1'•'
OWNI:R�Ii UILUER DECLARATION "
¢ 0 A. 0, . " INFORMATION
F
; u y I hereby affirm thatd am exempt from the Contractor's Liironse MISC.- u REFER TO,ORD county VALUATION S/FT. -
I- LLOa, Law forthe following reason.(Sec.7031.5,Business and Professions 'PERMIT ISSUANCE 10.00 C
Code.Any city or couy whch requires a permit to construct alter, - Z
� ¢¢�,o improve,dmnR fish or repair any structure,prom d. issuance,also ELEC.CONTR.'„ LIC NO.. 'I EL EC ..DED
'0 ¢ requires the applicant Int such.perent to file a signed statement that w r TOTAL ',"-37' PERMIT TO -
d o
he a licensed 9(co m to the with Sect i of the Contractor's s 3 iodic /
i E i L w(Chapte 9(commenemg with Sect ion]0001 ofUWiston3 of the - -
a Business and ProfesNons Cade)or that lie Is exempt therefrom and STV. PLUMBING PERMIT FEES L
W a the basis for the alleged exemption.Any violation of Section 7031.5 _ STORIES TYPE CO NSTF.
by anYaPPlicmd for a Permit'Subjects the applicant too civil penalty
of not more than five hundred'dDImD"s IS5000J: - ALTER-DRAIN&VENT-WATER (EA;) 5.00 ' -
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT:DEV ICE 4.00 OCC.GROUP REFUNITS
their sole compensation,will do tits 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 Contmetoi s License Low dots not apply to an
' property who builds or improves thereon,and who does such work FIXTURES`-PER TRAP '5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
-�� - himself or through his own employees,provided that such improve- -
mentoarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
,. • or improve,""t.is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
o builder will have the burden of proving that he did not build or im- - - RES IND CON PB Other
prove for porimse of sale.). - INDUSTRIALWASTE INTER. - 30.00 i
• - '❑ I,as ownerof the property:an,exclusively contracting with _ ❑ ❑ ❑ Q ❑
licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 - ASSESSORS PARCEL NO.
and Professions Code;The Contractor's License Law does not apply
1.an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) ,'1.00
- co,ntracts for such projems with a contractors)licensed pursuant to -
. the Contractur's License Law. - . SEWER-SANITARY-STORM EA.200ft/10.00 THACT^NO. PARCELNO,
9 I am exempt ower See ,11.&P.C.for[fit, WATER HEATER W/VENT 6.00
Driven
Owner Date WATER SYSTEM 5.00 - ACC.DATE ACO.FILE NO.
;., WORKFRS'COMPFNSAT`ION'DECLARA'T'ION WATER TREATING EQUIP. ,5.00
I hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ' ENG,SITE NO.
copy thereof(See 38009 Lab.CJ. -
Policy No. - Company
--0 "❑ Cerlifiel ' 9heod, '
FIRE SPRINK ENERGY TZO'
Z Z ❑k Cer' , the city ERS'n divl,'on. -
Appbeam MISC.= REFER TO ORD. YNr❑ No
PERMIT ISSUANCE10.00 CIiI%CA'I'EO FLOODZONE ^ A.L.U.C.
•^ -,LU
> ,.'.� COMPENSATION INSURANCE PLG.CONTR. ❑DENS. PLG. S..
CL O (This�xnion need' nm b cam PldeA it.th Ilii[ is for one - TOTAL Y❑ N❑ Y❑ N❑
2 hundred dollars IS 100)or 1.09 - , -
U O 1 certify that in the performance of the work for which this per- STV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I. mit is issued, 1 shall'not employ any person in any manner so as to -
O W became suhieet,to the Workers'Compensation Laws of Califontia. 1 BUILDING; ' '
DO + Date Applicant - ALTER OR ADD TO MECH. .,5.00
'} rn NOTICE,TO`APPLICANT: If.'aftcr nmking'this CcRificote of fix _
evsption,you should become subject in the Workers'Compensat ion APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE _
U - such provisions or this permit shall be deemed revoked �, AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 •' '
' CONSTR UCfION LEN LING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 •SEISMIC FEE
�I hereby affirm that there is a construction lending agency far 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
Lender's Name - - 'H EATI NG UN IT ER 100,000 B.T.U.)9.50
_ Lender's Add ss ELECTRIC �0
` l certify that l have read this application and state that the above VENTI LATION,FAN.(SING LE) 4.00
• information is correct. I agree to comply with all city and county PLUMBING _
ordinances and state laws relating to huildiilg construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby mtlhorize representatives of Ih is.cifg to anter upon the BOILER-COMP love,1UO,BOOBTUISEE FEESCH. MECHANICAL
" above-mentioned',proper) for inspection purposes. _
(We) agree to save indemnify cot a less tire City al' MISC.- REFER TO ORD.
Cuperti I las,lu gm osis and a ses which CONST.TAX _
n' wd f inst said City 'o conseque 'e of the PERMIT ISSUANCE 10.00
1" ra !n ore permit. x MECH:CONT. LIC.NO. - MECH. ,
'. TOTAL " TOTAL
Igna are of act,
OFFICE COPY