14903 " POST THIS'CARD NEAR,FRONT OF BUILDING
PERMIT NUMBER -
CITY OF CUPERTINO
14903
- INS?ECTION',DIVISION '
JOB INSPECTIONRECORD•
PERMIT EXPIRATION'
�""�` —SN IT - LOT#''
JOB.ADDR ESS�'GI D O V /�✓¢w3" _ /� d/ U
9 'PERMIT EXPIRES IF WORK
OWNER ' f}.�/G; A"t.a G' CONTRACTOR �r iJ-' L�-6- _ 'IS NOT STARTED WITHIN
INSPECTION DATE. INSPECTOR INSPECTION RECORD 180 DAYS OFPERMIVISSU-.
FOUNDATION ` NOTE, ,O "ANCE,OR,180 DAYS FROM '
LAST CALLED'INSPECTION.
UFER - ALL GRADING AND DRAINAGESHALL BE INSTALLED
' PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF •PERMIT VALIDATION -
CUPERTINO STANDARDS. ,
GARAGE-SLABS I - ` -
r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .' :,,�;; ,.,: r... -t
' UNDERGROUND /SLAB "
PLUMBING 1?l
ELECTRICAL - � ...•._ . : ISSUANCE DATE '.
MECHANICAL - ❑LOG. . ELECT. PL,. MECH
;E ❑ ❑ ❑ ❑ .
" 00 NOTPOUR FLOOR�UNTIL-ABOVE HAS BEEN SIGNED' BUILDwO.PERMIT INFORMATION '
' WOOD FLOOR' ' vAl.unnON .SIFT.
PLUMBING - ' -
-* MECHANICAL • . • ,� r�
' ELECTRICAL- . PER MIT,T0•
; �' - ' '
.. FRAMING' -
'3, STORIES TYPE CONSTR.
INSULATION
_ - UCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.FT.FLoon AREA 101M.ACREAGE
DIAPHRAGM I' _ - THE CONSTRUCTION TAX IS PAID.
BUILDING USE -
ROOF SHEATHING'- - " '• Res IND .,CON PB 01;,,, '
APPLY,NOROOFING.UNTILABOVE.HAS BEENSIGNEDFINALS, DATE` ,'INSP.. �� ❑'' ' 0 El ❑ '
ASSESSORS PARCEL NO
.ROUGH SAN.a
PLUMBING- ELECT.ENERGY
THACT.NO,• PARCELING.8 SHOWER PAN PLUMBING ENERGY•
MECHANICAL' - MECH.ENERGY Acc,DATE .Acc.FaE NO,,
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING'. .ENc,SFfENO.
-
INSULATION I PLUMBING
GAS TEST _ GAS -
FIRESPHINK ENERGY Ypu I
MECHANICAL0. ru❑- ',.7 ❑ ^+.❑ -.
COVER NO WORK.UNTIL ABOVE HAS BEEN SIGNED HEATING ' j}.
_ HOOD 20NE 'A L U.C.
EXTERIOR SHEAR= - ' ELECTRICAL RELEASE I' "�'.
INTERIOR SHEAR' FIRE DEPT. - ,v ❑ N❑ 'r N❑
a, SHEETROCK ='' GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING a
BUILDING '
.INTERIOR LATH TEMPORARY APPROVALS .
SCRATCHCOAT - ELECTRIC PLAN CHECK.-
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC.FEE.
OCCUPANCY OF,BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE-FOR,INSPECT.ION BY PHONING 252-4505 ELECTRIC
\ " oD
� ONE WORKING DAY BEFORE REQUIRED INSPECTION TLIJMBING 'may
1 PLEASE GIVE,JOB ADDRESS WHEN PHONING. '
Z "= SEE'PERMIT,FOR EXPIRATION DATE_- MECHANICAL
IMPORT' , CONSTTAX-
ANT! ., ' . ,.
.: PLEASE READ REVERSE SIDE BEFORE
TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
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APPLICANT TO'FILL IN INFORMATION.WITHIN REDLINES - USE BALL POINT PEN ONLY
- " BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT . , . 14903
2r(5 �1-e�E,ns lv � r BUILDING)-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - - PLAN CHECK VALIDATION
•
"AME _ -
0 OTV. L ELECTRIC PERMIT FEE - -
TR Nl �� VHONE J .. t L1
NorvrRAcraRs OUTLETS-SWITCHES- 00/1
-RECEP 10. 00 /
LL ' LIGHTING,FIXTURES ' , 10.00/100 :
c°acss oR's^I � •tLNCESPARESIDENTIAL °'4;00 ' , (,
�L 11�i'1 ` e-MI NP'L PHONE Li PANELS •' -10,00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.O.W.,
OR - PANELS (OVER'200 AMP% °`.H 20.00 NO
ENGINEER
LIC.NO, ISIGNS TRANS. - '3:00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS - SPECIAL CIRCUIT- " '5.00 '
.E
2IP
MP:'METER OR POLE INS. -.;20.00 •-
ADDRESS MOTORS SEE FEE SCH
ADDRESS r . '
SERVICE CHANGE I .;2000
.�o o_ LICENSED CONTRA CIORS'DLCI-ARATION
/✓\'�m
2 v G I heroby affum thatflia,in licensed under provisions Of Chapter 0 r'^ ISS
UANCE'LDATE
¢ z IL nunmmm illi ScCthm 7000)of Division 3 of the Bmsmcss and
g w' BLDG, , ELECT. .i PLG. MECH: .
A N i I nfese. Cod y bcens I:m full fa -•an e f p
z o m - ;cense lass 1 I Nt ober Y ' .
wr w ale Coulraew ' '
¢ m BUILDING PERMIT
¢¢ OWNER-BUILDER DECLARATION '
IS m INFORMATION'
La ;LL y I hereby zffirm thal.l,am exempt from the Contractor's License MISC.- - ' REFER TO ORD ` VALUATION - S/FT.
F No'J Law for the,following reason.(See,7031.5,Businessand Professions t,PERMIT ISSUANCE., `10.00
Code:Any city or county which requires a permit to construct,alter,
¢ ¢Q p improve,demolish,or repair uny slmclure,prior 10 its issuance,also ELEC.CONTR. . LIF N0: ELEC.
W
- O¢ requines the applicant for such permit to file a signed statement that �'• 7 TOTAL PERMIT TO
6'w m he:s licensed pursuant to the provisions ol.the Ce nt nctods License' -
rzr I,awlChapler9(commenungglh Seetum 7000)Of Division 3 oftlte
¢ Business unit Professions Codvl or th:d he is exempt therefrom and• GTY. . PLUMBING,PERMIT 'y FEE a
¢ Is-O the basis for the alleged cxenhptlOn.Any violation of Section 7031.5. ,, - STORIES TYPE CONSTR.
al by any applicant for a permit subjects ole applicant t..civil penalty gLTERDRAIN'&VENT-WATER (EA:1 '500
+ of not more than five hundred dollars(5500).1: - . ,
_ - ❑ 1,as Owner of the properly,or try employees"with wags as BACK+LOW PROTECT. DEVICE' 4.00 OCC.GROUP RES.UNITS
(heir sole compenmtion,will do the work,and the structure is not -
intended or*.ffcOrd for sale'(Sec. 7044, Business and,Pmfe➢sions DRAINS-FLOOR:ROOF,AREA:COND. 5.00
'•' Code: The Contractor's License Law does not apply to an owner of
property
ff who builds
so improveswn tnescpros'ide and whodoes SHICllpwoo Lk I FIXTURES-,PER;TRAP 5.00 sa FT.rLOORAREA TOTALACREAGE
'F meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.1W)UTLETS 6.00 -
j'oy or ingnovemhenl is sold within one year of completion,the owner.
I (n builder will have the burden of proving that he did not build or an- GAS EA.SYSTEM-OV EF 7`(EA.) _ '.2.00 BUILDING USE
'Q prove for purpose of sale.). INDUSTRIAL WASTE INT Fir„ 30.00 RES IND CON vR .mer
'1 O
CLI,as owner of the properly,am exclusively contracting will, - -,�- ❑ ❑ ❑! ,❑. ❑
' Q licensed contractors to construct the.pl'uoet(Sec7044,Business LAWN SPRINKLERS-1.INt,5, ,ASSEssoas PARCEL NO,
{ ane) it
Code:'1'he CenN:rtt Or's License Low does not apply r
m to un owner of properfy.who builds 01improves thereon,and who LAWN'SPRINKLE RS OVER 5(EA.) 1.00 ,
contracts forsuch projects with u ciuilructoRs)licensed pursuant lib
the Contractor's License Law. SEWER:SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO,
O ]am exempt under Set].-,B&P.C.for this43 (NATER HEATS T 6.00
reason - ` -
Owner Dale - WATER SYSTEM. 5.00 ACC.DATE, ACC.FILE No.
WOR KERS'COMPENSATION DECLARATION WATER TREAT% G dyI _w 5.00
l I hereby affirm that l have a certificate of consent to self-insure,' - ZONING
J or a cerllflaate f Workers'Compensation Insur meL or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C) �A'�1oN Wg'bl� - OW 1 '
1�
Policy No Company
O ❑ trHeJ copy Is hereby lurmsh J FIRE SPRINK ENERGKT-24
Z Z 4✓('ertified{ -Py
is lila will tic city .pec0on d v s:O I. ,
�` ) N115C r. REFER•TO ORD: /-
O. APV%' nt l�6�4e O•rLX.C4 � .; �:� N. Y ❑ ND ,:'V � N❑
~ in / PERM ITISSUANCE; 10.00
W 1 CERTIFICATENS
OIAEXEMPT
I(1N I ION
RFROM
WORKERS' PLG: LIC.C.No. PLG O'er FLOOD ZONE •A.L.LLC.
` CL Z( Phis secticur not tried nbe'con,deled if lire permit is for one TOTAL V❑ - IN yY ❑ N❑
hundred dollars IS 100)or less.) -
L) OI certify that in the performance ol'the work forwlhich this per- OTY. , •MECHAN161L.PERMIT' FEE FEE SUMMARY'
LL F C .
is issued,1 shall not employ any person in any manner so as to -
U' become subject to the Workers'Compensation Laws of California.
0 C. Date - Applicant - ALTER OR ADD TO MECH. 5.00 - BUILDING -
}-to NOTICE '1'O APPLICANT: If,after nlaking this Certificate of I?x- _
-? emption,you should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK .
provisions of tire Labor Code, you must fnrttwith'comply with FEE
.U such provisions or this permit shall be deemed revoked.`., AIR HANDLING UNIT(TO 10MC.F.M.). 4.00
r AIR HANDLING UNIT(OVER 10 C.F.M.) 6.00 'SEISMIC F,EE
CONSTRUCTION hIiNDINq ACBNCY�a�'� � . -
I hereby affirm iiat'there is a.coostruction%hr ding agency fat ,:,. EXHAUST HOOD (WITH.DUCT) ,' 5.00
the perf.rnhance of the work for which this permit is issued(See, -- - - MICROFILM
3097,Civ.C.). HEATING UNIT(TO'100,000 B.T.U.)•^8.00 a
Lender's Name - t HEATI NG UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address `ELECTRIC .'.
I certify that 1 have read this application and state that the above V ENTILATION,FAN (SINGLE) . 4.00
information-ais correct. I agree to comply with all city and county PLUMBING
ordinances and state Jaws relining to buildingconstruction:and BOILER-COMP(3H.P.or 400,000B.T.U.) 6.00
hereby authorize.representatives of this city to enter upon the
<' BOILER-COMP Inver too,00o BTU%SEE FEE SCR. MECHANICAL,
`! •i;!br(,�,+1" above-mentioned property for inspection purposes.' '
(We) agree to save, indemnify and keep harmless the City of MISC:- ' y t, ,REFER TO ORD. v
upurtino against liabilities,judgnients, costs unit expenses which^
PERMIT ISSUANCE u 10.00 CONST.TAX,
4nignature
ay in any way accrue-against said City In consequence of the '
ran ng of this permit- $ - MECH.CONT LIC NOf MECH TOTAL
IOTAL
of Applicant Contractor Dale' -
` OFFICE COPY