16325 POST THIS CARD NEAR FRONT OF BUILDING
' '.PERMIT NUMBER
CITY OF CUPERTINO 1
INSPECTION DIVISION �� �
JOB INSPECTION RECORD .
�., '•'� },. E -s• PERMIT EXPIRATION
JOB ADDRESS�6 / S0 �ey, Gil` BWNIT# 'LOT# RM)T EXpI ES�1F WORK
owrvER �,♦, •QJ� CONTRACTOR C �tl,� 2 S N (STARTED.WITHIN
I SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU..'
FOUNDATION, { ANCE OR 180 DAYS FROM
- NOTE: LA$T CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE" - - TO COMPLY WITH THE APPROVEEPL NS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. IF�� WW '
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED pp �/v + '�.4',
UNDERGROUND./SLAB SEP 2 G �9pp 9
PLUMBING City.of Cupertino-
ELECTRICAL ISSUANCE DATE
MECHANICAL APG 'O�'D- /nect� /iv BLuc,. ELECT. PLG. MECH ,
. . . 4,1pG ONLY . CCJ�-C GGYJ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEBUILDING PERMIT
A. INFORMATION
WOOD FLOOR VALUATION $/FT. '
PLUMBING
MECHANICAL Y
ELECTRICAL NJ
PEHMIr To - S
FRAMING - /7V et_ .
INSULATION 'LO f'��r �✓ /�6 NSW/h8 STORIES TYPE coNsn{
O
COcnCk�✓ 'i! ��
- OCC.GROUP RES UNITS
' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.Fl.I'LooH naso iu+aL.Acl+eaee {
DIAPHRAGM" THE CONSTRUCTION TAX ISrPAID
IIUILDI NG USE
ROOF SHEATHING _ - HES IND CON Pa oin.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE - INSP. El ❑ F-1 0 ❑ '
ROUGH SANS ASSESSORS PARCEL NO
'
PLUMBING - ELECT.ENERGY TRACT NO rARceL No
- TUBS 8 SHOWER PAN PLUMBING ENERGY.
MECHANICAL MECH:ENERGY
ELECTRICAL ' - BUILDING ENERGY ACC DATE ACC FILE No.
FRAMING ELECT.FINAL TEST'
ZONING ENG.SITE N0.
INSULATION PLUMBING
GAS TEST - - GAS
MECHANICAL-
FWESPRINK ENERGY T"14 i
' '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "Y E No Y ❑ , ND
FLOOD ZONE A.L U C.
EXTERIOR SHEAR ELECTRICAL RELEASE Yo N� r ❑ N❑�
INTERIOR SHEAR FIRE DEPT. '
SHEETROCK GRADE - FEESUMMARY
EXTERIOR LATH - BUILDING
BUILDING'
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN '
GAS FfIl
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY co SEISMIC P°
OCCUPANCY.OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. OFILM
ARRANGE FOR INSPECTION BY.PHONINGQ52=4505, ELECTRIC
Fw ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING. .
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —' 376.50
IMPORTANT!" covsr.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
1 - ER
PERMIT NUMB
'• INC LDI NG PROJECT IDENTIFICATION
ADDRESS
APPLICATION & PERMIT
AD20450 Stevens Creek Blvd. 1,6325
' BUILDING-ELECTRICAL-PLUMBING_-MECHANICAL
OWNER'S (415' PLAN CHECK VALIDATION
"AME QTY. ELECTRIC PERMIT FEE
Prometheus Developme�tEb73-6660 '
CONTRACTOR'S +
NAMEUTLETS-SWITCHES-RECEP 10.00/1.00
Crithfield Mechardc4.NG341107 LIGHTING FIXTURES 10.00/1,00
CO ( :��-
ADDRESS
(41,5 ;
CONTRACTOR APPLIANCES 4.00
4085 Campbell Ave. ' PRGNE321-7801 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO,
OR - PANELS (OVER 200 AMPI 20.00 ._
ENGINEER
LIC,NO. SIGNS TRANS. 3.00
ADDRESS 0H SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'B
AO MOTORS SE
ADDRESS
SERVICE CHANGE 20.00 ,
4¢ z
LICENSED CONTRACTORS DECLARATIONSEP U 19118 -
< i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
aa,a w (commencing with Section 7000)of Division 3 of the Business and /� SLOG, ELECT. PLG. MECH.
F w z Professions Code,an y ¢ rise is in full force m sl effect. CI of ❑ ❑ ❑
z O m - II,,�� 1y.��c(�,��ri}$}y_L.. IJc Numbc 'AA 11 C7
2 m IM hnC Cantraclor
a >! < < BUILDING PERMIT
¢ ¢ w 4 OWNER-BUILDER DECLARATION INFORMATION
w ;u r I hereby ul firm that 1 am exempt from�the Contractor's License MISC.- REFER TO ORD
u O¢ Law for the following reason.(Sec.7031.5,Businessand Professions VA WATION $/FT.
_ PERMIT ISSUANCE 10.00
Code Any city or County which requires a permit to construct,alter,
¢m � ELEC.CONTR. LIC.NO.
¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.
u w m ¢ requires the applicant for such permit to file a signed statement that - TOTAL - PERMIT TO
he is licensed pursuam to the provisions of the Contractor's License `
r z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the �L
4 o Business and Professions Code)or that he is exempt therefrom and
¢ 1- S the basis for life alleged exemption.Any v iolation of QTY. PLUMBING PERMIT FEE Section 703 ES I STORIES. TYPE CONSTR.
i3 by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500)Js
❑ I,as Owner of the properly,or my enfployces with wages as BACK FLOW PROTECT, DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES,UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS;FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law does not apply to an owner of
• property w1f0 build,nr improves Bfercon,an,Wh0 does SUCIf work FIXTURES-PER TRAP 5,00 $0.FT .FLOOR AREA TOTAL ACREAGE-
hinuelf or Through his own employees,provided that smel,improvo-
ments are not intended or offered for sale,11,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build Or im BUILDING USE
prove for purpose of sale.). RES IND CON PB Omer
INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting 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:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA:) 1,00
contracts forsuch projectswilh a contractions)licensed pursuant to SEWER-SANITAR V-STORM EA.2001t/10.00
,be Contractor's License Law. TRACT NO. PARCEL NO.
❑ l dm exempt under Sec..,BAP.C.for this
reusnu WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm that I have a certificate oreonseni IOself-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.L
Policy N..-C mpany
0 O Certified copy is here 1 'shed. - '
Z Z �Cenl(I• o fs a the city inspection division. - FIRE,PRINK ENERGY TY4
P: O Applicant MISC.- REFER TO ORD. .Y❑ N❑ Y ❑ N❑
CC W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSWION INSURANCE PLG.CONTR. LIC.NO. PLG.
t'rhis section need not be completed if the permit is for one TOTAL Y❑ IN Y C] N
Z ❑
hundred dollars IS 100)or less.)
U O 1 certify that in the performance Of the work for which this ver- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,1 shall not employ any person in any manner so as to
become subject to the Workers Compensation Laws of California.
y DaleAPplicum - BUIL G
�- W NOTICE TO APPLICANT: If,after making this Certifica in o1'Ex- ALTER OR ADD TO MECH. 5.00
2 emption,you should become subject to the WorkersCompensation
F. '_ 'APPLIANCE 5.00 L CHECK
V
provisions
Labor you duet forthwith comply with
such provisions or permit sinop -
be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.1 4.00 FE��E��pp O
CONSTRUCTIONLENDINGAG1iNCv AIR HANDLING 10p00GEM.16.00 �SPrSTA IC FEE
I hereby affirm than there is n construction lending agency for
EXHAUST HOOD(WITH DUCT) 5.00
the PeTforo unce of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
• 1 certify final I have read this application and state that the above VENTILATION FAN ISI NG LE) 4.00
information is Correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby aulhuriee repmsentativei of this city In enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. 376.50
(We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD. T-364. 50
"sper
judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ust said City in consequence of the
MECH.CONT. LIC.NO. MECH.
-.L/• ,. TOTAL 376.50 TOTAL
Sigf tre
u 'of Applicu /Contractor Dae F
//�(� OFFICE COPY