15654 POST THIS CARD NEAR FRONTIOF BUILDING
' •• � , 'PERMIT NUMBER j
CITY OF CUPERTINO.
INSPECTION DIVISION -; 15654,
1
JOB INSPECTION RECORD
� •. - ,. .;PERMIT EXPIRATION
JOBADDRESS oZ/•7lO :5'Tcr—ye � -_ �'��4UN1T#' LOT# -
^ , p PERMIT EXPIRES IF WORK .:
OWNER' [:><.ar( �L V r ' CONTRACTOR oLL-A'nAD J/`fv-1 IS NOT STARTED WITHIN
- ' INSPECTION DATE INSPECTOR INSPECTION RECORD 186 DAYS OF PERMIT ISSU-
�',* FOUNDATION 1 NOTE: - ANCE OR 180 DAYS FROM "
LASTCALLED INSPECTION.
UFER - - ALL GRADING AND DRAINAGE SHALL,BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF -PERMIT VALIDATION
PREGUNITE _ - 'CUPERTINO STANDARDS.'
GARAGE SLABS ,
POUR NO CONCRETE UNTIL ABOVEHASBEENSIGNEO - ;;, .' - - E.y.•" z
UNDERGROUND /SLAB v
' PLUMBING
ELECTRICAL S5UANCF.DATE
.MECHANICAL - < BLDG. ELECT. PLG. .MFCH-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED " ' BUILDING PERMIT
INFORMATION
WOOD FLOOR - EVALUATION s/ET.
' PLUMBING - Qppp
'a MECHANICAL
ELECTRICAL; - - PERMIT TO..
' FRAMING - ti /v 7CAkld<ll` R/l
INSULATION' - - e - . =sTORIEs •'ry ECONSTR
. .. • • •' 4Y .fir
- -- OCC.GROUP RES.UNITST'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so FT.FLOOR AREA TOTAL ACREAGE
�.� "DIAPHRAGM THE CONSTRUCTION TAXIS PAID -
USE
ROOFSHEATHING `'• NES IND LOGON USEPBov, ;
''APPLY'AO ROOFING,UNTILABOVE HASIBEEWSIGNEO "FINALS. I ' " DATE�� INSP.;: '� �' ❑
ASSESSORS PARCEL NO
'ROUGH SAN:k
PLUMBINGELECT.ENERGY. TRACT No, PARCEL NO
TUBS 8 SHOWER PAN - PLUMBING ENERGY '
MECHANICAL MECH.ENERGY - -
ELECTRICAL - ACC DATE' ACC FILE NO
�' BUILDING ENERGY
FRAMING,.,. - L ELECT.FINAL-TEST , -
ZONING ENG.SITE NO,
INSULATION PLUMBING ,.
GAS TEST - - GAS, -
: i- MECHANICAL FIRESPR IbK 'ENERGY T,74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .. FLOOD?ONE° El "E °ALM C.� ' "El
'
" EXTERIOR SHEAR ELECTRICAL RELEASE '
INTERIOR SHEAR FIRE DEPT: - Y❑ No Y n,❑'.
SHEETROCK' GRADE _ FEESUMMARY
EXTERIOR LATH BUILDING—
BUILDING OD
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC' ' PLAN CHECK . _
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE_ A '
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED,BY BUILDING.INSPECTOR. MICROFILM .
ARRANGE FOR 'INSPECTIONW PHONING 252-4505, ELECTRIC
z ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBwc,,.
PLEASE'GIVE JOB ADDRESS.WHEN PHONING.
- SEEPERMIT FOR'EXPIRATION DATE' - MECHANICAL'
A'
'- - CONST:TAX
IMPO.RTANT,I .
PLEASE"READ.REVERSE SIDE BEFORE °
TOTAL
CALLING FOR FINAL INSPECTION..
0FFICE COPY.'
APPLICANT TO FILL IN,INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY ;.
.PERMIT NUMBER' v
DING LDING PROJECT IDENTI FICATION m ,
BUILDING -PERMIT
& PERMIT
ADDRESS _ •• = 1565.4
,Z � Jit BUILDING
_ OWNER'`��� w + PLAN CHECK VALIDATION
NAME f/�..(,/1'SL ��f/�/IV1FLp
- ELECTRIC PERMIT ` FEE
PHONE '�,, • _ /X,"`p E/
CONTRACTOR'S
NAME Iwo OUTLETS-SWITCHES'-RECEP 10,00/1.00
LIGHTING,FIXTURES '. - 10.00/1.00
'ADDRESS .
COTRACTOR's -�--� Qr PPLIANCES-RESIDENTIAL . 4.00 -
�.�•Y1.1 /)�� PNONE PANELS 10.00 DATE OF APPLICATIONI"�•-
ARCHITECT 1 L. AX
I h I PLAN CHECK FEE KC.NO.
DR.. PANELS (OVER 200 AMP) 20.00
•5 ENGINEER " LIC.No SIGNS TRANS. "'` ^ 3100 ' '
ARCH.OR ENG. SPECIAL CIRCUIT - 6.00 PERMIT_VALIDATION
AOORESs¢'
+. 1• -
ZIP EMP.METER OR POLE INS. - 20.00 (�
APPLICANT SMOTORS SEE FEE SCH.
ADDRESS
AOOR ,•' j�lCv
SERVICE CHANGE 20.00 UJ
r O 0 LICENSED CON'T'RACTORS DECCARA'TION /
auaa
u I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
(commencing with Suction 7000)of Division 3 of the Business and
- BLDG. 'ELECT. PLG. . +MECH.
• I- 7 i Professions Cppyy��,ppnd��my license is in lull foreyy'p�1yJ c 5et.,r ❑ .. ❑ ',❑
Z z vi icense Class�4_L4.1_LR` Number_f/"/J�7
9 m )ate Con.n..... -
a u f BUILDING PERMIT
_ a Q OWNER-BUILDER DECLARATION -
¢ o d u - INFORMATION
x I hereby alfirm thnl'I am exempt from thn Contractor's License MISC:- REFER TO ORD
F LL O Q 1-aw for the following reason.(Sec.7031.5,Isminessend Professions pERMIT ISSUANCE 10.00 VALUATION- '$/FT.
m'a Code:Any city or county which requires a permit to construct,alter, Q
Q Q IT TO
improve,demolish,or repair any structure,prior to its issuance,also ELEC GONER: .LIC.NO. ELEC.
K requires the apphC2nl fUr sash pemtil t0 file a signed Slalmllent that TOTAL PERM
A w m u_ he is licensed pursuant to the provisions of the Contractors License T
F z r
Law(Chapter 9(commencingwith Suction 7000)of Division 3 ofthe !N (ate 1/.7gpQe
Q Business and Professions Code)or that he is exempt ther,hom and OTY. 'PLUMBING PERMIT E
W=$ the basis for the alleged exemption.Any violation of Section 7031.5 TYPE CONSTR.
d ; �. by any core
etha fare permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not marc than five hundred dollars fmy employee,
'
❑ 1,as owner at Nc property;or my employees whh rewages as
not 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(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:,The Contractor's License Law does not apply to an owner of
proper,y'Whabuild,or Improve,Ileo-eon,and who does such work FIXTURES-PER TRAP' - 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
Iurnsulto,through hi,own employee s,provided that such imp rove . GAS-EA.SVSTEM-11NC.40UTLETS 6.00
mends are not Intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or inm- RES . IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INEER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑'
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 Llcciew Law does not apply
to an owner of'property who builds or improves thereon,and who LAWN SPRINKLERS-'OVER 51EA.) 1.00 '
contracts for such projects with it contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Cmitfacdors Lice ase Law. TRACT.NO, PARCEL NO.
❑ I'sm exempt under Sec.-.BAP.C.-for this WATER HEATER W/VENT ' 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSA'f ION DECLARATION WATER TREATING EQUIP, 5.00
,I hereby al firm that I have a certiflci de of consent to,ell'-insure, - - - ZONING ENG.SITE N0.
of a ccrtiLcam of Wo ompenwtion Insurance,or a certified
copy be e f 00,Lnh. I '
Iblicy N Co.p' �(:rrL}A�� Q-mak_ - '
O ❑ e lifed opy is Lb furnished. FIRE SPRINK ENERGY T-24
.Z_2 C'crtific c is file with 11 1,,,pection diysinn. -
_ MISC.- REFER TO ORD.
O PPlicani ��-JJI-I,-..v t. Y ❑ N❑ v ❑ .N❑.
to (' '. I I17R L PERMIT ISSUANCE 10.00
ft. - C- 1'I I'ICA'1'b:OF It COMPENSATION
INS PROh1 WORKIiRS' FLOOD ZONE A,L.U.C.
W � ,. COMPENSATION INSD RANCIi PLC.CONTR. uCi NO. -
C Z q section need not be completed if the permit is for one TOTAL Y❑ N❑ v ❑ N❑
hundred dollars/$100)or less.)
U O 1 certify that in the performance of the work for which this per- 'DTV. .MECHANICAL PERMIT FEE ' • FEE SUMMARY
LL F mit is issued,I shall not employ any person in any nmamner so as to -
U become subject to the Workers'Compensation Laws of California.
T „ Date - Appliennl :BUILDING
- N NOTICE'1'O APPLICANT': If,after making this Certificate of lis- ALTER OR ADD TO MECH. , '5.00
? Implion,you should become subject to the Workers'Compensation APPLIANCE '5.00 PLAN CHECK
provisions of the Labor Code,'you must forthwith comply with FEE
L) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=CF.M.) 4.00 `
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEI SMIC FEE
1 hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT)
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 Nance HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's N....c ELECTRIC
I certll'y that I have Rind this application and state that Ute aboveVENTILATION FAN (SINGLE) 4.00
w information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building canSir uction, :mJ BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
li erbby authorize representatives of this city' to enter upon the LBO'IL
(CYel 1DD,BOO BTU)BEE FEE SCH. ' MECHANICAL
abovnmentio Ed m crty for inspection purposes.
(W ee to rove, demnify and keep'haradc,s the City.of MISC.- REFER.TO ORD.
etlino a rust liubi'ies,judgments, c J expenses whicli 'pERMIT ISSUANCE 10.00 CONST.TAX '
may in a way a e against sat y in consequence of the
ranting it. x NECK CONT. LIC.NO. MECH..
TOTAL TOTAL' 0g3
ign ore Of Applicant/Contractor Uute
OFFICE COPY $