16929'•i-'`. POSTTHIS CARD NEAR FRONT OF BUILDING.-,-,
-
;RMI,.NUMBER,
CITY OF C.U,PERTINO
16929
INSPECTION DIVISION '
JOB INSPECTION RECORD
TIONPERMIT
D•
JOB ADDRESS VAto V/&9_4_ ft UNIT#LOT#
/tR
�1/
't' ,_, � • � _
' PERMIT EXPIRE&IF WORK a
OWNER `(�. S - CONTRACTOR -[
,,DATE.
IS NOT STARTED WITHIN
-16oDAYSOF, •PERMITISSU--
ANCE OR 180. DAYS FROM ;
LAST CALL E D.I NSPECTI ON'A^
,
SIN PECTION INSPECTOR
- INSPECTION RECO
FOUNDATION •- /-"•. 2'- % 1 s
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS •.
-
UFER
PREGUNITE - '" `'
•
PP.RMIT VAI (DATION
r - j
t L� x .
'slM.W e'y1.a"`". "'4.T
- DATE.-
GARAGESLABS :'' • •'.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
Y
UNDERGROUND/ SLAB'
PLUMBING ., •;I,
-
ELECTRICALIssUnNCE
MECHANICAL - " , • c'1 - _
B%D • FLECr.
- PLO
l
DO NOT POUR FLOOR,UNTIL• ABOVE HAS BEEN SIGNED
-
+_i• �., r
BUILDING PERMIT
INFORMATION ,
• _
WOOD FLOOR
VALUATION
O
$IFT. 1
PLUMBING':
MECHANICAL. _
ELECTRICAL "'-
•
el Mi To
FRAMING .,2 —
INSULATION - Q ^, �•
'- -
srolaEs
TYPE CONSTR. ,I
OCC. CROUP
RES. UNITS
F Y • -CLd y�� J
-
`
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED.
'ROOF -
'NOTE: NO FI AL INSP. SHA` EMA E &FORE
THE�CONSTRUCTION TAXI PAID
..
so, r+. FLaaI+AREA
roTA+. Acl+once
.1
DIAPHRAGM
ROOF SHEATHINGr,.r
f;•
.Iua' INOUILDICON NG USE
PB. o+nr,
'El, ❑ E El' I
APPLY NO ROOFING.UNTIL ABOVE HAS BEEN SIGNED`
1 FINALS;. DATE .`INSP.
�+0
... ROUGH.
,
SAN.if
A,SESSORS PARCEI. NO �...!
; _ ;..--
PLUMBING -
ELECT. ENERGY
TUBS & SHOWER PAN - �
PLUMBING ENERGY -
IHACr NO.
PARCEL NQ
MECHANICALMECH.ENERGY
ELECTRICAL - Oj: (�,
_
BUILDING ENERGY
ACC. DATE
'.
ACC. FILE No
„
FRAMING. 1
ELECT. FI NAL -TEST '•
.•8C')•�
INSULATION
PLUMBING -
zoNiNc
-,FNr,. sIT1: No.
- -
GAS TEST
GAS-• .
"
MECHANICAL
FIFE SPRINK
ENERGY L9G
Y ❑ N❑
r 0 '4E]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED.
HEATING -
EXTERIOR SHEAR-
ELECTRICAL,RELEASE.
FLOOOZONE
v N�
A.L. U. C.
Y L N(]
INTERIOR`SHEAR ,-'
FIRE,DEPT. -
SHEETROCK —
GRADE
FEESUMMARY
EXTERIOR'LATH •"
BUILDING, ,'• ." ',i-
-
BUILDING .�
J� ��
.INTERIOR -:LATH •
.,TEMPORARYAPP.ROVALS
'SCRATCH COAT
ELECTRIC
,4
PLAN CHECK
,FEE '
--•.....-., .? '
GAB. �•
� ` -
SEISMIC FEE
i I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY'
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDIN G FINAL ISSIGNEDBY BU ILDINGINSPECTOR.
-,
MICROFILM
"AR,RANGE FOR INSPECTION BY PHONING 252-4505
ARRANGE
ELECTRIC
LU
WORKING DAY BEFORE REQUIRED INSPECTION
PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
z -'SEE PERMIT FOR,EXPIRATION DATE =
ti.
CONST TAX,
IMPORTANT(
PLEASE READ'REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
-- TOTAL
OFFICE COPY . '
AWLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTS FICATION,_
-,
& PERMIT
BUILDING — ELECTRICAL— PLUMBING — MECHANICAL
PER MIT NUMBER
ti
BUILDINGAPPLICATION
ADDRESS16-929..
�•�UD � -4
OWNER' _
NAME
PHONE
MRs <I2Ku>J� 251 )371
QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
-
-
CON
CDNTRACTDR'S ,
rvnmEUTLETS-
SWITCH ES•RECEP 10.00/1.00
LIGHTING FIXTURES, 10.00/1:00.
No -
-
ADDRESSTons
APPLIANCES -RESIDENTIAL 4.00 r
PANELS'' 10.00
PHONE I
DATCOF APPLICATION '.
AmorTECTPLAN
on -
EN 'NEER t
uc. eo.
PANELS (OVER 200 AMP) 20.00
CHECK FEE
SIGNS TRANS. - 3.00
ADDDRESS E"
E1
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
EMP. METER OR POLE INS. , 20.00
APPLIANTS
ADOREss' p
MOTORS SEE'FEE SCH.
$ If
j.,/�,y
'r•�
ISERVICE CHANGE 20.00
. LICENSED CON I' RACI'ORS DECLARATION.. .
I hereby affirm that 1 mal licensed under provisions mr Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
I'ri fessions Code, and my license is in full force and effect. ,
License Class Lic. Number
IS6UANCE DATE
_
LDG.
ELECT.
LEC
SKI'_
. PLC. MECH.
' � ❑
-
Dale Contmewr
.y, ,,z.
CC! of
V'
_ OWNER -BUILDER DECLARATION '
I hereby affirm thal.l am exempt from the Contractor's License
Law for lite following reason. (Sec. 7031.5, Business and Professions
Code. Any city or county which requiresa permit to construct, utter,
improve, demolish, or repair any structure, prior to its issuance, also
cnUhes the applicant for such permit to file a signed statement that
lie is licensed pursuant to the provisions of the Contractor's License
BUILDING PERMIT
INFORMATION
MISC. REFER TO ORD -
'
-
"PERMIT ISSUANCE 10.00, 2a0
'VALUATION
r�
O d i
5/FT.
'
ELEC. CONTR. - - • - 'LIC. NO.
I
ELEC.
TOTAL 2�1�PERMIT
TO
.�
- -
OTY. A.,PLUMBING PERMIT - .FEE'
Luw(Chapter 9(commencing with Section 9000) of Division 3 ofthe
Business' and Professions Code) or ( hat he is exempt therefrom unit
iA
,STORIES
TY4 CONSTR.
Ire haeis for the alleged exemption. Any violation of Section 7031.5
- .a
by any applicant for a permit subjects 0'e applicant too civilpenalty
of not more than five hundred dollen (S5001):
ALTER,--DRAIN&VENT-WATER (EA.) -
❑ I, as owner of the properly, or my employees with wages :is
sole compensation, will do the work, and the structure is net
BACKFLOW PROTECT. DEVICE 4.00.
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec: 7044, Business and Professions
Code: 'fire Contractor's License Law does not apply to an owner of
_
FIXTURES - PER TRAP S.00
property who builds or Improves thereon, and who does such work
himself or through his own employees, provided that such improve-'
mems are not intended or offered for sale. If, however, the building
SG. FT. FLDOfl AREA
TOTAL ACREAGE -
',GAS -EA. SYSTEM -11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not huiW or int-
prove far purpose al'sale.).
❑ I, as owner. of the properly, am exCluslvely contracting with
- . -..
GAS EASYSTEM OVER 4 (EA) -` 200
_ BUILDING USE
FES IND CON Pe Omer
❑ ❑ ❑ ❑ ❑
INDUSTRIAL.WASTE INTER. 3000
.
licensed contractors to construct the project (Sec 7044, Business
:are Professions Code: The Con owlnr a License Law does not apply
In an owner of property who builds of improves thereon- an&who
' LAWN SPRINKLERS - 1 INC 5 V.B. '' 6.00
-
LAWN SPRINKLERS - OVER 5 (EA.) .•' 1.00
- ASSESSORS PARCEL NO_ -
contracts for such projects with n contractor(s) licensed pursuant to
the Contractors License Law.
,SEWER -SAN V -STORM EA. 200ft/10.00 -
TRACT NO.
PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C. for this
WATER HEATER W/VENT '6.00
mielon
Owner Uate
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE N0. -
WATER TREATING EQUIP. •, 5.00
- WORK F-RS'COMPENSA-1']ON DECLARATION
I hereby affiorr 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 thcr��pp(( c. ff0�0��ab.C.y.��,,
I of Y NoW(e/.jlf¢fp�nY—LI4@=
..,`
FIRE SPRINK,
y N
' ❑ v ❑
ENERGY T-74
v N
❑ ❑
❑ C liked s r yl ushe
n ❑li Corti I' pY lite th - t' tY. nspe an divis an'
1 I
MISC.- REFER TO ORD.
CI RTI ICATI OP P I'MI' ION PROh1 WORKERS•
PERMIT ISSUANCE • ',10.00
PLOOD zo NE
A. L. U.C.
COMPEN. ATION INSURANCE
(This section need Oat be completed if the per it is for one
v ❑ N ❑
Y'❑ N ❑
PING. CONTR, LIC. NO.
PLG.
TOTAL
hundred dollars IS 100) or less.)
I certify that in One performance of the work for which this per-GTY
mil is issued, I shall not.employ any person in any manner so as to
'MECHANICAL PERMIT FEE
,
FEE E SUMMARY
BUILDING
g'!j ed
become subject to the Workers' Compensation Laws of California.
Dam Applicant
NOTICE 'I'0 APPLICANT: If, after making this Certificate of Ex-
ALTER OR ADD TO MECH. • 5.00
APPLIANCE - 5.00
PLAN CHECK
FEE `
emption, you should became subject to the Workers' Compensation
provisions of the .Labor Codc'you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10=C.F.M.) 4,00 .
AIR HANDLING UNIT 6.00
SEISMIC FEE
-., � ,0, -
' .
- CONSTRUCTION hIiNDINC AGENCY
I hereby affirm that there is x construction lending agency'fnr
I' • EXHAUST HOOD (WITH DUCT) '5:00
the performance of the work I'or which this permit is issued (Sec.
3097,Civ.C.). " '
MICROFILM�-
-
HEATING UNIT (TO 100,000 B.T.U.) 6.00 -
Leader'sNam
Lender's' Address' -
Addr
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
ELECTRIC'
/^f
VENTILATION FAN (SINGLE)- 4.00
' BOILER-OOMP(3 H.P, or 100,000 B.T.U.) 6.00
I certify that lhavereadlhisapplicrion uad,t.tcth.t theabove
information is -correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
-
PLUMBING
-
BOILER -COMP -(Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city to enter. upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify a it keep harmless the City of
misc.,,`"? REFER TO ORD.
upertino against liabilities, jud • e s, costs ad' expenses which
may in an ay accrue gain sa' 'ty in. corse uence of the
TAX
-
'
ICONST.
- - PERMIT ISSUANCE -, 10.00
•ranting s permit 1
MECH. CONT LIC. NO.
A,
MECH -
TOTAL t
-
TOTAL
/5 3
Skinner of Ap marl ant a It IA)atel
OFFICE'COPY , '