16476POST THIS CARD NEAR FRONT OF BUILDING.
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS D O 3 Z- � `V. S U \A y-l'�+C� UNIT# _LOT#
I L
OWNER .J -C:,`�`(^ D S \. CONTRACTOR UCV
PERMIT NUMBER
16476
P �IRATION
,,..{{ -�
PERMIT EXPIRESIfF, w06K
IS NOT STARTER 1NIITHIN.
180,DAYS OF PErRMITISSU.;
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.'
INSPECTION DATE I INSPECTOR
INSPECTION RECORD
f
FOUNDATION' -
LIFER L
NOTE:
ALL GRADING AND DRAINAGE:SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CIN OF
CUPERTINO STANDARDS.
' PREGUNITE
PERMIT.VALIDATION
'-
TE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
y�uFL �=wT -flc-% p w�
— -I fo
UNDERGROUND/SLAB
PLUMBING - ;
I-: -
oily at cliowoISSUANCE"DA
ELECTRICAL
MECHANICAL
BLOC. ELECT
\��J IrLs�SJ
PLG. MEJ;H
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD FLOOR
- VALUATION .
(DD:D
SIFT,
PLUMBING
MECHANICAL
ELECTRICAL.14
PIiA. o.V
PeHMIrTo
FRAMING Gi
INSULATION
STORIES
T 'E CONSTR
-
OCC GROUP
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID � '
so Fr FLOOR AREA
1
TOTAL ACREAGE
DIAPHRAGM
ROOF SHEATHING 2 ®
�c
s IND Lnr!ON usePB oGrai
44N 0 ❑ 0
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SANA
A55ES51HS PARCF.I. NO
"
PLUMBING -
ELECT. ENERGY
TUBS &SHOWER PAN
PLUMBING ENERGY
TRACT NO
PARCEL NO
MECHANICAL kL5
MECH.ENERGY
ELECTRICAL
BUILDING ENERGY
ACC DATE
ACC FILE NO
FRAMING
ELECT. FINAL TEST
INSULATION
PLUMBING
ZONING
ENG SITE NO.
GAS TEST
GAS'
'
MECHANICAL
FIRE SPH INK
0 N0
EN[NGV T.29
° ❑ Na
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATINGV
EXTERIOR SHEAR
ELECTRICAL RELEASE -
FLOOD ZONE
yo No
A LU C.
1 NO
INTERIOR SHEAR I
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH Cf
BUILDING
BUILDINGQ
�L f�D'
.INTERIOR LATH
TEMPORARY P ROVALS
SCRATCH COAT, -/ ✓
ELECTRIC
PLA CHECK nU9
FE--F'Pf�•� i7^.
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE f
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
o�ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE -
`"
ELECTRIC) f
1
PLUMBING '1DOT
MECHANICAL
CONST, TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY
O
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�N
UJ -
CL0
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of
01.
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-PLh,ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
"'e"BUI LDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
.PERMIT NUMBER
1647 I�
, `t 1
BUILDING
ADDRESS
/P339 ( e
OWNER'S
NAME
.
ffVM0PHONE 6 a
QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
�. �1�
GATE OF APP❑CATION i
CTRAITORS
NAONME
t'Yy tV0 m .C. No.
OUTLETS -SWITCHES -RECEP 10,00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
CONTRAS
t)CO Ref PHONE 7-j&
APPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
PANELS (OVER 200 AMPI 20.00
PLAN CHECK FEE
SIGNS TRANS. 3.00
F.0+NO.
L'ECREMAFI ( &_SIC, LIC.ND.
AARCH, OR DDRESS ENG.
SPECIALCIRCUIT S.00
_ PERMIT VALIDATION
NIO M qal,pqqMEMP.
METER OR POLE INS. 20.00'
A
ADDR
DRESS Ess
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 `
10 -- L
LICENSED CONTRACT ORS DECLARATION
'
_ 4
MAR
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 700e i of Division 3 oLlhe Business and
Professions Code, and my license is in full Division
a'yd effect
License C ass Lie. Number TlAr 2z4(o
ISSUANCE DATE
BLDCy ELECT. PLG. MECIy
hYY-'VI/ IFJC„'7(
Dole Contractor alshr LA 1
city ofIOUBUILDING
1hM�/Ij
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from Ole Contractor's License
Law for the nycitfollowing r countytocnd Professions
o reasonntyw.ch c. reta03 il" perthismit
Code: Anycitywu Nyir any structure permit totsi....n", alser,o
n its issuance, also
improve, demolish, repair any Me
requires the applicant for such permit co file a signed Statement that
he is licensed pursuant to fire pmvisiou, of I be Contractor's License
Low (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or chat he is exempt therefrom and
PERMIT
INFORMATION
MISC. - REFER TO ORD
VALUATION
000
$/FT.
'
PERMIT ISSUANCE 10.00 1 rC6
ELEC. CONTR. LIC. NO.
ELEC. �.PC
TOTAL a. 9 4 "�
PERp11T TO
,,// '
LT jQ((T7b 1k
OTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (55001.):
ALTER-DRAIN&VENT-WATER(EA.) 5.00 Iy
`Ldo
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do Ilse work, and 'he sl ructure is not
BACK F LOW 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: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who docs such work
himself or through his own employees, provided that such improve-
mentsarenotintendedorofferedforsale. If, however, the building
FIXTURES - PER TRAP 5,00
SO, PT. FLOOR AREA
Jkla
TOTAL ACREAGE
GAS - EA. SYSTEM -1 INC.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 build or im-
prove for purpose of sale.). -
Cl 1. as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2,00
BUILDING USE
E IND CON ve oro.,
El ❑ El El
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1,00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: 'Fire Contractors License Law does not apply
to an owner of property who builds or improves thereon. and who
ASSESSORS PARCEL NO.
contracts for such projects with it contractons) licensed pursuant to
the Conlmclois License Law.
SEWER -SANITARY -STORM EA. 2001t/1 0.00
TRACT NO.
PARCEL NO.
❑ lam exempt under Sec. ,114P.C.fRthis
WATER HEATER W/VENT 6.00
Owner
Dale
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WORK ER3'COMP ENSATION DECLARATION
WATER TREATING EQUIP. 5.00
1 hereby .(firm that I have a certificate afeHmient In sclpinsurc.
or a certificate of Workers' Compensation Insurance, or a certified
Y'%L%1K� C �0
ZONING
ENG. SITE NO.
copy thereof (Set. 3800, Lair
they No. Company
FIRE SPRINK
y ❑ N❑
ENERGY T-24
v ❑ N❑
❑ Certified copy is hereby furnish
Rf Curti 'ed ca y isd wi h tit Inspgclion division.
ApplicCor
MISC. - REFER TO ORD.
CIiRT1171CATI:OF E EMPTION PROM WORKERS'
^
PERMIT ISSUANCE 10.00 <�Q�
FLOaO zoNE
A. L. u.c.
COMPENSATION INSURANC17
(This section need not be completed if the permit is for one
PLG. CONTR. LIC. N0.
PLG.
TOTAL 6L O`i
Y ❑ N❑
Y ❑ N❑
hundred dollars IS 100) or less.)
,
I certify that in the performance of the work for which this per-
mit is Issued, I shall not employ any person in any manner so as t0
CITY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
/ 00
become subject to the Workers' Compensulion Laws of California.
Date Applicant
NOTICETO APPLICANT: If, after making this Certificate of Ex-
ALTER OR ADD TO MECH. 5.00 x DO
APPLIANCE 5.00
PLA CHECK
,1 JU'
emption, you should become Subject to the Workers'Compensulion
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
FEE Ca(sB"C9 ,
V
AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00
SEISMIC FEE
1I/
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
die performance of the work for which this permit is issued (Sec.
3097, Civ C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
H EATI N G UN IT (OV ER 100,000 B.T.U.) 9.50
ELECTRIC
9 aD
VENTILATION FAN (SINGLE) 4.00 L
I certify that I have rend thix.ppll[atmn and State that the ab.ve
information is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building crostrucllon, and
PLUMBING
s�
BOILER-COMP(3H,P•Or100,000B.T.U.) 6.00
BOILER -COMP Minor 100,0008TU)5EE FEE SCH.
MECHANICAL
/^
` ,LJ
hereby authorize representatives of this city to enter upon the
above-mentioned proper' y for inspecti purposes.
MISC. - REFER TO ORD.
CONST. TAX
(We) agree 10 Save, indenmif
yen rep handless the city of
Cupertino against liabilities,cujudgmcd s, osis and expenses which
y in any way accrue guinst said C' in consequence of the
ing f is iL
PERMIT ISSUANCE 10.00 1 C6
MECH, CONT. LIQ NO. MECH.
TOTAL
)
TOTAL
Si aure of Apili t/ oRt,OC,o, Date
`�✓e"
V
OFFICE COPY