15201 POST THIS CARD NEAR FRONT OF BUILDING
{w F PERMIT NUMBER
• CITY OF CUPERTINO , 15201
INSPECTION DIVISION
s.. JOB INSPECTION RECORD
// -1 PERMIT EXPIRATION
1,�,
JOBADDRESS �^z-; s'V lL ''
K-' ad'V/ /JVD UNIT# LOT# `
a PERMIT EXPIRES IF WORK
OWNER ! V .Ijc CONTRACTOR i t/"*QLD- "'e) LaV IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
- ANCE-OR 180 DAYS FROM
FOUNDATION
NOTE: LASTCALLED INSPECTION.
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEgMIT VALIDATION
PREGUNITE - CUPERTINO STANDARDS. -
GARAGES LARS ;
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB,
PLUMBING - r�`I
ELECTRICAL 'SUV p `SOV ISSUANCE DATE
MECHANICAL city Of' BLDG ELECT PLG. Mscg
Cuomoertx x
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION s+FT.
PLUMBING - -
MECHANICAL -
ELECTRICAL PERnur To
FRAMING Q• V7 o
INSULATION _ -a, - - STORIES TYPE CONSTR.
OCC GROUP RES UNITS
w PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sO Fr FLOOR AREA TOTAL AcgcnGE
t7
DIAPHRAGM •THE CONSTRUCTION TAX IS PAID r
nuaDiNr,USE
+� ROOF SHEATHING IIES "NDCON PB om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 E ❑ ❑ El
ASSESSORS PARCEL NO
• ROUGH SAN.a J.,a -
PLUMBING p L-' Y ELECT.ENERGY ' " ' �
`TRACT NO. PARCEL NO
TUB'8'T&SHOWER PAN - Q�(, PLUMBING ENERGY v 4r
MECHANICAL .. MECH.ENERGY '
ACC.DATE AC FRE NO.
ELECTRICAL BUILDING ENERGY
FRAMING _ 7,Z �( W ELECT.FINAL TEST ZONING ENG.slre No,
. INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK
ENERGY T 7
MECHANICAL '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. 'v ❑ NE] ° NQ
-
EXTERIOR SHEAR _ _ ELECTRICAL RELEASE FLOOD ZONE A.L U C.
INTERIOR SHEAR FIRE DEPT.' Yo No Y ❑ A[]
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH 3 c( eluIT2 MPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ;
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING '
°z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. t
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE o`F COMPLETION
BUILDING INSPECTOR'S OFFICE
Date
i......... .... 19............ Building Permit No
The Building Located at
.......ft�2E...............
Ownedby Q �.v �.Dt:: �.................. ...............................................................
Completed For Use As: S.F.D.WL._..
................................................
Has Been
Completed
P
....................................................................... ........................I............................................
....................................... ................................I........................................................................
.................................................................................................................................................
....................................
PD-7 BUILDING, INSPECTOR
F or L
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
6131LDING PROJECT I DENTIFICATION J/ -2 PERMIT NUMBER
aU,LD,N APPLICATION & PERMIT
ADDREJ i �nSO /1 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL _. 15201
o ER'S O" PLAN CHECK VALIDATION
:•
Mm VE S i QTY. ELECTRIC PERMIT FEE
PHONE
NAmenacroRs OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
ADDRESS rolls PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS ' 10.00 DATE OF APPLICATION
AARRCHITECT PANELS (OVER 200 AMP) 20.00 __FLAN_CHECK FEE .C.NO.
o
ENGI
IC.NO J#C01 SIGNS TRANS. 3.00
ARCH.OR ENO ( SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
DRES
EMP.METER OR POLE INS. 20.00
APPLr CANTS MOTORS SEE FEE SCH. ^'
ADDRESS
SERVICE CHANGE 20.00 9
• ,O/ �//
w o
M - LICENSED COM ACTORS DECLARATION
in w I hereby affirm that 1 am licensed under provisions of Chapter 9p0 ISSUANCE DATE
y a a Icomnsencing with Section 7000)of Division 3 of the Business andDG.. ELECT. PLG. MECH.
F 7 z Professions Cole nd my license is in full force and effect 1q
O i — Licenso C s Lic.Number
m = w Date Contractor -
< m ¢ a - OWNIi RBUILUER DECLARATION BUILDING PERMIT
E o s u 0 3 INFORMATION
E:
; y I hereby affirm thin I am exempt from the Contractor's License MISC.— REFER TO ORD
H _ PERMIT ISSUANCE y�� vnwnnoN S/FT.
u_o j Law for the following reason.(Seo.7031.5,Business and Professions _
Code:Any city or county which requires a permit to construct,alter,
.Q ¢<2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
i w m c requires the applicant for such permit to file a signed statement that TOTAL /�f PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License /
r z i Law(Chapter 9(commencing with Section 7000)of-Division 3 ofthe
m o Business and Prafessio is Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
2Hpm the basis for the alleged exemption.Any violation ofSection 703 1.5 1 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty DRAIN&VENT-WATER (EA.) 5.00
of not more than ALTER-
five Imod'ed dollars S /y yie
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not
OC .GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 —. 3
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT,FLOOR AREA TOTAL ACR CAGE
himse. 'ants are not hrough
ownemployees,orge.provided1,Eever,hat the
improve- GAS-EA.SYSTEM-l 6,00
mems are not In is gold a,offered
on for gale.If,however,thu building 7 O E
or improvement is sob within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 U .N
builder will have the burden of proving that he did not build or im- BUILDING USE
prove purpose of sale.). RES .IND CON P9 Other
I,as owner of the property,ant exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ - ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:"f he Contractor's License Low docs not apply
fo an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contracw s)licensed pursuant to SEWER-SAN EA.200ft/10.00 f0
the Contmctor's License Law. TRACT NO, PARCEL NO.
❑ Ian xempt under Se • B.&P.C,for Ih WATER HEATER W/VENT 6.00
reason _ ��.QQ�x J��r
Owner _ _ )ate /)( WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORKERS'COMPBNSA'I'ION DL'CLARA'f10N11 WATER TREATING EQUIP. 5.00
1 hereby affirm Him I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lah.0 7-
Policy No ComP:mY
Q ❑ tlifi copy ns hereby fur s cbe FIRE SPRINK ENERGY T.24
Z Z Certif deJ L_M���t�r�he yy i s ti Division. MISC.- _ REFER TO ORD.
Q Applicant- • 'L Y ❑ N❑ Y ❑ N❑
~ va PERMIT ISSUANCE
�
CERTIFICATE COMPENSATION
INS FROM WORKERS' '10700 FLOOD ZONE A.L.U.C.
W � COMPENSATION INSURANCIi PLG.CONTR. LIC.N0. PLG.
CL Z (This stelion need not be completed if the permit is I'ur one TOTAL S / a Y❑ N❑ Y ❑ N❑
hundred dollars(Stool or less.)
V 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT. FEE FEE SUMMARY
U_ H- mil is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
w Date Applicant BUILDING y .�
>_ y NOTICE TO APPLICANT: If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 ��V
F Z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.FM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CW.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 pp ��••
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 p
information is correct. I agree to comply with all city and county PLUMBING S/
ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives foriins of Ibis city it)es enter upon the BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL (S 9a
herebym authored property forinsp of ion purposes.
(We) agree to save, indemnify and keep harmless lite City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE •s CONST.TAX Q3
may in any way accrue againgl sail City in consequence of the rat„
r ing of this permi Y/I 1 MECH.CONT. LIC.NO. MECH.
TOTAL 9S9 TOTALk147
Signature of Applicant Contractor ate
OFFICE COPY �'