14557 AI
- POSTTHISCARD,NEAR FRONTrOF BUILDING" k
T T l• PERMITNUMBER
=' �. CITY� OF CUPERTINO
OF
414557
INSPECTION DIVISION'
JOB INSPECTION RECORD w
IDj 2 A ,, I'',(J ',J y I 1 PERMIT EXPIRATION
JOB ADDRESS ` i.J /�! U/(/L{Iht_"- F 4=: UNIT# LOT#
PERMIT EXPIRES IF WORK '
CONTRACTOR vl 'v1 ,+ (;A IS 'NOT, STARTED,WITHIN
INSPECTIO DATE INSPECTOR 'NSP TION RECORD ' •'18oDAYS-OF PERMIT Issu';.
FOUNDATION,.', "'I - ' ANCE OR 180 DAYS FROM'S
' NOTE:.,,. --- -- '' - LAST CALLED INSPECTION+,
_la UFER r' �F.': ALL GRADING AND.DRAINAGE;SHALL BE INSTALLED
,PREGUNITE„ TO COMPLY WITH THE APPROVED PLANS AND CITY"OF - PERMIT VALIDATION
CUPERTINO STANDARDS - '
GARAGE SLABS • ,-' ` - I 4 �`h
POUR NO CONCRETE UNTIL ABOVE HAS-BEEN SIGNED
UNDERGROUND./SLAB
PLUMBING �, . - I - i .f.:�'( Irv� a
ELECTRICAL � 5' ISSUANCE DATE
MECHANICAL ;. v - 'BLDG'- ELECT.' - PLG. • MECH.
�
'- +
emu of
F- DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED CU BUILDING PERMIT
INFORMATION
A. -w
ODD LOOR - : I- VALUATION SIFT. -I
r PLUMBING r. • : x Y` •' .t `�t_ .i\,
I"+ MECHANICAL
,ELECTRICAL ' - _ I- PPE-RMIT TO •t+, r
FRAMING '"
STORIES YPE CONSTR)•:
x INSULATION ._ � "�' � . I�
OCC.GROUP 'RES.UNITS -
!.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOR AREA TOTAL ACREAEEv
ROOF'„( NOTE NO FINAL INSP,SHALL-BE MADE BEFORE.'
r�t DIAPHRAGM - 'M - THE CONSTRUCTION;TAX IS PAID, r , `
ROOPSHEATH ING '` '- I ' Y ' t� REs :I NO CON USE
o.,•, r
APPLY"NO-ROOFING UNTIL�ABOVE HAS'BEEN SIGNED I FINALS DATE' INSP: , 0 n ❑ El
I ASSESSORS PARCEL NO
` L ROUGH ' SAN.#,
PLU•MBI N,G - - ,,' ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY;' '. TRACT NO PARCEL NO
j ' MECHANICAL_'_ MECH.ENERGY •'` ' '
BUILDING ENERGY -
ELECTRICAL GYe- ',•. .ACC DATE ACC FILE NO, :1
FRAMING, ELECT.FINALTEST.', -
+' ZONING "ENG SITE NO
I INSULATION .i ' PLUMBING ., - t
' GAS TEST ' GAS L
R -
FE SPRINK ,ENERGY T.24 -i
- - MECHANICAL I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ,HEATING7.
° • •" ` 0'' "� '
I FLOOUZONE' , AL.U.C.
j EXTERIOR SHEAR < ELECTRICAL RELEASE -
_ .,i. FIRE DEPT `:Q NEj ° ❑ -;N❑'"l
INTERIOR SHEAR - i;
a r SHEETROCK - •I' GRADE -I .FEE SUMMARY
?' EXTERIOR LATH( ' BUILDING
, .!NTE
RIO R;eQTH :.. 'TEMPORARY APPROVALS 'euILgING
SCRATCH COAT, `• ELECTRIC_ -1"" - P.L'AN,CHECK '
.-.. :.. „,. . t. GAS P• .: I.
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - S
SEISMIC,FEE �. •'`t
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDIN&FINAL IS SIGNED.BY BUILDING INSPECTOR MICROFILM;
ARRANGE'FOR INSPECTION ELECTRIC
BY PHONING 25245Q5 i;
~ ONE,WORKING-DAY BEFORE,REQUI,RED`INSPECTION
O "PLEASE GIVE.JOB ADDRESS,WHEN PHONING PwMewG
..`
Z
PEE'FERM'T.fOR-.EXPIRATION DATE CAL,
•M ECHANI
IMPORTANT'
PLEASE : '' cgNST TAX
READ REVERSE SIDE BEFORE a. TOTAL
CALLING'FOR FINAL INSPECTION..' ,
OFFICE COPY
APPLICANT TO-FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
1 LD!NG PROJECT I DENTI FICATION - PERMIT NUMBER
a aIN 'APPLICATION & PERMIT 14557'
oft-3y` O• 'Wocf- Qd BUILDING—.ELECTRICAL—PLUMBING=MECHANICAL
OFNE 5 + - PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE '
'PHONE
CONTRACTOR'S -
NAME _ G � -1--t UTLETS-SWITCHES-RECEP 10.00/1.00 WIDD
/.v - / I uc.No. 7 LIGHTINGFIXTURES 10.00/1.00
CONT ACT, s •' • '
ADDRESsp - - Cya5�74 Y•; PPLIANCES:RESIDENTIA '4.00
D /2' r •��( e/wZ ¢LYOPHONE (/ e/ 'PANELS _ IO.00 DATE OF APPLICATION
ARCHITECT - - PLAN CHECK FEE - P.C.N0.
OR - PANELS(OVER•200 A
ENGINEER /�
P --I LIC.W. _", SIGNS TRANS.
AOOPEEa AEC;OR ErvG. 3 SPECIAL CIRCUIT - PERMIT VALIDATION
S Z S• A/'.(4/ASFt' A/ 9,/v ZIP9evI& EMP.METER OR.POLE INS. 20. 0 L
,'11,�'1j'^s(///�
•
APPLICANTS MOTORS _�(--�tl l_�K9 l�L-�-�l
xODRESSLIGAN ''L F&C 'SEE FEE SCH. v
3 3 f ✓L L✓O SERVICE CHANGE. 20.00 - ell
I� I C�
M o LICENSED„CON1 RACTORS DECLARATION - r o r(S1�
au u I hereby affirm that J am licensed under provisions of Chapter 9 _'
Z ISSUANCE DATE
(commencin with 7000)of Division 3 of the Business and a a g BLDG. ELECT. PLG. MECH.
HHi Professions Code,and my,license isNfull force,'Inmd1pf�ee ❑
Z,i m D License C'ss Contra for SYbp7� �
_ m H j - Dete ✓f_Y— Contractor V/ /r 6/FL/A'rC v
4 x - • BUILDING PERMIT
s ¢ a OWNER-BUILDER DECLARATION.-
rc'w u INFORMATION
X
I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
H u o J Law for the following reason.(Sec.703 1.5,Business and Professions ,1 pERM1T ISSUANCE I CIAO
VALUATION
fw> Code:Anycilyorcounty whichrequiresapermittoconstruct;alter, - -
¢ a ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC. Q -
o u requires the applicant for such permit to file a signed statement that TOTAL -
- u w m M„ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Hise Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe `h--
f�z o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE -
M H $ , the basis for the alleged exemption.Any violation of Section 7031.5 r, STORIES TIYPE CONSTR. .
a3 by any applicant for a permit subjects the applicant toacivil penalty, gLTER-DRAIN -WATER.(EA.) 5:00
of not more than five hundred dollars(8500):):
•❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP .REB.UNITS
their sole compensation,will do the work,and tile structure is not
intended or'oll'ured for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conlractor's,License Law does not apply .-an owner of -^
+ property who builds or improves thereon,and who does such work FIXTURES-PER TRAP` 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own wnployess;provided that such improve ,-
Centsarenotintendedorofferedforsale.If,however.the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EASYSTEM--OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that hg .did not build or im' - RES IND CON PB 'Omar
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00
O 1,as ownet of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct Ihe.projecl(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 then•ou.and.who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. - PARCEL NO.
❑`'I um exempt under,Sec. ,B.&P.C.•I'nr Cis
reason WATER HEATER W/VENT - '6.00 i•
Owner Dae, WATER SYSTEM - '5.00 - ACC.DATE ACC.FILE NO.
r WORK ERS'COMPFNSATION DECLARATION WATER TREATING EQUIP.' 5.00 a•. -
I hereby affirm that I have a certificate of consent to self-insure, - - ZONING ENG_SITE N0. ..
or a certificate of Workers'Compensation Insurance,or a certified _
spy Cher 1cQ B➢-.3flAA�Lab.C.). �u��,,rrQ�ll C is
-
Policy No. r mPany " _ _
Q D-CertiGedcopyisherehyfirmshed. -' FIRESPRINK ENERGY T24 .
Z Z P' CC,!Jri `L op is�,f)le�d v/ith the city inspection division. „
O
APPlicaml�[C -�.C-'T�•C% MISC:- • REFER TO ORD: .Y ❑ 'N❑ Y,❑ N❑
CC rn PERMIT ISSUANCE 10.00 '
'LU — CERTIFICATE PE EXEMPTION FROM WORKERS' FLOOD ZONE. A.L.U.C.'
W � ' COMPENSATION INSURANCE PEG.CONTR. LIC.NO. PLG, -
1 O (This section need not be Coal if the permit is for one TOTAL, Y❑'. N❑ Y ❑" N❑
Z hundred dollars(5100)or less.) -
V O 1 certify that in the performance of Ole work for which this per. OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not employ any person in any manner so as to
O W become subject to tbe.Workers'Compensation Laws of California.
Date Applicant' BUILDING
a ALTER OR ADD TO MECH. 5.00
} rn NOTICE.TO APPLICANT: IL after making this TS'Compe si fix-
F ? nn vision you the L become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, you must forthwith comply with FEE '
U such provisions or this pennil shall be deemed revoked. AIR HANDLING UNIT(TO 10,00DGF.M.) 4.00
CONSTRUCTION'LENDING AGENCY AIR HANDLING UNIT(OVER tOp000FM.16.00 SEISMIC FEE -
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) `•5.00 -
the.performar
race of the work for this permit is issued(Sec. -MICROFILM
3097,Civ.C.1: ' HEATING UNIT'(TO.100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC'
I
1 Zertify that I.have read this application' d state that thv. use VENTILATION FAN (SINGLE) 4.00 ,
.• information is correct.I agree to comp) ith all city and county PLUMBING -
ordinances and state laws relay to wilding construction, and BOILER-COMP(3 H.P,or 100,000 B.T.U.) 6.00
hereby authorize reprewo ves o his city Io enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned prope for ins tion purposes.
(Wep agree ro su indem S d keep harndess It I,
Chy of MISC.. ., ' .REFER TO ORD. -
upertinoregainst abilit]a - gm?,/os, costs and expenses which PERMIT ISSUANCEiCONST.TAX
may in y w ace ag at said City in co equence of the
Iant' g H.CONT.. LIC.NO. MECH. ;
TOTAL• I TOTAL -
S nature pplicnn nlraclor - .. D
OFFICE_COPY