14558 POST THIS CARD NEAR FRONT OF BUILDING PRRMOT NUMBER
CITY OF CUPERTINO 1455$
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
l JOB ADDRESS /v luo rr•- �d- UNIT# � LOT#
I / PERMIT. EXPIRES IF WORK
OWNER ,hoc.?d,C.$ CWE CONTRACTOR 1 I Kl ./C„ E..e ,Q-, ) NOT STARTED WITHIN
I SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: -
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY APPROVED PLANS AND CIN OF PERMIT vALmnnory
CUPERTINO STANDARDS.DS.
GARAGE SLABS 4('•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB '?
PLUMBING
ELECTRICAL ISSUANCE DATE
SLUG' ELECT PLG. MECH
MECHANICAL
g a❑ _ ❑ ❑ :
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED RMIT .
INFORMATION
WOOD FLOOR4t cupe VAOUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING
$iOHILs TYP[CONSTR.
' - INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
- 5p FT FLOOR PREA TOTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
�• DIAPHRAGM THECONSTRUCTION TAX IS PAID -
BUI LOI USE
ROOF SHEATHING Hes IND CON Pe 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 1:1 El ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.# ,
PLUMBING ELECT.ENERGY
1HACT NO, PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY '
MECHANICAL MECR ENERGY '
ACC DATE ACG FILE NO
ELECTRICALBUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING - ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENeacv T.za
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v " Y Q RE]
FLOOD ZONE A.L UC.
EXTERIOR SHEAR' ELECTRICAL RELEASE v El' N� v ❑ N❑
INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH jBUILDING
INTERIOR LATH
TEMPORARY 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 ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE - ^"
�a CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
S�a„
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
_ , APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY,`
• BUILDING PROJECT IDENTIFICATION - PERMITNUMBER -
SoILDINGLI,
APPLICATION'& PERMIT , I A 558
ADDRESS SSP, 1007
0/23 No. (rUOLG rod BUILDING'-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S /
/�R/p PLAN CHECK VALIDATION
NAME `/JL AN]/f C
PRe � _r. QTY. ELECTRIC PERMIT FEE
PHorvE '
CONTRACTORS
NAME eo OUTLETS 11.00] '
Ur //A'f S
6��lA1rC MJC LIC rve. 346q 7,Y f LIGHTING FIXTURES 101DO/1.00
CONTRACTOR'S
ADDRESS � ��JJ�� IItt &0ij 7#k-- APPLIANCES-RESIDENTIAL 4.00
3393 a 1 "
CAL �
/RPHONE' /yp / PANELS 0.00
DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE -' P.C.NO.
OR PANELS (OVER 200 AMP) -,20.00 I
ENGINEER ,
C.No, SIGNS TRANS. 3.00 _
ADDRESS ENG' - SPECIAL CIRCUIT 5.00 - . PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 .
APPLICANT'S ,
ADDRESS � MOTORS ZS��A SEE FEE SCH.-%' . .
33,13 (� 1A 0e.( �CuO p11 SERVICE CHANGE 20.00
' 0o LICENSED CONTRACTORS DECLARATION
u I hereby affirm that I am licensed under provisions of Chapter 9
2 ISSUANCE DATE
uFi Q v6i (commencing llitlr Section 700e)i of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r w z Professions Cod and Dray license is in full force a effect � - -
El El
00 z w o License Class Lic.Number-
r w Dale A- Z--A'S- - Contractor.ylL( Pct
Qyf
�t
Cu f3�fn0' BUILDING PERMIT
¢ m w . OWNER-BUILDER DECLARATION INFORMATION
w ;LL�,� 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- - REFER TO ORD -
a. 0 Q Law for the following reason.(Sec.7031.5,Business and Professions - VALUATION $/FT.
H - PERMIT ISSUANCE
Em04 Code:Any city or county which requires aperminoconstrucgalleq
le Q CI improve,demolish,or repair any structure,prior to its issuance,also ELEC CONTR. _
wD a. requires the applicant for such permit to file a signed statement that //// r- /o TOTgL pEgrytlr TO
m y he is licensed pursuant to the provisions of the Contr:co is License 'B •"T� '� 973 /��
z> Law(Chapter 9(commencing with Section 7000)otTivision 3 offal T�
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE '
rc H m the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
u 3.- by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).).. ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UMTS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- .
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS.EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose ofsale.), RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 E] -E]
El 0 El
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL NO.
❑ I am exempt under Sec B.&BC.I'or this
reason WATER HEATER W/VENT 6.00
Owner Dale WATER SYSTEM - 5.00 ACC.DATE ACG FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate oC consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO.
copy fl eri:�($ec.3800,Lab.CJ-
Policy No.'pa9z!/.)_Cor�eTfiv G/I`ATi Or!
O ❑ Certified copyl Irr (y fur all'd FIRE SPRINK ENERGY T-24
Z 2 �Certlfled yoN ded�KI the city inspection division. -
0 Applicant .�IJMie... C.LP/.✓ MISC. REFER TO ORD. v N� v ❑ N�
F y PERMIT ISSUANCE 10.00
LU - CERTIFICC :OFSATION INS FROM WORKERS' FLOOD ZONE A.LU.C.
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG,
Z (This section need not be completed if the permit Is for one _ _ TOTAL Y[-] N[] Y [D IN
hundred dollars(S 100)or less I
U 0 I certify thal,in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL mit Is issued,I shall not,employ any person in any manner So as to
Q W become subject to the Workers'Compensation Laws of California.
.IL Date Applicant BUILDING
} W NOTICE TO APPLICANT, If,alter making this Certificate of Ex- ' ALTER OR ADD TO MECH. 5.00
F Z emption,you should become subject to the Workers'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 10=C.RM.) 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,Civ.C.L - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.) p
Lender's Address' ELECTRIC lag
I certify that I have read this application and state that the above - VENTILATION FAN (SINGLE) 4.00
information is correct.'I agree to comply with all city and county PLUMBING
�• ordinances and'state laws relating to building construction, and BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to-save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses whichCONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ranting of this permit MECH.CONT. LIC.NO, MECH.
TOTAL TOTAL
Signature of Applicant/Contractor Date
OFFICE COPY