15633 POST THIS D'NEAR FRONT OF BUILDING, • PERMIT'NG BER
CITTOF CUPERTINO ' .15633
I'N§PECTION'D I V ISI ON
JOB INSPECTION RECORD
'• /0��
PERMIT EXPIRATION
JOB ADDREES_S' /O/�v-/� ' �/UL� /'1u UyN'I'T# _LOT# •�pERMIT EXPIRES IF WORK
OWNER '�-,� % CONTRACTOR �/ efj-�QiLLO K �O IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU _
. FOUNDATION. i - - - -ANCE OR 180 DAYS FROM
NOTE: LASTCALL EDI NSPECTI ON,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE'APPROVED PLANS AND CITY OF PERMIT VALIDATION
-
GUPERTINOSTANDARDS. R• ._'. „•,
GARAGE SLABS' - - - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Sj�—Qf/' • 1-�� j -u�CL'"t
" "UNDERGROUND /SLAB
PLUMBING.
ELECTRICAL - ISSUANCE uarE.
MECHANICAL •BUTGLE
. Ec T. PLG 'MECH,
❑, El_c
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING - - VALUATION SIFT.
MECHANICAL v -
ELECTRICAL - 1g r - y/'�GERMIT I i
FRAMING. IxP ` /
STORIES TYPE CONSTR.
INSULATIONtoo . :I
OCC.GROUP RES..UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO VT,FLOOR AREA TOTAL ACREAGE,
'. ROOF' " NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
_ BUILDING USE
ROOF SHEATHING HES, IND .CON PB
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED' FINALS DATE INSP.
ROUGH - SAN.q .Assessoas PA RCLNo
E
PLUMBING ELECT.ENERGY
.THACT N0. PARCEL NO
TUBS&SHOWERAN PI " PLUMBING ENERGY -
MECHANICAL - MECH.ENERGY
ELECTRICAL _ may ,djd BUILDING ENERGY , - ACC.DATE .Acc FILE No.
FRAMING _ ELECT.FINAL TEST
_ PLUMBING •ZONING ENG.SITE N0:
INSULATION;•, "' .
GAS,TEST' ' GAS
MECHANICAL FIRE SPRINK ENERGY T 24.
•
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ` E] ` IN
FLOOD ZONE A L U.C..
EXTERIOR-SHEAR. - ELECTRICAL RELEASE .
INTERIOR SHEAR - FIRE DEPT.- - Y❑ NoY L::N❑'
. SHEE,TROCK - - GRADE FEE SUMMARY
EXTERIOR LATH' ' BUILDING
INTERIOR LATH TEMPORARY APPROVALS .f BUILDING
SCRATCH COAT ELECTRI , PLAN CHECK '
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. "
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLU 81Nc QOe
O PLEASE GIVE JOB ADDRESS WHEN PHONING.'
'.. Z - - - - 'MECHANICAL
= S.EE PERMIT FOR EXPIRATION DATE --
IMPORTANT! coNST.TAX .
PLEASE READ REVERSE SIDE BEFORE TOTAL'.
CALLING.FOR FINAL INSPECTICIN..
OFFICE"COPY
`APPLICANT TO FILL IN INFOIWWATION WITHIN RED LINES - USE B LL POINT PEN ONLY
BUILDINGPROJ CT IDENTIFI PERMIT NUMBER . ,
Oro APPLICATION & PE T 15633
OW
O / r U
ADDRESS (0 p
sr� ( ILDING—ELECTRICAL—PLUMBING—MECHANICAL
. OWNER'S ^ L`�
PLAN CHECK VALIDATION - a
NAM (�PE CITY. ELECTRIC PERMIT FEE
V ��
CO ACTOR'S
NAME rl ll0 qS OUTLETS-SWITCHES-RECEP 10.00/1.00
J (a�`r C1 LIC.N0.3 6 LIGHTING FIXTURES 10.00/1.0
CONTRACTOR'S
ADDR Ess rA. APPLIANCES-RESIDENTIAL . 4.00
PANELS 10.00 DATE OF APPLICATION'
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 _.
ENGINEEflse ,
c.No. SIGNS TRANS. 3,00
ADDRARCHESS OR END SPECIALCIRCUIT S,QQ PERMIT VALIDATION
ZIP ITEMP.METER OR POLE INS: 20.007'
APPLICANTS - MOTORS SEE FEE SCH.
ADDRESS L,' /
S / lWSPAY S SERVICE CHANGE 20.00 / /j�■f/
E.02 LICENSED CONTRACTORS DECLARATION
a cl w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE _
¢ n (commencing with Section 9000)of Division 3 of the Business and ` BLDG. ELECT.. PLG MECH.
Professions Code,and m license is in full for an ell j� ❑
z O m License Clu Lic.Number L
m _ Date' q 4 ovactor
z a W a w R-BUIL ER DECLARAT ` BUILDING PERMIT
X
;n �' 1 hereby aflinn that I'am exempt from) e Co moor's License MISC.— REFER TO ORD
INFORMATION
UA I N
E/FT.'
.. o j Law for the following reason.(Sec.7031.5, ass and Professions -
I- — PERMIT ISSUANCE 70.00
my Code:Any city or county which reyuiresuperat,to construct,alter,
¢ 2 ¢ imptove,demolish,or repair any.structure,prior to its issuance,also ELEC.CONTE. LIC.NO,. ELEC.
a a c LL requires the applicant for such peimit to file a signed statement that TOTAL - PERMIT TO
w m he is licensed pursuant to the provisions of the Contractor's License a y T -
H :za Law(Chapter9(commencing with Section 7000)of Division 3 ofthe 1-48
4 O Business and Professions Code)or that he isexempt therefrom and CITY. PLUMBING PERMIT FEE
M r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN IEA.) 5.00
of not mom than five hundred dollars($500).1: '
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE. 4.00 OCC.GROUP RES.UNITS
their sole eompenaltion,will do the work,and the structure is not
pRAINS-FLOOR,ROOF,AREA,CON D. 5'00
intended or offered for'sale (Sec. 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,511 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or Improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) -
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER - RES IND CON PB othe
. 30.0 r
❑ 1,as owner of the property,ani exclusively contracting with ❑ ❑ ❑- ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. ASSESSORS PARCEL No.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5( 1.00
contracts forveh projectswith u contrectmis)licensed pursuant to SEWER-SANITARY-STORM EA.2051f
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,BAP.C.for this WATER HEATER W/VENT
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 '
1 hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workeri Compensation Insurance,or a certified ,
copy thereof(Sec.3800,Lab.C.).
0 XX,
Policy No. Company -
, ❑:'Certified copy is hereby furnished. FIRE$PRINK ENERGY T-2<
Z 2 ❑ Certified copy is fled with the city inspection division. MISC. REFER TO ORD.
ox Applicant - V❑ N❑ V ❑ N❑' •.
~ mr-4g;gp
Lu — CfiRTIPICATGOF ESMPTIFROM WORKERS' PERMIT ISSUANCE
- FLOOD ZONE A.L.u.C.
W a COMPENENSATATION INSURANCE
URANCE PLG.CONTR. sec No. PLG. '
CL Z( This section need not be completed if the permit is for one TOTAL Y❑ N❑' Y[J N❑
hundred dollars(S 100)or less.) -
' (,.) O 1 certify that in the performs 1 of the work for whicIVOIs per r
MECHANICAL PERMIT FEE FEESUMMARY
LL F mit is issued,I shall not emplo n rson in any me as to0 bec0 )ih 1 to Workers' npNauws of ria.
Dalc;�Applicunt ALTER OR ADD TO MECH. 5.00BUILDING
NOTI I7 'f0 AI'PL CANT: a r mthis Certificate of Ex-emption,you should become Iect m the Workers'CompensationAPPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply withAIR HANDLING UNIT(TO 10pODGF.M.1 4.00 FEE
such provisions or this permit shall be deemed revoked.CONSTRUCTION LENDING AGf:NCYAIR HANDLING UNIT(OVER 10=1C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency forEXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for whicli this permit is issued(See: MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT OV ER 100,000 B.T.U.)9.50
Lender's Address ELECT IC•w`
I certify Oun I have read this application and state that the above VENTILATION FAN (SING LEI' 4.00
information is correct. I agree to comply with ull city and county PLUMBING
ordinances send state laws relating to building construction, and BOILER-COfY1P(3H.P.Dr100,0008.T.U.) 6.00 Q
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL -w
above-mentioned property for inspection purposes,
(W
It to save, indemnify mud keep harmless the City of MISC.'- REFER TO ORD.
ape ti gments, sand expenses which PERMIT ISSUANCE 10.00 CONST.TAX
a y gainst s rt m consequence of the
ti f pt rmlt MECH,CONT. LIC.NO. MECH.
TOTAL TOTAL %/' .".!jJ
8 ant/C retractor Dale
OFFICE COPY