15751 POST THIS CARD BEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO.. .. 15751
INSPECTION.DIVISION
JOB INSPECTION RECORD
• ' - {� PERMIT EXPIRATION
JOBADDRESS/O• � IV ✓�� f— /�./� / .UNCIST# ' _LOT# PERMIT EXPIRES,IF WORK
CANERL 20 i1./ U / 6-LIJ CONTRACTOR �1 .Q,.L6C'C.�.C,l, .IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - 'ANCE OR 180 DAYS FROM
NOTE: -
LIFER � � ALL GRADING AND DRAINAGE SHALL$E INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY 05 PERMIT VALIDATION
CUP.ERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r/,/S Ak- �•t %__
"UNDERGROUND /SLAB
PLUMBING
ELECTRICAL t - - T� ISSUANCEDATE
MECHANICAL - - .+y+,Q -ELECT. v�, m 11 ECR.
• 1 ebLgl �
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �.pp \ ILDING PERMIT
,� G� VY' INFORMATION
WOOD FLOOR
PLUMBING - .I - vnwnnoN• _ s $/FT.
MECHANICAL
ELECTRICAL PERMIT TO
41�� '
FRAMING -
INSULATION _ STORIES TYPE CONSTR.
' f
OCC GROUP, RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
. ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE. sa,Fr.FLOOR AREA TOTAL nceeAee
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB m"�l
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. ❑ El El E) El
ASSESSORS PARCEL NO,
ROUGH SAN.#
PLUMBING ELECT.ENERGY .
TUBS&SHOWER PAN PLUMBING ENERGY TRACT No, PARCEL No '
MECHANICAL MECH.ENERGY -
ELECTRICAL „ BUILDING ENERGY ACC DATE ACC,FILE NO.
FRAMING - ELECT.FINAL TEST `
PLUMBING ZONING ENG.SITE NO.
INSULATION '
GAS TEST - GAS -
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING p ❑' N❑ ° ❑ 'N❑
EXTERIOR SHEAR ELECTRICAL'RELEASE - - FLOOD ZONE ALUC. I
INTERIOR SHEAR FIRE DEPT. - v❑ NE] Y ❑ ' N❑
SHEETROCK GRADE _ FEE SUMMARY
EXTERIOR LATH BUILDING '
.INTERIOR LATH - -
' TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC �_ PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE
OCCUPANCY OF BU ILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR: MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505; ? i ELECTRIC _
F ONE WORKING DAY BEFORE REQUIRED INSPECTION..'
PLUMBING '
. O PLEASE GIVE JOB ADDRESS WHEN PHONING. d
z -.
— SEE PERMIT FOR EXPIRATION DATE It MECHANICAL
IMPORTANT! Ito
"i'I; CONST.TAX
PLEASE READ REVERSE SIDE BEFORE '1y "r TOTAL
'CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - •'
ABU I LOING PROJECT I DENTIFICATI .APPLICATION & PERMIT PERMIT NUMBER.- -r
- aD,LD,NG . , 1 C 7 C
ADDRESS :� I J 1 5
ala. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'5 - .. PLAN CHECK VALIDATION
NAME - UC QTY. ELECTRICPERMIT FEE
gQuT 0 .
_ - HONEir
CONTRACTORS
NAME 14$ UTLETS-SWITCHES-RECEP 10.00/1,00 '
Q..ELT 7L,C.N0. CI LIGHTING FIXTURES 10.00/1.00,3
4 CONTRACTOR'S -
ADORES$ APPLIANCES-RESIDENTIAL .4.00ke `
PHONEPANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR f PANELS (OVER 200 AMP) 20,00 t
ENGINEER
Lm.NO.I SIGNS TRANS: 3.00 �--
ADDRESS ENG _ SPECIALCIRCUIT 5.00 PERMIT VALIDATION
IIP TEMP.METER OR POLE INS. 20.00
APPLI MOTORS SEE-FEE'SCH. �Q 0-,-(24-
ADDRESS
E55 1 �
SERVICE CHANGE 20;00 /❑ .7/ i
Ho o LICENSED CONTRACTORS DECLARATION
¢z w I hereby affirm that I am licensed,finder provisions of Chapter 9 / ISSUANCE DATE '
h Q (commencing with Section 7000)of Division 3 of the Business and 0 LDG.. ELECT. PLG. MECH.
r H z Professions Code,and m license is in full f a and effect.
z o m - License Ctas _ Lia Number ,
9 FIo Date Contractor
P: L
a m V� UILD NG PE
¢ ¢ OWNER-BUILDER DECLARATION RMIT
B
o a v - INFORMATION
w ;LL H 1 herby affirm that I em exempt from the Contractor's License MISC.- REFER TO OR
F LL o'¢ Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE OV
VALUATION; - $/FT.
Code:Any city or county which requires a permit to construct,alter,
2 ¢ ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. C
ar a LL requires the applicant for such permit to file a Signed statement that TOTALF�D PERMIT TO
K
he is licensed pursuant to the provisions of the Contractors License •--= T
rzi
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
rF i o Business and Professions Cade)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE
¢ h m the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES •TYPE CONSTR.
a3 - by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not mor than five hundred dollars($500).): '
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Oce.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or offered.for sale(Sec.7044, Business and Professions - DRAINS-FLOOR,ROOF,AR EA,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.IT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve.
rents are not intended or offered forsale.It,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving first he did not build or im- RES IND CON PB Omer
EJ 1,
for purpose of sale.). INDUSTRIAL WASTE INTER: 30.00 ❑ ❑, ❑ ❑ ❑ _
I,as owner of the property,am exclusively contracting with
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 Codtractor's License Law does not apply
to an owner of properly who builds or improves thereon.andwhoLAWN SPRINKLERS-OVER 5(EA.) 1.00 r _
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORMEA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACO FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 '
I herby at that 1 have a cerlificaleof consent to self-insure. ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance or a certified
copy the ru Lahrinn ). O
vnPolicy N Caereby
" \ ❑ Certified copy is hereby furnish ed. {_ FIRE SPRINK ENERGY T-24
Z ' fled copy is Bled with the,city inspection division: -
p Kpplicantcant -, � . MISC.- � - REFER TO ORD. Y❑ N❑ y'❑ N❑
Fy PERMIT ISSUANCE 10.00 .FLOOD ZONE A.L.U.C.
0: CERTIFICATE OF EXEMPTION FROM WORKERS"
LU COMPENSATION I NSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one - TOTAL Y❑ N❑ Y ❑ N❑
D Z hundred dollars($100)or less I
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall.not employ any peon min any manner so as Io
U become subject to the Workers'Compensation Laws of California.
�'w Date-, Applicant BUILDING
a ALTER OR ADD TO MECH. 5.00
} ren NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z er vision you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions io flue Labor Code, you must forthwith comply with FEE
'V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00DQF.M.) 4.00 •'
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,C)MC.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 .
flie performance of N work r which this permit is issued(Sec. MICROFILM
3097,Civ.c.I HEATING UNIT(TO 100,000 B.T.U.) 8.00 - ,
Lender's Name - HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 S� -
Lender's Adss
dreELECTRIC
I certify that I have read this application and state thaLthe 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-CDMP(3H.P.or100,000 B.T.U.) 6.00
hereby authorize representatives of this city to'enter upon the BOILER-COMP IOVEr100.000BTUISEEFEESCH. MECHANICAL
above-mentioned properly forinspection purpows. -
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. '
4. uperlino against liabilities costa and expenses which - CONST.TAX f:
ay in a y way accrue agar said yin consequence of the PERMIT ISSUANCE 10.00
ra Ing this p it. MECH.CONT. LIC.NO. MECH.
Y _ _ TOTAL TOTAL
gnamra Ap icarintractor Dote
OFFICE COPY