15756 POST THIS RD NEAR FRONT. OF BUILDING PERMIT NUMBER
:,, CI-M OF CUPERTINO 1575
•INSPECTION•DIVISION
JOB INSPECTION RECORD '
rPERMIT EXPIRATION
. JOB ADDRESS�� ' �•- V✓d L�� - UNIT# _LOT# 'g
- PERMIT EXPIRES IF WORK-'
- OWNER �Lr� e U ,(' , CONTRACTOR c: -Z l Z ,EY,fG /G IS NOT STARTED WITHIN ,
INSPECTION ATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT iSSU-`,
FOUNDATION - OR 180 DAYS,FROM':
NOTE: LAST CALLED INSPECTION.;
LIFER, s ALL GRADING AND DRAINAGE SHALL BE•INSTALLED
PREGUNITE TO COMPLY WITH'THE APPROVED PLANS AND CITY OF 'PERMIT,VAI.IDATION
CUPERTINO STANDARDS. `
:.'GARAGE SLABS '• - - 'j `
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /S'• �i1iFi , .�2 .y_c- ' . j
'
UNDERGROUND /SLAB - - ' tL '""- •'
PLUMBING
ELECTRICAL " - _ ISSUANCE DATE - - i
MECHANICAL - - T77 EL T. PLG.❑ m❑ i
El 1 r
VDO.NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
i. WOOD FLOOR " INFORMATION '
PLUMBING VALUATION --.SIFT.
' MECHANICAL - -
'ELECTRICAL. - PERMIT TO
FRAMING . . •_`9",•-7'
INSULATION - - STORIES TYPE CONSTR.
OCC.GROUP RES;UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF - - NOTE:NO FINAL INSP'SHALCBE MADE BEFORE •SO.FT,FLUUB AREA TOTAL ACREAGE
DIAPHRAGM,' THE CONSTRUCTION?AX IS PAID' -• '
BUILDING USE
ROOF SHEATHING - ,. RES ..IND 'CON Pa - UT—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE- INSP. ❑ ❑ ❑ ❑ • ❑
ROUGH SAN.N - ASSESSORS PARCEL NO.
PLUMBING ', ELECT.ENERGY, -
TUBS'8 SHOWER PAN' - PLUMBING ENERGY - TRACT•NO. PARCEL NO
. � r MECHANICAL MECH.ENERGY.
ELECTRICAL•' - - - BUILDING ENERGY ACC.DATE ACC.FILE NO, �• 1
FRAMING ELECT.FINAUTEST _
' ZONING ENG.SITE NO.
INSULATIONS - PLUMBING
GAS TEST - GAS -
' MECHANICAL FIRE SPRINK • ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ` ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE Pepon zorvE A.ruc
INTERIOR'SHEAR FIRE DEPT. - Y.El N❑ 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 OCCUPANCY SEISMIC FEE
OCCUPANCY OF'BUILDING IS NOT PER N MITTED UTILBUILDINGFINALISSIGNEDBYBUILDING INSPECTOR. 'MICROFILM
' s
ARRANGE FOR INSPECTION BY PHONING,252,4505, ELECTRIC
Lu 'ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING10 'PLEASE GIVE JOB ADDRESS'WHEN PHONING.
Z
--SEE PERMIT FOR EXPIRATION DATE - •MECHANICAL •
,IMPORTANT! '
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ,'z' ;• ° TOTAL
_ -CALLING FOR FINAL INSPECTION. _
OFFICE COPY
APPLICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE B LL POINT PEN ONLY
" BIJI LD1 NG PROJECT 1 D NTI FIC -PERMIT NUMBER _
B°ILUING/o/a3 •WdL 5v - APPLICATION & P IT 15756
ADcmm s
f;VI#=rI GARC� to& BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'$' - PLAN CHECK.VALIDATION
NAME ,�/�yy QTY. ELECTRIC PERMIT FEE ..
GOK/-V/" FW�LIL- � HONE �
CONTRACTORS
'
NAME c OUTLETS-SWITCHES-RECEP -10.00/1.00
1ZGL rGL11Gr LIC.NO. 375G4,2_ _5 LIGHTING FIXTURES 10.00/1.00
" i
CNTRAAC DDRESS ams
AAW - - APPLIANCES-RESIDENTIAL 4.00
gip.,
N50 I; L 110 PHONE I5 3rop W10ANELS 1 104)B / DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.+NO.
oR - - PANELS (OVER 200 AMP) .. 20.00 r
E GINEER ,• - ,
.wh17 Luc.No.tq Sy" SIGNS TRANS. 3.00 '
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS cy� SPECIAL CIRCUIT 5.00 -
$•$3 MA IIUIV ST Vi',51 2IP .T/O3 EMP.METER OR POLE INS. 20.00
ADDRESS - I MOTORS SEE FEE SCH. .27
ADDRESS
'$0 a:)Vw*,,0 15T. R04-0*0 [ca *Put SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
a u u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE
r a (commencing with Section 7000)of Division 3 ofthe and
w ¢ - BLDG. ELECT. PLG. MECH.
r w m Professions Code, nd license hs in full fcanAapd,eSSept.� ❑, ❑
o i m W License Cass Lue.Number S �6//O0
H w r J Date Contractor
am s 3 BUILDING PERMIT
at a OWNER-BUILDER DECLARATION -
o a u - - - INFORMATION
w 3 LL w 1 hereby affirm that I am exempt from the Contractor's License MISC.- - REFER TO ORD
VALUATION
FU Oj Law forlhe following reason.(Sec.7031.5,Business and Professions' , PERMIT ISSUANCE - .90
Code:Any city or counly,which requiresa permit m construct,alter, - -
2 ¢Q p improve,demolish,or repair any structure,prior to its issuune,,also ELEC.CONTR. .` LIC.NO. ELEC.
a0
m u requires the applicant for such permit to file a signed statement that TOTAL S d 4r_J PERMIT TO
he is licensed pursuant to the provisions of the Contractors License _ ��----��//��y..�..
r z i
Law(Chapter 9(commencingwlth Section 7000)of Division 3 of the 06`!7-
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
rE r the basis for the alleged exemption.Any violation of Section 7031.5 - 5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant loo civilpenalty - ALTER-0DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC:GROUP RES,UNITS
their sole compensation,will d0 the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREACOND. 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-
.cuts are not intended or offered for sale.If,however,the building GAS-EA.SY,STEM-11NC.4OUTLETS 6.00 '
or improvement is sold within one year.of completion,the owner- GAS-EASYSTEM OVER 4(EA.) 200
builder will have the burden of proving that he did not build or inn- . - .
- . BUILDING USE
RES IND CON PB - Other.
prove for 1,as owner
of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ - '❑
❑ d as owner of the property,he 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 Contractor's License Law Joos notofapply
to anowner of properly who builds improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 I
contracts for such projects with a contrtr actors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 _
the Contractor's License Law. TRACT NO, PARCEL N0.
0 I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner - Date WATER SYSTEM 5100 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP.. 5.00 -
1 hereby affirm that I have a certificate of consent to self-insure, -
or a certificate of Workers'Compensation Insurance,o-rLa�-certifieedd - ZONING ENG.SITE NO.
copytheLab,C)Qwvr3LF(• 1•I�4tP"11.1LT1 '
copy the 0,Lab.
J-1'F�
O M, Certified copy is hereby furnished FIRE SPRINK ENERGYT-24
Z 2 ❑ Certified copyisfded with the city inspection division. - REFER TO ORD.Q Applicant MISC.- Y ❑ N❑ Y ❑. N❑
CERTIFICIFROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE
PLG.CONTR. LIC.NO. PLG.
11 O (This section need not be completed if the permit is for one TOTAL ❑ N❑ Y❑ N.❑
Z) 2 hundred dollarS(5100)car less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
ILL.I- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'CompensalionA Laws of California.
0'y Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
>_ N NOTICE TO APPLICANT'. If,after making this Certificate�of Ex- - -
F;2 enhption,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 of this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOC.F.M.) 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,CN.C.) H EATING UNIT(TO rI 00,000 B.T.U.) 8.00 -
Lender'sName _ 'f HEATING UNIT(OVER 100,000 B.T.U.)9.50 •ELECTRIC Z
Lender's Address
I,certify that I have Fead this application and orate Thal the above VENTILATION FAN (SINGLE) 4.00 .
„ information is correct. I agree to comply with all city and county PLUMBING
ordinances and star, laws relating to building construction, and BOILER-COMM 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.purposeBOILER-COMP (Over 700,000 BTU)SEE FEE SCH. MECHANICAL
s.,.
(We) agree to save, indemnify and keep harmless the City at MISC.- REFER TO'ORD. -
upertino against-liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 'CONST.TAX
may in any way accrue against said City in consequence Of the
Tailing of this permit �p MECH.CONT. LIC.NO, MECH.
TGTAL_ TOTAL
Signature of Ap- a(or Date
OFFICE COPY