15941 . �•+':., � . P( $TTHISCARDNEARFRONTOF.;BUIL'DING ;j "y
.t a PERMIT NUMBER
CITY OF C.UPERTINO
x59741
r, INSPECTION'DIVISION r
JOB INSPECTION RECORD
�; yl.�i .Nl BUD�.F tfyl° Vr-w7 t e PERMIT EXPIRATION :; o
J08 ADDRESS ,UNIT# LOT# a-,'� " -
-- PERMIT EXPIRES IF WORK.'
OWNEF• ' ' 'l•11�1.°fJdZ:�Q ` .co"TRACTOR ° �. S f;-,1" ` ,r: IS NOT. STARTED WITHIN , .
INSPECTION DATE INSPECTOR 'INSPECTION RECORD i'SWDAYS'OF.PERMIT ISSU£;
FOUNDATION ' ,.;y... r -� ANCE-OR,180'DAYS FROM'k
.NOTE." ,'` � r " LAST CA L L E D I NSP ECTI ON "I
ALL GRADING AND DRAINAGE.SHALL BE INSTALLED
PR EGUNITE -
TO COMPLY.WITH THE APPROVED PLANS AND CITUOF,' 'PERMIT.VALuanoN
+ ' CUPERTINO STANDARDS. a
GARAGE SLABS,, -;d - • I i, r2;� ,.� ,;i '
POUR.NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
/
UNDERGROUND /,SLAB
r PLUMBING :jt•
,
L .?' ELECTRICAL .. - .. ^ :� r.!
�. yi p "ISSUANCE DATE
MECHANICAL c - y BLDG. - ,ELECc. PLG MECH.
DO NOT POUR FLOOR'UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
,W INFORMATION' "
OOD FLOOR• v- a 5
A A
, _, V LU TION $/FT
PLUMBING p � .�*� + �. -
MECHANICAL + +;
ELECTRICAL PERMIT To c
FRAMING
INSULATION ' l i_+' r "S_TORIES TYPE CnNSTR .-
N '
UCG GHOUP RES,UNITS
PLACE NO SUBFLODR UNTIL ABOVE HAS BEEN SIGNED - o PT.aooRARPA o.ALACREAGE
`r ROOF ,. NOTE'' FINAL INSP:SHALI,BEMADEBEFORE { s'
+� - - THE C NSTRUCTION TAX IS PAID
DIAPHRAGM
y h ' BUILDING USE
Ar..a ROOF.SHEATHING +� +r - s, " RES IND "CON- PB
APPLY NO•ROOFING UNTIL ABOVE HAS BEEN'SIGNED '" FINALS -••- "� , DATE .INSP,.:y ' Q' "•[1 E .'❑''
I!ASSE SSORS FARCE LINO.
ROUGH - • 'SAN.N
t1l ' PLUMBING :a , - r • ; ELECT.ENERGY-
TUBS B SHOWER PAN PLUMBING.ENERGY 1TRACT No PARCEL NO
MECHANICAL`,. - MECH.ENERGY.
ACC.DATE,', ACC FILE NO. T'
ELECTRICAL + - BUILDING ENERGY •,, g '
pit
FRAMING ELECT.FINAL TEST
P INSULATION -• , <. PLUMBING I, ; ZONING T o."#ii
GAS TEST. °.,. : �, GAS ,+ i sI E' {
t
ENG N
_ .FIRE SPRINK ENERGY T 24,•y
MECHANICAL r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� ❑ t"0
S LOOD mNE y; A L u c ,
EXTERIOR SHEAR? -i. ELECTRICAL RELEASE ?. ,
a : INTERIOR SH EAR `t'; FIRE DEPT.' N� ✓�]- ,NQ
y+.. SHEETROCK +
',x GRADE, N FEE SUMMARY
EXTERIORLATHL BUILDING:."', `,* '? . - -
INTERIOR LArW ` -.TEMPORARY'-APPROVALS BUILDING
-� SCRATCH COAT - ' ELECTRIC 's PLAN CHECK ]
GAS Y . EEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE"
1 I'1 ,A OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BYBUILDING INSPECTOR ;'MICROFILM
p _ x+
ARRANGE FOR INSPECTION BY PHONING 2524505 `` ELECTRIC
��a ONE WORKING-DAY BEFORE REQUIRED INSPECTION
z PLEASE,G IVE'JOB ADDRESS WHEN PHONING PLUMBING a
�`. SEE PERMIT FOR EXPIRATION.DATE yT MECHANICAL
FMPORTANTI- corysT rax
PLEASE READ.REVERSE SIDE`BEFORE TOTAL'
CALLING FO
R FINAL'INSPECTION .
OFFICE COPY ' I '
" AR,PtiC„4Nz=TO FI4L Ii ,4NFORMATION ,WITHIN RED LINES ,- USE'BALLr POINT`IP,EN ONLY•`'.> ,
BUI LDI NG PROJECT I DENTI FICA:WN,- - - •” J-. rPERMIr NUMBER " •�
•" BUILDING 6„ I ', ''APPLICATION &(PERMIT- _ 1 Gf� A �_ ;
t - ADDRESS - • - I J J 4
/O� N." 0' Fe' �Pd-/00.3 BUILDING-ELECTRICAL—PLUMBING"!MECHANICAL
"
;g A4 m OWNER'S w/ PLAN CHECK VALIDATION.
4; G/D/_ NDe� � '`8,�,QTY. - "ELECTRIC PERMIT - FEE { -:;• 6 S" ,, Q
,14AME CTOR'S t� VVV
qmE '�- _/ .OUTLETS-SWITCHES:-RECEP •10.00/1.b6
6" evI�¢C/C' a LIC:NO, LIGHTING,FIXTURES •.10.00/1 00
CONTRACTOR'S
ADDRESS APPLIANCES' RESIDENTIAL ;,4.00 ,
' PHONE PANELS' '.k 10,00 .I DATEOFAPPCICATION'�
_ ARCHITECT PLAN CHECK FEE P.C:'NQ '
PANELS(OVER 200'ANIP,) •+ •' 12000
ENGINEER
.`..ucdrvo. ' SIGNS TRANS: .,n •� .r y 3,00ARCH.OR
( ADDRESS ENG. - SPECIAL CIRCUIT F,.. 5.00 PERMIT VALIDATION
zIP EMP.METER ORPOLE,INS ,,1 20.00 - I 1;3_w.4
,+ APPLICANT'S
I'- ADDRESS •,- • . MOTORS SEE,FEE SCH.
SERVI CECHANGE °` 20.00 <, i
i
woo - . LICENSED CONTRACTORS DECLARATION d -
4'. a o u '1 hereby at that I am licensed under provisions of chapter9 a' 1
y'Q m (commencing with Section 7000)of Division 3 of the Business and'' -- - ISSUANCE DATE •'
BLDG. ELECT. PLG.' MECH.
C y — License Class
COdC,and my license Lie.In full fOFCC and effect. , y _ `/
2 o w - Date—.-.,
Class Lin Number 111KX'IY '� ❑t
o m �o Date Conhac[or'
4 . _r BUILDING PERMIT
g•¢ w a OWNER-BUILDER DFCCARATION, - ! INFORMATION '•'"
alo a " MISC. a +. 1 REFER TO ORD
y I hereby affirm that am exempt. rom the Contractor's License
LL O a Law for the following reason.(Sec.7031.5,Busine6send Professors 'VALUATION $/FT.
� - PERMIT ISSUANCE a ., 10.00'
Code:Any city or county which re luiresu permit to construct,alter,
' - do
S ¢ , a0 O Improve,demolish,or repair any structure,prior to its Issuance,also �ELEO CONTR� - LIC.NO. . 'ELEC t 0
¢ requires the applicant for such permit to file a signed statement that h TOTAL
4 v w m¢ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
k r '.J Law(Chapter 9(commencing with Section 7000)of Division 3 of the - - / ° ?- "" o-
io ' Business and Professions Code)or that ho is exempt therefrom and DTV. `PLUMBING.PERMIT,' :'FEE' 1
•¢ I-o the basis for'the alleged exemption:.Any violation ofSecliod903 L5 - .,{ STORIES TYPE CONSTR.
1 + aim by any applicant for a permit subjectslhe applicant to a civil penalty' , ALTER-DRAIN&'VENT-WATER (EA.) 5.00 %
of not more than five hundred dollars($500).):..I' -
❑,,1,as owner of the property,or my,employees with wages as gACWFLOW.PROTECT{DEVICE , 4.00 OCC.GROUP PES.UNITS
their sole compensation,will do the,wark,'and the structure is not.
intended or offered for sale,(See. 7044, Business and Professions - DRAINS-FLOOR,.ROOF,AREA,COND.. 5.00 ' ...
Code:The Contractor's License Law.does not apply to an owner of - ' - -
fTN. _ properly who builds Or imp...Cs thereon,Bad who does such work ' FIXTURES--PER TRAP.. .,i S 0D - '$D.FT.FLOOfl AREA �TOTALACREAGE�
himself of through his own employees,provided that such inipro c
mems am not intended or offered for sale.If,however,the building GAS-EA SYSTEM-1 INC.4OUTLETS 600
I`� or,improvement is sold within'one year of completion,the owner. GAS-EA:SYSTEM-OVER 4'.(EA) „> 2 00 BUILDING USE <,
40 budder will have the,burden of proving that_Ite did not build o im-.
+'� prove for purpose of sale.). ` '°- RES IND' CON PB Other
0`1,as Owner of the prop rty am'excluslvely contmctingwith INDUSTRIAL WASTE INTER '•� .O El
-„OI
licensed contractors to'cone met the project(Sec.7044,Business - LAWN'SPRINKLERS-1ANC 5 V B'. 600 A5 ESSORS 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.-OV_ER'_5(EA.)- 1.00
contracts for such projects with a con Ractor(s)licensed pursuant to -' -.
the Contractor's License Law. _ SEWER-SANITARY-STORM EA.-200ft/10.00 TRACT No PARCEL NO.
❑ bom exempt under Sec. ,B.&l'.0'for this -
reason� WATER HEATER W/VENT `y' 6.00
Owner [<aM� Rat '/ WATER SYSTEM - ' 5.00s
. 1 •ACC.DATE .ACC PILENO. .
WORKERS'COMPENSA7'ION DECLARATIONWATER _ S
'TR EATING EQUIP 5. 1
- I hereby infirm that Lhave a certificate of consent to self-insure, % ,tpv
° 'ZONING ENG.SITE NO.;
or a certificate of Workers'Compensation Insurance,or a certified
` copy thereof(Sec.3800,Lab.C) y r
Policy No, Company
O ❑ Certified copy is hereby famished 8 FI RE SPR INK ENERGYT�24 .
z'.Z.j ❑ Certified.copy,is filed.with the city inspection division. ' '
�O - Applicant a. MISC. R OORD. ' a , Y❑. NQ; G,0 'N[
~•y ':PERMIT ISSUANCE
�' CF:RTIFICA EMPTIO NFROM'WORKERS' 1000 ;-FLOOD ZONE A.LU C. .
W,>_ , COMMPENSAPENSATION INSDRANCF. PLG.CONTR. LIC.N0: PLG
0-10 (This section need not be completed If the pemuIs l for one TOTAL { Y❑ N[3Y, N
D�Z hundred dollars IS 100)or less.) - - ,
00 '.. l eerily that in 0a performance of the work for which lhis,P`cr- OTY. MECHANICAL PERMIT . . •iFEE FEE SUMMARY
LL'} : Our issued,I shall not employ any,person in any manner so as 0, _
C) w become subject m the Workers Compensation Laws of Callfommo:.
Date Applicant _ ALTER OR ADD TO MECH :5.00 BUIILDING
} yy- NOTICE TO APPLICANT: It,altevmaking this Cerlalicate of Ex - - �G- 4
z loreptiom,you should become subject to the Workers'Compensation APPLIANCE _ '"5.00 PLAN CHECK -
i- provisions of the Labor.Code, you must forthwith Comply with o- , FEE
V` - such provisions or thispermit shall be deemed revoked. AIR HANDLING UNIT(TO 10,OOIJCF.M.) ,4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10p00C.EM.) 600 SEISMIC FEE',_
1 hereby affirm that there is'a constriction lending agency for EXHAUST HOOD (WITH DUCT) ` _ t"5:00 ( • -I, -
Oleperformance of the work for which this permit is issued(Seca - ' MICROFILMr
-e 3097,CieC.). „v - HEATING UNIT(TO 100,0008.T.U.) 8.00
Lender's Name HEATINGUNITIOVER100,000B.T.U.0.50
` Lender's Address - - - .. ELECTRIC,
?'T"tilj ( certify°ihatlhac cud this appli anon and slate that the above I♦ " VENTILATION FAN (SINGLE), " 400
° mtonnalion is correc[.I'agree to comply,with all cityand county PLUMBING J.
ordinances and state laws relating to building construction and - - BOILER'COMP(3H P.On100000 B.T.U:1 600 J mi
it herety.aulhorie representatives of.this,city to enter upon the - ' a
'✓ above-mentioned property for inspection purposcs'. BOI LER-COMP (Over 100,000 BT61 SEE FEE SCM , 'MECHANICAL,,, _
(We)-agree to save, indemnify and keep harmless the City of I MISC.'- REFER TO ORD
'+ upertino,against liabilities,judgments, costs and expenses whah PERMIT ISSUANCE .10.00 .CONST.TAX'
i"-I, may,in=any way,accrue'against^said City in consequence of the
' $:
rantn D6this permit i MECH.CONT LIC.NO. MECH -'
Gcr�Ci° tGt/Gtdq�/ TOTAL (TOTAL
I + '' Signemre oPApphcanl/Contractor` ,Date i; �y b• '
OFFICE COPY �': ,