15953 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15953
INSPECTION DIVISION
JOB INSPECTION RECORD
SV 061-7 A-- PERMIT EXPIRATION
JOB ADDRESS ioia3 .I,yoc /\-� UNIT#• _LOT
1 > �y ] PERMIT EXPIRES IF WORK
I1 OWNER Wg Lu,g • J(.ic5 �S CONTRACTOR 7]16C7t1yAL "altll IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD IBB onus OF PERMIT
FOUNDATION ANCE OR 186 DAYS FROM
'NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
j
PREGUNITE TO-COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS.
i GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED <jg4
t UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL RLOc. ELECT vLc. MEcR
Alto
-' ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED IN ILDING PERMIT
WOOD FLOOR INFORMATION
LIMBI NG - - VALUATION SIFT.
PECHANICALL C Q„\��•
PERM1II TO
E ECTRICAL '
FF AMI NG -
N ULATION STORIES .TYPE CONSTR.
OCC.GROUP HES UNITS
PLAC NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT FLOOR AREA TOTAL ACREACE
-. DIAPH AGM THE CONSTRUCTION TAX IS PAID
ROOF SH BUILDING,USE
ATHING .HES IND CON USE,
oln.,
APPLY t 0 ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L El L E] L
ASSESSORS PARCEL NO
ROUGH SAN.H
PLUMBING ELECT.ENERGY
TUBS&SHC WER PAN PLUMBING ENERGY TRACT No PARCEL NO
MECHANIC L MECH,ENERGY
ELECTRICAL ACC DATE ACC FILE NO
BUILDING ENERGY
FRAMING ,a0 ELECT,FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING -
GAS TEST GAS "
MECHANICAL FIRE SPRINK ENERGY T$4
COVER NO WOR UNTIL ABOVE HAS BEEN SIGNED HEATING YE] NL ` L 'NL
FLOODIONE A.L.U,C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR - FIRE DEPT. ;❑ NLS L N❑.
SHEETROTF
_ p GRADE - FEE SUMMARY
EXTERIOBUILDING
INTERIOTEMPORARY APPROVALS BUILDING
SCRATCH ELECTRIC PLAN CHECK
GAS FEE
NO TAPEUNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANNG IS NOT PERMITTED UNTIL BUILDING FINAL SIGNED By BUILDING INSPECTOR. MICROFILM
LU GE FOR INSPECTION BY PHONING 252-4505, a ELECTRIC.
RKING DAY BEFORE REQUIRED INSPECTION. PLUMBwc
OGIVE JOB ADDRESS WHEN PHONING.Z SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.-TAX
PLEASE READ REVERSE SIDE BEFORE "M' TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY 4,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY -
�'-• BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER
RIALOING APPLICATION & PERMIT
ADDRESS �j � I"P A7 �, 1 /9I
A fl Irv( A K BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 1 �v53
OWNER'S ;
NAME PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
LDe►-i t3ao<s1RGNE
CONTRACTOR'S
l( NAME �A OUTLETS-SWITCHES-RECEP 10.00/1.00
j MMAL MELI'la LIC.ND.ZS�oS7 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
j ADDREss APPLIANCES-RESIDENTIAL 4.00
ZJ ALDo J, C. PIioNE968-8744 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE ' P;C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.NO - SIGNS TRANS. 3.00
ARC R DR ENG, PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 ,
APPLICANT'S
ZIP TEMP.METER OR POLE INS. 20.00
- (//!-'.✓j`.^�_,ti��
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE - 20.00
O o LICENSED CONTRACTORS DECLARATION
a v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE i
rt n (commencing with Section 7000)of Division 3 of the Business and
BLDG. ELECT. PLG. MECH.
- Z w i Professions Codd��,,��Rd ryy license is In full for and Cfp�t ❑ ❑ ❑
o z w o
Date
floes SG.i V Lia tract. S�VJr7
�w� Uale 7+7-1� SComracm
aaaa OWNER-BUILDER DECLARATION BUILDING PERMIT
woar' INFORMATION
; LL H I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
H u O J Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
i Code:Any city orcounty wldchregolres a permit to construct,al tor, PERMIT ISSUANCE 10.00
SE 2<p improve,demolish,or repair any structure,prior to ifs issuance,also ELEC.CONTR. LIC.NO. ELEC.
G u requires the applicant for such permit t0 file a signed statement that TOTAL pERMl7 TO
v w re he is licensed pursuant m the provisions of the Con is License
H z¢ Le w(Chapter 9 I'momencor with Section 7000)of Div
of t he C -
4 O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M 1-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 � by any applicant fora permitsubjects the applicant 4>acivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dol lays t$500)1
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
[heir sole 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,CON D. 5.00
C.
The Con[rac or'a License Law does not apply io an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 S0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale,
mprove-mentsarenotintendedorofferedforsale,if,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
budder 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 of sale.). INDUSTRIAL WASTE INTER30.00 RES IND CON PB - Omer
.
❑ 1,as owner of the property,am exclusively contracting with El ❑ ❑ ❑ 13 licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V:B600 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 o contractors)licensed pursuant to _
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I um exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner UaIC WATER—SYSTEM ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION - - WATER TREATING EQUIP. 5.00
1 hereby affirm that I have.a certificate orconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
. PolicyolicNro se C.mpe.Y'ST1 FOND
0 ❑ Certified copy is hereby furnished I FIRE SPRINK ENERGY TY4
Certil"•d c Jflled y��t�L�I��• it n t'on division. v ❑ N❑ Y ❑ N❑
z Z MA4-_IBJ oSetT�lZI. � MISC.- REFER TO ORD.
� 0 Applicem
L4 CERTIFICATE OF EXEMPTION FROM WORKERS'. PERMIT ISSUANCE 10 �FLooO zorvE A.L.U.G.
LU > (This section need not beTcOmplletLG
ed Rif the Epennit is for onu PLG.CONTR. LIC.NO. TOTAL 1 Y❑ N❑ v ❑ No
ao '
Z hundred dollars IS 100)or less.) x
0 0' 1 certify that in the performance of the work for which this pe MECHANICAL PERMIT Jv FEEC� `.��0 FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as to J
U become subject to the Workers'Com pe mation Laws of Calllornia.
Is. Date Applicant ALTER OR ADD TO MECH. 5.0 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z empiion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=12—F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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 or the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name - -
. Lender's Address - / HEATING UN IT(OVER 100,000 B.T.U,)MO ELECTRIC
I certify that I have read this application and state that-the above VENTILATION FAN (SINGLE) 4,00
information is m
correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enterer 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 ORDCup .
mayinno against liabilities,Judgments, costs and expenses the PERMIT ISSUANCE ,-1(],00 CONST.TAX
may any way accrue against said City in consequence off the
.• ranting of this i` MECH,CONT. LIC.NO. MECH.
7-21-88 THeRINnI. 256x57 TOTAL TOTAL
Signam o Applicant/Contractor Date MELHRNICAL
OFFICE COPY