15998 _.POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF: CUPERTLNO = 15998
INSPECTION DIVISION
JOB INSPECTION RECORD'
� p
/�� .�r. r0� P ERMIT,EXPI RATION'
JOB ADDRESS d 3 '� ` 'r VOLF� � UNIT# ' LOT#
- PERMIT EXPIRES IF WORK
OWNER g�jjE' CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 18O DAYS OF PERMIT ISSU.
,FOUNDATION - ANCE OR, 180 DAYS FROM
LIFER ALOLTGRADING AND DRAINAGE SHALL BE INSTALLED 'LAST CALLED INSPECTION.,
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF .PERMIT V ALIDATION
CUPERTINO STANDARDS. ,
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
••
—UNDERGROUND SLAB f
PLUMBING - 'V�.. . •�.'�4
ELECTRICAL'. ISSUANCE LATE'
MECHANICAL ` , - I,LDc .e LErrr Pcc. MECH. -
❑ ' ❑ f ❑ O
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT `
INFORMATION
WOOD FLOOR VALUATION .sTPr.
PLUMBING-
MECHANICAL -
ELECTRICAL PERMIT TO
AA
FRAMING
INSULATION STORIES TV PE CONSTR. '
� (�.�, ,
OCC.GROUP RES'UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED P COQe
' ROOF _ NOTE:NO FINAL INSP:SHALL BE E BEFORE sn.FT.FLoov AREA roraL acREacE
DIAPHRAGM THE,CONSTRUCTION TAX IS PAID,
BUILDING USE
ROOF SHEATHING - - ' Hes IND CON 'PB 011111
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q Q ❑ ❑ ❑ '
ASSESSORS PARCE
' ROUGH SAN.p ' L NO
PLUMBING - ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&'SHOWER PAN'. PLUMBING.ENERGY - -
MECHANICAL ,J� MECH.ENERGY. '
ELECTRICAL - BUILDING ENERGY Acc.DATEAcc.EAE No
FRAMING - ` - ELECT.FINAL TEST zoNlNc ENG.SITE No.
INSULATION PLUMBING
GAS TEST GAS..
MECHANICAL EIRE SPRINK ENERGY T.24 ,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NE] "0
, .
EXTERIOR SHEAR ELECTRICAL RELEASE � T FLOOD ZONE A.LU.C.
INTERIOR SHEAR FIRE DEPT. t ., Y❑ NO ' Y L-1 N❑
SHEETROCK GRADE _ FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH` - TEMPORARY APPROVALS
SCRATCH COAT . ELECTRIC PLAN CHECK •"' •rw -
GAS' FEE.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC'FEE '
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL;BUILDING FINAL'IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING.252-4505, ELECTRIC.
H ONE WORKING DAY BEFORE REQUIRED INSPECTION ` . !�' PLUMBING
O ,PLEASE'GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMITTOR EXPIRATION'DATE•—, ul'y MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE', I: TOTAL
CALLING FOR FINAL INSPECTION. -
OFFICE COPY
(MM(� APPLICANT TO,FILL IN INFORMATION WITHIN RED.'LINES - USE BALL POINT PEN ONLY
BUI LOI NG PROJECT I DENTI FICATION v ` 't` ,' . 1. ?ERMIrNUMBER
ADDRESS APPLICATION.& PERMIT . :j '
ADDRESS
-
\�, - BUILDING ELECTRICAL-_PLUMBING-MECHANICAL „+''
`�) 59 8
OWNER'S
PLAN CHECK VALIDATION.
NAME QTY, - ELECTRIC PERMIT , FEE
511---- PHONERI V - .,
CONTRACTORS
NAME OUTLETS-,SWITCHES-,RECEP '10:00/100 '
Cal-Air. Condit1.0 ic.NO. 137195 LIGHTING FIXTURES_'' .10.00/1.00 ,
1
ADDRESS
APPLIANCES-RESIDENTIAL - 4.00 .. a
CONTRA San•Jose,..Car. - ,
.1775 S 1st Bl 66.NE 947-0155 PANELS 10,00 DATE OF.APPLICATION
ARCHITECT - PLAN CHECK FEE i P C N0.
OR - PANELS (OVER 200 AMPI ':20.00 - u
ENGINEER
L No. SIGNS TRANS. 3,00 a
ARCH.DR ENG. PERMIT VALIDATION
ACHEOR SPECIAL CIRCUIT ' 5.00 'r
,ZIP TEMP.METER OR POLE INS. 20100
APPLICANT'S -
11 AOOREss, - MOTORS ,SEE FEE SCH
SERVICE CHANGE '2000'3%
.02 LICENSED CONTRACTORS DECLARATION.
a E,w • I hereby affirm[hat 1 am licensed..nder provisions of Chapter 9 ].ISSUANCE GATE
w <w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. 'PLG. - MECH.
H z Professions'Co de d Imense is in full fore fga{. - -
oi¢ W License Cir �yUy Li C.Number 13 y_1J7
F w H Do, Contractor 6/'1// Contractor �a],-�]YT- i �'
P, se a ' - ' BUILDING PERMIT '
¢ ¢w OWNER-BUILDER DECLARATION INFORMATION
F
;A N 1 hereby affirm that I am exempt from the Contracto'r's License MISC.- REFER TO ORD
H a.p J Law for the following reason.(Sec.7031,5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION
S/FT.
Code:Any city or county which requires a permit to construct,alter, I
ac 2 ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.:
¢ requires the applicant for such permit to file a signed statement that TOTAL
a
o LL PER MITTO.' •'
w m he is licensed pursuant to the provisions of the )of Division
License - - -
er Law(Chapter ndProfessions de)or Seat he is exemftthe therefrom
and `
(C the
o Business andthe alleged xempt on that he lotion fSectiefrom and QTY. PLUMBING PERMIT FEE
¢ H m [he basis for the alleged exemption Any violation of Section 7031.5 STORIES TYPE CONSTR.-
2 by any applicant for a permit subjects the applicant to a civil penalty - ALTER-DRAIN (EA.) 5.00 - -
of not more than five hundred dollars($500)J: - ;
❑ I,as owner of the property,or,my employees with wages as BACK FLOW PROTECT. DEVICE -4.00 OCC.GROUP RES.UNITS
their'sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of 1 I
property who builds or improves thereon,and who does such work - FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE^,f 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-11 INC.4 OUTLETS'6.00 ,a
or Improvement is sold within one year of completion,the owner-
.�^ builder will have the burden of proving that fie did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE '
`dJ prove for purpose of sale.). RES. IND CON PB
1:1
OtM1ar-
MM ❑ 'I,as owner of the property,am exclusively contracting with INDUSTRIAL'WASTE INTER. 30.00 ; ' Cl 1:11:1El,
\`V licensed contractors to Construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC5 V.B., 6.00 - ASSESSORS PARCEL NO:
and Professions Code:The Contractor's License Law does not apply - `
NO-
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.), 1.00 .
Contracts for such projects with a contractors)licensed pursuant to - -I
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO HPARCEL NO.
❑ 1 am exempt under Sec. B.&PC for this' - WATER HEATER W/VENT " 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE - ACC:FILE NO.'
IJ
WORKERS'COMPENSATION DECLARATION WATER TREATING'EQUIP.'
hereby affirm that I have a certificate of consent to self-insure, .ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE N0.-
copy thereofSCc.3800,Lab,CJ. - - v
Policy No. Company_T.i 1 4y Pa It Tal
Q ❑ Certified copy is hereby furnished. - FIRE SPRINK ENERGY T-24
z Z Cl Cartip' d co is til wry tue,my,inspection division. _ r
FQ Apphcunt,�Ss�. �,3,uX].L1pYy121C�-.CQB1 MISC.- •• - REFER TO ORD. y-O NQ Y� N�
may , W-(C`Ii RTIIF.IICATE OFS '�NIIPTT�OlIQ7Y ROM WORKERS' - PERMIT ISSUANCE 10.00 FLOOD ZONE j - A.L.U.G
LU COMPENSATION INSURANCE PLG.CONTE. . LIC.NO. PLG., - `
Z (This section need not be completed if the permit is for one TOT (. as'Y.❑ NQ Y❑ .N❑
hundred dollars($100)or less.) ey' �w
U O I certify that,in the,performance of the work for which this per- QTY. MECHANICAL PERMIT PEE FEE SUMMARY
LL F mit is issued,I,shall not employ any person in any manner so as to
O,W became subjectlto the Workers'Compensation Laws of California. "
.,y Date - Applicant C� 'BUILDING
},tin NOTICE TO APPLICANT:.If,after making this Certificate of Ex_ ALTER OR ADD TO MECH. 0 �I
I.:.•2 • emption,you should become subject to the Workers'Compensation APPLIANCE 5. PLAN CHECK''
provisions of the Labor Code, you must forthwith comply with ,FEE
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
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 of the work for which this permit is issued(Sec. -- MICROFILM
3097,Civ.C.).- HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 i _
Lender's Address .ELECTRIC
I Certify that I have read this application and state that the above .VENTILATION`FAN (SINGLE). 4.00
information is correct. I agree to comply with all city and county ;PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.)
hent, ..[bonze representatives of this city to enter upon the BOILER-COMP,(0wnI00,000BTUI5EEFEESCH. MECHANICAL--• .
ame Cut'. ed properly for mane ction purposes.
( ) agree to sae I emnif and keep Harmless the City of MISC.- REFER TO ORD. - ..
up no against li it 'e;judg cuts, Costs and expens which . CONST.TAX
any way a it gains[ said C'y in a'(Zah sen of he PERMIT ISSUANCE 14,06 oL
of this per IL MECH.CONT. LIC.NO, MEC
TOTAL 1 .-
TOTAL
rf / �'
Si t eo p nt/ ontractor Date Cal-Air arl `137195 a TOTAL '
OFFICE COPtl . .