16232 POST. THIS CARD NEAR-FRONT OF•BUILDING -
A ' PERMITNUMBER
OF =CUPERTINO ," I1 .23Z
INSPECTION DIVISION
JOB INSPECTION RECORD F
PERMIT EXPIRATION '
�0'/a3 �/' #t/1%0LFc
JOB ADDRESS UNIT# _LOT#
-.r PERMIT EXPIRESJF WORK-1
OWNER ` �.,Pp.�/ ,`. :CONTRACTOR ' ` �{ 't '.IS, NOT STARTED 'WITH IN
!- ' INSPECTION DATE INSPEC OR INSPECTION RECORD ;,16o.DaysoFPERMIT issu '
?ANCE OR 180 DAYS FROM'%
i � FOUNDATION'S NOTE: '
LAST CALLED INSPECTION. '
LIFER - ALL GRADING'AND,DRAINAGE SHALL BE INSTALLED 5 i
d°' t -TO COMPLY WITH THE APPROVED PLANS AND.CITY-OF- �. ,P6RM1UT VALIDATRJN ,, - yl "
1 PR EGUNITE
CUPERTINO STANDARDS + - s
GARAGE SLABS'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED'
'- UNDERGROUND /SL'AB
PLUMBING
W'o
ELECTRICAL r - .e P. i1 ISSUANCE DATE
" fV1ECH'ANICAL ELECT. PLC MECyi
,
` G
DO NOTTOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 0(Cope s�N ORMATIONI'.s
WOOD.FLOOR' 'I » CN -VALUATION „vy, t$rFT
PLUMBING n".
MECHANICAL ' ,3M''
_ - e, t .<
_-ELECTRICAL -+�'' .'PERMI/r--Tyo
_ FRAMING ' �v .. t t.� {'
INSULATION , ORIs'„' t - , CONSTR_,i
TY PE
RES UNITS ;
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED >
^ So FT'FI.00R AREA TOTAL ACREAGE { ,
+ ROOF. NOTE:NO FINAL INS°.SHALL BE'MADE BEFORE , + ;
.I...
THE CO
DIAPHRAGM .1 NSTRUCTION TAX IS PAID
INBUILDING VSE
ROOF SHEATHING + .1 - "vss' D CON, RB : o
e APPLY NO.ROOFING,UNTILABOVE HAS BEEN SIGNED; " FINALS y'!'DATE INSP, 0' ' � .,0'' '❑ '�
.... .ROUGH ,. '.. -•"' -BAN.p .,
SSESSORS'PARCEL NO
PLUMBING, 1,
ELECT.ENERGY ,
TUBS 8 SHOWER PAN;'. PLUMBING ENERGY TRACT NO ,PARCELli
No
l:-- - MECHANICAL + A`� tj
MECH.ENERGY - r 'ncc,Dnre ACC FILE No.
'ELECTRICAL . ,,,_ . i BUIL DING,ENERGX' '�; `
FRAMING - ELECT.FINAL TEST ZONING ENG.slrE No..
INSULATION PLUMBING - _ , - t :
I
GAS TEST . _ GAS
- ` c MECHANICAL'. I FTRf SPR INK ENERGY-L44 -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "` [:j NO
”
„.
FLoop ZONEn nLucy,
+'�• EXTERIOR SH EARELECTRICAL RELEASE
'^ INTERIOR SHEAR-'' - '" „'FIRE DEPT -; I'„ ' «"D'' N.O' ❑ HQ
SHEET.ROCK - ' ,_4W .. GRADE'S - , . FEE/SUMMARY '
EXTERIOR LATH.. - s. BUILDING BUILDING
+, INTERIOR 'LATH `. A-' 1,„, � `� TEMPORARYAPPROVALS � � _
SCRATCH COAT:` - 'Y ' ” '.` ELECTRIC _ ,PLAN'.CHECK
•} . + GAS FEE'.;
R PLASTER UNTIL`ABOVE HAS BEEN SIGNED' OCCUPANCY „ 4 , ''SEISMIC FEE.' I
OCCUPANCY OF BUI LDI NG.IS NOT PERMITTED UNTI L BU I LDINGF INAL IS SIGN EDGY BU ILDING INSPECTOR: P ICROFILM-
.I'
- + . ECECTRID 60
'ARRANGE.FOR NSP.ECTI,OWElY PHONING,2524505 a n
ONE WOR BEFORE REOULRED:INSPECTION PLunnelNc'
Z � ,; , PLEASEG'IV.EJOBADD,RESS,WHENPHONING ''-.'
MECHANICAL
SEE PERMIT FOR'EXPIRATION/DATE = '
'IMPORTANT!, CbNST TAk-
'F o
PLEASE,READ REVERSE SIDE.BEFORE TOTAL ' !
CALLING FOR FINAL INSPECTION
.OFFICE COPY'
,.� E
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICAT .PERMIT NUIsi
BU110I
'h DI DING APPLICATION & PERMIT
s1 6 2 3 2
' ~ BUILDING -ELECTRICAL-'PLUMBING—MECHANICAL' I -V U'V LI
OWNER'S — I PLAN CHECK VALIDATION
NAMEHf+ -�
• - i^� - OTV. ELECTRIC PERMIT FEE
CONTRACTORS Mrd
NA NAE Y\ �}�) /^ UTLETS=SWITCHES-RECEP 10.00/1.00
t .N .`-'�1V LIGHTING FIXTURES - 10.00/1,00 ..
cn
ooeea roR's r'4� t APPLIANCES-RESIDENTIAL 4.00 -
PHO.E50 PANELS 10.00 DATE OF APPLICATION
ARCHITECT , - PLAN CHECK FEE P.C:NO.
GR - - PANELS (OVER 200 AMP) i _
ENGINEER '
LIC.No. SIGNSTRANS. 3.00 °i'
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT
ZIP EMP.METER OR POLE I
AS _ .•i MOTORS FEESCH.
ADDREDDRESSS
SERVICE CHANGE 20:00Q�
Z ..
wo " LICENSED CONI'RACTORS.DECLARATION - - "'
FU w 1 hereby affirm that I am licensed under provisions of Chapter 9 i ISSUE DATE
a R, (commencing with Section 7000)Of Division 3 of the Business and BLDG. I.ELECT. PLG. MECH.
H m z Professions Code,and my license is in full force and effect. q ❑'
.2 o w License Class Lie.Number V4 ❑.
O Date Contractor
H N F utt
a m =1. BUILDING PERMIT
¢ ¢ a OWNF-R-BUILDER DECLARATION
.o a u - INFORMATION
E,
; a-w I tiemby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
F UOJ Law for the following reason.(See,7031.5,Business and Professions PERMIT ISSUANCE VALUATION S/FT.
Code:Any city or county which requires a permit to construct.alter, p�
icQ ¢ Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC NO. ELEC. �/J V✓ '' r
¢. requires the applicant for such permit to file a signed statement that TOTAL ✓�V- PERMIT TO
n w$ ha is licensed pursuant In the provisions o1the Contractor's License > 1r
r
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 7e7--f �Z�'CT
f i o• Business and•Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT -FEE -
¢ H$ the basis for the alleged exemption'Aoy violation ofSection 7031.5 N STORIES ' TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATERIEA.15.00 '
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with�wugas 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(Sce.7044, Business and Professions' DRAINS-FLOOR:ROOF,AREA,COND. 5.00
Code:The'Conlractor'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-
ments are net intended oroffend for sale.If,however,the budding GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year Of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) "2.00 BUILDING USE
buttder will have the burden of pioving that be did not build ur im: REB' ,IND CON .PB ,Omar
prove for purpose of salol. INDUSTRIAL WASTE I NTE R. 30.00 I
❑ 1,as..her of the property,an exclusively conlmeting with - ❑ , ❑ ❑ - ❑ ❑l
. 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 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 a contractods)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00
the Contractor's License Law. - •TRACT NO. PARCEL NO.
o.Eln1 ant exempt under Sec. -,B.&P.C.fnr this WATER HEATER W/VENT 6.00
Owner Date, WATER SYSTEM 5.00 -
ACC.DATE ACC.FILE N0.
,WORKERS°COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
- I hereby affirm that I have a certificate ofcunsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
Copy thereof 00,Lab.C.). F
/ Policy.No thereof
0 ' ❑ CCPDNe copy 'horehy furnished. FIRE SPRINK ENERGY T$4'
Z Z ❑ .Cert" py is .with I e cit 'nspection:divismn.
0 Applicam MISC.- REFER TO ORD. Y N❑ v ❑ N❑
~ — - PERMIT ISSUANCE• 10.00 FLOOD zorvE A.L.u.c.
CERTIFICATE OF EXF,MPTI N FROM WOR KI'RS'
LU > 'COMPENSATION INSURANCE. PLG.CONTR. LIC.NO.- PLG.
C O: (This section need not he completed it the penmll Is far one TOTAL - Y❑ N❑ Y❑ No
Zhundred dollars(S 100)or It
U O 1 certify Thal in the Performance of the work for which this peOTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as tor- _
U become subject to the Workers'Compensation Laws of California.
w Dam Applicant ALTER-08 ADD TO MECH. 5.00 � BUILDING
} y NOTICE TO,APPLICANT': If,after,making this Certificate of F.x-
F 2 emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK'
provisions of the Labor Code, you,must foitliwifh comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.)' 4.00 '
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,00011F.M.) 6.00 SEISMIC FEE
I hereby affirm't11m 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.). I HEATING UNIT(70,100,000 B.T.U.) 8.00 )
' Lender's d
Address me
Lender's Addr . HEATING UNIT(OVER 100,000 B.T.U39.50 ELECTRIC. oD_ �'
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and slate laws rotating to building construction, and B5ILER-CONP(3 H.P.or 100,000 B.T:U.) 6.00
hereby authorize representatives of this city to enter upon.the BOILER-COMP (Over 100,000BTU)SEE FEESCH: %MECHANICAL
above-mentioned property for inspection"purposes. _ -
(We) agree to'save, Indemnify and keep harnlless'th"C_ity of MISC.- REFER.TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City inconsequence of the ` PERMIT ISSUANCE 10.00
Oil th"rriw mit - MECH.CONT. LIC.NO. MECH.
TOTAL ' . TOTAL
' Sig are of App marl C racmr Date, '
OFFICE'COPY S