16278 POST THIS CARD NEAPFRONT OF BUILDING
PERMIT NUMBER.
CITY- OF CUPERTINO . 1627
INSPECTION DIVISION
JOB INSPECTION RECORD
•'�I�� , 1', PERMITI EXPIRATION
JOB ADDRESS N /rl(^ E!/S/%/Y`/1 UNIT# ' _LOT# - c PERMIT EXPIRES IF WORK
('n y-.�
OWNER �//`, q uG,K1Y. CONTRACTOR 5e V S ci-� �I q-' IS NOT STARTED WITHIN
INSPECTION DA INSPECTOR INSPECTION CORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 160 DAYS FROM
NOTE: LASTCALLEDI NSPECTION.
UFER ALL•GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE, TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.- ° -
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _414W
UNDERGROUND /.SLAB
PLUMBING
ELECTRICAL - .1 ISSUANCE DATE
MECHANICAL _ euiELEcr ECH.
Guy Otl
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - l auILDwD PERMIT
WOOD FLOOR - INFORMATION
VALUATION S/FT.
PLUMBING _
MECHANICAL -
ELECTRICAL PERMIT To f
FRAMING -
* • 'C !r'I C
INSULATION - sTDRI TYPE CONSTR. i
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. - ROOF. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE , SO FT.rcOGR AREA TOTAL ACREAGE
DIAPHRAGM . THE CONSTRUCTION TAXIS PAID
BUILDING USE
ROOF SHEATHING - - RES IND CON - PB C'br,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ' ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING - ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT No, PARCEL No,
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY .ACC.DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG SITE No. .
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ NE]
EXTERIOR SHEAR - ELECTRICAL RELEASE _FLOODZUNE- A,L,UIC"
INTERIOR SHEAR FIRE DEPT..
o NoY a .No
SHEETROCK GRADE - FEESUMMARY
EXTERIOR LATH IBUILOING
INTERIOR LATHTEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC -PLAN CHECK
GAS
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
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR-EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE'BEFORE
CALLING FOR FINAL INSPECTION. R o "TOTAL .�
OFFICE COPY `'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'BU I LOING PROJECT I IDENTIFICATION PERMIT NUMBER -'
y BUILDINGI
. APPLICATION & PERMIT
AI {01?
00$ pLLcoA4aL_ BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 16278
NAME
HSTI=f Elp $un5htrie 9ega,.ty 5,001
NAME PLAN CHECK VALIDATION
• M4gn4M E..ic,rpo. IT ELECTRIC PERMIT FEE 5
PHONE 1 / I A4' � La aU' a
NAMERA°rocs UTLETS-SWITCHES-RECEP 10.0011.00
W'"We¢/S riI(sH 5EMVUE LICtso 51508$ - LIGHTING FIXTURES 10.00/1.00 jam
CONTRA TORs APPLIANCES-RESIDENTIAL 4.00
44991 4M'DI111ER 8L✓0 PRONE W5165t-3µ3I PANELS 10.00 DATE OF APPLICATION
ARCHITECTW T PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER -'
LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENG' SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH. T. ./t•l l�J�,y)la^CA
ADDRESS J /Y�IIVI�Ny-fL�
A SERVICE CHANGE 20.00 Q1 Ic-'U
woo LICENSED CONTRACTORS DECLARATION 0
a i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE-
(commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT. PLG. MECH.
w Z Professions Codlband my license is in full for% and elf IT. ❑
p O w - License Inss _Lie.Numb
) / OEl
F m r DaleContractor
¢ x E PAID BUILDING PERMIT
¢ ¢ a OWNER-BUILDER R-BUILDER DECLARATION
iO a INFORMATION
w u' 0 H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
VALUATION $/FT.
u_O¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 1 lug
L Cade:Any city orcounly whichrequiresapemiiuoconstruCtalfeL AVU
¢o 00 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
¢ requires the applicant for such permit m file a signed statement that TO
a w$w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H z> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE `I ISI
X h the basis for the alleged exemption.Any'rotation of Section7031.5 STORIES TYPE CONSTR.
A ; by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,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,CON D. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREATOTALACREAGE
• himself or through his own employees,provided that such improve-
meets are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 200 BUILDING USE
builder will have tile burden of proving Dtnl h - . - . .
e did not build or im- RES IND CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,BusinessLAWN 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 contmctorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ftl10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under sec. ,B.&P.C.for finis
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, TONING
or a certificate of Workers'Compensation Insprmsce,of a Certified ENG.SITE NO.
copy(here {{,�SeL 1 00,1-ab.GJ.r. -
PolicyNo. SI ComPany n< ltnf
th
O ❑ Certified n>PY is hereby furnished. nSuM1
❑ Certified o fed will the FIRE gPRINK ENERGY T14
Z 0 copy y inspection division MISC.- REFER TO ORD.
Q APPlic:urt V D N� V D N�
~ • 10.00 as
- 1(. CIiRTIPICC0 OP SAIO EXEMPTION FROM WORKERS' PERMIT ISSUANCEFLOOD ZONE A.L.U.C.
CL / COMPIiNSA1'ION INSURANCE PLG.CONTR. LIC.N0.CL PLG,
Z (Phis section need not be completed if the permit is for one TOTAL v N v N
hundred dollars(S100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL U mil is issued,I shall not employ any person in any manner so as to
OW become subject to the Workers'Compensation Laws of California. L`L'�
y Dale Applicant BUILDING
>_ WNOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 5 -
H 2 emption,you should become subject to the Worker'Compensation APPLIANCE 5.00 PLAN CHECK Lrj
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE 2U
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE rJU
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
On, performance of the work 1'or which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 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 alLCtly and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-CONVIP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of (]its city to enter 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 ORD.
upertino against "a..... s;judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
tay, in any way accrue ga nst said City in consequence of the
,an
(ingo�this permit //r{/7,� MECH.CONT. LIC.NO. MECH.
X llQn1l /1 TOTAL
fJV1A+.- YgI31Ib8 TOTAL
Signature of pplicant 'ontractor Date 76
OFFICE COPY