16570 POST THIS RD NEAR FRONT OF BUILDING • PERMIT NUMBER
�.. C11TOF CUKRTINO . 'f 657D n
INSPECTION DIVISION
JOB'INSPECTION RECORD
. 1 � 1' •(,(�/� 1pd� PERMIT EXPIRATION ' ,
JOB ADDRESS I d I K3 A r VI/d L7� UNIT# _LOT# "
PERMIT EXPIRES IF WORK
OWNER Lf CONTRACTOR Gj �;�•'T,n/p (,.r(,�si?C,�c- IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 100 DAYS OF PERMIT ISSU
FOUNDATION - - ANCE OR 180 DAYS.FROM
NOTE: LASTCALLED INSPECTION. '
LIFERALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EG UNITE - TO COMPLY WITH THE APPROVED,PLANS AND CITY OF PERMIT`VALIDATION
CUPERTINO STANDARDS,
GARAGE SLABS "
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �D-/f�S k9/� wA d-
UNDERGROUND'/SLAB K457 jf.41 " ttlAl_�
PLUMBING
ELECTRICAL ISSUANCE ware
MECHANICAL - ., ELECT" PLG. MECR-
❑ o ❑ a .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDDING PERMIT
WOOD FLOOR '
OC INFORMATION
PLUMBING - • - CAI t CUott �" $IFT.
MECHANICAL -
ELECTRICAL _ - PER"'IT TO '
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES UNITS .I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO FT.FLOOR AREA TO TAIL ACREAGE
i
DIAPHRAGM THE CONSTRUCTION TAX IS.PAID .
ROOF SHEATHING _ - Res IND.
USE
PR �orl,,.• '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED- - FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.#
ASSE55ORS PARCEL NO
� ' - ,
PLUMBING' ELECT.ENERGY
- TRACT NO , PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY' ACC.DATE ACC.FILE No 7
FRAMING .ELECT.FINAL TEST - !
INSULATION PLUMBING ZONING ENG.SITE NO. ,
r
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑, NE]
.FLOOD LONE A.L U.0
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. v❑ "❑ v ❑: "❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
` INTERIOR LATH TEMPORARY APPROVALS 'BUILDING
SCRATCH COAT • ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUP.ANCV SEISMIC FEE i
i " OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICLU
F--�' ONE WORKING DAY BEFORE REQUIRED INSPECTION.
. . O PLEASE GIVE JOB ADDRESS WHEN.PHONING. PLUMBING
Z
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! II•" CONST:TAX
PLEASE READ'REVERSE SIDE BEFORE " TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY . I?�, •.. _
14,°.
APPLICANT TO FILL IN INFO ATION'WITHIN RED LINES - USE LL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FIC .PERMIT NUMBER
ADIDRESS APPLICATION & PE IT 16570
ooREN � �7
�3 i/"o/.. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
NAME . PLAN CHECK VALIDATION
'• Af-- C_-r401)6-/f/:SPHONE OTY, ELECTRIC PERMIT FEE
CONTRACTOR'S
NAME H OUTLETS'-SWITCHES-RECEP 10,00/1.00
A)0 FLS 0c,NO, J?g43 LIGHTING FIXTURES 10.00/1.00
ADDR.EESSSTO[R1's I PPLIANCES-RESIDENTIAL 4.00
) [-.- F_ [- ,.J PHONE 9//dO PANELS 10,00 DATE OF APPLICATION
ARCHITECTOR PANELS (OVER 200 AMP)' - 20.00 PLAN CHECK FEE-* C,N0.,
ENGINEER - T
' LIC.NO. ISIGNS TRANS. - 3.00
AOODR'Ess E"G' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00
APPLICANT'S •�
aooREss MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 / �+
�00 LICENSED CONTRACTORS DECLARATION - (/f} 'F/✓I Qr�O %!�p ;
¢ 0 U I hereby affirm that I am licensed under provisions of Chapter 9
2 w ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
w i Professions Cod�O ,'red m�license is in full fore �d�c f cj" BLDG. ELECT. PLG. MECH.
z z g a License C ass O Lia Number (
w Date Contractor V '
¢ ¢ w a OWNER-BUILDER DECLARATION �pO BUILDING PERMIT
°n ° - MISC.- REFERf(M`j1sy, ly
INFORMATION
X ; LL w I hereby affirm that I am exempt from the Contractor's License `�--' , VALUATION $/FT.
u.°a Law for the following reason,(Sec.7031.5,Business and Professions 10.00 � 70.
- st PERMIT ISSUANCE
Code:Any city or county which requites a permit to construct,alter,
aar¢� improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.- LIC.NO. ELEC. G
O u requires the applicant for such permit to file a Signed statement that C19PtiiC.�,JO' �C q� TOTAL5yr SU PERMIT TO
F
m he is licensed pursuant to the provisions of the Contractor's License _ YY
r z rt
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe -
4° Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r e the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toe civil penalty
of not more than five hundred dollars($500)Ji ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 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 docs 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-
Poemsmanotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder 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.). RESINDUSTRIAL WASTE INTER. 30.00 1:1 El
I❑ ❑N FES❑ Other❑
❑ d as owner of the property,he exclusively contracting with
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 s th does not apply
co an owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts oar's h projects with a contractor(s)licensed pursuant no
�- the Contractor's License LawSEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT No. PARCEL No.
❑ I an,exempt under Sec ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date' - WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP.' 5:00
I hereby affirm that I have a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy there Sec,3800,LabC J2PolcNCompanyK _PUBL/C t )A
-
Q .�7 Certified copy is hereby furnished. 'FIRE SPRINK ENERGY T-24
Z Z �E. Certified cp is fled work the cit ins echoo vi on.
FO Applic:ntt �"tjf n7CLK a'/g le E MISC.- REFER TOORD: Y ❑. N❑ Y ❑ N❑
2N -CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00' - FLOOOZONE A.L:U.C.
LU > COMPENSATION INSURANCE . PLG.CONTR. LIC.NO, PLG,
CL Z
es
('This section,need not be completed if the proton is for one TOTAL Y❑ N❑ Y[:] N❑
- hundred dollars($100)or ls.)
) O 1 certify that in the performance of the work for which this per- DTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Date Applicant BUILDING -
a ALTER OR ADD TO MECH. _ 5.00 -
} N NOTICE TO APPLICANT: If,after making this Certificate sa ion
2 em prion,you should become subject to the Workers'Compensation APPLIANCE
' H - 5.00 PLAN CHECK
provisions the Labor Code, you must forthwith comply with 'FEE
CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY ' AIR HANDLING UNIT(OVER=00C.EM.) 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 ITO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 v
Lender's Address ELECTRIC S •S
I certify that l have read this application and state that the above VENTILATION FAN.(SINGLE).' 4.00
. information is correct.1 agree to comply with all city and county PLUMBING'
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Oar 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of - MISC.- REFER TO ORD.
uperti o against liabilities,judgments, costs d expenses which PERMIT ISSUANCE .10.00 CONST.TAX .
m ny way accrue agai s said in equence'of the -
a tin ofthis permit - MECH.CONT. ..LIC.NO. MECH.
� ' 61TOTAL 'TOTAL
store of Applicant/Contractor ate '
OFFICE COPY
t t .