16633 POST THIS CARD NEAR FRONT OF. BUILDING
-- i PERMIT NUMBER
CITY =0F ,CUPERTINO 16633
INSPECTION'DfVISION
'. JOB INSPECTION RECORD
, .ryel0�'�'-_� PERMIT EXPIRATION
JOB ADDRESSIO Io1.3 N, byo +\+/ 11
UNIT# LOT*t r
OWNER //11 n n , PERMIT EXPIRES IF WORK f
4 CONTRACTOR `U C`7Z.�7. . LCC � , IS NOT, STARTED WITHIN'l
INSPECTION DATE INSPECTOR I 4NSPECTION RECORD - 180 DAYS OF PERMI7:ISSU- i
FOUNDATION . ANCE OR 180DAVS•FROM
NOTE:
LIFER '
ALL GRADING AND DRAINAGE SHALL BE INSTALLED 'LAST CALLED INSPECTION. '
PREGUNITE% TO COMPLY WITH THE.APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.' ',
GARAGE SLABS ' - r'-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL,
i5SUANCE DATE Y `
_ MECHANICAL' _ _ '9LUa- ELECT. PLG. �'MECH
p'�,1ti� ❑ LTJ` ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED. g� BUILDING PERMIT
WOOD FLOOR -( INFORMATION
4 PLUMBING - 1 VALUATION: SIFT.
MECHANICAL . . '�'lty Ot CU B1tU10
ELECTRICAL. , -PEHMITro -
FRAMING - -"T
INSULATION - STORIES .. TYPE GO"STR.
- OCC GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ' WILDING USE
Sp FT.FLOOR AREA TOTAL ACREAGE
De ,ROOF '- NOTE:NO FINALINSP.TALL BE MADE BEFORE ' ,•
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
BUI '
ROOF SHEATHING , _ RES „IND CON PH 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH
ASSESSORS PAHCE L NO
SAN.0
PLUMBING ELECT,ENERGY
_ TRACT NO PARCEL NO,
TUBS B SHOWER PAN', - PLUMBING ENERGY
MECHANICAL MECH.ENERGY '
ELECTRICAL .. ACC,DATE ACC FILE No.
BUILDING ENERGY .. _ .•�
FRAMING - ELECT.FINAL TEST `
INSULATION PLUMBING zoNlNc ENG.SITE No. '
GAS TEST - - - - GAS '
MECHANICAL FIRE SP91NK .ENERGY T.24 -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ ' NE]
EXTERIOR SHEAR - - ELECTRICAL RELEASE : FLOOD ZONE ' -A.L.uc
INTERIOR SHEAR FIRE DEPT: - Y❑ "❑. .Y ❑:- ,N❑
SHEETROCK; - - GRADE FEE SUMMARY
EXTERIOR LATH r 'BUILDING"
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC ! .pCAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE,
` OCCUPANCY,OFBUILDING IS NOT.PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR: MICROFILM
ARRANGE.FOR'INSPEGTION, BY PHONING 252-4505, ELEcrRic �w
r• LU ONE,WORKINGDAY BEFORE ',REQUIRED INSPECTIO_ N.
PLEASE GIVE JOB ADDRESS WHEN PHONING.,' PLUMBING
Z > MECHANICAL
1. SEE PERMIT FOR EXPIRATION DATE -..
IMPORTANT!
CONST.Tax
PLEASE READ REVERSE SIDE BEFORE , i, a ^z ! "
TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT 1 C
amLmrvO - t .0 63 3
- ADR ss sP. �`:
. � � BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIOAT ION
NAME /I DTV. ELECTRIC PERMIT 'FEE 1
l+G� PRONE
CONTRACTORS QOUTLETS-SWITCHES-RECEP 10.00/1.00 '3,00
NAME PLC
-
�l�! C o .L.9-CLIC,No. 7 �-LIGHTING FIXTURES 10.00/1.00 r,(o0
CONTRACTORs APPLIANCES-RESIDENTIAL � 4.00 -
ADDREss - LjG.1 •� � -
(� PHONE //1 QQO PANELS - 10.00 /..L I,SO DATE OF APPLICATION
PLAN CHECK FEE
ARcwTECT IS
(OVER 200 AMPI' 2000. '-
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR END. - - SPECIAL CIRCUIT 5.00 , PERMIT VALIDATION
ADDRESS
ZIP
EMP.METER OR POLE INS. 20.00
APPLICANTS - MOTORS 5N- SEE FEE SCH. 5100
ADDRESS
SERVICE CHANGE 20.00 /per,
o 0 o LICENSED CON'T'RACTORS DECLARATION HS ✓A-' AFM - at,
<u u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE '.
"' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG,. MECH.
A
Professions Code,a�d my l,iYk',,ense is in full Iorce,aBJ4ffecj,� Rpt El
i o y- License CI s b,�Lic.Number CC��✓✓fl// 44 G q 1L�1I
g ,°u Date Contractor Fe r '10 O rGuQ -
w¢ OWNER-BUILDER DECLARATION ec£� BUILDING PERMIT
u REFER TOO INFORMATION
X 3 n y 1 hereby affirm that I am exempt from lite Contractor's License MISC.- VALUATION
r u N J Law for the following reason.(Sec.7031.5,Business and Professions j PERMIT ISSUANCE .10 no 7.2:'00
Code:Any city or county which requires a permit to construct,alter,
2 Q¢0O improve,demolish,or repair any structure,prior to its issuance,also, EIEC,CONTR.. `LIC.IN J ELEC.
a_ O ¢ requires the applicant for such permit to file a signed statement Thal �C -�Y�j7 TOTAL 7�,�0 - PERMIT TO
Wm LL he is licensed pursuant to the provisions at tire Contractor's License EL&-r-7
rir
Low(Chapter 9(commencing with Section 7000)of Division 3 of the
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
lire basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant tua civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 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 Ptofessions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor'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 m through his own empldffered forS,provided that such improve.
ments mselfonot inthhis or employeesa e.provided
thathowevsuch
building GAS-EA.SYSTEM-i INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int- RES IND CON PB Other
prove for purpose of Sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑
licensed-contrto
acrs 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 o builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
wh
_ contracts for such projects with a commetor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO., PARCEL NO.
lire Contractor's License Law.
❑ I am exempt under Sec...B&P C (Or this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5A0 _• ACC.DATE Acc.FILE ND.
WORKERS'COMPENSAIION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that 1 have a cert ificale of consort to pelf-insum, ZONING 'ENG.SITE N0.
' or a certificate of Workers'Compensation Insurance,or a certified
copy thereytJ$e�, 800 Lxb.C.I
Policy No. _770ompanY- LJ0(LBLd.G
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 kit Certified copy is fled with tiro city inspection division. MISC.- REFER TO ORD. y NO v N❑
h mApplicant ' ' '
• PERMIT ISSUANCE 10.00 OODZONE A.C.U.C.
Cr - r CIiRTIFICATE 017 EXEMPTION FROM WORKERS'
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. y❑ NC3 Y N[
IL 0 (This section need not be completed if the permit is for one - TOTAL
:) 2 hundred dollars IS 100)or less.)
U O .1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,1 shall not employ any person in any manner so as to
0Q become subject to the Workers'Compensation Laws of California. BUILDING
Date Applicant ALTER OR ADD TO MECH. 5.00
>_ Del NOTICE'f0 APPLICANT: If,after making this Certificate of ISx-
Ls Z entpOnn,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK.
provisions of the Labor Code, you most forthwith comply with AIR HANDLING UNIT(TO 10=C.F.NL) 4.00 FEE
V such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00CF.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.). t+ HEATING UNIT (TO 100,000 B.T,U.) 8.00
Lender's Name _ HEATING UNIT(OVER 100,000 B.T.U.)8.50 ELECTRIC
Lender's Address
I certify that l havemial this application and state that th+above VENTILATION FAN (SINGLE) 4.00 PLUMBING
. information is correct. 1 agree to Comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
ordinances and state•luws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes. -
(We)'agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
tint against liabilities,judgments, costs and expenses which .PERMIT ISSUANCE 10.001AftCONST.TAX
my• any way accrue against ity eb 'quence of the
ran ngsof this per it. MECH.CONT. LIC.NO. MECH.
D TOTAL TOTAL
gnalurc o Applicant/Conlrac or Date
OFFICE.COPY , . .