16792 POST THIS CARD NEAR FRONT OF BUILDING -
PERMIT NUMBER
CITY OF CUPERTINO 16792
INSPECTION DIVISION
JOB INSPECTION RECORD
'•, - ) / �j (PERMIT EXPIRA ON
JOB ADDRESS ,V " G✓QG'�� K �� UNIT,,A�3 OT#
PERMIT EXPIRES IF WORK
OWNER �LIlL0�1/S ��y��-a>R4xnaDTOR UC/'S BL1�{�—s IS NOT STARTED'WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION. I
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
O i .
' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB . J. '4A% l4(�,Cy'
PLUMBING Y.S
ELECTRICAL Iss unre
MECHANICAL - BLDG eLecr v[.e. MECH.
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING - ��r11
MECHANICAL , D0ll'
ELECTRICAL ,Off'cupedirlo
FRAMING 4.
l^ •�'i1114
INSULATION STORIES IYEE CONSTR.
-
OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
Ay � OAREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
�-v•{.,)
ROOF SHEATHING RES INA coN v0 ,o..„•,
APPLY NO HOOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El. ❑ CD El ,
ROUGH SAN.N ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRAGI N0, PARCEL NO
MECHANICAL MECH.ENERGY '
ACC UATF. ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION - PLUMBING ZONING ENG.SITE NO,
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑' Y ❑ No
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U C.
Y❑ NEI N[]
N[]INTERIOR SHEAR FIRE DEPT.
'SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING l BUILDING
INTERIOR LATH TEMPORARY APPROVAL
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O �� - PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - MECHANICAL
= SEE PERMIT FOR EXPIRATION DATE -
•'1 '•K. - I ' r
IMPORTANT! st
PLEASE READ REVERSE SIDE BEFORE TOTAL-
CALLING FOR FINAL INSPECTION.
OFFICE COPY L
I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI1.DING PROJECT IDENTIFICATION -PERMIT NUMBER
goILOINc D23
APPLICATION & PERMIT 16792 .
ADDRESS �Al
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL -
OWNER'S PLAN CHECK VALIDATION
NAME A\
rVS � s ,rv-vN�s QTY. ELECTRIC PERMIT FEE
CONTRACTORS rV tY �P�' ?/.�
NA `�5�� UTLETS-SWITCHES-RECEP 10.00/1.00 -2
A
L IC.No. LIGHTING FIXTURES 10.00/1.00
f.REACiDR56 's
AD APPLIANCES-RESIDENTIAL 4.00 `
ARE
PPHONpPANELS 0.00 DATE OF APPLICATION
ARCHITECT ftpaw
PLAN CHECK FEE P.Ca NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
Ne IC.NC.- SIGNS TRANS. 3.00
' ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS �. SPECIALCIRCUIT 5.00
I ZI. fIAr, I TEMP.METER OR POLE INS. 20.00
APPLICANTS . MOTORS SEE FEE SCH. /__/
ADDRESS 6 46
13q P_ SERVICE CHANGE 20,00
woo LICFNSFU CONTRACTORS DECLARATION - A�
¢ u u I hereby affirm that I am licensed under provisions oMIS 9 . ISSUANCE DATE
y a n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F N i Professions Code, nly,licensu is in full fumy�Q� t ❑ ❑ ❑
o SO w o License C a Lie Number / jUN 12 1989
m L DoteContracmr
a x BUILDING PERMIT
¢ ¢ a OWNFR-BUILDER DECLARATION
w ¢a,u MISC.- - j ARD INFORMATION
3 u H ( hereby assn"that I am exempt from the Contractor's License
uOa Law for the following reason.(Sec.7031.5,B1uiness and Professions VALUATION $/FT.
r - PERMIT ISSUANCE - 10.00
Code:Any city or county whichrequiresa per mit toconstruel,alteq UQ
¢ R Q 0 improve,demolish,M repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O
Y. CLL requires the applicant for such permit to file a signed statement that TOTAL
PERMIT TO
w w Lc v licensed pursuant to the provisions of the )Contractor'sLicense `J
Hz > Law(Chand Professions
nCde)cing with Section is exempt
:led
Q the
Business and Professions Code)or that he is exempt therefrom:md QTV. PLUMBING PERMIT FEE
¢ =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE NSTR.
n ;� by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN IEA.) 5.00
of not more than five hundred doll."(S500).):
❑ 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,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 50,FT.FLOOR REA TOTAL ACREAGE
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-I INC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA) 200 ``
builder will have the burden of proving that h - . . .
e did not build or im- BUILDING USE
RES IND CON PB Ohber
prove for purpose owner of f the
INDUSTRIAL WASTE INTER. 30,00
❑ d as owner of the property,he exclusively, 7044,Bu with ❑ ❑ ❑ ❑ ❑ -
licensed contractor to the project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions grope The Contractor's License Law docs not apply
to fir owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
conthe C.cls fcto,'s projects pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License law. TRACT NO, PARCEL NO.
❑ I am exempt Linder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKFRS'COMPI?NSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have u certificate of consent to sul Glnsure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
ropy thereof(Sec.3800,Lab.CJ.
I Policy N 11 Company
0 ❑ rlilied copy s hereby furnlshe . FIRE SPRINK ENERGY T 24
Z Z C d ) i- 't c cI in 1 ivision.
0 Applmut _ E- _ MISC.- REFER TO ORD. Y ❑ N Y ❑ N❑
• ~ y PERMIT ISSUANCE 10.00
IC 'IiItTII'ICATGO i 1: TIO F O RK.R FLOOD ZONE A.L.u.C.
LU COMITNSAI'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
0- Z (This section need not be conInleted if the permit is for one TOTAL Y E] N❑ Y [:] NJ[]
hundred dollars IS 1001 or less.)
U O 1 certify that in the performance of the work for which this per. QTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as m -
U become subject to file Workers'Compensation Laws of California.
i Date-Applicant ALTER ORADD TO MECH. 5.00 BUILDING 3^
} m NOTICE TO APPLICANT: If,after Puking this Certificate of fix.
F Z emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00011F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the coo k fur which this permit is issued(Sec. MICROFILM
3097,Civ.C.). 1 HEATING UNIT ITO 100,000 B.T.U.) 8.00
I/
Lender's Name I� HEATING UNIT(OVER 100,000 B.T.U.)9.50
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 stale laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(0ver 100,000 BTU)SEE FEE SCH. MECHANICA
above-mentioned property for inspection purposes. `
(We) agree to save, indemnify and keep harmless the City of MISC.• REFER TO ORD.
upertino against liab' s,judgments, costs and expenses which T.TA
may in any w ac ue against said City in con •quer 'e of the PERMIT ISSUANCE 10.00
r tr g tl S en i MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of A lbmat(Cont"ct r I U.l
OFFICE COPY -