16838 POST,TH'cidLA RD NEAR FRONT OF BUILDING'
- y y PERMIT NUMBER -
CI . OF CUPERTINO: 168'318
INSPECTION DIVISION.
.JOB INSPECTION RECORD �-
• PERMIT EXPIRATION
UN
JOB ADDRESS �oIa3 N' hJO C. � �`'- 'I �• - I
IT# _LOT# ' '- - _ _ • PERMIT EXPIRES IF WORK
OWNER ,.^/ CONTRACTOR F E -IS NOT STARTED WITHIN i
. INSPECTION DATE INSPECTOR ' ' INSPECTION RECORD 180 Days of PERMIT lssu=
'
FOUNDATION DAYS4110M,I
LAST CALLED OR 180
i NOTE: -" . ANCEINSPECTION.':
LIFER :
i' FER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE'
TO COMPLY WITH THE APPROVED PLANS ANOCITY OF PE•! +IT VALIDATION
'
� CUPERTINO�STANDARDS.' • . '' t;t+
GARAGE SLABS - r ' ,+ •':
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED f ' "—
P iT)
`UNDERGROUND /SLAB' '
PLUMBING 19
1
ELECTRICAL'j° - - S.Uv, - S CE DATE .
MECHANICAL' -> , Bp4[u-h}+� T. PLcs -MEcq. .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED '• - BUILDING PERMIT'•._-
' 4,.-;' INFORMATION '
WOOD FLOOR . - - VALUATR) r-S/FT.�'
PLUMBING.-
MECHANICAL ,
ELECTRICAL - " , PERM"To
FRAMING. . - •y. ? •��G:L`�•j
INSULATION TXPE CONSTR .
STUgIF
• - , OCC GROUP RES.UNITS .
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
•NOTE.NO FINAL INSP.SHALL BE MADE BEFORE so Fr,FLOOR AgFA rorAL AcaEACE
DIAPHRAGM. , THE CONSTRUCTION TAX IS PAID _
ROOF SHEATHING RESP IID '.UILDCOONN USE
PEI �0, .,
APPLY NO ROOFING UNTIL ABOVE•HAS BEEN SIGNED FINALS 06ATE INSP.. ❑ ❑S
,A SE,ORSPAgCEL NO, .
ROUGH SAN.N -
PLUMBING - ELECT.ENERGY 4'
TRACT NO. PARCELNO.
I TUBS&SHOWER PAN - - PLUMBING ENERGY-,'
•. I is
` MECHANICAL MECH'.ENERGY- `' ` 1Ace Onre; ••Acc..FILE NO,
ELECTRICAL BUILDING ENERGY
FRAMING, ELECT.FINAL TEST.,' y
INSULATION
,ZONING . ENG.SITE NO�
- PLUMBING ..
GAS TEST GAS '
1 FIRE.SPRINK ENERGY T 24
' MECHANICAL '
-COVER NO WORK UNTIL ABOVE-HAS BEEN SIGNED HEATING,
EXTERIOR SHEAR-: ELECTRICAL"RELEASE FLOODZONE AL.UO!
INTERIOR SHEAR - FIRE DEPT; , ' v❑ ".❑ -v I]- N❑
SHEETROCK GRADE - FEE SUMMARY -
EXTERIOR LATH - BUILDING - -
BUILDING'
INTERIOR LATH .ry TEMPORARY APPROVALS ''
SCRATCH COAT - ELECTRIC - ° PLAN CHECK
. GAS FEE J
NO TAPE ORIPLASTER UNTIL ABOVE HAS BEEN SIGNED' OCcuPA:Ncv t p: 'SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252,4505, ' ELECTRIC '
"'� ONE WORKING.DAY BEFORE REQUIRED INSPECTION. PLUMBING:
PLEASE GIVE JOB ADDRESS WHEN PHONING'.
i Z �,,, MECHIANICAL
ti — SEE PERMIT FOR•EXPIRATION DATE-
- T CONST TAX
IMPORTANT! ,:
PLEASE READ REVERSE SIDE BEFORE ' TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY --
-_ +
ELECTRIC SERVICE NOTICE P.G.B E.COPY
BUILDING INSPECTOR'S NOTICE
A CITY/OF CUPERTINO hy('
/7 To 19✓�.nM / .
You ore hereby authorized to Connect electrical service for
i n
'Owner or Tenant V
AI--/
L)
No.of Wires— Size of Wires O Size o4 Switch �� �
Motor Load Voltage Phase
Heating Load
K,W. Vohage
Light 110 New Service Reconnea
No.of MetersT More Service
Heor 140__ hree Wire
�— Power Three Phase Move Meter
No.of Add.Meters ,
0M ELECTRICAL INSPECTOR
I
` r
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTORS NOTICE
CITY OF CUPERTINO
1� I
To �I 19 G5"
You are hereby authorized to Connect electrical service for
Owner or Tenant L--, C4!4/.gI4 C `' 11
At
r No.of Wires ! Size of Wires J— U Sae of Switch 2
Motor Load Voltage Phase
{{ Healing Load K.W. Voltage
Noof Meters Lig �ce
/1 ht I10__New ew Se Service Reconnect\ .
t. Hear 110 Three Wire More Service
No.of Add, Meters Power .? Three Phase Move Meter
�• ELECTRICAL INSPECTOR
A
v
APPLICANT TO FILL IN INF MATION WITHIN RED LINES - USE LL POINT. PEN ONLY
' -PERMIT NUMBER
BUILDING.PROJECT IDENTIFI N APPLICATION-& PEWIT 11 16838
, '
16 8 3 8
' t! IORE23l N. oI t .9 BUILDING -"ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME ELECTRIC PERMIT FEE S -
r CI F1• H2NEIIS'843' _
NAM[RA Gas UTLETS-SWITCHES-RECEP: 10.00/1.00, - -a--
♦14•eG. (qt," LIC.NO. LIGHTING FIXTURES - 10.00/1.00 . '
ADDRESS TOR's APPLIANCES-RESIDENTIAL 4.00 ' - 1
py�(g� I��F PHONE. PANELS 10.00 •DATE OF APPLICATION
ARCHITECT nn 1-I PLAN CHECK FEE-' P,C;NO.
oR. pgGFHw NS PANELS (OVER 200 AMP) - 20.00 - -y, ,
ENGINEER '
( S OC. LIC.NO:,- SIGNS TRANS. 3.00 '
ARCH.OR ENG.- PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 . -
f. r
• • ' Cr ZIP EMP:METER OR POLE INS. 20.00 # ,
ADDREPLICSS MOTORS' -SEE FEE SCH.
ADDRESS �. //
87S . Fl l
o SERVICE CHANGE 2000 j• 1
00i - ��
O o LICIiNSEU Nf RACTORS DECLARATION '
'Q u I'lu,.by a]I on that 1 am licensed under provisions of Chapter 9' - a .ISSUANCE DATE' "
w G m (commencing with Section 7000)of Division 3 of the Business and - B ELECT. .,PLG.' MECH.
r y z Professions Code;and my license is in full force and effect. ❑ ❑
o 0 w w License Class Lia Number `,
r
Dale _ Contractor `1�s1.
a w m s r _ e DING PERMIT
¢'¢ w OWNER-BUILDER DECLARATION - - Cup INFORMATION.'
w ;LL I- 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- - REFEWTO ORD
VALUATION _ $/FT.
, FLLN4 Lawforthe following reason.(Sec.7031.5,&Ismiasand Professions PERMIT ISSUANCE 10.00 ,
Code:Any city orcounly wllichrequiresapermiltoconstruct,alter.. ELEC.LONTR. U0.NO.
to a Q improve;demolish,or repair any structure,prior to its issuance,also ELEC. '
u w m LL requires the applicant for such permitro file a signed statement that TOTAL - PERMIT TO A
he is licensed pursuant to the provisions of the Contractor's License
p z i
Law(Chapter 9(commencing with Section 7000)of Division 3ofthe e 'TF-F(A e- .
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE /
sio
..¢ 1-m the basis for the allege)exemption.any violation of Section 7031.5 STORIES- TYPE CONSTR.
La by any applicant,fare permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
#
Of not more than five hundred dollars(S500)J: -'
,. 0 1,as owner of the property,or my employees with wages'as BACK FLOW PROTECT.DEVICE 4.00 Dec.GROUP RES.UNITS
their sole compensation,will Jo the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 r
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 SQFT.FLOORAREA .TOTALACREAGE
-• himself c r.through his own employees,provided that such improve. _ . .,
mentsme not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 I '
or improvement is sold within one year of completion,the owner GAS'-EA.SYSTEM-OVER 4 IEA.)
builder will have the burden of proving that he did not build or im- 2.00 BUILDING USE: .)
prove for purpose of sale.). RES IND CON PR Other
INDUSTRIAL WASTE INTER. 30.00 ❑ ❑- . ❑ I ❑ .❑'
sspp I as owner of the property,he exclusively contracting with
Iicerlsro contractors tod to construct the prices(See.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 '
man owner of property who builds tr improves rased a and who LAWN SPRINKLERS-OVER 5(EA.), 1.00
+ contracts for such censeprojectsL with a mnlractorts)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
reason
1 am exempt under Sec. - ,B,&I'.C.for this WATER HEATER W/.VENT 6.00 )
Owner yya,-+ _ Ume WATER SYSTEM 5.00 - -
,/ ' ACC.DATE ACC:FILE NO.
;WORKER IPI ECLARnTION WATER TREATING EQUIP. 5.00
I hereby affirm Ilial l have a certificate ofcoment to self-insure. ZONING
or a certificale of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab C.).
Policy No. Company
Q ❑ Certified copy is hereby furnished. 'FIRE SPRINK• -ENERGY T2
Z Z' 0 .Certified copy is'riled with the city inspection division. MISC.- REFER TO ORD. `I
O Applicant _ _ ; 'V'❑ N❑ Y_❑ N❑'
_CC N'.: CERTIFICATE,OF EXEMPTION FROM WORKERS' . PERMIT ISSUANCE - 10.00 . FLOOD ZONE A.L.U,C.
Lu COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, s_
CL O (This section nee).not be completed if the permit is for one - TOTAL Y❑ N❑ Y,❑ N❑ '
Zsla., Indmd dollars(S 100)or less.)
U 0 1 certify that in the performance(if the work for which this perCITY. - MECHANICAL PERMIT FEE FEE SUMMARY 'V-
'LL
H mit is issued,I shall not employ any person in any manner so as to
U become subjecl to the Workers'Compensation Laws of California. -
I�'., ,• " Date A licaot '' BUILDING
' Q. pI ALTER OR'ADD TO,MECH.. 5.00 '
} 0 NOTICE TO.APPLICANT: If,after making this Certificate of Ex.
F ? emption,you should become subject t°the Workeri Compensation APPLIANCE 5.00 PLAN CHECK.
provisions-of the Labor Code, you must forthwith comply with FEE' '
.0 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
Ili.. . ' . CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.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,Ci,C.), 'HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
Lender's Name
Gender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
•I certify that l have read this application and state that the above VENTILATION.FAN (SINGLE) 4.00 / 4-
information is correct. I agree to comply with all city and county PLUMBING-
op1munces•and'state laws.relanng to building construction, and BOILER-COMP I3 H.P.or 100,000 B.LU.1 6.00 -
.•'' hereby.a ullm,mc..presentativto of this city to enter upon the
above-mentioned property for Inspection purposes BOILER-COMP(Over 100,000 BTU(SEE FEE SCH: 'I' 'MECHANICAL
(We) agree tosave, indemnify and keep harmless the City of 'MISC. - REFER TO ORD.
Cupertino, gainst liabilities,judgments, Costs and expenses which - - CONST.TAX
may in any way accrue•agarst said City in' ms quence of the PERMIT ISSUANCE 10'.00
3minl{oflhis permit ^Q l�yk-�. / MECH.CONT. LIC.NO. MECH. + -.
p d
Bw +✓ ^11- TOTAL ' -.I TOTAL '
Signature of Apphc nt/Conti for Date
OFFICE COPY