17139 POST TH,tS CAfj`D NEAR FRONT OF BUILDING
PERNk NUMBER
CITY OFA CUPERTINO
INSPECTION DIVISION.. 71.39
i'' . JOB INSPECTION RECORD
s„ �y
J
f f '
\
.• P`ERMI7,' ` FIAATYON”'
v�.7_1'_ JOB ADDRESS 6 Z3 (/1l UNIT# _LOT# J ' L i
RMIT EXPIRES IF WORK'-'
- DwrvEq "0 ! �f'-(Ycp ggCTOR � S' (�1-p0 p�.( � � IS NOT STARTED WITHIN
INS E INSPECTOR INSPECTION_RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ ANCE OR '180.DAYS FROM
NOTE: L'ASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
PREGUNITE TO.COMPLY WITH THE APPROVED PLANS AND CITY OF __ PERMIT vnLmArroN
CUPERTINO STANDARDS,
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 3 - �• -,�� : I
UNDERGROUND /SLAB MAR 2i iylty
PLUMBING
ELECTRICAL A of"�!!wlq(1/ , issu/YnNCE bnrvF`r:ac
MECHANICAL, - LOe: ,ELEGY,I Pu;, mecR .
DO NOT FOUR FLOOR UNTIL ABOVE HAS BN SIGNED BUILDING PERMIT ❑
EE
WOOD FLOOR - - •� INFORMATIONS
- PLUMBING - vgwgnoN SIFT,
MECHANICAL
ELECTRICAL " - - - PERMIT TO
FRAMING
INSULATION TORIES TYPE c STR,
9.
196`
- -IOCC.GROUP RES UNITS
`...,\ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED grtilYO '.
ROOF .NOTE: INAL INSP,.SHALL BE MADE BEFORE, sO.FT.FLOOR AREA 'TOTAL ACREAGE
��� DIAPHRAGM THE CONSTRUCTION,TAX IS PAID cv -
/// ROOF SHEATHING - BUILDING USE
_ RES. IND CON . PE omr'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED =TEST ,
ALS DATE INSP: ❑ ❑ ❑ ❑ ❑
ROUGH - .nssessogs PngcEL NO.
T
PLUMBING RGY
TUBS&SHOWER PAN ENERGY TRACT NO. PARCEL NO.
MECHANICAL RGY�
ELECTRICAL NERGY - . qcc.DA_TE Acc,FILE No,
FRAMING•' AL TE ST '
INSULATION _ . z0N NNG ENG SITE NO.
GAS`TEST. - GAS ..
MECHANICAL FIRESPRINK ENERGYT-24 E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �� Y ❑ N❑ Y ❑ NO
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE = A.L
INTERIOR SHEAR FIRE DEPT. YON❑/l 4 Y ❑_, NEI
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR-CATH. BUILDING 1
.INTERIOR LATHTEMPORARY APPROVAL .BUILpINc 12G.OD
SCRATCH COAT - ELECTRIC.- PLAN CHECK -
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE I -
OCCUPANCY OF'BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
F MICROFILM -
ARRANGE FOR INSPECTION BY PHONING-252-4505, . ELECTRIC
Iw— ONE WORKING DAY BEFOREREQUIRED INSPECTION. PLUMBING
t Z PLEASE;GIVE,JOB ADDRESS WHEN PHONING.
k S - — SEE PERMIT FOR EXPIRATION DATE - q MECHANICAL I '
IMPORTANT!
CONST.rnx
r R 'il
PLEASE READ REVERSE SIDE BEFORE. TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY /
APPLICANT T,O FILL IN INfORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
�' .BILM40l NG'PROJECT I DENTI FICATION . - l • FERMIT NUMBER
ADDRESS APPLICATION"& PERMIT 1 71 3p
ADDRESS BUILDING - ELECTRICAL-PLUMBING.=MECHANICAL I a7
O/?3 I✓y✓C�-�B
OWNER'S - PLAN CHECK VALIDATION
rvam ��JG QTY. ELECTRIC PERMIT :FEE
-PHONE
CONTRACTOR S.
NAME + OUTLETS-SWITCHES-RECEP 10.00/100
o-' ^•� 'Z�j'✓O�Q'-ffFO_ OSS Lc �. LIG HTING FIXTURES 10.00I7.00' V;�
CONTRACTOR'S " _ .S�yg RESIDENTIAL 4.00 " • -
ADD?}s , - .
7./� $ ON�' ./ PANELS 10.00t N"
;.•O GATE OF APPLICATIONr '
ORCNrtECiL PANELS (OVER 200 AMP) 2000 PLAN CHECK-FEE P.C..NO.
.
OR � �•
ENGINE R' R .J
fiV SIGNS TRANS. 3.00
ARCH.OR ENG. 5{OD PE..,T'VALIDATION
r.
ADDRESS -�i'R.A ,A.�p-j/f> SPECIAL CIRCUIT „ : ,
• , . . .' zIP EMP.METER OR POLE INS. 20.00 3-�
APPLICANTS / MOTORS SEE FEE SCH.
- AOORF55 __/��
SERVICE CHANGE 21 110.00
0 0 0- .LICENSED CONTRACTORS DECLARATION5r-.,ISSUA
V
a o U I hereby affirm that'I am licensed'under,pmbisions of Chapter 9 � ` �'� NCE DATE M
r•Q i (commencing with Section 7000)of Division 3 of the Business and i LDG.s ELECT. PLG. MECH.
F z i Professions Code and my liven: is in full force and effect. _ - .CyS
z o 13 License Class 'Li Number' , �� j
O Z H t0 Dale Contractor r C1���'
¢-x s J - 1' BUILDING PERMIT
w u OWNER-BUILDER DECLARATION - - •,INFORMATION
KoA; M •REFER TO ORD
; I hereby affirm that I run exempt from the Contractor's License -
'w u O¢ Law for the following reason.(Sec.7031.5,Business and Professions I A 10.00 VALUATION $/FT.
Fri Code:Any city or county which requires a permit to construct,after, '
ac¢.0 improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR.,, LIC.NO. ELEC. ��/`�o ' �� r
0 m requires the applicant for such permit to file a signed statement that 'Cityof TOTAL D e0 PERMIT TO
a. w m a- he is licensed pursuant to the provisions of the Contractor's License
°r z>0 Law(Chapter 9(commencing with Section 7000)of Division 3 of the
er Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT - 'FEE
H o the basis for the aIle d exem tion.An
gc p heapphear of$cclion 7031.5 STORIES TYPE CONSTR.
n ;m by any applicant fora permit subjects the applicant loacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 r 11(7
I not mote than five bandied'dollars($500).): ,
❑ 1,as owner of tiro property,or my employees with wages as BACK FLOW PROTECT.DEVICE A= A Q --UC-C.GROUP RES.UNITS
their sole compensation,will do the work,and the sl ructure is not
intended or offered for sale..(Sec: 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 's
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 ,U SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that sucli improve- - - - -
t, .cuts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
a or improvement is sold within one year of completion, the owner- _ GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or if GAS BUILDING USE
prove for purpose of sale.).' INDUSTRIAL WASTE INTER. 30.00 RES IND- CDN PB Omar'
❑ 1,as owner of-the property;am exclusively contracting with - 'Q �I,�Q
licensed contractors to Construct the project(Sec.7044,Business j LAWN SPRINKLERS- 1 INC 5 V.B. -• '•6.00 ASSESSORS PARCEL No.�
and Professions Code:The Contractor's License Law docs 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 acontractous)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law: TRACT NO. PARCEL NO.
. 0. I am exempt under Sco' ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
v Owner ate WATER SYSTEM 5.00 - ACC:DATE Ace FILE NO.
WORK LRS' OMPENSATION DECLARATION WATER TREATING EQUIP a 5.00
P hereby affirm that I have a certificate of consent to self-insure, _
or a certificate of Workers'Compensation Insurance,or a certified - ,ZONING ENG.SITE NO. -
.. copy thereof(See.3800,Lab.0.).. I - -
Company 17 .AJA•/iL6'1/�i9>I�G "
0 ❑ Certified copy 'her yfurnisI d. • - FIRE SPRINK ENERGYT-24 '
z Z ❑ Certified. y is Iled wi Ol city on division. -
F 0 Applica MISC:-' REFER-TO ORD. Y'O NY O . ry0
Lu' CERTIFICATE
m PERMIT ISSUANCE 10._00 ��r 00 FL00020NE .A.L.U.C.i
_ E EMPT ION FROM WORKERS'
W%� COMPEF.N ATION INSURANCE PLG.CONTR. LIC.No. PLG,
1 O (This section need not.bebomplclad it the permit Is for ono TOTAL <(/' ✓• V-�•, N❑ V 0 N�.
�,Z. hundred dollars IS 100)or 1.S)
L) O 1 certify that in th0performance of the work for which this per- QTY. MECHANICAL PERMIT'. FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
U become subjcel to the Workers'Compensation Laws of California.
ED Date Applicant : 'ALTER OR ADD TO MECH. 5.00 BUILDING
}`tn NOTICE TO.APPLICANT', If,after making this Certificate of Ex- L
F Z emptioi,you should become subject to the Workers Compensation APPLIANCE '5.00 PLAN CHECK
provisions,of'theLabor Code you must forthwith comply with F lD
U' J-CX77 L.1
such provisions or this,peore t shall b•deemed Invoked. AIR HANDLING UNIT(TO 10SMC.F:M,) 4.00 ' FE6"1 /\I{,�
CONSTRUCTION LENDING AGENCY , AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 .• - SEISMIC FEE CJ,
II hereby affirm that there,is a construction I faiISn agency for ' EXHAUST.HOOD (WITH DUCT) 5_.00
the performance cf-the work for which this permit issued(Sec , MICROFILM3097.Civ
C).• - HEATING UNIT(TO 100,000 B.T.U.) "8.00
Lender's Nam
Lender's Address s
ea HEATING UNIT(OVER'100;000 B.T.U.)9.50 ELECTRIC
I certify that I have read linsappli afire and late that the above 'VENTILATION FAN (SINGLE) 4.00 LD D
information is correct 1 agree to comply with all cityand county PLUMBING ('
ordinances and state laws relating to building onstruction and BOILER-COMPOH.P.Or100,000&T.U.) 6.00
Qfa� hereby anthema oTresentatnes of this city hl ter. upon the ;BOILER-COMP lover 00,000 BTU)SEE FEESCH "MECHANICAL
uuu��J above-mentioned property.for Inspectionpurposes.. ,
r� (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. .
r uperline against liabilities,judgments, Costs and expenses which CONST:TAX
ay in any w� accrue against said City of te'
' con equence ,PERMIT ISSUANCE � 10.00
rantin lhi ermiC ;, MECH.CONT:. .� LIC.NO. MECH. o
TOTAL TOTAL SIo.
Signa f Ap cant/Contractor Date -
OFFICE.COPY ;