17391 'POSTTHISCARD'NEAR FRONT OFBUILDING
PERMIT NUMBER
-
CITY ,OF CUPERTINO . 173 1
INSPECTION DIVISION
JOB INSPECTION RECORD
- w+ 0'3p - PERMIT EXPIRATION
JOB ADDRESS X0123 N..11�o L.F T—Vr ''" J UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER SH- � coNrRAcroR�pk(,$L _�{� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPEC ION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ 'ANCE OR 180 DAYS FROM
NOTE: , LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY,WITH THE APPROVED PLANS AND CITY OF - PERMIT VMJDAT1oN
h CUPERTINO STANDARDS:
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �j p-$,q ib54c�-cf�s a1rji&
UNDERGROUND /SLAB. - n.l LooA\
PLUMBING - - Q�'
ELECTRICAL - ISSUANCE DATE
BLDG ELECT I ELF,. MECH.
MECHANICAL ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ BUILDING PERMIT.
INFORMATION
WOOD FLOOR vALUATION $/FT.
PLUMBING - -
MECHANICAL - PERMIT To
ELECTRICAL q
FRAMING: .
STORIES TYPFtONSTR.
INSULATION "
aCC.GROUP RES.UNITS
4 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SG.IT,FLOOR AREA - TOTAL ACREAGE
ROOF NOTE,NO FINAL INSP.SHALL BE MADE BEFORE
. DIAPHRAGM THE CONSTRUCTION TAX IS PAID
'-BUILDING USE
ROOF SHEATHINGNes' IND CD PB Oma
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ El 1:1ASSE550 PARCEL NO.
ROUGH SAN.h
PLUMBING ELECT:ENERGY - ' '
TRACT NO. PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY -
MECHANICAL MECH.ENERGY -
ELECTRICAL " — BUILDING ENERGY C— Acc oar A;c.INCE No..
FRAMING" ELECT.FINAL TEST
PLUMBING ' ZONING ENG.SITE NO
INSULATION �=
LASTEST - GAS _
MECHANICAL FIRE SPI r. ENERGY r24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING El
EXTERIOR SHEAR ELECTRICAL RELEASE w.00D ZONE A.L u.c.
INTERIOR SHEAR FIRE DEPT. . t v ❑ N❑ v ❑ N❑
SHEETROCK ' GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH 1 TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING I SNOTPERMITTED UNTILBUILDING FINALISSIGNED By BUILDING INSPECTORt MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTFWf'
"J' ONE WORKING DAY BEFORE REQUIRED INSPECTION.
f— PLUMBING '
!� O�. PLEASE GIVE JOB ADDRESS WHEN PHONING. "
ZMECHANICAL
SEPERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE . TOTAL O.
CALLING FOR FINAL INSPECTION. �-
OFFICE COPY
APPLICANT TO FILL IN INFORMATION,WITHIN RED LINES - USE BALL POINT PEN ONLY
- 4'- BIAI Lf.II NG PROJECT IDENTIFICATION� ` ''
'PERMIT NUMBER
BUILDING -. APPLICATION & PERMIT F 1 q� (�q
ADORESa ; •' - 1 I 1 .J I
�D 13 WO S`�j}cg p3 '� BUILDING.-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
NAME PLAN CHECK VALIDATION
.57fio,4i/L/N _ QTY. ELECTRIC PERMIT FEE
vXrvE
NAVERAcrORs OUTLETS-SWITCHES-RECEP 40.00/1.00
L�rdi.Yc bG LIGHTING FIXTURES 10.00/1.00
ADDR•E�Ss'1�ORQ5 •,�/ y.q �lO ' D PPLIANCES-RESIDENTIAL 4.00
Y // /9y>
PANELS 10.00 DATE OF APPLICATION. :^
OR x7i PANELS (OVER 200 AMN - 20.00 ,; PLAN CHECK FEE P.C.No.
EN EER
LC.NO. SIGNS TRANS. 3.00 -
ADDRESS ENO' SPECIAL CIRCUIT '5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESSTS MOTORS - SEE FEE SCH. 1
SERVICE CHANGE 20.00 'E�. 1
ee0z
'FOO LICENSED CONTRACTORS DECLARATION
w -
u I herebyal0nn that l am licensed under provisions of Chapter 9
¢ 2 w n° s ISSUANCE DATE t '
I_
¢ H (commencing with Section 7000)of Division 3 of the Business anti - - BLDG. ELECT. PLG. ' MECH.
H H Z Professions Code,anA m license is in full for,•s'tpd of I. - ❑
z o�n- Licens Cl - Lia Numher 77
z H w Date - ❑ ❑'
H y _ J ��_Contraclor I IV /L
e, w a OWNER-BUILDER DECLAR O1CYI-N - BUILDING PERMIT
wo A " INFORMATION
; 0 H I hereby affirm final 1 am exempt from the Contractor's License MISC.- REFER TO ORD
uO ¢ Law for the followingreason.(Sec. uires a,Businessand Professions - VALUATION $/FT.
L - w � PERMIT ISSUANCE 10.00
Code:Any city or county which requiresapermit toconstruct,,also
2 ¢ ¢ improve,Demolish,or repair any permit
Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. '
n
- m a requires isic the applicant for such revisit to file u sinned actor's Li that TOTAL
X he is licensed 9pursuant(commencing the provisions of the )of Divi,i.n Llb'fthe PERMQIT TO
HiQ Law(Chapter ndProsionsoe)orSection isexemfttheefoofthe PLVh•�,�
4 O Business and Professions Code)or that he is exempt therefrom 1.5 DTV. PLUMBING PERMIT FEE
KHm
thebasisthe atom exemption.Any violation of Section malty STORIES. TVP ONSTR.
by any applicant fora permit subjectstire$500P.licant on civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollar(my employees
'
❑ I,as owner at the property,a my employees with wages as BACK'F LOW 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,CONO. 5.00
Code:The Contractor's License Law does not apply to an owner of
Properly 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-
mentsarenotintendedor°ffered for wee.If,however,the building GAS-EA.SYSTEM-1 INC.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 am- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
R ESr.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 INoIS Other
❑. ❑ 11 1:1❑ I,as owner of the properly,am exclusively contracting with -
CoCO
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 --ASSESSOVS PARCEL NO.
and Professions Code:The Contractor's License Law does 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 a contractors)licensed pursuant to
the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT6.00 ",
reason
Owner Date WATER SYSTEM 5.00 - -ACC.DATE ..ACC FILE No.
WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, -or a certificate of Workers'Compensation Insurance,or a certil'led _ _ ZONING' ENG,SITE NO.
ropy thereof(Sec.3800,Lrb.C.). - - - - -
Policy No. ContpanY sTi/'lt' /"seLN�
O ❑�Certified cop is hereby furnish RE SPRINK ENERGYT 24
Z Z ypx(,a Certified Pry Is G eD con the c' inspection division. -
FO PCpplicunt a MISC.- REFER TO ORD. 'y'❑ 'N❑ '!v ❑ N❑
CC !2 TIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 LOB - FLOOD ZONE A.L.0 C.
'UJ > COMPENSATION INSURANCE P G.CONTR. LIC.NO. PLG.
d O (This section hued not be completed if the permit is for one A1~yam /T/pp TOTAL ��r� V❑ N❑ V E] N❑
Z hundred dolla,,($100)orlessD -
U O 1 certify Wet in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY '
U. F mit is issued,1 shall not employ any person in any manner so as to
Q W become Subject to the Workers'Compensation Laws of California. I
St. Date Applicant BUILDING
} W NOTICE. TO APPLICANT: If,after making this Certificate of Ex. ALTER OR ADD TO'MECH. 5.00
F. Z amption,you should become subject to the Workers'Compensation APPLIANCE, 5.00- PLAN CHECK
provisions of the Labor Code, you must forthwith comply with s E
CJ such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10A00C.F.M.
-CONSTRUCTION LENDING AGENCY , AIR HANDLING UNIT(OVER,I0,00011F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) - Met
the performance of the work I'or which this permit is issued(Sec. '-MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.1 .0
Lender's Name H EAT[NG U N IT(OV ER 100,000 B.T.U.)9.50
Lender's Address - ELECTRIC
'. I certify that I have read this applicationandstate that the above VENTILATION FAN (SINGLE) 4.00
infornsatioi is correct. I agree to comply with all city and county BOILER-COMP13 H.P.Or 100,000 B.T.U.) 6.00 'PLUMBING �Ot�'
ordinances end state laws relating to building construction, and
hereby authorabove-mentioned
representatives of this city to enter upon the BOILER-COMP IOver 100,00.0 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property representatives
inspection othis
purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE. 10.00 CONST.TAX _
may In an ry accrue City in consequence of the -
ranting This permit. MECH.CONT. LIC.NO. MECH.
y TOTAL TOTAL Zp`�
nature of Applicant/Contractor to
OFFICE COPY