16015 (2) POSTTHISCARD NEAR FRONTOF BUILDING
PERMIT NUMBER
CITY OF. CUPERTINO 16015
INSPECTION DIVISION I
JOB'INSPECTION RECORD (,
3
JO B•ADDRESS " PE RMI7EXPI RATION
UNIT�yy��,_I LnOIT/#()��_ PERMIT EXPIRES IF WORK
OWNER µryli ✓TWD CONTRACTOR Lau& & r6wcF�-!if'' - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS-FROM
FOUNDATION �-. 0-I�S NOTE: LAST CALLED INSPECTION.
UFER i D- ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. . "!
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � '"•�; I'�r 1�-�'
UNDERGROUND /SLAB
PLUMBING A,
ELECTRICAL _ P� ISSUANCE DATE
MECHANICAL - 11_11 ELECT PEG. MECH
. AUG 1.2 19L$. ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR City Of Cupert INFORMATION
VALUATION 5/ET.
PLUMBING
MECHANICAL " '
ELECTRICAL' PERMIT To ~ -
.:
FRAMING )
INSULATION^ - STORIES TYPE CONSTR.
. co�C(�7, •Qi/G77— OCC.GHUIOF RES.UwrS
' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE p1i 11_01111 nRLA roTnL nc+I:ACE
� DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING.USE
ROOF SHEATHING RES IND CON, PB, On:,•:
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP- 1:1 ❑ ❑ ❑ - ❑
ASSESSORS PnR CEI.NO
RCUGH SAN.#
PLUMBING ELECT.ENERGY d_ THACTNO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH. ENERGY.
ACC DATE ACC FILE NO
' ELECTRICAL BUILDING ENERGY
FRAMIN Gly ELECT.FINAL TEST
TONING ENG SITE NO.
INSULATION �j �G- PLUMBING
GAS TEST GAS _
FIRE SPRINK ENERGY L)G
MECHANICAL Yo
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - N� v ❑ NE]aLooD zoNE nLuc.
EXTERIOR SHEAR ELECTRICAL RELEASE '
❑ ry� ry�
INTERIOR. SHEAR FIRE DEPT. L
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK,
GAS FEE
NO TAPE OR PLASTER.UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE I
OCCUPANCY OF BUILDINGIS NOT PERMITTED UNTIL BUILDING FI NALIS SIGNED BY BUILDING INSPECTOR. MICROFILM
ELECTRIC
i°•,TT
roti ARRANGE FOR INSPECTION BY PHONING 252-4505, EL
cam' LLI ONE-WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
OPLEASE GIVE JOB ADDRESS WHEN PHONING. Iff
Z -
• — SEE PERMIT FOR EXMECHANICALPIRATION'DATE — -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL '
CALLING FOR FINAL INSPECTION!
•OFFICE COPY
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BI,ILnING , APPLICATION & PERMIT
aooR 102 g3 ✓E BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 1601 5
OWNERS fJ _,/ - PLAN CHECK VALIDATION
NAME QTY- ELECTRIC PERMIT FEE
S m L/AO PRONE2s3—OZ0
COERacTOR's OUTLETS-SWITCHES-RECEP 10.00/1.00
Q
///s�•{�LE/(ci uc.No,�� S7 LIGHTI NG FI XTUR ES 10.00/1.00
CONTRACTOR'S
aooRess 1\/J ••II lS%jarY.TOS� APPLIANCES-RESIDENTIAL 4.00
./SOV N1_ dC VVPRDNE -2X3-375— PANELS 10.00 GATE OF APPLICATION
RRcnfTlicT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE C.NO,
O
ENGINEER
ARC ON uc.NO. SIGNS TRANS. 3.00
AODRE55 ENG. SPECIAL CIRCUIT S,QQ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
nDONES
S s MOTORS SEE FEE SCH. J'7%1Dh033(
SERVICE CHANGE -
o ¢ z
r
00 LICENSED CON'T'RACTORS UECLARA'fIONLa ,
a u . 1 hereby affirm that I am licensed under provisions of Chapter 9
ar u (conunencing with Section 7000)of Division 3 of the Businessantl AUG 1 ISSUANCE DATE
F, m 2 Professions Code,and my license is in full force and cf1eCL BLDG. ELECT. PLG. MECH,
z o ,., — License Class Lic.Number
F m y J
w Date Contractor El El
�ty of UperUq BUILDING PERMIT
F
f
¢ ¢ w ¢ OWNER-BUILDER DECLARATION -
aO' U MISC.— REFER TO ORD INFORMATION
`, 3'
g u t- 1 hereby affirm that I em ex erupt from the Contractor's License vA LUATION $/FT.
u o j Law lie the following mason.(Sec.7031.5.Businessand l'rofessions �,�
— PERMIT ISSUANCE
Code:Any city or coomy which requiresa permit riot o crosuance,alser,o
�'1I,� ('y�/�
as as Q ¢ p improve, or repair any structure,prior lv its issuance,also ELEC.CONTR. LIF NO. ELEC. ,^/z Rio)WC 33
oLL mgoicesthe applicant for such Purmil to(ilea cignad statement that TOTAL 1YJrW PERMIT TO
u w m he is licensed pursuant to the provisions of the Contractor's License �I /
rzi
Law(Chapter 9(communcing with Section 7000)ofDivision 3 ofthc {y.� '��7Gb�/
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ r pm the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit Subjectsthe applicant loacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of not'tore Ih an five hundred dollars(5500}).
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do life work,and lite structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code,The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who docs such work 2 FIXTURES-PER TRAP5.00 so.FT.FLOOR AREA TOTAL ACREAGE
himself'or through his own employees,provided that such improra-
mcnts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
Or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that ne did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove 1,as owner
of sale.). INDUSTRIAL WASTE INTER. 30.00 0 IND c❑oN O oQr
❑ L as nwmcr rs the Property,the
crojecty Se contracting with
licensed contractors to construct the pmceet(Sec 7044,Basle's LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Frowner of Codprop:The Contractor'sbuidLicense s tit does not apply
to tr owner of properly who builds t r improvli thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
conlmcls for such protects with a contranod sl licensed pursuant to
the Contractors License Law, SEWER-SANITARY-STORMEA.200ft/10.00 TRACTNO. PARCEL NO.
❑ lam C%CmpllmdL'r See. ,BARC.for this WATER HEATER W/VENT 6.00
en
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAT ION INiCLARATION WATER TREATING EQUIP. 5.00
I hereby atom Oml 1 have a ce'lificme of consem m self-insure.
III,a cerlif eme of Workers'Compuneation Imurn me,ora Certified ZONING ENG.SITE NO.
copy NuEof(see.3aoo,Lan.c.). 0 _pip �
Policy N rt Cmereb yfu f V n
Q 4ry❑� Certified copy is hereby furnished.
the FIRE SPRINK ENERGY T-24
Z Z I Certified copy is III,,] with life coy incpecl ion division.
Fp Alp icam MISE.- REFER TO ORD: v ❑ N❑ v ❑ N❑
� N
CERTIFICA1'E 01'EXEMPTION FRO\I WORKERS' PERMIT ISSUANCE —ieto FLOOD ZONE A.L.U.C.
LU > CON1PlNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. M
CL ('Phis sect i<itt need nal be cuinplcletl i(Thu pen..it is I., one TOTAL I�Ik� V❑ N❑ V❑ N❑
� Z hu n deed dol l ors(S 100)or less.)
0 O 1 certify That in filo perfoun loce of Thu work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1— mit is issued,I shall not employ any Person in any manner so as in
O hcroimc subject to file Workers'Compensation Laws of California. y ,�
W DatE Applicant ALTER OR ADD TO MECH. 5.00ZVI BUILDING oil
} m NO'I ICE TO APPLICANT: If,after making this Certificate of Ids-
FZ en.plem,you should become subject to lite Worked Compensation APPLIANCE 5.00 PLAN CHECK
provisions of file Labor Code. you must forthwith comply with
U such provisions or fills Permit shall he deemed revokm. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE
CONS'1'RUCHON LENDING AGENCY AIR HANDLING UNIT(OVER I0,000GEM.) 6.00 SEISMIC FEE
I hereby affirm the there is a chuch ts loading agency for EXHAUST HOOD(WITH DUCT) 5.00
mhich
the performance of life work !or wthis permit is issued(Sec. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U:)9.50 ELECTRIC '
^
I certify that l I...encid lhisapplic,limp andstate that lite above VENTILATION FAN (SINGLE) 4.00 1
information is Correct. I agree to Comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of This city to enter upon the BOILER-COMP Wiser 100,000 BTUf SEE FEE SCH, MECHANICAL
above-mentioned property tativ inspection purposes.
(We) agree Io save, indemnify and keep harmless the City of misc.- REFER TO ORD.
Cope,.full against liabilities,judgments, costs and Expenses which CONST.TAX
may n any way accrue against said City in consequence of IIIc PERMIT ISSUANCE —
•r'nit Kills per til. MECH.CONT. LIC.NO. MECH.
aT&4i2 �—Z9'-� TOTAL ^ /�j\ TOTAL ctryr�
Sig ature of Applicant/Contractor Date G IIf..LJ'
OFFICE COPY