16141 (2) POST THIS CARD NEAR FRONT OF.BUILDING " PERMIT NUMBER
' CITY- OF CUPERTINO 16141
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXP�IRATION� ,
JOB ADDRESS.,�t�i a ��"''��TTE c UNIT# - ' '_LOT#
15�APERMIT EXPIRES IF WORK
OWNER >�}-L.,✓:�I, U CONTRACTOR IS L; IS NOT, STARTED WITHIN''
INSPECTION- ' DATE INSPECTOR. SPECTION RECORD 180 DAYS OF PERMIT-ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: v ,''r
1 UFER - ALL GRADING AND DAAINAGE,SHALL BE INSTALLED LAST CALLED INSPECTION.
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
_PR EGUNITE _ ., i •+ CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED t ,/ c� � . �-•-'
4t1 +
• - " UNDERGROUND /,SLAB -
PLUMBING
ELECTRICAL '" '' ISSUANCE DATE -
MECHANICAL I - eux; R9❑EGT, �� MECR.
-4'
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED dig! i
. R DINGPERMIT
WOOD FLOOR ,
- VALUATION
PLUMBING" . -
MECHANICAL
ELECTRICAL • + .. s PERMD
,FRAMING
INSULATION„ - STORIES. TY ECON$TR
fi
UCC.GRUUP RES.UNITS
PLACE NO SU BFLO0R UNTIL ABOVE HAS BEEN SIGNED "'; coc oir-r
SO.FT 'LOCH AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALLBE MADE BEFORE
DIAPHRAGM - - THE CONSTRUCTION.TAX ISRAID_•
ROOF SHEATHING. BUILDING USE
RES INDCON PB Oma•,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' E 1 O - E E
ROUGHSAN.q ASSESSORS PARCEL NO
PLUMBING . ELECT+ENERGY
TRACT NO. PARCELNO.
TUBS&SHOWER PAN I PLUMBING ENERGY .
MECHANICAL MECH.ENERGY -- - '
ELECTRICAL - - BUILDING ENERGY - ACC.DATE . ACC.FILE NO,
FRAMING ELECT,FINAL TEST - -
INSULATION - PLUMBING M1f ZONING ENG.SITE No.
GAS TEST - GAS
,p
MECHANICAL FIRESPRINK ENERGY T•)4
COVER NOMORK UNTIL ABOVE HAS BEEN SIGNED HEATING, - "° ❑ _ N ° `" N❑
EXTERIOR SHEAR JELECT ICALRELEASE ELOOD zorvE A.L,U C:
INTERIOR SHEAR' - FIRE DEPT. YE] ' NE] Y I] N0
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH - T MPORARY APPROVALS BUILDING GTL
'SCRATCH COAT - - ELECTRIC PLAN CHECK
GAS.` FEE '
NO TAPE O&PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF-BUILDING;IS NOT PERMITTED UNTIL BUILDING FINALIS SIGNED BV BUILDING'INSPECTOR. MICROFILM
:ARRANGE FOR INSPECTION BY PHONING 252-4505,'- ELECTRIC U
F- ONE WORKING DAY BEFORE,REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Ax
SEE PERMIT FOR EXPIRATION DATE - ' MECHANICAL•
` IMPORTANT. _ CONST.TAX
I
PLEASE READ REVERSE SIDE BEFORE, , c
CALLING,FOFGFINAL INSPECTION. TOTAL. V7�J
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -'USE BALL POINT''PEN ONLY
Ul LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
SO DING _ l,�/ ^ APPLICATION & PERMIT L , 16141
AOlRE55 Ck — l�
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL °
OWNER'S PLAN CHECK VALIDATION
A
�ryyQ{��^' {1(�. QTY. ELECTRIC PERMIT FEE
�\�1`N. '� �VlNirt,C •x�r'\VHOrvE�`��",�Ir
cory ACTOR'S' r
NA E _ OUTLET&:SWITCHES-RECEP-, 10.00/1.00
Q 1., �od�5 LIC.NO 21$052 LIGHTING FIXTURES 10.00/1'..00
Y , . i y
-
CONTRACTORSADDH ESS - APPLIANCES-RESIDENTIAL 4.00
' ZZJV "•�1�� •.,err PHONE�1'�V�CT PANELS. 10.00 ,� DATE OF APPLICATION
AR T A CHECK .P.PANELS (OVER 200 AMP) - 20.00 PLAN FEE C.NO."
-
'uc.No.VN061 SIGNS TRANS. 3.00
ARCH.OR ENG. ' t;, PERMIT VALIDATION
ADDRESS C f1L, S• SPECIAL CIRCUIT - 5.00' -
'L-l�(7T( W EMP.METER OR POLE INS. 20.00
ADDRESS. MOTORS I, SEE FEE SCH.
Z11sb . S '19 SERVICE CHANGE 2000
wO o LICENSED CON'fNACTORS DECLARATION
v I'herehy affirm•that 1 ons licensed underprrvenonsof Chapleri) - ISSUANCE DATE•- . ^
N z w (commencing with Section 7000)of Division 3 of the Business and
_ a d BLD .� LECT. PLG. MECH.
RNi 'rf s d• d •iso is full force andyyyyyyfffffffec111111,,,,,,���- -
O i m o ic.Numbla&—
r �.r J c_ Cnntruclor.�I11JJ�`.. -
a y F J • �J L • BUIL G PERMIT
rs o u O O4'N�f3B$LDFR D17CLARATIA - - - V INFOR ION
E:
;e- n- I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD ��
W o¢ law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE }g96 VALLUUg17 $/FT.
w0 J'' Code Any city orcounly which requinsa permit toconslraeL alter, yy'tyyll w/
Q ar a improve,demolish,Or repair any structure,prior IO Il51ss'nance,also ELEG CONTR. L'IC.NO. ELEC.:
a a rc requires the applicant for such permit In file a signed statement that TOTAL- PERMIT TO
w m he is licensed pursuant to the provisions of,the Contractor's License _ "�'
HZQ Law(Chapter 7(Com men c ing wi t h Sen l inn 7000)o f Division 3 of t he _ "
th �1gWll�( ,
Business and fr
Professions Code)nr that he is exempt therefrom sort QTY. PLUMBING PERMIT FEE 1,' I�I
M I- S e basis for the alleged exemption.Any violation of Section 7031.5 STORIES _ TYPE CONSTR.
by any applicant for a permit subjects the applicant to A civil penalty 00&VENT-WATER IEA.15.
of not more than rise hundred dollars($500)): ALTER-DRAINC l
❑ I,as owner of the property,or my employees with wages as CK F LOW PROTECTDEVICE
their sole compensation,will do the work,and the structure is not . OCC.GROUP AES.UNITS
intended or offered for sale (Sec. 7044;Business and Professions AINS-FLOOR,ROOF,AREA,COND -
Code:'I'Im 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 AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the buildingGAS-EA.SYSTEM-1INC.4OUTLETS
or improvement is soil within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.06
builder will have the burden of proving that he did not build or Tal. -BUILDING USE
prove for purpose of sale)_ RES IND CON PB Otber
E I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE"INTER. 130.00 ❑ ❑ - ❑ ❑ ❑
licensed contractors t0 construct Ile praicet(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6:00 '' ,ASSESSORS PARCEL NO..
;uml Professions Code:The Contract,,,', Law does not apply - -
to lin 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 SEWER-SANITARY-STORM EA.200ft/10,00
the Coal rector's License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sac.—,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACG DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm.that I have a certificate of consent 10 wll:insurx'. ZONING ENG.SITE NO.
,r a certificate of Workers Compensation Insuru ce,pr�a certified
yApY"Itlle[p>f fSey13�0%Ca1�Q.1 l
Sf1lf}y,'A'rrs�(gif(Se 3fift) P,'rTAy1i U
,� ❑ Cc ledc yi. herery 11misl d.: I, FIRE SPRINK - ENERGY T-24
FZ .�.It,1 Ted y is filet.Fv\h city 1tn hot,:d Iv n. MISC -'. `i. ' REFER TO ORD, ❑ O ❑ ❑
O ppllcam -O 1f Y NV N
CC y -CF-RTIFICATEOF EXEMPTION FROM WORKF-RS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
L COMPENSA'PION INSURANCE PLG.CONTR. LIC.NO. PLG. '
D
Z fl'his section need not he completed if the permit is for one TOTAL Y❑ N❑ Y❑ N El
hundred dollars IS 100)or less.)
U O 1 certify that in file performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensa l ion Laws of California.
Date ApplicantBUILDING G
>_ GO NOTICE TO APPLICANT: IL after making this Certificate of Ex. ALTER OR ADD TO'MEC H. .5.00 O a
emplion,you should become subject to the Workers'Compensation _ APPLIANCE - ,5.60 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE '
U such provisions or this permit shall be deemed revoked. .. AIR HANDLING UNIT(TO 10=C.F.M.) '4.00 -
• CONSTRUCTION LENDING ncenlcY AIR HANDLING UNIT(OVER 10 p00C.FM.) 6.00 SEISMIC FEE //r
I hereby affirm that it •r 'is con' nr mg agency for EXHAUST HOOD (WITH_DUCT) 5.00
the perlounioce of the net] this permit is Issued(Sec. MICROFILM
3097,Civ.C.). HEATING.UNIT(TO 100,000 B.T.U.), 8.00 . -
Lcnder's HEATING UNIT(OVER 100,000 B.T.U.)9.50 - ELECTRIC
ABdress
I cerify(hat 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-COW(3H.P.or100,000B.T.U.)'6.00 'r
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL'
ve-mentioned Property for inspection Purposes.
( )
agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORD.
•r no against liab"tiCI,jn Igmenfs„costs and expenses which anPERMIT ISSUANCE .1BfB0 ' CONST.TAX
in in y way a roc id, 't stdA Cily in wnseyuencc'of rile -
r, din It's per Il. MECH.CONT - 'LIC.NO., MECH. , ' !^T' ��A--.///
TOTAL a.�`A VI 'roTAL S/ 6/
gnat •of Applicant/ odrac or Uale ' /'
OFFICE COPY