15192 (2) T THIS CARD NEAR FROWT OF BUILDING
PERMIT NUMBER
CITY OF CUPErRTINO, 15192
INSPECTION DIVISION
JOB INSPECTION RECORD '
{1/� ' /�! PERMIT EXPIRATION
JOB ADDRESSW
JILI� M�r�a, /") UNIT# LOT#
1 1 ` PERMIT EXPIRES IF WORK '
OWNER ) �.n� CONTRACTOR �I V IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION - NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PER41I1 VALIDATION
PREGUNITE. CUPERTINO STANDARDS.
GARAGESLABS -\"U• i(}T. k '� kb
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED i''
UNDERGROUND /-SLAB
PLUMBING
ELECTRICALISSUANCE DATE
MECHANICAL „, e(�L'D1cI ELECT PLC. MFc"
Q 4E ❑ ❑ 5
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED O� c�C 1•' BUILDING PERMIT
WOOD FLOOR INFORMATION
L C�pgv ATION TIFT.
PLUMBING / /-fid X03 Ot V
MECHANICAL PERTnm To
ELECTRICAL U �•
FRAMINGU
p SIORIES TYPE CONSTR.
INSULATION G^g9 li i y Z
OCC GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
50 FT 110011—LA 1piAL ACREPGL
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM
THE CONSTRUCTION TAX IS PAID
NUILOIOG USE
ROOF SHEATHING l.�•-1 � RES IND GN Po oll,..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DATE INSP. El ❑ ❑ ❑ ❑
nssessays PnviceL No
ROUGH SM11
-
PLUMBING 7" ELECT.ENERG �9.
INACT NO PARCEL NO
TUBSB WE may- /Z-S"L1 .y PLUMBING ENERGY
MECHANICAL - - 1 MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENO SITE NO,
INSULATION PLUMBING .
GAS TEST . GAS
FIRE SPNINK ENERGY T�Zi
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOODZONE AOUc.
EXTERIOR SHEAR - 4 ELECTRICAL RELEASE
INTERIOR SHEAR 4C{ FIRE DEPT. v❑ -El v N
❑
/ SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH 'ZU32 BUILDING i
BUILDING
INTERIOR LATH - TEMPORARY APPROVALS ;
SCRATCH COAT ELECTRIC `Z PLAN CHECK
FEE
/ GAS
1 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE r,..
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
• Z MECHANICAL - -
- SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
CITY OF.CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
.5.�
Date .... .;Z_qt ........................ 19-65.7- Building Permit No. 1-4-13-2,
The Building Located ......
Owned by ...attv /V& /�—
..........................................................................................................
Com let
HasAltered)
fas Been 42��ZlorUseAs: .......... .......................
(
..................................................................................................................................................
.................................... ............................................................................................................
............................. ...................................................................................................................
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........***"*"**"**'
PD-7 ING INSPECTOR
,AiP, (CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION B_ - -PERMIT NUMBER
DOLDING APPLICATION & PERMIT 15192
'S U
ADDRESSO '
d- Era BUILDING -ELECTRICALM
-PLUMBING-MECHNICAL
OWNS 1 PLAN CHECK VALIDATION
N � '\olend LU11 , lsoNE OTY. ELECTRIC PERMIT FEE
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS ,
PHONE PANELS 10,00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c.NO.
OR
ENGINEER `�,'
G 5bG No. SIGNS TRANS. 3.00
5.00 PERMIT VALIDATION
ARCH.DR ENC, SPECIAL CIRCUIT
ooREs
zlv C&ID TEMP.METER OR POLE INS. 20.00 1
APPLICANT MOTORS SEE FEE SCH.
SERVICE CHANGE 20.0
o o LICIiNSIiU CONI' ACTORS DECLARATION �
rt u I heieby affirm that I in licensed under provisions ol'Chapter 9 s,�\ ISSUANCE DATE
Na w (commencing with Section 7000)of Division 3 of the Business and fS ELECT. PLG. MECH.
E.y z Professions Co e, it my license is in full I'nree and effect. C
Licen sc Lic.Number
9 z H o Uate� Contractor
- BUILDING PERMIT
It w < OWNER-BUII.DIiR DIiCLARA'TION INFORMATION
od- MISC.- REFER TO ORD
w 3 LL R. I hereby AIRm that 1 ani exmnpt from the Contractor's License VALUATION
Foo I Law forthe following mason.(See.7031.5.Businessand Professions PERMIT ISSUANCE 1
vua Code'.Any city or county which requiresu permit toconstmct,aller,ec ea
Q0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u enquires Ile applicant for such permit to file a signet)slatenlent that TOTAL Q PERMIT TO
a w m he is licensed Pursuant to the provisions of the Contractor's License n q
Hai
Law(Chapter 9(commencing with Section 70001 of Division 3 Ot the
- < Business and Professions Code)or trot he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ fZ the basis for the alleged exemption.Any vlalulion of Section 7031.5 STORIES TYPE CONSTR.
d ;? by any applicant for a permit subjects the applicant o a civil penally gLTER DRAIN&VENT-WATER IEA.) 5.00
of not more than fisc hundred dollars($5001.1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Dee.GROUP RES.UNITS
their sole conhpensution,will In the work,and the structure is tint
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:I'hc Contractors 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 s0.FT.FLOOR AREA TOTAL ACREAGE
merits are noontide own ffered ers. le.If,
Lever,the
improve- - GAS-EA.SYSTEM-1 6.00
mese,are not ugh his or employees,
her sate.If,ed that
s the building 2
or improvement Is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im.. RES IND CON Pa Ome,
provef orpow of sale.). INDUSTRIAL WASTE INTER. 30.00
6: as owner of the property,am excluxively contracting with 19 ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
Slid I'mfeWons Code:The Com moor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iv xempt uyndcr5 c. �]_._,B.&P.C1{-fforrths WATER HEATER W/VENT 6.00
re8�/�
mason
IU•
owner 1. I WATER SYSTEM 5.00 Acc.DATE ACC.PILE No. '
WORKIiRS'COMPhN,o' ION UBCLARAT ION I WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of constnl to self-insure, ZONING ENG.SITE NO.
or v ec tilieale of Worker;Compensation Insurance,or u certilind
copy thercol'(See.3800.Lab.C.)}.Tr II,t�1k A
Policy No. CompunY-)AY E_1- -L-1f-r u--o-, S-
Q ❑ blit, 'oPY'is hereby lar is ted. FIRE SPRINK ENERGY T 24
ZZ Z Ccrtili d m c' division' MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
0 Applicant- Y N Y N
D_ T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.u.C.
LJ > COM1ITTNSAT10N INSURANCE. PLG.CONTR. LIC.NO. PLG.
4' 01(This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
Z If....lend dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PER
rkFEE FEE SUMMARY
LL I- our is issued,I droll not e,,,,]by any Person in any manner sa as In
Ow become subject to the Woers'Compensation Laws of California.. BUILDING
Date Applicant ALTER OR ADD TO MECH. 5.00 �Q
} ti NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Worker;Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 109MC.F.M.) 4.00 -
CONSTRUCTION LENDING AGENCY
AIRHANDLINGUNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE �6 ��
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Cis.C.l.
Lender,Name HEATINGUNIT(OVER 100,000 B.T.U.)9.50 ' ELECTRIC
nd
Leer i Address -�'
I certify that I have read this application and nate that the above VENTILATION FAN (SINGLE) 4.00
infnmmtion is rotate. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction,I'd
and 6OILER-COMP(3 H.P.or 100,000 B.T.U.1 6.00
hereby aulhoriee representatives of this city to enter upon the BOI LER-COMP(Over 100.000 BTU)SEE FEE SCH. MECHANICAL
above-mcnlioncA properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. O
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may ' any wuy accent, again, aaidECit, in consequence of the PERMIT ISSUANCE 7&00
ran of Iles per»il�.y� MECH.CONT. LIC.N0. MECH.
I,
TOTAL ��S✓ TOTAL
Signature of APPlicam m
/Coructor Uv
OFFICE COPY