15193 (2) POST THIS CARD NEAR AONT OF BUILDING
�.` PERMIT NUMBER '
CITY;-O'F"C PERTINO 15193
INSPECTION DIVISION
JOB INSPECTION RECORD
• I PERMIT EXPIRATION
JOB ADDRESS—J�g9 Marl(/,Ir'�// -UNIT# _LOT# 1p
'IIPERMIT EXPIRES IF WORK
OWNER. \ !d CONTRACTOR b� \ IS NOT STARTED WITHIN
INSPECTION DAT INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
—" TO COMPLY WITH THE APPROVED PLANS AND CITY OF P6:RMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS ,(5.,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB.,
PLUMBING
ELECTRICAL M QD" ISSuANCE DATE
MECHANICALNELDG ELECT. PLG. MCCH
\yO V u \ ..
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
C\tY INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
PERMII TU
ELECTRICAL G��` +S W�_
FRAMING,
STORIES TYPE CONSTR,
INSULATION
OCC GROUP RES UNITS
PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED his - -
50 I ILUOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEF RE }
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING 'S RES IND CON PB O'l-,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING ,j ELECT.ENERGY
_ INnn No PARCEL No
l TUBS& ROWER PAN -SS1 6- ,/ PLUMBING ENERGY
MECHANICAL -2- -7;9 - MECH.ENER7
ACC DATE ACC FILE NO
' ELECTRICAL � BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG SITE NO,
INSULATION PLUMBING '
GAS TEST - GAS
FIRE SPRINK ENERGY L74
-
MECHANICAL l Ej No V ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD LUNE ALU C.
EXTERIOR SHEAR ELECTRICAL RELEASE
N
INTERIOR SHEAR 'FIRE DEPT. `' ❑ NNE] L„ ❑
SHEETROCK ( GRADE FEESUMMARY
EXTERIOR LATH L _ BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC 'L PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS'BEEN SIGNED OCCUPANCY SEISMIC FEE . y
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ` r
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z ..�
— SEE PERMIT FOR EXPIRATION DATE —
MECN,ANICAL
IMPORTANT! PTOTA
PLEASE READ REVERSE SIDE BEFOREL
CALLING FOR FINAL INSPECTION. '—
OFFICE COPY,
FINAL GRADE
� �TtOUTL LIF- �
File No. _
Date
Location
Tv vim}---
r
Subject
Notes
i
i
Approvg�d
D to Inspector .
i
1
'APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
yBUILDING PROJECT IDENTIFICATION - PERMIT NUMBER I
AI UILR EsJ,Y6• G- �- APPLICATION & PERMIT 15193
ADOs
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL g'
OwNER'S PLAN CHECK VALIDATION
NAME Ndd QTY. ELECTRIC PERMIT FEE
•
UV I P ( tbo, J*40
oNTRacroRs OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
1IC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
A APPLIANCES-RESIDENTIAL 4.00
C
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLA_CHECK FEE P.C.NO.
eoi* `t C LIC.NO, W SIGNS TRANS. 3.00
ARCH.OR ENG, SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION
s r '
S. EMP.METER OR POLE INS. 20.00
APvucarvrs MOTORS SEE FEE SCH.
D RESS G�r/'C./
SERVICE CHANGE 20.
o o LICENSED CON RACfORS DECLARATION Q V
rt v U I hereby a(finn that I am licensed under provisions of Chapter 0 h t ' ISSUANCE DATE
to a$ (commencing with Section 7000)of Division 3 of the Business and ELECT. PLG. MECH.
H w z Professions Code. 1 my license is in full force and effect. K
z o m - License Lic.Number
.010
r w Uatc-I��J�� Coru
ntcmk
r 0
C BUILDING PERMIT
Q w ¢ OWNER-BUILDER DECLARATION INFORMATION
woAD MISC.- REFER TO ORD
. I hereby affirm that 1 am exempt from the Con tote.."a License VALUATION $/FT.
F u•0 4 Law for the following reason.(Sec.7031.5;Husinessand Professions PERMIT ISSUANCE
to Code:Any city or county which re4uiresa permil to construct,alter, a3
rt ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
A Q /!
-DLL requires the applicant fur such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contr:¢tur's License
w m a
r z to
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Buness and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ F O sithe basis for the alleged exemption.Any violation o'Sectimh 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjects lheapplicunt mucivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred doollalars(5500).):
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
Itch sole compensation,will do Rte work,and the structure is not
intended Or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R -
Cod,:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who docs Such work FIXTURES-PER TRAP 5.00 SO.IT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.H.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 �' G/ a
or improvement is sold within one year of completion,the owner. GAS-EASYSTEM-OVER 4 (EA) 200 /(OBUJILDING USE
builder will have the burden of proving thus he did not build or Tire . . .
- RES IND CON PB Omer
proveJer purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 R) 0 El El
r L ae owner of the property,.,it exclusively contracting will
licensed contractors to construct the project(Sec.7014,Business LAWN SPRINKLERS- 1 INC 5 V.B: 6.00 ASSESSORS 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 fur such projects with it contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.
the Contractors License Law. 00 TRACT NO. PARCEL NO.
❑ Ia1N(I mptunder Sec. 1 B.&P.C.for li WATER HEATERW/VENT 6.00 //d
eal' -I.tfq . .
Owner-IV.]LI Dute WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKIr-RS'COMPENSAI'ION DECLARA'T'ION WATER TREATING EQUIP. 5.00
I hereby infirm than 1 have a certificate ul'consent to wif-insure. ZONING ENG.SITE NO.
or a cerificate of Workers'Compensation Insurance.or a certified .
copy thereoflScc.3800,1ab.C.).Erfr1�N/�
Policy No. CumpanY=-1��4-s4_ �) VSL
O ❑ rlihe 'opy is herebyf jjnished. SLl FIRE SPRINK ENERGY T 24
Z Z CT Certific _ iled�:(y�'me T io 'divisiin. MISC.- REFER TO ORD. � � � C]
O Applicant 1 ' Imo-_ a v N Y N
CCT CHRl'IFICA'lli OP EXEMP'r1ON PROM WORKERS' PERMIT ISSUANCE 1A7B0 FLOOOZONE A.L.u.C.
OI > COMPI!NSATION INSURANCE PLG.CONTR. LIC.NO. PLG. / p
CL. D 1'1'his section need not be completed If the permit Is for one TOTAL (0 L Yo N F Y� IN
Z) 2 hundreddnllars(SI00)oruNv)
U O 1 certify that in the peroor mance of the work lin which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
IL F unit is issued.I shall not employ any person in any inner so as to
U become suhbctl to the Wnrkcrs'Cump1.,nsatinn Laws of California.
O w Datc pplicant �o ABUILDING o�
1 ALTER OR ADD TO MECH. 5.00 �
} N NOl IC17
ion,TO APPLIShould beau: If,after making this r%'Certificate sa Ex-
? eunvision you should become e. you In the Wrthwit Compensation Tun App LIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permil shall be dcancd rcvokcJ. AIR HANDLING UNIT(TO 10,000OF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 SEISMIC FEE /6.3
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. MICROFILM ,
3097,CO.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC O
Lender's Address
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 �� Q
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby uuthorirc representatives Of this city to enter upon the BOILER-COMP(Over100,000 BTUI SEE FEESCH. MECHANICAL ( 0
abavomanion,d property for inspection purposes.
(We) agree to cove, indemnify and keep harmless the City of MISC.- REFER TO ORD. OZ. �,.r
upertimo against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX �i -j„
may ' any way accrue again. sa.0 City in conscyucn a of the -/
ren of phis perm L MECH.CONT. LIC.NO. MECH. R
TOTAL 0 (0 �- TOTAL
Sig alone(Applicant/Contractor Dale
OFFICE COPY