03010039 (4) CITY OF CUPERTINO -
BUILDING DIVISION PERMIT >CON=TRACTOR INFORMATION`2
BUILDING ADDRESS:
PERMIT NO.
91 R12 MONTR 17T
OWNER'S NAME:
APPLICATION SUB DATE
NE:
SANDARY NO. CONTROLNO,
ARCHITECT/ENGINEER: PHONE p:
BUILDING PERMIT INFO
�Z BLDG ELECT PLUMB MECH
0o R O ISTING O D O O
TO ARRANGE INSPECTION
�� INSPECTIONS �1 K ),EDATE {IN$PEG? CALL 777-3228 MONDAY-FRIDAY 24 HOURS JOB DESCRIPTION
.:�> i3'�Ln J81 3Z —s 0 S DENTLe1
BEFORE REQUIRED PISPECDON.JOB ADDRFSS ❑ SFDWL ❑ KITCHEN REMODEL
ggu� FOUNDATION/PIERS/H.D.S. AND PERMIT p ARE NEEDED WHEN PHONING. ❑ADDITION ❑PLUMBING RE-PIPE
UFERGROUND
3 ° RAL
PAD/SETBACK-CERT ❑ MULTI-UNIT ❑ MODIFISTRUCCATION MODIFICATION
u.D RESIDENTIAL_COMMERCIAL_OTHER_ C3 INTERIOR ❑CHIMNEY REPAIR
GARAGE SLABS/PREGUNITE _ IMPROVEMENT ❑SWIMMING POOLS
Cc POUR�NO CQNC,RETEtUNT(L�ABOVEHA's;BEENS(QNEp_' HAZARDO— afIREARFA (] BATH REMODEVRHPAIRO DEMOLITION
r-
�v, UNDERGROUND/SLAB ❑ C1 OTHER
S< YES If I understand that o Class A roof assembly is required:
X c UNDERGROUND PLUMBING
� � UNDERGROUND ELECTRICAL 0N Initial Lc.e.o.p
COMMF�CIAG
1)dINOT;POUREFEOOR;UNTIUABOVE"HAS!BEEN SIGNED•„„; EMS ING ROOF COVERTN. ❑NEW BLDG/ADDITION ❑ DEMOLITION
UNDERFLOOR PLUMBING ❑TENANT ❑ FOODSERVICE
UNDERFLOOR MECHANICAL Number of existing coverings IMPROVEMENT
UNDERFLOOR ELECTRICAL Toberemovad Teberemined ❑OTHER
UNDERFLOOR FRAMING VENTS
UNDERFLOOR INSULATION
PLACE NO SUBFI"i00R-UNTILABOV&.Hp$'9FEN SIGN�p TYPE OF ROOF COVERING
ROOF SHEATH/DIAPHRAGM PXI--yS'r�'fNG PROPOSED-
PLUMBING ❑ Built-Up Roof 0 Built-Up Roof
TUBS&SHOWER PAN ❑ Asphalt Shingles El Asphalt Shingles
MECHANICAL ❑ Wood Shakes ❑ Wood Shakes
ELECTRICAUPOOL BOND ❑Wood Shingles ❑Wood Shingles
MING/STAIRS/E.EGRESS ❑ Other(Specify) ❑Other(Specify)
CATION/VENTILATION
_ Provide LGB.O.Repan Na.
EXTERIOR
NOdSHEA HOLD DOWN HASIBEENiSIGNED rt Provide Mfgr.Installation Specs.
EXTERIOR SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP
EXTERIOR LATH/W-SCREED
SHOWER LATH
�NO,TAPF,OR'PLASTERUNTI4ABOVE HAS fir
SCRATCH COAT L^ 04,
SEWER/WATER -/
TEMPORARYAPPROVALS
OCCUPANCY
i
�Q PINA4S f� -- a: •� r.rr -.:_,:
y PLANNING 777-3308
{ j GAS TEST /
Q
GRADE
ALL(408)378-
) 0 FIRE-CALL(408)378-40(0
HANDICAP
7 U ELEC'T'RICAL S
W PLUMBING
j Z MECHANICAL '7- _
” ENERGY 6 �'+�/ /��
VISUAL FINAL ONLY ^ J / /
BUILDING y •I L/l
OCCUPANCY OF BUILDING IS NOT PERMI74EDl T
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f,.UNT1WBUILDING.PINAL IS SIGNED BY BUILDING
"1 f r ,W - -
PECTOR :arN QyrE "";"� ERTIFICATEOFOCCUP CY
-INSPECTION: PLYWO D: IN-PROGRE S:
INSP. DATE INSP. DATE I INSP. DATE ��! V
TEAR O •INSPECTION: BATTENS: FINAL: '
INSP. DATE / INSP. DATE INSP. DATE
NO : OSHA APPROVED ACCE STO ROOF SHALL BE PROVIDED FOR INSPECTION