16230 (2) POST THIS CARD NEAR FRONT OF BUILDING "
' PERMIT NUMBER
�= CITY OF CUPERT3 :
IN0 16230
INSPECTION DIVISION
' JOB INSPECTIONtRECORD ,
- - ••PERMIT EXPIRATION '
<` JOB ADDRESS 1637 ! Vl�D2 A—' ,UNIT#. _LOT# 1 .' .!
r - PERMIT EXPIRES IF WORK
OWNER _.. 'S ' coNrRAcroR 7� �•5 �-6 �,,. IS NOT-STARTED WITHIN'
INSPECTION - DATE INSPECTOR INSPECTION RECORD 1Bo D11
gvs OF PERMIT Issu
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
UFER - - - -ALL GRADING AND DRAINAGE SHALL BE INSTALLED,
PREG UNITE TO COMPLY WITH THE APPROVED PLANS`AND CITY OF � PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ; _ ,"•
UNDERGROUND /SLAB
PLUMBING il 01,
ELECTRICAL +• rssuArvce unrE '
MECHANICAL - - - _BLDG, ELECT I PLG. . MECR
1:1 El
DO,NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT.
` INFORMATION `
-1 WOOD FLOOR VALUATION 31sT:
PLUMBING -
MECHANICAL �
ELECTRICAL - A ",'MIT To
FRAMING'. ,+ - U` _ r10-/z'NAI; A�C*L-i..
STORIES TYPE CONSTR.
INSULATION - -
'OCC GROUP RES UNITS
,PLACE'NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO IT FLOORAREA TOTAL ACREAGE
-� - ROOF- NOTE:NO FINAL INSP.SHALL,BE MADE BEFORE -
DIAPHRAGM THE CONSTRUCTION TAX IS PAID y
ROOF SHEATHING BUILDING USE
RES IND, -CON PB o
APPLY NO ROOFING UNTILABOVE HAS.BEEN SIGNED' " ` •FINALS T:'- I)ATE,'.,;„” .INSP. � ❑- iEl ❑ ❑
ASSESSORS PARCEL NO
- • ROUGH SAN.N - •. -
PLUMBING - ELECT,ENERGY- - +
TRACT NO. PARCEL N
TUBS&SHOWO.ER PAN PLUMBING ENERGY - • ^ "
MECHANICAL .- - ` - MECR.ENERGY
ELECTRICAL - ,/ BUILDING ENERGY - Acc.DATE acc.FILE No I
FRAMING - ELECT.FINAL TEST I
., ZONING ENG,SITE NO.
INSULATION PLUMBING - -
'' ' GAS.TEST - GAS
- - FIRE SPRINK ENERGYT-24
MECHANICAL. -
. - - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y,El, "� "�
EXTERIOR SHEAR ELECTRICAL RF'� � - - '�"+�
-FLOoq ZONE ILL.U.Cr
ANTERIOR SHEAR � FIRE-DEPT. � :.� _ 1 ' r ❑ N❑ Y ❑ NO.
- SHEETROCK r _ GRADE FEE SUMMARY
EXTERIOR LATH BUILDING':
INTERIOR' LATH _ - - TEMPORARY APPROVALS ' BUILDwG Qy
SCRATCH COAT. ELECTRIC PLAN CHECK
GAS
NO TAPE OR PLASTER UNTILABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE I p'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
r
ARRANGE FOR INSPECTION BY PHONING 252-4505;'• ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z o PLEASE GIVE JOB ADDRESS WHEN PHONING.
PLUMBING
MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX .
PLEASE READMilEVERSE SIDE BEFORE -
CALLING-FOR FINAL INSPECTION, TOTAL U.3S
OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-� BUILDING PROJECT IDENTI FICA710N PERMITNUMBER
BUILDING APPLICATION & PERMIT q (I r� �'O
ADOREss �p I
03 ICp TBUILDING — ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S
NAME PLAN CHECK VALIDATION
A/ ,+ OTS'• ELECTRIC PERMIT FEE
kfL /V PNONE
NgrvrRAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00 _
7 LIC ND LIGHTING FIXTURES 10.00/1.00
CONTRACTOR S C�Q APPLIANCES-RESIDENTIAL 4.00
Aoon `` ,wE ff�y�. ��,,yy��
t.Ji✓'r.ACC "T -r
ARCHITECT HONE PANELS 10.00
GATE OF APPLICATION
OR PANELS (OVER 200 AMP) � 20.00 PLAN CHECK FEE P.C.NO.
ENG � L`�INEER '
LIC.No.3L&C',jr SIGNS TRANS. 3.00
ARCH.OR ENG.
ADDRESS SPECIAL CIRCUIT 5.00 PERMITVA LIDATION
ZIP TEMP. METER OR POLE INS. 20.00 ,r
APPLICANT s
ADDRESSMOTORS
SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
D ¢z
Foo LICENSED CON'(RAC'Ib RS DECLARATION
< u I hereby afrnm that 1 may licensed under provisions of ChatPERMIT
9
a w (commencing with Section 7000)of Division 3 of the Busined. ISSUANCE DATE _.
F w Professions Code,'nd y license is in full for' a fee BLDG. ELECT. PLG, MECH.
Q i H o License Clns Lic.Number
H j Uatc CmVrzctor ❑ ❑ ❑ ❑
Q y E J
¢ ¢ ¢ a W -BUILDER DECLARAT BUILDING PERMIT
u INFORMATION
w' Ow MISC.— REFER TO ORD
3 `y I hereby affirm Ilett 1 am exempt Dan the Convectors Lse
u o¢ Law fur the following reason.(Sec.7031.5,Business and Profens VALUATION
— PERMIT ISSUANCE 10.00 $/FT.
Ea>f Code:Any city Dr county which structur a permit toconsuanco Q ¢ D ImprnVe,deIr10I15I1,Of reFlalr any SIIIICInrL',prlOr IO IIs ISS4aRCn ELEC.CDNTR. LIC.NO. ELEC.O LL «quires the applicant for such permit to file a signed stutenmaat TOTALhe is licensed pursuant Io te provisions of the Contractor's Lse ���pPFSRMIT TO
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ep��LHy� I''Business and Professions Code)or tum he is exempt tlherelrod DTV. PLUMBING PERMIT �F6E QCa.'-" <��w' Wla.��¢ r the basis for the alleged exemption.Any violation ofSection75 1���77 STORIESTYPE CONSTR.
by any applicant for a permit subjeclsthe applicant to a civil pely gLTER-DRAIN&VENT-WATER IEA.) 5.00of not more than five hundred dollars(S500L):as owner of the property,or my employees with waas BACK FLOW PROTECT. DEVICE 4.00their sole compensation,will do the work,and the structure t OCC.GROUP RES.UNITS
!.limited or offered for sale (Sec. 7044, Business and Profes DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cade:The Contractor's License Law does not apply to an owner of
property who buiId,ormproves t hereon,;al d who does such w or k FIXTURES,PER TRAP 5.0D SO.FT.FLOOR AREA TOTALACREAGE
himself re through his own mend fors, le,11 ed that such improve-
or nts Improvement not
is sold or within one year o l)',however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is e b within one year of lie did coo,the owner
builder will have the burden of proving Ih;tl he Aid not build or ins GAS-EA.SYSTEM-OVER 4 (EA.) 200 BUILDING USE
prove 1.as ownerose
of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ d as owner of the property,am exclusively convecting with ❑ ❑ ❑ ❑ ❑
-fitPed contractor,od tole construct (lieproject 1 La 7044,ot apply LAWN SPRINKLERS-IANC5 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Code The Contractor's License Law does not apply
to an owner of property who builds or improves fiction,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to -
lac Contractors License Law. SEWER-SANITARY-STORM EA,200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,e.&P.C.for tllis WATER HEATER W/,VENT 6.00
reason
Owner Date WATER SRE
5.00
ACC.DATE ACG FILE NO,
WORKIiRS'COMI'ENSA'I'[ON DECLARATION WATER TREATINGQUIP. 5.00
1 hereby afftrn that I have a emlificalt of co"'c,nl to self-insure, - -
cerlif icate.of Workers Compensation Insurance,or acertified ZONING ENG.SITE NOPally thereof(Sea 3800,Lab.C.l_e1'nicy erCompanyO ❑ Cert ified copy ishemby furnished. FIRE SPRINK ENERGY T�Zq
Z ZCerfife y s file with the city inspection division.F O A P nt MISC.- REFER TO ORD. YN❑ v � N�� y Cli .FIFIC 1 )M WORKERS' PERMIT I10.00 FLOOD ZONE A.L.U.C.
W OAIPHNSATION INSURANC17 PLG.CONTR. .NO. pLo1 0 (This section need not be conhpleled if the permit i.s for oneTOTALN[3 Y ❑ ryE]
LD Z hundred dollars fS 100)or les.)
UO• certify that in the performance of the work forwhichthisper OTY AL PERMIT FEE FEE SUMMARY
IL H mit is issued,I shall not employ any person in any Runner so as to
O become subject to the Woi kers'Conhpensation Laws ofCalifornia.
y Date Applicant ALTER OECH. 5.00 /-7 o-0} W NOTICE TO APPLICANT: If,after making Ilth Certificate of fix-
enlPtion,you should become subject to the Workers'Compensation qpp LIAN - 5.00 PLAN CHECKprovisions of the Labor Codeyou must forthwi111 comply withFEEsuch provisions or this permit shall be deemed revoked. AIR HANDO 1OMaF.M) 4.00 A,
CONSTRUCI ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00SEISMIC FEE x70
1 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
3n97,CIv.C.). - HEATING.UNIT(TO 100,0008.T.U.) 8.00 -
Lender's Name
Limder's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6A0
hereby'authorize representatives of this city to enter upon the -
ahove-mentioned property for inspection purposes. BOILER-COMP (DVar 100,000BTl11SEE FEESCH. MECHANICAL
(WA)'agree to save, indemnify and keep harmless the City of MISC.- R7RTOD.
u Bruno against liabilities,judgments, costs anal expenses which CONST.TAX
I way against said City in consequence ol'the. PERMIT ISSUANCE00r' LingOft 'S pen ' MECH.CONT. LIQ NO. TOTAL 3S
Si afar Applicant/ ontra or Ua e - /7
OFFICE COPY