15292 (2) :r THIS CARD NEAR FRONT OF BUILDING PERNIITNUMBER
CITY OF °CUPERTINO 15292
INSPECTION DIVISION
JOB INSPECTION RECORD
•. / !! PERMIT EXPIRATION
JOB ADDRESS—( � P�S -k�7?5 ZVCi _Rd_UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER �( G•/ sZ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION; '.', " ,�4 ATEA' ;INSPECTORC'P:,,?Idg$;Al&44INSP,ECTON'RECORD+�7,;,-."1~;S ,i 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PIRAIII VAI.RATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO ------- TI ISA OVE HAS BEEN S ONE
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE UPlE
MECHANICAL BLUE I ELECT I PLG Ny CCIR
❑ ❑ ❑ GJ
DO NOT PO FLOOR TI .;ABOVE AS BEEN SIGNED d; g „U LDIN6 PER T- IZ9
WOOD FLOOR Q kr: IN FORMAT[bkl N"
''>t.
J,3�VALIA�Iil. IIIT.
PLUMBING �q
MECHANICAL -f+
EE` PERMIT TOELECTRICAL
FRAMING 0,
snuu ES rvEE coNsn+
INSULATION
UCC GROUP RES UNITS
PLACE N SUB LOOK Nt x gDVE S-11 EtM SIO EDI
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 51, n FL°°'+"r+Fn ICI nL ncHF nct
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
11MLIDINC,115E
ROOF SHEATHING I+Ia IND CON PB olm•,
APPLY NO ROOFING,UNt L`ABOVE! AS.BEEN SIGNED,at•is: F1 SIttA4`T'P"Nf's.0ATE,,`dl
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING ELECT.ENERGY
THACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL �)f. BUILDING ENERGY ncc o"Te ACC BUILDING
FILE NO
FRAMING - ,1_ ELECT.FINAL TEST
ZONING ENO 511E NO.
INSULATION PLUMBING of
GAS TEST GAS
MECHANICAL FIRE SPRINN ENERGY T]a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 7, "Cj "o
FLUOU IUN! ALUC.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ I] N❑
SH EETROCK GRADE °P,i OkE SUMMARY'- ell I
EXTERIOR LATH BUILDING 177--777-1
INTERIOR LATH TEMPORARY APPROVAL BUILDING • a
SCRATCH COAT ELECTRIC PLAN CHECK
G
FEE
AS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I ISEISMIC FEE L's—
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU `
I-_ WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
-• 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
• — SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL j�fsa
CALLING FOR FINAL INSPECTION.
OFFICE COPY
PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
DI NO PROJECT IDENTIFICATION PERMIT NUMBER '
871.ort�;
APPLICATION & PERMIT 15292
]"(';r
LL�AI � BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
Darien S PLAN CHECK VA IOATION
" F DTV. ELECTRIC PERMIT FEE
�p a
1 v2 Q PHONE V 3�--
nn TRACTORS UTLETS-SWITCHES-RECEP 10.90 f"O 36
LIC.No. 2 LIGHTING FIXTURES AM
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
AGGRESS
PHONE PANELS 10.00 DATE OF APPLICATION
On ECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEEP.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH,OR ENG. 5.00 PERMIT VALIDATION
AOOnkss SPECIAL CIRCUIT
ZIP EMP.METER OR POLE INS. 20,00
ANTS MOTORS SEE FEE SCH.
ADDRESS .-
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
a v u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
1O (conunveing wills Section 7000)of Division 3 of the Business and
Ni Professions Code,and my license is in full force and effect. BLDG. ELECT. PLG. MECH.
Z
0 w - License Clam Lic.Number sJC.
O Z�w Dale Conl actor U
P '" {� QQjj��I LDING PERMIT
a ¢ w¢
OWNER-BLT LDER RECTA RATION {Wh1FORMATION
w 3 " REFER TO ORD
u 1 hereby affirm that I am exempt from the Cnnlmctor's License MISC.— VALUATION S/FT.
w0< Law for the following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE
FW Code:Any city or county which requiresa permit reconstruct,alter, U
¢ ¢ <2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requites the applicant for such permit to file n signed slacramd that TOTAL PERMIT TP
A' w$ he is licensed pursuant to the provisions of the Contractors License / •)`ST1Tl
Fri
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhc /al/TC'R.(OR
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢r $ the basis for rhe alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicanllo a civil penally ,7 ALTER-DRAIN&VENT-WATER (EA.) 5.00 �•
of not.more than five hundred dollars(S5001.):
❑ I,as owner of the property,or any employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work.and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to en owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
r himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.I L however,the thudding GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
-`9 or Improvement is sold within one year of complelion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 200 BUILDING USE
builder will have the burden of proving that h . . .
e did not build Or im' RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I as owner of the property,am exclusively Contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
..,it Professions Code:The Contractor's License Law dues not apply
to an owner of properly who builds or improves Ihcreon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conlractods)licensed Pursuant to SEWER-SAN V-STORM EA.200ft 10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under ec.T,B.hP.C.for this WATER HEATER WIVENT 6.00
rcamn
caner c_en ._ Dare WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
/Q1srxt((gGKu�s'CO PI!FSM ION DECLARATION WATER TREATING EQUIP. 5.00
I hereMy affirm that I h ve a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a Certificate of Workers'Compensation Insurance,or a Certified
copy Ihereof(Sec..1900,Lab.C.).
Policy No. Company
.. Q ❑ Cerlified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified Copy is filed with the city inspersion division. MISC.- REFER TO ORD.
O Applicants[ v ❑ At V ❑ N❑
fry
CERTIFICATE OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE FLOODZONE A,L.U.G.
W > COMPFNSAI ION INSURANCE PLG,CONTR. LIC.NO. PLG. t
O_ 0 (This section need not he completed if the permit is for one TOTAL o% Y C] IN C] Y❑ N❑
D Z hu relied dollars 1$100)or less.)
U 0 I certify that In the performance of the work for which this per, GTV. MECHANICAL PERMIT FEE FEE SUMMARY
1L mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California. (yp
O M Dam A+ licant FSEISMICFEE
I p ALTER OR ADD TO MECH. -E0B
lois NO'T'ICE TO APPLICANT: IL after making this Certificate of ion
Z provdnyou Should become
e, youto Ise Workers'Ccomplym rets APPLIANCE 5.00
provisions of the labor Code, you mus[ drevoke comply with
C.1 such provisions or This permit shell be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAODC.F.M.) 6.00 I hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which([Its permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 6.003097,Civ.C.).Lender's Name HEATING UNIT IOVER 100,000 B.T.U.)8,50 /
Lender's Address
1 certify that I have read this applicalinn and state that the shove VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building conslruclion, and BOILER-COMP(3 H.P.Of 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL
ahovcnsentioned properly for inspection purposes.
(We) agree to save, indemnify ..it keep limudcss [he City of MISC.- REFER TO ORD.
upertino against ITabllitie a figments, costs and expenses which pERM1T ISSUANCE CONST.TAX
ay in any way accru again said CH in consequence of the
con( orthuspeprul. MECH.CONT. LIC.NO. MECH.
TOTAL a _ TOTAL 3�44"a
Signature of A PPlicnntlCon radar Date
:f` OFFICE COPY