15543 (2) _ POST'THIS CARD NEAR FRONT OF BUILDING
�^ _ _ PERMIT NUMBER
CITY OF CUPERTINO 15543
INSPECTIONDIVISION -
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDR ESS 1601 $aTatOCJa—SUT1nyVale UNIT# _LOT#'
.. _ PERMIT EXPIRES IF WORK
OWNER Sys—Scan CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS of PERMIT ISSU-
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE: -
LEER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION..
PREGUNITE TO COMPLY W ITH THE APPROVED PLANS AND CITY OF PI i R MIT VALIDATION
CUPERTINO STANDARDS. _
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISs ANCE DATE
MECHANICAL BLDG., eL111 PLG. MEr,R.
❑ ' El ❑ �.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED D BUILDTNG PERMIT
WOOD FLOOR
INFORMATION
QVALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING - p1W Q�YU !1'
INSULATION . ,r TNV sTORCiEs Tw= coNsrR.
OCc.GROUP- RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 4.
I ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT,FLOOR pEn TOTAL ACREAGE
f• DIAPHRAGM - THE CONSTRUCTION TAX IS PAID A
BUILDING USE
ROOF SHEATHING - -RES: IND CON PB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ o ❑ 0 0
ASSESSORS PARCEL NO,
ROUGH SAN.# -
PLUMBING - ELECT.ENERGY °•
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO., PARCEL NO
MECHANICAL �/'J_88' MECH.ENERGY -
ELECTRICAL BUILDING ENERGY ACC On.H ACCFILENo
FRAMING ELECT,FINAL TEST
ZONINO ENG.SITE NO.
INSULATION' -. � PL'UMBING:•
GAS TEST. - - - GAS -
MECHANICAL FIRE SPRINK ENERGY CPa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y,Q NE] Y I] NO
FLOOD ZONE A.L U C
EXTERIOR SHEAR - ELECTRICAL RELEASE -
INTERIOR SHEAR n FIRE DEPT. ❑ NO,
SHEETROCK GRADE, FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - - TEMPORARY APPROVALS - eul�glNG -
SCRATCH COAT ELECTRIC . PLAN CHECK
GAS FEE,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERM ITTED UNTIL BU ILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM.
f
ARRANGE FOR INSPECTION B.Y PHONING 252-4505, ,ELECTRIC
Il' ONE WORKING DAY BEFORE'REQUIRED INSPECTION.
�. PLUMBING
z PI-EASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATIONDATE'= MECHANICAL . '
IMPORTANT! coNST.Tnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL,INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I IDENTIFICATION - PERMIT NUMBER
BUILDING APPLICATION & PERMIT 15543
'I ADDRESS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
y OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE '
/ PHONE
CON1EN/ N "c ORs Q UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.N (/r7-T LIGHTING FIXTURES 10.00/1.00 '
CONTRACTORS - APPLIANCES-RESIDENTIAL 4.00
A�'pjnOrRESS ` p -
PHONE e�/ PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
. OR JPANELS (OVER 200 AMP) 20.00
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ADDRESS ENG
SPECIALCIRCUIT 5.00 PERMIT VALIDATION
zIP TEMP.METER OR POLE INS. 20.00c/'
APPLICANTS
ADDREMOTORS SEE FEE SCH.
SS
., SERVICE CHANGE . 20.00
0 O LICENSED CONTRACTORS DECLARATION / /7 CI' • -.
Q u I hereby affirm that 1 am licensed under provisions(if Chapter 9 ISSUANCE DATE '
< a N (commencing with Section 7000)of Division 3 oftheBusiness and BLDG. ELECT. PLG. MECH.
O Professions Code d�y�ase is in full fur /�.
0 i License Cla "�C Lic.Number ��
Dote CanlnlCtor
a r M BUILDING PER
� ¢ ¢ a OWNIi R-BUILUF,R DL'CLA A ON
o d u INFORMATION
E ; LL I- I hereby utl'irm that I um exempt teem the Cnntrxctors License MISC.- REFER TO ORD
acOj Law for the reason.(Sec.7031.5,h asinessand Professions VAwATION JET.
- PERMIT ISSUANCE 10.00
Code:Any city c r county which requires a permit to construct,alter,
R< improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0, ELEC
G u r,c rv,the applicant for such permit to file u signed shdumen(that TOTAL. 104 PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chapter 9(commencing with Section 7000)of Uivision3of the a � ZI-17
4 O tlusiness and Professions Cnde)or that bets exempt therefrom and QTY. PLUMBING PERMIT EJ
I- $ the basis for the alleged exemption.Any violalion of Section 7031.5 } V STORIES - TYPE CONSTR,
n3 - by any applicant for a permit subjects(lie applicant boa civil penalty
ALTER-DRAIN IEA.) $.00
of not more than five hundred dollars(SSOO.): a �Q
Cl I,as owner of the properly,or my 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 net
intended or offered for Sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does riot apply to an owner of
property who builds or improves(hereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner* GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
st}'" prove for purpose Lolthe
RES INDUSTRIAL WASTE INTER. 30.00 13 El
❑ ❑ Othor
❑ as owner of the property,nm exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
n 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 IEA.) 1.00
contracts for such projects with a contractorlsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
O m m
tuexept under Sec. ,tl.&P.C.far thisreason WATER HEATER W/VENT . 6.00
El
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self-in sure,
or a ce}rctificate�o�yf dWo�r{kpers'La bCompensat�e Insurance,or a certified ZONING ENG.SITE N0.
Popvii�3dp(T'6mpany xl%24FIS�
❑ C��rtifed mpy is hereby furnish��pp,, FIRE SPRINK ENERGY T-74
Z ..B� citified
c I- i I.
i(y ins cel' h I> u
p Applicant Misc.-
2
ISC.- REFER TO ORD. Y N Y Q . NO
rn CIE R'TIF CAT Ii Pix EM ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.c.
LU - COMPRNSA NINSURANCF PLG.CONTR. LIC.NO, pED,
CL
Z ('This section need not be completed if the permit is for one TOTAL V N0 Y-0 N0
hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- not is issued,I shall.not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
y Date Applicant BUILDING
} to NOTICE'10 APPLICANT''. If,after making(his Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F 2 emption,you should become subject to the Workeri Compensation APPLIANCE -J-M PLAN CHECK '
provisions of the Labor Code, you mus( forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.EM.) 6.00 SEISMIC FEE
I hereby,affirm (hal Ohre is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(SOC. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U:) 8.00 '
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
'rsAr information is correct. 1 agree to comply with all city and county BOILER H.P.Dr 100,000 B.T.U.1 6.00 PLUMBING
ordinances and,stme laws relating to building Construction, and -
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over.100,000 BTU)SEE FEE SCH,
3 above-mentioned property for inspection purposes. MECHANICAL
7 (We) agree to save, indemnify and keep Iharrnless the City of MISC.- REFER TO ORD. �r -
upertno against liabilities,jud ents, costs and expenses which PERMIT ISSUANCE 10:00 /71 CONST.TAX
may in''any a accrue u• said City in consegl cc of he
ranting MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Sign r plica ontmc[or ate -
OFFICE COPY