16621 (2) POST THIS CARD�NEAR FRONT OF'BUILDING PFR Yr NUMTT ry
.CITY 'OF CUPERTINO 1621
` INSPECTION DIVISION
JOB INSPECTION RECORD Z�
�' • • R �l)� , I .P/ RMIT ON
jXPIe I
JOB ADDRESS ' ``� UNIT# _LOT# C9 / ..•`T�
_ PERMIT EXPIRES IF WORK
' OWNER r cONTRAcroR --'IS NOT STARTED WITHIN
INSPECTION DA E I INSPECTOR IN PECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCeOR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. ,-
GARAGE SLABS
POUR NO CONCRETE UNTIL A OVE HAS BEEN SIGNED ' - j Jyo,
UNDERGROUND /SLAB '
PLUMBING hlgv
ELECTRICAL VP. I UANCA.DATF.�
MECHANICAL CI, �} q T M .
2 sett
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED L;�UC BUILDING PERMIT
INFORMATION
WOOD FLOOR �ry er ALUAIIIN s/FT.
PLUMBING a1 — — ®I'D'1 CLQ-�LbJ6- PCFsQ HrJLk:B OMl ��`d„k
MECHANICAL T'
ELECTRICAL cam W4 _ %F'f+E�l1;,TO
1 IrnY F"`
FRAMING
INSULATION Q sroRlEs TYPE CDNsn+
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE .6,Wl ARj t TOTggMACL
THE.CONSTRUCTION'TAX.IS PAID. USE Y
DIAPHRAGM � � -
BUILDING USE
ROOF SHEATHING �•`��� - Res 'INo CON no oll„—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
ROUGH SAN,NASSESSORS PARCEL NO.
PLUMBING ELECT.ENERGY 8 ( drIII-65'i - DS- 26
'TRACT NO. PARCELING
TUBS&SHOWER PAN PLUMBING ENERGY ! 'L''
MECHANICAL -2S= MECH.ENERGY ACC.DATE ACC FILE NO
ELECTRICALBUILDING ENERGY
_ FRAMING - - ELECT.FINAL TEST - �•� 2f ZomlNc ENG.SITE No.
INSULATION PLUMBING �Lr, '.'!�; W
GAS TEST - - �/ GAS G p _
_ _ IR 'SPRINK ENERGY R2<
' MECHANICAL �'�j . �',
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _N 8 a"l�v N❑ s ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEA�t UFLOOD ZONE A.L.0 C. -
1/
INTERIOR SHEAR FIRE DEPT, v ❑ N❑ v ❑ No
SHEETROCK• GRADE -FtE SUMMARY
EXTERIOR LATH BUILDING /
INTERIOR LATH - �j TEMPORARY APPROVALS JBUIIDING If 3 c
SCRATCH COAT ELECTRIC PLAN CHECK
GAS'. �EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED I OCCUPANCY ' t SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. A
;MICROFILM
ARRANGE FOR INSPECTION BY'PHONING;252-4505, ELECTRIC
a� ONE WORKING DAY BEFORE REOUIREDdNSPECTION. PLUMBING
. Z PLEASE GIVE JOB ADDRESS WHEN•PHONING.
— SEE PERMIT FOR EXPIRATION DATE'— MECHANICAL
IMPORTANT! coNST.Tnx.
PLEASE READ REVERSESIDE BEFORE TOTAL
CALLING FOR FINAL I"NSPECTION: -
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
�- . BLALDING PROJECT IDENTIFICATION "PERMIT NUMBER
eoogsN APPLICATION & PERMIT �?Z1
APPREaS coni t,no, q Lit 25. lJ 1
uperq 1lv tallfOrnla BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
,y4jyt OWNER'S PLAN CHECK VALIDATION
C�Aa NAME Terry Brown Construction/ CITY. ELECTRIC PERMIT FEE ;
Jim Sisk Development,408-996-372 )
cr
NAIVE nary Brown Construction
NAIVE C' OUTLETS-SWITCHES-RECEP 10.00/1.00
J
w MgG5 11. 51 Std! LL.ND.1335264 LIGHTING FIXTURES 10.00/1.00 PJ 7 3 Z• �(�
cAoNooTRAness-TO-M721 Granada Ave. D APPLIANCES-RESIDENTIAL - 4.00
Cupertino, CA �50144W-496-3722 PANELS 10.00 DATE OF APPLICATION -.
nCNITELT Paragon Design roup PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
on
O
,GIIBIM!!R .
uc.No. n/a ISIGNSTRANS. 3.00
ApRDR ES S Alberto Way, Suite B SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
L0s Gatos, CA 195032 EMP.METER OR POLE INS. 20.00 �_�
APPLICANTS
0060 Pasadena Ave. MOTORS SEE FEE SCH. /
Cupertino, OA 95014 SERVICE CHANGE 20.00
woo LICENSED COME RACTORS DECLARATION s 2
¢v w 1 hereby affirm that I am licensed under provisions of Chapter 9AR U1 J
�1
rt (commencing with Section 7000)Of Division 3 of the Business and 1 6u ANCE GATE
Z Professions Cod• and my licmtse is in lull ly cud uffuct
DG. ELECT. PLG. MECH.
zo i L W License Cl. Lic.Number City of CupBff1110
Date S Contractor
M y a J
¢ ¢ a TR-BUILDER DF.CLAR BUILDING PERMIT
oa`a ImIryI ,mkil,t INFORMATION
w g t y 1 hereby a inn tat I am exempt from t Ie Omrai(l l'r icense MISC._" - REFER TO ORD
HLLoQ Law for the following reason.(Sec.7031.5,IlusinessanAnom, l°ns PERMIT ISSUANCE VALUATION $/FT.
Code:An cit orcount - 10.00 Z.l1d n 0
y y yir any structure Permlttoconsmance. teq ELEC.CONTR. LIC.NO. v�
¢ ¢a p improve,demolish,or repair any structure,prior m its issuance,also E LEC Q'�, r�
K o ec requires the applicant for such permit to file a signed statement Thal TOTAL (( L
n w $ he is licensed pursuant to the provisions of the Contractors License f PERMIT TO
Hi
Law(Chapter 9(cbmmencing with Section 7000)of Division 3 of the
Q
f 4 o Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE V
¢I- pm the basis for the alleged exemption.Any,violation of Section 703 LS STORIES TYPE CONSTR.
a3 _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
Of not more than five hundred dollars(8500)):
❑,1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP .RES.UNITS
their sole compensation,will do the work,and'ihe structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of -
'�T property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 so.RT.FLOOR"EA TOTALCAACREAAAGE
'_7 himself or arc of ughrote his awn employees, le.I i,ed that such improve- � g- I b /
memprovement is intended or within ed one or year o If, thebiddingowner, GAS-EA.SYSTEM-1 INC.4OUTLETS 6.00
or improvement is sold within one year Of completion,t the o r im-
builder will have the burden of proving that he did not build or ins- GAS-EA,SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of the.). _ INDUSTRIAL WASTE INTER. 30.00 - RES IND 0 PB Ome.
❑ d as owner of the property,he exclusively contracting with ❑
I nod Pro contractors od to construct the prc;cent(Sec:7044,Business LAWN SPRINKLERS-1 INC 5 V.B: 6.00 � ASSESSORS PARCEL N0.
and Professions Property
The who
tractors License Low docs not apply •�
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 35 / - h
contracts for such projects with a contraaorls)licensed pursuant m ✓.T O lJ U
the Contractor',am
License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,13.&P.C.for this
reason WATER HEATER W/VENT 6.00
C'ivIi1c, (( ''77 //�� Dale - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W P 'ORK Ii �CbM liPOISA1'IOPTI)ECLARA'I'ION WATER TREATING EQUIP. 5.00
I here y affirm That 1 have o certificate
of consent m sal Gilisure,
or o cert)-care Of Workees'Compensation N,mumw,or u certified �Z 20NING ENG.SITE NO.
copy there (Sec.3800,L.b.C.y.y, s�
POIicY No. Company I"Y�J LLLy.J�Ir '/ND .
O Cl Certified copy is hereby furnished FIRE SPRINK ENERGYT2d
Z Z If I a tlifuyhe ry i filed ith the city inset tion division. ❑
F O n(,Tcant MISC- REFER TO ORD. ❑v N❑ ❑v N
CC LO CER'I'I' + 1" ht ORKEItl" PERMIT ISSUANCE 10,00 ).2.,970 FLOOD ZONE A.L.U.C.
LL COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLO
pay V❑ N� V N�
EL O ('Phis section need not be completed if the permit is for one TOTAL
� Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE EE SUMMARY
LL {- nlit is issued,I shall not employ any person in any manner so as to
Ow become subject to it,,Workers'Compensulion Laws of California.
n Datt Applicant BUILDING
ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLICANT': if,after making this Ceni wwo of Ex-
Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK
U
provisions of the Labor Code, you mull forthwith comply with FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 EISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
thm
e performance of the work for which this permit is issued(Sec MICROFILM
. 3097,CIV.(.'.) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 2f
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 l 2
information is correct. I agree to comply with all city and county BOILER H.P.Or 100,000 B.T.U.)- 6.00 PLUMBING g
ordinances and state laws relating to building construction, and
r hereby enthoritc representatives for inspection
ns ect this city to cater'upon the BOI LER-COMP (Deer 100,000 BTU)SEE FEE SCH. MECHANICAL �Z
hereby
autionod Property for insP of
,th Purposes.
(We) agree to save, I erpnify End Acp VralesS y(p ���000�LL misc.- REFER TO ORD. ajT-
li.billitie,judsment cost. and e � PERMIT ISSUANCE 10.00 2 p(7 CONST.TAX 9l pp
t s ' nSey once /J
of o t is pcnnil. O MECH.CONT. LIC.NO. MECH.
�3 TOTAL qg� [��OTAL 17
Sign Applicant/Contractor Date -
OFFICE COPY