15591 (2) POST THIS CARD NEAR FRONT OF BUILDING
P,Fg MI T NUMBER
.CITY OF CUPERTINO. 15591
.� INSPECTION DIVISION
JOB-INSPECTION RECORD
- - PERMIT EXPIRATION
JOB ADDRESS �6 `3.2, `Oooe-,,v d J;c UNIT# LOT#
�
I - PERMIT EXPIRES IF'WORK
OWNER 9-4L Cj Q�f U .D CONTRACTOR C Z . Ri .. IS NOT STARTED WITHIN
INSPECTION D E INSPECTOR - INSPECTION RECORD ` 180 DAYS OF PERMIT ISSU-
I FOUNDATION - ANCE,OR 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 VALUATION
GARAGE SLABS
CUPERTINO STAN DARDS.
'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - •! .. , •"""
' , _ UNDERGROUND /SLAB
PLUMBING �
ELECTRICAL ISSUANCE LATE
MECHANICAL - BLDG ELECT. .PLc. MFCaT.
' ❑ ❑ ❑ , ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT -
O INFORMATION
WOOD FLOOR '• dvALUAnoN $TFT.
PLUMBING
MECHANICAL
I ELECTRICAL ` ,�`\'�0 PERMITTO
FRAMING J �( t'�A C '�-
INSULATION sTORIE TYPE CONSTR,
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so sr FLOUR ARLA TOTAL ACTEAGt
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB OmT ,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE' INSP., L L 11 L L '
ASSESSORS PARCEL NO
ROUGH• SAN.#
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
T TUBS B SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY ' 4
ELECTRICAL BUILDING ENERGY ACC OAJE ACG FILE NO
FRAMINGELECT ALTEST - zONDNc ENG.SITE NO. ,
INSULATION PLUMBINGUMBING
i
GAS TEST . GAS
MECHANICAL -
FIRESPRINK ENERGY T-74
❑
L N ED ❑
f. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING V ` N
FL00020NE ALU.C.
EXTERIOR SHEAR. ' . - ELECTRICAL RELEASE '
INTERIOR SHEAR FIRE DEPT. �L NEJ L "L'
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC I L-2 i PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI LBUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC OO,
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR,EXPIRATION DATE -' ' MECHANICAL
IMPORTANT!. coNsr.TAX
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
PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
BVILDING �
ADOI Ea/ s. . s 15 5'91 .
3 ✓en BUILDING - ELECTRICAL-PLUMBING -MECHANICAL � +`1
OwsER'S PLAN CHECK VALIDATION
NAMEy'wa�,� QTY. ELECTRIC PERMIT FEE
r' H vuonE J o1rQJ
NAMERnc ' UTLETS-SWITCHES-RECEP 10.00/1.00
/C/ Llc.0 LIGHTING FIXTURES 10.00/1.00
CDons
ADDRESSDRW!Z i_11 lG lie PPLIANCES-RESIDENTIAL 4,00
J
,2' a Ron Ij�-y PANELS 10.00
DATE APPLICATIO
• OR RRtiECi PANELS (OVER 200 AMP) 20,00 PLAN CHECKK FEE P.0
N
.NO.
ENGINEER
LIC.NO SIGNS TRANS. 3.00
ADDRESS Enc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
. ZIP TEMP.METER POLE INS ,20.007ff f%
APPLICANTS MOTORS SEE FEE SCH.
a .
ADORES$ \n`'y�a�
/) r• SERVICE CHANGE 20.00, o" z
02 CONTRACTORS // o
Foo LICENSECONTRACTORS ULCLARATIO '
a v U I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE t
v, "' (commencing with Section 7000)of Dirs"n 3 of Business and
Q BLDG. ELECT. PLC. MECH.
Hoz Professions Cod• nd I ion 1i is in force aJ - ❑ ❑
z o H - License Cla Con Bomber -
� H o Dalo-f�/}�j�f��y/+�3 Contractor
a '
/ • ' - {LP
III
a o a G OWNER-BUILDER DECLARATION AWFO FO RMATION ERMIT
w ;LL w 1 hereby affirm that 1 am exempt the Contractor's License MISC.- REFER TO ORD
HLLog Lw,for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 1000 ALUATION s/FT.
Code:Any city,or county which requires a permit to construct,aIle' -
R¢0 improve,demolish,or repair any structure,prior to its Nsuance,also ELEC.CONTE. LIC.NO. ELEC.
w- O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
$ he is licensed pinuonl.to the provisions of the Cmltrmtor's License '
Fzi Law(Chapter 9(commencing with Section 7100)ofDivision 3 ofthe T
< Business and I'rofessiorts Cole)or That he is exempt therefrom and OTY. PLUMBING PERMIT FEE ` - 7
is F 0 the basis for the alleged exemption.Any violation of-Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a pcmlit subjects(tic applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S50D.):
❑ 1,is owner of the property,or my employee,with wages as µ BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP BBs.overs
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044. Businesn and Professions DRAINS-FLOOR;ROOF,AREA,COND. 5.00
Calc:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,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 iHiprove-
munlxarenetintendedoroffered for sale.If,however,the budding GAS-EA.SYSTEM-I INC,4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder wdl have the burden of proving that he did not build or int- BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the property,um exclusively contracting with ❑ ❑ ❑ D El
licensed contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO-
aad Professions Cod,,:'rhe Contractor's License Law docs nm apply
to an owner of property who builds or improves thereon,and who LAWN SPR IN KLERS-OVER 5(EA.) 1.00
contracts for such projects with a contructocs)licensed pursuant to SEWER-SAN V-STORM EA.2001t/10.00
the Contractor,License Law. TRACT NO. PARCEL NO.
O lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACE.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby antro that I have a c,rti T,re of cocsent In s,Ifmimure' ZONING ENG.SITE NO.
or a certificate orworkers'Compensation Insurance,or a certified
copy Ihereo f(Sec,3ROD,Lab C.).
Policy No. Compact
O ❑ caroted copy is here fumishcJ.
Z Z �Certlf p J' �th the c� s U Division. FIRE SPRINK- ENERGY T 24
p Appf¢anC _ _pis I MISC.- REFER TO ORD. YE] NE] Y0 eE
CC T PERMIT ISSUANCE 10.00
Lu CIiRTI i (70 Of EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.c.
W need not be co N INSURANCE PLG.CONTE. LIC,ry0. PLG Y❑ ry❑ Y ❑ ❑
Z (This section aced not 4 completed i1 the permit rc for one TOTAL N
hundred dollars(S 100)or less)
U O 1 certify that in the perfomwnce of the work fur which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
W I- mit is issued,I shall not employ any person in any manner m as to
Ow become subject to the Workers'Compensation Laws of California.
M Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
- WNOTICE TO APPLICANT: If,utter making this Certificate of Ex
• Z emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he decined revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCEM.) 6.00 SEISMIC FEE
I 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(See. PCONST.TAX
3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00Lender's NamL,odcr's Addlxs HEATI NG UN IT(OV ER 100,000 B.T.U.)9.5000
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00information is correct. 1 agree to comply with all city and county urdiwnces and xlate laws relining to huilding coostrumion, and BOILER-COMPI3H.P.or100,000B.T.U.1 6.00hereby authen, representatives of this city to ener upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.above mentioned property for inspection purpovcs.(we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertmo against iabilitics,judgments, costs veal expenses which
may in 'any wu accrue ogeinst_NIt City in conuyucnce of the PERMIT ISSUANCE 10.00
[grou-tin oft s iL !� 7 MECH.CONT. LIC.NO. MOTAL 'Ofl
Cglow
/-ter// / / V TOTAL
Si mof Applicant/Contractor Half
OFFICE COPY
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
� W-
t..
To
You are hereby authorized to Connect electrical service for
t� jt Owner or Tenant ` 4""t' F �✓/1 !� �./ ll—T' A r 11
At,,
r No.of Wires Size of Wires r / Size of Switch I 0 1)
Motor Load Voltage Phase
Heating Load K.W. Voltage
po W42
r
No.of Meters
Light—]10_New Servim Remrrt,
Heat 170ihree Wue More Service_
No.of Add.Meters Power`\V ,. �] r//�I Three Phase Move Meter
0- ELECTRICAL INSPECTOR ^^T v ' rTl-S
r