15199 (2) - r
' 1
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF �CUPERTINO 15199
INSPECTION DIVISION
JOB INSPECTION RECORD
.PERMIT EXPIRATION
JOB ADDRESS ^Z rLrl.F✓, o,) ✓c UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTORIS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RIEZORD , 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE'OR,180 DAYS,FROM
IQ. NOTE: LASTCVLEDINSPECTION.
LIFERALL GRADING AND DRAINAGE SHALL BE INSTALLEDF.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
`+ CUPERT�OGSTAN `5
GARAGE SLABS 1 J 1.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED $q $tloWr.V2 VWU 0 tl "JL
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL `I `' V ISSUANCE I r}�
U TE
MECHANICAL BL
ELECT r.. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING �� y
MECHANICAL -.a,2- ;:jr
- v `
ELECTRICAL - PERMR TD
FRAMING - - - `P'I U-//
INSULATION STORIES TYP CONSTR.
.DCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:'NO FINAL INSP.SHALL BE MADE BEFORE sn.FT ELUDE AREA rnrn�ACREnr.E
DIAPHRAGM - THE CONSTRUCTION TAXIS PAID . " -f`^'•;
BUILDING USE;
ROOF SHEATHING I'3--'df&-84 I Q' }-fij O IN❑D C❑ON e Q,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO
ROUGH SAN:N-/
PLUMBING p�C --" ELECT.ENERGY
U OWER PA PLUMBING ENERGY - TRACT No. PARCEL No
MECHANICAL s- MECH.ENERGY / d
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE No
FRAMING 'A, ELECT.FINAL TEST
INSULATION W PLUMBING ZONING ENG,SITE NO
GAS TEST �C6 GAS
FIRESPRINK ENERGY L24
MECHANICAL ME Q
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NEI "�
AC
' EXTERIOR SHEAR 3_a, - Q G� ELECTRICAL RELEASE FLOOD ZONE LU
INTERIOR SHEAR _ �1 . FIRE DEPT. Y❑ N - y N❑
SHEETROCK I qq IGRADE • FEE SUMMARY
EXTERIOR LATH. -1- BUILDING
INTERIOR LATH —Z '— `1 TEMPORARY APPROVALS BUILDING ,
SCRATCHCOAT ELECTRIC -yj c PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC
Z ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESSWHEN PHONING.
— SEE•PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX ;
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
FINAL GRADE , —I
i ROUTr SLIP
File 'No t
Date
Location
Subject
Notes
Approved
D e Inspector
y
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
a Q BUILDING INSPECTOR'S OFFICE p
Date ....� ........L. ..S.3............. 19............ Building Permit No. f.5'. .(...-
The Building Locayted, at ...1.-Q.q.�,Z.....�CJt� .>q.�-, w.. V�.p.............
Owned by ..... \..11..'1�.�r'. .........FU��jA�..REN _r—�. .............
Completed �.t].WL
Has Been or Use As: ... . .... .. .......................................................
(A tere )
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
....-.ham. . ...........................................
PD-7 BUILDING INSPECTOR
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATIONPERMITNUMBER
APPLICATION & PERMIT [� (](]
ADpRE55
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'
PLAN CHECK VALIDATION
MaPME HONE OTY. ELECTRIC PERMIT FEE
+� , ,
1
NAME ac7DRa UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00 '
DDREScroRs
ADDRESS
APPLIANCES-RESIDENTIAL . 4.00
a
CONTRACTORS
PHONE PANELS - 10.00 DATEOFAPPLICATION-
ARCHITECT PLAN CHECK FEEP.C.NO.
OR \ PANELS (OVER 200 AMP) 20.00 -
NGIN R L
c. o. SIGNS TRANS. 3.00
ARCW OR DDRESS ENG. ' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
S, P EMP.METER OR POLE INS. 20.00 ��^ 1
APPLICANT'$
AooR ss \ MOTORS - SEE FEE SCH.
SERVICE CHANGE 20.00 p�
0 Mai LICENSED CONI ACTORS DECLARATION
n3MOO�/
I hereby affirm that I am licensed under provisions of Chapter 9 .v,a N (Commencing with Section 7000)of Division 3 of the Business and SSUANCE DATE
L'OG. ELECT. PLG. M H.
0 D z Professions Code,, d my license is in full force and effect. Q
Z o w- Licari Lic.Number
o m;wo Date Contractor -
Q Y i J BUILDING PERMIT
w OWNER-BUILDf:R DECLARATION
u'x+ 0 LL I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
�u.04 Law for the followingreason.(Sec.7031.5,Business and my
�
ons PERMIT ISSUANCE 10 �C l VALUATION S/FT.
vi Code:Any city orcounty whichrequiresapermitioconstrt¢Lalteq �T a� H-6
aO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEG 6a lS 7
O u requires the applicant for such permit to file a signed statement that TOTAL a PERMIT TO
e. w m he is licensed pursuant to the provisions of the Contractor's License
F z a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the &=o U) .
i c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
em the bosis for the alleged exemption.Any violalion of Section 7031.5 STORIES TYPE CONSTR.
n3 .. by any applicant for ve Bond,edd.11m,ects Dhe 500).)icant Ica civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of no[more than five hundred dollars(my employees
❑ I,as owner at the property,or my employees with re is as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will(S the work,and the structure is not
Code eJ or offered for sale(Sec. 7044, Business and n ol'neros DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R -3
/
Code:The Contractor's License Law does not apply to sR owner al'
M property who huih or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50 FT FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provide)Dem such impnwc
or hoprenolintended or wilhinron yearl o If,omleion the the uilding GAS-EA.SVSTEM-11NC.40UTLETS 6.00 7�
or improvement is sob within one year of completion,the owner- GAS EASYSTEM OVER 4(EA) 200
builder will have the burden of proving that lie did not build ar im- - . - . 2.00 USE
prove purpose of sale.). RES IND CON PB Other
I,as owner of theProperty,am exclUsivel INDUSTRIAL WASTE INTER. 30.00 � ❑ Cl ❑ ❑
Y contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
aEd Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves therm..,and who LAWN SPRINKLERS.-OVER 6 (EA.) 1.00 -
contracts for such projects with a contractor(s)licensed Pursmmt 10
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ I an xcmpt under •c.. B.&P.C.fir Illi,basol WATER HEATER W/VENT 6.00 d^Al
Owner: WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK BRS'COMPENSATION DECLARK, ON4 WATER TREATING EQUIP, 5.00 ' .
hereby affirm that I have o cc Hil'icnte of COIISenI 10 SCII'-insure, n
m a certificate Df Workers'Compensation Insurance,or a ceilitiW ZONING .ENG.SITE NO.
copy thereof(Sa:.3800,Lah.C.).f111 \�
Policy Na. Cmerch y_r .I
Q ❑ Alfie opy rs here ed fur al.
oe FIRESPRINK ENERGY T 24
Z Z Cer01'ie yyyyed 1 rc ti JlviSlon. ❑
F p Applicant _ __�fti� _ _ MISC.- REFER TO ORD. Y ❑ N v ❑ No
O: N CE ICTIFICATF.OII EXEMPTION FROM WORKERS' PERMIT ISSUANCE a FLOOD ZONE A.L.U.C.
LU > COMPP.NSA'I']ON I NSURANCE PLG.CONTE, LIC.NO, PLG.
CL 01Z (This section need not be completed if the permit is In,one TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars($100)'or les")
U O 1 certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I. mit is issued,I shall not employ any person in any nmnner so as to
U W become subject to the Workers'Compen,,ImR Lawsof Culifomie.
Q. Date.Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE. TO APPLICANT: If,after Rmking this Certificate of Ex
F- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of-the Labor Code, you must I'orthwilh comply with FEE '
U Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction landing agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UN IT(OVER 100,000 B.T.U.)9.50 7
Lender's Address ELECTRIC 0 0�"""7'
I certify mail have read this applicalion Imi s aro Dmt Ilse above VENTILATION FAN (SINGLE) 4.00
Q,?.) �L
�) information is correct. I agree to comply with all oily and county PLUMBING _L
ordinances and state laws relating to building Construction, and BOILER-COMP(31-I.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city es enter upon the BOILER-COMP (Over io0,0008TU1 SEE FEE SCH. MECHANICAL
above-mentioned agree to property indor emnify
ands purposes.
(We) agree to save, tns,judgments,
and keep ImrnJess the City of MISC.- REFER TO ORD. o
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE ICT CONST.TAX / Q3
May in any way accrue again t sais�City in conseque ce of the - !
Kra gafthispermi{� _ _us MECN.CONT. LIC.NO. MECH.
TOTAL
UX /
ant/Co /J
J
Signature of Applicntractor 't
OFFICE COPY