15509 (2) POST THIS CARD NEAR FRONT OF•BUILDING -
PERMIT NUMBER
CITY OF CUPERTINO 15509
INSPECTION DIVISION '
r z I JOB INSPECTION RECORD'
JOB ADDRESS 026 .. N. INT f� ✓ �ol� PERMIT EXPIRATION
UNIT# ' _LOT#
O �1�1 - PERMIT EXPIRES IF WORK
OWNER c NTR OR IS NOT STARTED WITHIN
INSPECTION DATE 1,INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION,
UFER ALL GRADING AND DRAINAGE SHALL,BE INSTALLED -
TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT'VALIDATION
PREGUNITE OUPERTINO STANDARDS. ' . { . .
GARAGE SLABS VAII
�+-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -3- f✓'GAYNI'e oic e-f cK>
t t ltN it;l l,C L i
UNDERGROUND /SLAB b CK v'C .� flt ®S
PLUMBING - U
ELECTRICAL - Q B o `
IssuANCE unrE
MECHANICAL
.IOcI ELECT PLc. I MECEI.
L .1 El
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 7-,22-� AGZ 2 `4r BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION 3IFT.
` PLUMBING
MECHANICAL
PERMIT To
ELECTRICAL -
FRAMING
,INSULATION STORIES TYPE CONSTR.
I
,OCC.GROUP RES.UNITS'.
e
PLACE ND SU BFLOOR UNTIL ABOVE HAS BEEN SIGN vC N-
'
SO.Fi'I FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '
�'. DIAPHRAGM ,THE CONSTRUCTION TAXIS PAID -
BUILDING USE
ROOF SHEATHING RES IND CON PB Om+i
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SI NEDAla .
FINALS DATE INSP. 0 El El � �
ASSESSORS PARCEL NO,
ROUGH
PLUMBING .ENERGY ' TRACT NO. PARCEL N0TUBS&SHOWER PAN ING ENERGYMECHANICAL ENERGY 'ELECTRICAL ING ENERGY Acc,DnreAcc,FILE No
FRAMING' .FINAL TESTZONING ENG.SITE NOINSULATION � INGGAS TEST ANICAL iFIRE SPNINK ENERGY T;Za
COVER NO WORK UNTIL ABOVE HAS BEEN SIG 0 NG "� "�FLooOzoNE A.Luc.
EXTERIOR SHEAR R I CA L REL EASEINTERIOR SHEAR EPT.• Y N[3 Y 0 N❑.
SHEETROCK E FEE SUMMARY
EXTERIOR LATH
INTERIOR .LATH TEMPORARY APPROVALS
BUILDING . .>
SCRATCH'COAT ELECTRIC PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
.J
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. 'MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, { ELECTRIC
o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION,D'ATE - :• MECHANICAL
IMPORTANT! CONST.TAX .
PLEASE READ REVERSE SIDE BEFORE '',mj:jk" - � ;, r
CALLING FOR FINAL INSPECTION.. TOTAL .-
OFFICE COPY '
APPLICANTO FILL IN IN WITH RED LINES - USE BALL POINT PEN ONLY 1
BUI LRI NG PROJECT I DENTI FICATION PERMIT NUMBER 111
BGI EPS Pio APPLICATION:&''PERMIT 1 /9
nooREss ./ ./ - , 1 5 5 O V
.3 /✓I' WO LFA /1� BUILDING -.ELECTRICAL=PLUMBING-'MECHANICAL -
OWNER'S - - - - , PLAN CHECK VALIDATION
NAME ' r DTV. ELECTRIC PERMIT FEE 1 .
CONTRACTOR'S
NAME• - '- mac, ` OUTLETS-SWITCHES-RECEP 10.00/1.00
'-W uc. a? - LIGHTING FIXTURES „10.00/1.00
CONTRACTOR'S - '
AD RESs PPLIANCES-RESIDENTIAL 4.00
((// OIv/ ✓�PHON6�0✓f '�IO PANELS 10.00 DATE OF APPLICATION'S -:
ARCHITECT - q PLAN CHECK FEE P.C.N0.-
2� off hh�� � .�}� ���.L_x/I Lj/ PANELS (OVER200 AMP) 20.00
ENGINI�L//� �' 1' r �{// -
YYY��r ��r��-LL /'lll�//���-x��� J�y-F- SIGNS TRANS: ' - i - 13.00
ARCH.OR ENG. - +
/ ADORE ��MM�� SPECIALCIRGUIT ®� PERMIT VALIDATION
6W' 5. ! r-�• ZIP - EMP.METER OR POLE INS.' 20.00
APPLICANT'S; 01... �CN-fDr CLCI
ADDRESS MOTORS SEE FEE
SERVICE CHANGE 20.00 •o n�I� X80
o LICENSED CONTRACTORS,DECLARATION -_
a i w I hereby affirm that,[am licensed Pinder provisions of Chapter 9 ' ISSUANCE GATE
H< m - (com ncreing with Section 7000)of Division 3 of the Business and BLD ELECT. PLG. MECH.
H y z Professions Code, y license is m full forcefj�� - ❑ ❑ ❑
z o w License Cla Lic Number ✓fie vv
Q =r Dale �Contractor-. �l� • ,
M ¢ ¢ a. OWNER-BUILDEWDFCARATION BUILDING PERMIT
- INFORMATION
` 0 a o I hereby affirm that I Lx g H am exempt from the Contractor's License MISC. - REFER TO ORD
u
w LL L ¢ Law for the following reason.(See.7031.5,Business and Professions VALUATION' $/FT.
L - PERMIT ISSUANCE 10.00 3-
Code:Any city oocoun[y which requiresa permit construct,alter, //A.vw./v1
ac ¢¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.", ELEC. /"
K o u requires The applicant for such permit to file aligned statement that n - .TOTAL
A w m m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
r Z <
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ,
g i D Business and Professions Cade)or thia he is exempt therefrom and- QTY. PLUMBING PERMIT FEE
¢ H m the basis for the alleged exemption.^Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant toacivilpenalty ALTER -WATER'IEA.) 5.00
of not more than five hundred dollars($500).): - '
❑ 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 the 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
property who builds or improves Diemen,and who docs such work F IXTUR ES-PER TRAP• 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended or offered for saledf,howeveq the building GAS-EA.SVSTEM-.11NC.40UTLETS 6.00
or improvement is sold within one yeaa,of completion,the owner- GAS-EASYSTEM-OVER 4(EA) '200
builder will have the burden of proving that h . . .
e did not build or im- BUILDING USE
'RES IND CON PB 'Other
prove for purpose of sale.). • INDUSTRIAL WASTE INTER: 30.00 '
❑ d as owner of the pniperEt be exclusively contracting with S P ' ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN'SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply ,
to anowner of property who builds improves thereon,and who LAWN SPRINKLERS-'OVER 5(EA.) 1.00 _
contracts for such projects with a a coontrtr actors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. - PARCEL NO.
❑ I am exempt under Sea ,B:&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM. - •5.00 --`
ACC.DATE ACC,FILE NO.
WORKERS'COMPENSATION DECLARATION. WATER TREATING EQUIP. 5.00
I hereby affirm that l'have certificate of consent to self-insure, _ ZONING ENG.SITE NO.
or a certificate of Workers'Compppnmlion'Insurance,or a certified
copy[heLCofy5fp.1�P,:beb.C.YA] �/AIA+ CO
Policy N((rr!l�40 /(00''f�wll __lU��� A
O ••❑ Certifie shore y urns FIRE SPR INK ENERGY T-24
z Z `ApCnllifie c s n�i' ,e dty inspection division. MISC.- REFER TO ORD. - Y
H CERTIFIC 'rE OF EXEMPTION FROM WORKERS' "+' "PERMIT ISSUANCE - 1400 FLOOD ZONE AILU.C.
LU - COMPENSATION INSURANCE PLG.CONTR.' LIC.NO. _ pL�,
O' (This scctidn need not be completed if the permit is forone ', TOTAL yl[:] N� V NC]
Z hundred dollars($100)orless) -
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT• FEE FEE SUMMARY tr/
LL f- mit is issued,I shall not employ any-person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
ED Date ^ Applicant _ BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex- - ALTER OR ADD TO MECH., 5.00
? emption,you should become subject to the Workers'Compensation APPLIANCE- 5.00 PLAN CHECK
probe visions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall deemed revoked. - AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY n " AIR HANDLING UNIT(OVER 10=1C.F.M.) 6.00 SEISMIC,FEE 74
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 _
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 6.00 +
Lender's NameName 'H EATI NG,UN IT(OV ER 100,000 B:T.U.)9.50
Lender's s ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) . 1 .4.00
G information is correct. I agree to comply witti all city and county PLUMBING
?. ordinances and state laws relating to building construction, and BOILER-COMPI3 H,P.or 100,000 B.T.U.) 6.00
t hereby_authorize representatives of this city to enter upon theBOILER'COMP (Over.100,000 RTUI SEE FEE$CH. MECHANICAL
above-mentioned property for inspection purposes,
(We) agree to save, indemnify and-keep harmless the City of MISC.- - REFER TO ORD.
up in against liabilities,judgments, costs and expenses which CONST.TAX '
ay in y way'wcrue gam ut said City in consequence of the PERMIT ISSUANCE 10.00
ranting i it. MECHI CONT. LIC,NO MECH. r
TOTAL TOTAL ('7
Vf Z I �J
/\ I
Signah a of ApplicantbC4fitractor. 41Dale II n
OFFICE.COPY