15533 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
r . .., CITY OF
T CUPERTINO ,
+ l INSPECTION DIVISION
/j� I,'JOB INSPECTION RECORD'.
JOB ADDR ESS �oI-2-3 •` ✓VOLlf �' PERMITEXPIR�TION
•UNITS#_ LOT PERMIT EXPIRES IF WORK
OWNER IQ7/•Q•.CIcT CONTRACTOR P/w77,aue AS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT Issu.
FOUNDATION NOTE: ANCE OR .180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED. ' LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND,CITY OF HeRMn VALJDATION
CUPERTINO STANDARDS.
GARAGE SLABS >'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -C! F/klu
UNDERGROUND /SLAB cG bk. �20C tl
PLUMBING 12..g$ C'•Yc vO
ELECTRICAL' S - —OK � lip DANCE DATE
MECHANICAL R D', ELECT, PLG. ' .MECK
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT.
@LTI ON
- WOOD FLOOR - L A IDN :.,sIFT.
PLUMBING
MECHANICAL - 3S4•-e-al
ELECTRICAL' - - PERMIT To
! .FRAMING �/Lf .f0.1/+cr, .
INSULATION. - - I, STORIES T HE coNSTR,. ,
» - ,• OCC.GROUP RES UNITS
/�'t•� PLACE NOS.UBFLOOR UNTIL ABOVE HAS BEEN SIGNED - • ' , `- '
<•\J� - - - $O.f T.F�00R AREA TOTAL ACREAGE
• .ROOF � NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
BUILDING USE , ! ..
l ROOFSHEATHINGRES • IND CDN. PB' .O"'o,
Y.
APPLNO ROOFING UNTIL ABOVE HAS BEEN SIGNED, FINALS ` DATE - INSP.� ❑ ❑ ❑ ❑ •' ❑
ASSESSORS PARCEL NO.
ROUGH sAN.a
PLUMBING ELECT.ENERGY ' 1 -
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY - .AcG DATE Acc.FILE No.
ELECTRICAL - BUILDING ENERGY - -
FRAMING ' ELECT.FINAL TEST ZONING " ENC..SITE No.
' INSULATION' ' - PLUMBING _
GAS TEST GAS!'
FIRE SHRINK 'ENERGyj24
-' MECHANICAL '
Tv .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED 'HEATING -
Y N Y ❑ ' NE)FLOODZONE ',A L U C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT, - - Y.❑ N❑ Y ❑ N❑
SHEET.ROCK GRADE
FEESUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING3 1
17
SCRATCH COAT ELECTRIC PLAN CHECK
- GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS EN SIGNED CUPANCV SEISMIC FEE
BEDC
OCCUPANCY OF BUILDING ISNOTPERMIT.TEDUNTIL BUILDING FINALISSIGNED_BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR,INSPECTION BY PHONING 252-4505, , ,; ELECTRIC.
Fw ONE WORKING DAY BEFORE' REQUIRED INSPECTION. PLUMBING
�. PLEASE .GLVE.JOB ADDRESS WHEN PHONING.. "`
y Z _SEE PERMIT FOR EXPIRATION DATE — i*` MECHANICAL
IMPORTANT! CONST TAX
PLEASE READ REVERSE SIDE BEFORE' '' " TOTAL '
CALLING FOR FINAL.INSPECTION.
OFFICE COP.V
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
RUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
SOU ND APPLICATION.& PERMIT 15533
ADRESS r
1/L'i s `,f oup DP BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ..
OWNEWS 4IJ
AME J PLAN CHECK VALIDATION
S �\ pa';•T OTV. ELECTRIC PERMIT FEE 1
V� PNONE 'smo
NAMERAcroR's OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES•RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION'
ARCHITECT PLAN CHECK FEE PC NO
OR ��NARD �-• PANELS (OVER 200 AMP) - 20.00 ..
ENGINEER
orzscvA AIA LIC.N.,CIOI4 SIGNS TRANS. 3.00
� ADORE6g ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
Ti'/i Iw ISLY4 zIP I EMP.METER OR POLE INS. 20.00
ADDRESS - MOTORS SEE FEE SCH,
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION !!!
a u G I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE -'
Ina T (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH,
F O u Professions Code,and my license is in full force and effect. ❑ ❑ O
z 0 L License Class Lic.Number
o m H Date Contractor '--
Y S t+•7"' LDING PERMIT ,n r.'r•
S ac w OWNER-BUILDER DECLARATION `� FORMATION;yS¢}`d;�t
W;t 1 hereby affirm that I am exempt from the Contractor's License M ISC.- REFER TO ORD '
w w o Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE. . 10.00 VALUATION SIFT.
� v; Code:Any city or county which requires a permit to Construct.alter. (�pg11B��{ f�/••6
R a: Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. Pahl Wim/-
. - 0, requires the applicant for such permit to file a signed statement that TOTAL VEV PERMIT TO
m y he is licensed pursuant to the provisions of the Contractor's License _
Fi > Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe �. r1 S ° i j 11 I'll..",
'! �N7cR/b•Cz I'Al �'
4 c Business and Professions Code)or that he isexempt therefrom and OTV. i PLUMBING PERMIT '' t i 'r FEE `
H$ the basis for the alleged exemption.Any violation of Section 7031 5 rSty,.S':Yh•<.. 'fr's aia:.-.,.fl?'k,.- "i ,f.,t',:r� n� t4 .x17 STORIES TYPE CONSTR.
a. by any applicant fora permit subjects the applicant to a civil penalty ALTER•DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500)):
❑ 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 thereon,and who does such work FIXTURES-PER TRAP 5.00 60.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
, menti are not intended or offered for sale,IL however,the bullding GAB-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 BUILDING USE
builder will have the burden of proving that he did not build or am- RES IND CON PB Osnar
pr°gf(forpurpoof sale.). . INDUSTRIAL WASTE INTER. 30.00
fly L u se owner of the Property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
It censed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESWRSPARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with a contractor(s)licensed pursuant to _
the Contractors License Law. SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO. PARCEL NO.
.-.----._ -0-1-am.exempt under.Sec. ,BAP.C.,for this WATER HEATER W/VENT -- 6.00
ea on
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WO KERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 he firm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
ropy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
j,]/,. Applicant Y❑ N❑ Y ❑ N❑
CC CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU -' '-"'-- COMPENSATION INSURANCE- PLG.CONTR. LIC.NO. PLG.
O. O (This section need not be completed if the permit is for one TOTAL Y'❑ N❑ Y❑ N❑
� Z hundred dollars IS 100)or less.) 's -v..v �.,'wx °p'. 'i s-:'s' ...
U O I certify that in the Performance of the work for which this cer Ofy.`- ;MECHANICAL PERMIT'l. : FEE.; -FEE SUMMARY
FF mit is issued,1 shall not employ any person in any mannerso as to s.,,w,l,`}ti••, a ;.,w ,�, v-, r '�n'+'-
LL U become subject to the Workers'Compensation Laws of California.
W Date Applicant ALTER OR ADD TO MECH. 500 BUILDING 7
} N NOTICE TO APPLICANT: If,after 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 most forthwith comply with FEE
U Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO t0,000C.F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1OA000.F.M,16.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
theperformanceof the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 5.00
Lender's Name HEATING UNIT IOV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building Construction, and BOER-COMP(3H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this city to Enter uPon the g01 ILLER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
"against
o save, indemnify and keep harmless the City of MISC.• REFER TO ORD.
st liabilities,judgments, costs and expenses which CONST.TAX
y accrue against Said City in consequence of the PERMIT ISSUANCE 10.00permit MECH.CONT. LIC.NO. MECH.
7 If} hen TOTAL TOTAL `Z "t5
plicant/Cont 'tor D to
ACclrc enov