15641 (2) EI
POST THIS CARD NEAR.FRONT OF. BUILDING t
., PERMIT NUMBER
CITY O,F GUPERTINO 156�tk1
INSPECTION DIIVISION ;
! JOB,INSPECTION RECORD
PERMIT EXPIRATION I �
JOB ADDRESS l.6
�a3 -IN 'T, ' _LOT# '•� 1 -
L, PERMIT EXPIRES IF WORK
OWNER Q 'r a 6-- p-� ~ '.'coNrancroR�•• �HL671�- c'7J`, , - ISNOT STARTED WITHIN
INSPECTION . ' -DATEINSP CTOR INSPECTION RECORD. AS0 DAYS OF PERMIT"ISSU
FOUNDATION'S NOTE. y' ANCE.OR 180,DAYS FROM��'
- - LAST CALLED INSPECTION
UFER .. ALL GRADING AND DRAINAGE SHALLL'BE'INSTALLED .w-
PREGUNITE , TO COMPLY WITH THE APPROVED PLANS AND CITY OF .PERMIT VALIDATION
r ° f CUPERTINO STANDARDS: - '•b1
GARAGE SLABS ayµ, r _( , . t
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED { / ' `'
UNDERGROUND /SLAB. }A ry a
PLUMBING . ?+ rf
ELECTRICAL „ r }'ISSUANCE DA;E
MECHANICAL P.o- - BLDG. - .ELECT•. PLc. .Mec R.l
:IVEl D . ❑- ®~
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
W00D,FL00R
INFORMATION
' t' VALUATION - $IFT.
PLUMBING
I'.. MECHANICAL -
ELECTRICAL 7 • IEy PERMIT TO
FRAMING a - , ,-'' :1fSI z ! {
INSULATION STORIES- TYPE CONSTR._
. ,e , ,'.' •y'. {„ . .
AV,
` s`. OCC.GROUP: RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED V, -
SOFT •T
,FLOOR AREA OTAL ACREAGE c,
ROOF ' NOTE NO FINAL INSP.SHALL BE MA�g
DIAPHRAGM " v
THE CONSTRUCTION�TAX;IS PAID'
ROOF'SHEATHING - ` - ,
fk• BUILDING USE
� -BEs IND corv' 'PB o
' .'APPLYAO'ROOFING UNTIL ABOVE,HAS BEEN SIGNED,, ,FINALS " ❑¢- ❑ ' ❑ ❑ > ❑
DATE INSP.r
'ASSESSORS PARCEL NO
U ROUGH SAN.p "t>
IV
PLUMBING1. <',,. ,ELECT.ENERGY _ Y
i I n , ✓ .TRACT NO. y TARCEL NO
y
TUBS 8 SHOWER PAN � � PLUMBING ENERGY �
MECHANICAL - MECH.ENERGY
ELECTRICAL ,' ACC DATE , Acc.FILE NO,
'BUILDING ENERGY .
I FaAMING- '`, ELECT.FINALTEST : -
- ••INSULATION _ <• PLUMBING' +:• •- , zow NG ENO SITE.No
'GAS TEST - GAS - I » ''
G
- i., MECHANICAL
,FIRE SPgI^K- ENERGY T}G.. I I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ,» HEATING' u❑ -'"❑, `' ❑ '"�" ,I
r{ - ,EXTERIOR SHEAR - •:, .,-� ELECTRICALRELEASE ,. FLooD zorvE A.L u.c -
INTERIOR SHEAR- i FIRE DEPT.` "+Y ❑ N❑ Y ❑, tN❑;
SHEETROCK' ' " GRADE, . . -
FEE SUMMARY
EXTERIOR LATH `T _ .,- BUILDING ,•'r
INTERIORLATH ',,-TEMPORARY APPROVALS :E eulLOwc
SCRATCH COAT . ELECTRIC '` PLAN CHECKPrtq
' GAS . .. :FEE'Po r
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED• OCCUPANCY,, w SEISMIC FEE
OCCUPANCY OF,BU I LDING IS NbT PERMITTED UNTI L BUI LDING F INAL IS SIGNED BV BUI'LDING.INSPECTOR
.+ MICRO FILM +
AR`RANGE'F,OR'INS'PECTI,O,N BY PHONING 252:4505; " ELECTRIC T
�A. o�. ONE.WORKLNG'OAX BEFORE,REQUIRED ''INSPECT.ION PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING
—,SEE PERMIT:FOR.EXPIRATION DATE MEcGANICALs ''>
L i
.IMPORTANT! CONST"TAX
PLEASE READ REVERSE SIDE BEFORE
"-CALLING:FOR FINAL`.INSPECTION: TO AL.,+h OFFICECOPY — -- Y --/
r
APPLICANT TO{-FI,LL IN INFORMATION WITHIN RED LINES:--1' USE BALL POINT PEN ONLY
a
n v PERMIT NUMBER r.+
b BUILDINGPROJECT IDENTIFICATION 1 +c
1 ! aDILDINc x B" qrG� ,APPLICATION'& PERMIT , . ,
s Au
e ,7 CLg „ r BUILDING ' ELECTRICAL'PLUMBING'—MECHANICAL 1•
OWNER'S 1 1 PLAN CHECK VALIDATION
NAME QTV. a ELECTRIC PERMIT -' FEE +
:ter D 0AjA5ri NONE
CONTRACTOR'S - -
NAMFOUTLETS-SWITCHES'-RECEP,.10.00/100
ua NoLIGHTING FIXTURES /7: " 10.00/1.00 `
CONTRACTOR'S , 4 •, {' \
APPLIANCES RESIDENTIAL 4.00
PANELS 1, '„ 10,00 'J' .b .DATE OF APPLICATION
` ARCHITECT - -YPLAN CHECK FEE'. . P C NO.,
OR ry
PANELS (OVER"200•AMP) 'P •,2000 `
ENGINEER' _
LIC.NO, SIGNS TRANS.. ' - 300
ARCH,OR ENG.. . . . Y, ft'PEflMIT VALIDATION • L-
I ADDRESS ,-' SPECIAL CIRCUIT' • t . '. 5.00 D ,
t•`? ZIP EMP.METER OR POLE INS ;2000
APPLICANT'S - ~
ADDRESS - wu. MOTORS.' SEE FEE SCH r
SERVICE CHANGE ' 2000
M o LICENSED CONTRACTORS DECLARATION i aI '
a E,U I hereby affirm that I am licensed under provisions of Chapter 9 !ISSUANCE DATE
r-.z w (commencu with Section 7000)of Division 3�ofthe Busin_essand - 'ME H� .
g PLG. C
y Q y ,r. BLDG. ELECT.
o Professions C e nil li,ease is in full fort a d c.
Our,
I O w a.r ' Licens Cla Lie Number :� :�, A'�'❑•• ❑; _ �
9 Date' Contmdor
,A r a, —y/i i;JjO�—dam r l
a m j y . ., . •..., { ', C...' .,• • . -." ...BUILDING PERMIT
, OWNER-BUILDER DECLARATION �'�+'•'
a hi o- • , . .s ' INFORMATION
i o a MISC.— _ .,,REFER TO ORD
X g; u.y. 1 hereby affirm that I am exempt from the Contractor's License - y VALUATION $/FT
� LL0 La for the following rrason.(Sec.70315.Business and Professions p . PERMIT ISSUANCE �b5 `.1000 t 1 5 .
Code:Any city or county which req hires a perm t to construct,alter, r
R ce s, 0., improve,demolish,or.repair any structure,prior to Its issuance also ELEC.CONTR.NTR, LIC.NO: 1 ELEC.
K m LL requires the appllcan Lfor such permit to file a signed statement that Hh. ^ITOTgL T -„p, PERMIT TO
n w he is licensed pursuant to the provisions of the Contractor's License. y:�r• . I,
care Law(Chapter 9(commencing with Section 7000)o'Division 3 ofthe. ""
Q Business and Professions Code)or that he is exempt therefrom and QTV. PLUM BINGPERMI+ 11, FEE -� !
_,$-. the basis for the alleged exemption.Any violation of Section 703 L5 .: ]STORIES• TYPE CONSTR.
a ; bypny applicant for a permit subjects the applicant ton civil penalty ,. I"d'..?{ + _k
of not more than five hundred dollars lS500)J.a 1p A,LTER-DRAIN&VENT_WATER (EA.) 500 t:'
❑ 1,as owner of the property,or my employees with wages as i OCC.GROUP .. RES.UNITS
their sole compensation,will do the work,and-the structure is not BACK FLOW PROTECT;_DEVICE 4.00
intended or offered,for sale (Sec. 7044, Business`und Professions DRAINS"'FLOOR ROOF"AREA,COND. 500 : '
Code:-The Contractor's License Law does not apply to un owner of -
property who builds or improves thereon,and who does such work FIXTUR ES,F PER TRApU' ig t..5bo 1 90 FT'FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve' - r -
memsare'Got intended or offered for sale.If,however,the buddig .GAS-EA.SYSTEM 11NC.40UTLET$ 600 - -
r improvement is sold within one year of Complete me own - GAS=.EA.SYSTEM=OVER 4(EA.) 2.00 - .,BuaowG USE
builder will have the burden of proving that liedid not build or Im- - - - qE5• IND• + CNG PB Other
prove for purpose of sale J., I NDUSTR IAL WASTE I NTER.r3000
❑, 1,as owner of the property,am exclusively contracting with - a❑'. ❑ �'❑ ❑ ,
" licensed contractors to'construcl the project(sec.7044,Business LAWN SPRINKLERS='1-INC5,V,B:' 6.00 - - ASSESSORS PARCEL No.
• and Professions Code:The Contractor's License Law does not apply "
to,au"owner of property who builds or improves thereon;and who ^ _ LAWNaSPRINKLERS-�OVER_61EA_.1 � 1.00 . -
- ] contracts for such projects with a contmetoKs)licensed pursuant to TRACT
' -
theContractor'sLicenseLaw., ,j" SEWER-SANITARYSTORM EA:200ft/1000 I .TRACT NO : PARCEL NO_
❑t lam exemptunder Site ,B:&P.C.for this ' 1NATER+HEATER W/VENT x 600 t '. ]i' +
reason -
,; Owner - I Date WATER SYSTEM ;•. ` 500 f' ACC DATE -.Ace FILE NO.
WORKERS'COMPLNSATION DECLARATION WATER TREATING EQUIP, 500
' - 1 hereby affirm that I have a certificate of consent to self-insure,'—, q - i- r�
n r• : ys ZONING ENG.SITE:NO.
T i 'cola ctirtifioate'of Workers'Compenyltiop Ins anw,o a cetll(led �'
copy[her We 3 fes,bab'.C.I. -zL
'
Policy
N /KC''
O ❑ Certified copy ishereby furnished. IF
ra' i FIRE SPRINK '" _—ENERGY T24'
z 2 `.Certified copy,is filed with the city inspection.division MISC. :';REFER TO ORD �y. r,N y ❑ sry❑
APp marti..❑
cc - ' - PERMITISSUANCE ., i1 a+ +, 1000 a+ ', FtooD zorvO "ALuc,
lr CERTIFICATE OF EXEMPTION FROM WORKERS' -
LU : COMPENSATION INSURANCE, "• PLG.CONTR- S,uC'N0. PLG +`y i4 N y❑ ,t N O
C O ' (This section need not be completed if the permit Is for ane - y "a TOTAL Q ❑
Z h indred dollars($100)or 11SO t -
U O,: I •rtify that in the performance of the work for which this Per- QTY. - ,MECHANICAL PERMIT ' FEE. FEE SUMMARY r.x
LL {-' mit is issued,1 shallnotemploy any person in any manner so as to
U become subject to tire Workers'Compensation Laws of California.,
Q'IL , Date - Applmant - ALTER OR ADD,TO MECH BUILDING
} N ` NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
� Z empticn,you should become subject to the Workers'Compensation APP-LfANCE .-6.00 PLAN CHECKS
provisions of the Labor Code, you must forthwith comply with r - FEE'�� 3 "^
U such provisions or,this permit shall be.deenied revoked AIR HANDLING'UNIT IT '10,000, • .1 4 0 -
CONSTRUCTIONLENDINGAGENCY FAIR HANDLING IO .F.M.1600 '- .SEI SM IC FEE '
' - Thereby affirm that there iss.construction lending agency for ,EXHAUST HOOD (WITH DUCT) 'Q --
the performance of the work for which this permit Is Issued(Sec. MICROFILM
3097,Civ.C.1. . HEATINGUNITITO 100000BT:U.) 800 " t
Lender's Name HEATING UNIT.IOVER 100000 B:T.0 19.50 e
Lender's Address - ELECTRIC.ik H '
I certify that l have read this applieahoii and state tlmt the above VENTILATION FAN.(SINGLE) - 4.00 r
information Is Correct. I agree to comply with.all city and county PLUMBING'
r� ordinances and,state laws relating to building construction and . 'BOILER-,COMPI3H P.or�1000008T.U.) 600 t r
hereby authorize representatives oftms city to enter,upon the BOILER-COMP ]Ova'100,000 BTU]SE E FEE SCH I+ ,MECHANICAL 'VV
atiove-mentioned property for Inspection purposes - - " ] S
(We) agree to Save,"indemnify and keep,harmless.the City of MISC.' EFER TO ORD
upertino against liabilities,judgments, costs and ex enses which O CONST TAX - 1
.. may in-anyway`accrue against said City in consequence of the +PERMIT ISSUANCE`'1 11. 100012-0
I - ranting of t 's permit MECH.CONT uI - LIC NO. MECH
- .d• ^n ' ' TOTAL aIh1 TOTAL -
).
Signature of pplicant Centrae ,r :"Date o3
OFFICE COPY` "