16813 'POST THIS CARD NEAR FRONT OF BUILD_ ING
PERMIT NUMBER
CITY OF CUPERTINO 1$813
INSPECTION DIVISION
JOB INSPECTION RECORD
,PERMIT EXPIRATION.
• JOB ADDRESS �r_47—(.1 `W WLI��_- e F "UNIT l D�LOT# '
PERMIT EXPIRES IF WORK
OWNER .- Cb CONTRACTORr IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD _ 180 DAYS PERMI7ISSu-
ANCE OR 180 DAYS FROM'
FOUNDATION NOTE: ' LAST.CALLED INSPECTION.
UFER 1 ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
- CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- MAR 31 I,MU :-
UNDERGROUND /SLAB
PLUMBIIBG �y�., /N� y}���q , �'. //4;i`+ + t.i
ELECTRICAL ISSUANCE DATE
MECHANICAL w�L� OFtS BLDG. ELECT. PLG. MECR. -
IIIM
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED :�:_5�5��cx�C. W,3tiC\ BUILDING PERMIT
INFORMATION .
WOOD FLOOR o VALUATION S/FT.
PLUMBING iJ.
MECHANICAL ^A_ '
ELECTRICAL - - S
INSULATIONPERMIT TO
Az? ti Lc .
FRAMING - - - -
STORIES TYPE CONSTR.
- � (�`
OCC.GHOUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO IT. FLooR nlreA iorAL ACREAGE
THECONSTRUCTION TAXPAI
IS D 03
DIAPHRAGM �`-'•'�
'
1 +
BUILDIiTGJSE
ROOF SHEATHING i+Es IRO CON PB ov— ;
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED -FINALS ' -DATE INSP. - ' � c D El 0
ASSESSORS PARCEL NO
ROUGH
PLUMBING go ELECT.ENERGY2-4
TRACT NO, PAR EL NO
TUBS B SHOWER PAN p PLUMBING ENERGY
MECHANICAL MECH.ENERGY ACC.DATE ACC FILE No.
ELECTRICAL' ' BUILDING ENERGY _ -
FRAMINGELECT.FINAL TEST
INSULATION::
_ ZONING ENG.SITE NO.
��'o, . PLUMBING
GAS TEST GAS
' MECHANICAL FIRE SPRINK ENERGY T 2
Y Y-❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _
• a000 ZONE A.L.0 c.
EXTERIOR SHEAR ELECTRICAL RELEASE - Y� NF] Y L7 01
INTERIOR SHEAR FIRE DEPT. _
SHEETROCK - GRADE _ FEE SUMMARY
EXTERIOR LATH - - BUILDING -
INTERIOR LATH ' :. TEMPORARY APPROVALS BUILDING 667 SYJ
SCRATCH COAT ELECTRIC- - PLAN CHECKI
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE` 7,S-6 ,
OCCUPANCYOF.BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING.INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505,' ELECTRIC p'' „m
ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING
PLEASE GIVE JOB'ADDRESS WHEN PHONING.
z
'SEE MECHANICAL
FOR EXPIRATION DATE —.',". MECHANICAL
IMPORTANT! coNST.TgX;
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION'... I�Q' • '�
OFFICE COPY.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PENONLY
BU I LDING PROJECT-IDENTIFICATION PERMIT NUMBER'
ADORE"sem - I- Z APPLICATION & PERMIT 1 (�81
✓' I �,I n 1 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I U 8
. OWNER'S _ 1 W PLAN CHECK VALIDATION
NAMEOTV. ELECTRIC PERMIT FEE
a. PHONE '
CONTRACTOR'5 OUTLETS-SWITCHES-AECEP 10.00/1.00 NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00 f
CONTRACTORS
APPLIANCES,RESIDENTIAL '
DDRESS4.00
ADDRESS
Lf PHONE PANELS 10.00 DATE OF APPLICATION ,
ARCHITECT - - - PLAN CHECK FEE - P.C.N0.
OR • E.L��.f� A ,. PANELS (OVER 200 AMP) 20.00
ENGINEER W.A. . P fN6
�"""'ffff e,\,RR u.c�.pNo. �1 ' SIGNS TRANS. 3.00
AARCH.OR DDRESS wE"G STE If SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ANTS ►!- zIP EMP.METER OR.POLE'INS. 20.00 3,
APPLI rs MOTORS SEE FEE SCH. I�/
ADDRESS r.
�^'C• SERVICE CHANGE 20.00
0 LICENSED CON'1'RACTORSDE:CLARATION
Fin - I hereby affirm that I am II ensu(under provisio Is of Chapter 9 WK
F3 1 ISSUANCE DATE:
¢ (commencing with Section 7000)of Division 3 of the Business and .BLDG.- ELECT. PLG. 'MECH.
r w i Professions Code, 1 my license Ism full for, a e ect {{
Z o m License Cl ss� Lic Number City Q/C(Ip `P' 7"" LA
Cr Date z Coltructor_
BUILDING PERMIT
¢ o i OWNER- UILDER DECLARATION - I INFORMATION
w3 LL G I hereby affirm that 1 um exempt from the Contractor's License MISC.- REFER TO ORD .VALUATION
HUD4 Law for the following reason.(Sec.7031.5,Business;md Professions PERMIT ISSUANCE' 10.00 8/FT.
mw Code:Any cityorcounty whicbreyuiresaperntittoconstruc Latter;
¢¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. r LIC.N0. TOTALELEC. 11
a
D ¢
Helpfiles the pplic
aant for such permit to file a signed.statement that' I
w m m he is licensed pursuant to(lie provisions of the Contractor's License PERMIT TO
rT Law(chapter 9(conmencing with Section 7000)ofDeision 3 oflhe
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE JI V W'l_
¢ r D the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
a ; by any applicant for a permit subjects the applicant to a civil penally
of not more than five hundred dollars(S500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employee,with wages as BACK FLOW PROTECT. DEVICE 4.00 ocC.GROUP HES.UNITS
the it 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,CONE. 5.00
Code:The Contractors License Law does not apply to an owner of
' property who builds or Illlproves thercon,and who does such work FIXTURES-.PER TRAP - 5.00 n0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.IC however,the building GAS-EA.SYSTEM-1 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 hcdid not build or mi. - RES .IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000
❑ I,as owner of the Pro m . .
Perry.aexclusively contracting with ❑ '❑ ❑ ❑ ❑
licensed contractors to construct the IT,roject(Sec. 7044,Business LAWN SPRINKLERS-1INC 5 V.B. . 6.00 ASSESSORS PARCEL NO,
and Professions Code:The Contractor's License Law docs not apply 'h
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00
357- I - v 2
amlrucrs for such projects with u contractorts)licensed pursuant to
the Contractor',License Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt wider Sec. .B.&P.C.for this - WATER HEATER W/VENT 6.00
reason
Owner Dote WATER SYSTEM - 5.00 qec.DATE Ace.PILE No.
yO MPF.NygA/71p�yr.,�1)(I°��•f7�RATION WATER TREATING EQUIP. 5.00
ereby a f LH T have 5 e!Y[1rt of Consent to self-ioswe.
ore 'oficatc of W okay Cantpcys�tial Insurance,or a certified ZONING ENG.SITE NO.
copy th ,o(ISec.3800, puIbC
my
I'ol¢y No. Company_
p ❑ Certified copy is hereby furnished. - ` FIRE SPRINK ENERGY T 24
z o thv,G red py is I11ed dm the city'inspection division. MISC.' - REFER TO ORD. ❑ ❑ ❑ ❑
\ 11eC,l _ Y N V N
PERMIT ISSUANCE '10.00
Lu
CE If ICCOMPE I ATION INS PROM WORKERS FLOOD 20NE A.L.U.C.
W COAfPIiNSATIOM1'INSURANCfi PLG.CONTE. LIC.NO. PLG:
= Z (This section need not be completed it the permit is for one TOTAL ' V❑ -❑ v❑ N❑,
hundred dollms(S 100)or Ica.)
U O 1 certify that in the performance of lee work Ivor which flits per- CITY. MECHANICAL PERMIT FEE FEE SUMMA V
LL I- mit is issued,I shall not employ any person in any manner ,,as to
0 w become subject to the Workers'Compensation Laws of California.
IL Date Applicant ALTER OR ADD TO,MECH. 5.00 BUILDING
} w NOTICE 1'O APPLICANT: If,after making this Certificate of Ex-
F_ Z emption,you should become subject to the Workers'Compensalmo APPLIANCE 5.00 PLAN CHECK
provision of tire Labor Code, you most fo lllwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10A00 C.F:M,) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.EM.1'6.00 SEISMICFEE 1
I hereby affirm that there ie a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 -
the performance the work o�,hlcllJW,��permit is' ucit(Sce. - MICROFILM S+
3097.CivC.) ��---8 ,M HEATING UNIT HTO 100.000 B.T.U.) 8.00
Lender's Name HEATING UNIT IDV ER 100,000 B.T.U.I9.50 ELECTRIC
LenJar's Addruse_ r. Lr/ 'y`t'.rO
I certify that T have read this application and stare that the above VENTILATION FAN (SINGLE) 4.00
ink norMion is correct, I agree to comply with all city and county _ PLUMBING �-•I�
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby umhorio, representatives of this city to enter upon the
above-mentioned property for inspection purposes. IBOILER-COMP )Over 100,000 BTU)SEE FEE SCH. 'MECH ANICA . ID
(We) agree to save, indemnify and keep harmics, the City of MISC.. REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 - -CONST.TAX: _302,
30 rV,
CV-
., in any way accrue against said City in consequence of the ��+s-
r [his perm' MECH.CONT. LIC.NO. METH.
It-S TOTAL . TOTAL 3S
Signature of ApphcangContra<[or Uare 1O9i
OFFICE COPY