15867i
POST THIS CARD NEAR FRONT,OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15867
INSPECTION DIVISION
JOB INSPECTION RECORD '
PERMIT EXPIRATION
JOB ADDRESS
/ •'mow" /�+ "LI�•1IT,# #LOT, --Z-
PERMIT EXPIRES IF WORK
OWNER m coNTRAcroR •+y Qw�
�/ IPP
IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM .
FOUNDATION »�•iiI/1 NOTE: - '
LASTCALLED INSPECTION.
LIFER ALC GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE - CUPERTINO STANDARDS.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -•
UNDERGROUND IISLAB
PLUMBING p�`
ELECTRICAL �aOv a �( ��5UA'NCE DATE
MECHANICAL ` ELECT PLG, MFCR. '
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDINGPERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING - -
MECHANICAL -
ELECTRICAL
PER ra IT To
FRAMING b
INSULATION SICHILl. TYPECONSTR. '
' occ. Rouv xalrs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
(ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO. " .0O"AREA MTA ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
'BUILDwc USE
ROOF SHEATHING 5_ ; RES . IND CON PB om,,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ;l ❑ ❑ 0 ❑
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING ELECT. ENERGY all
TUBS 8 SHOWER PAN < PLUMBING ENERGY
MECHANICAL -,.-y MECH.ENERGY
. ;
- ELECTRICALAMC ACCFILE NO,
BUILDING ENERGY �
FRAMING — ELECT.FINAL TEST zorvlNc ENG.SITE NO.
INSULATION PLUMBING.
GAS TEST GAS' ' '.T
FIRE SPRINK ENERGY T.
MECHANICAL N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� ` �
.
' EXTERIOR SHEAR '7 ELECTRICALRELEASE 4LOOD20NE A.L7Cv� N� t I] NEI
SHEAR _ FIRE DEPT.
SHEETROCK $ GRADE - FEE SUMMARY
EXTERIOR LATH rj-y4 BUILDING '
INTERIOR LATH /(�� � ,TEMPORARY APPROVALS BUILDING
SCRATCH COAT `Zlr'q"7 S ELECTRIC PLAN CHECK 15
GAS FE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC EE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDI NG FINAL IS SIGNED BY BUILDING INSPECTOR. -
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
• F F- : ONE WORKING'DAY BEFORE REQUIRED INSPECTION. aLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. ftn
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
via
IMPORTANT! CONST,rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE.COPY
,.APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTI FICATION.
PERMIT NUMBER
ao'o,°Eu runty,Spring Carat APPLICATION & PERMIT I t �+
Lot 293 3A BUILDING - ELECTRICAL-)LUMBING-MECHANICAL I o
OWNER'S Dseg ry (].,yam - PLAN CHECK VALIOATIOry
NAME "'x"Js^J `x'x^Mx, Inc'• & OTY. ELECTRIC PERMIT FEE
,• Developrerlt PHONE 415/595-2100
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
yyww'nn, InC• LIC.No. p-4M7 _
LIGHTING FIXTURES 10.00/1.00
CONTRACTORS y(1n In PPLIANCES-RESIDENTIAL 4.00
Poor FSS
94065 fm PHONE415/595-21 PANELS 10100 DATE OF APPLICATION
ARCHITECT � SSeni an, PANELS (OVER 200 AMP) "20,00 PLAN CHECK FEE .C.NO.
ENGINEER Associates C 3%
. Associates uc NO. 1,1�JTJ SIGNS TRANS. 3.00
AARCH CH
DDRESS ENG •f SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
Am Hts•, CA zip 92707 TEMP.METER OR POLE INS. 20.
APPLICANT'S MOTORS SEE FEE SCH. -
A R '
Twm Dolphin Dr. F&C 94065SERVICE CHANGE 20.00,1
Edi Yv�p/{
o o LICENSED CONTRACTORS DECLARATION W
c i w I hereby affirm that I am licensed under provisions of Chaplcr'J ISSUANCE DATE
a e- (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT PLG.
F m i Professions Code, y license is in full fare L
z O v, - License C l y ,Jpp� Lie.Noodle
wDate-�(_��(_ CmtlTuclor
a u s -a BUILDING PERMIT
¢ a OWNER-BUILD------ ARATION
a " MISC.- REFER TO ORD INFORMATION
w ; LL N I hereby affirm that I am exempt from the Contractor's License VALUATION 5/FT.
,- LL oa Law Im.the following re...a,(Sec.7031.5.Buslnessand Professions PERMIT ISSUANCE 10.00
as county Code.Any city or which requiresa permit 10 comarict.liter, 1.K�q
727¢ ¢ improve,demolish,Or repair any structure,prior to its issuance,also ELED.CONTR. LIC.NO. ELEC. ,
O ¢ requires the applicant for.ach permit to File a signed statement that TOTAL PERMIT TO
w $ w he is licensed pursuant to the provisions of the Contractor's License -
H z Y 1-aw(Chapter 9(commeneingwith Scetion 700()0(Division 31
- a Busloess and Professions Code)or that he is exempt themGont and DTV. - PLUMBING PERMIT FEE �I-
sio
¢ F the basis for the alleged exemption.is the applicant
of Section natty STORIES TYPE CONSTR.
a ; - by any applicant for a permit subjects the applicant tuacivB penahy ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500)J: '� ��
❑ I,as owner of the properly,or my umployces'with wages is BACK FLOW PROTECT. DEVICE 4.00
their sole compenulion,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Coma ftor's License Law does not apply to an owner of R-3
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SQ FT,FLOOR AREA TOTAL ACREAGE
himself or through his own cmployces,provided that such imPnsve- GAS 6.00
menu are not intended or offered for.sale.IL however.the building 2349
or improvement is sold within one year of completion, the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.l' INDUSTRIAL WASTE INTER. .30.00 INo cory PB Omer
❑ I,as owner of the properly,am exclusively contracting with ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Code:The Contractors License law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.)- 1.00 366-09-31,32,33
contracts for such projects with a conlraetort if li<nwd pursuant to -
theContractor'sLicenseWw. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec,-,B&PC.fm this
reason WATER HEATER W/VENT 6.00 809$
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORT:ERS•COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy 0mreaf(Sce.3800,Lab.C.). LInited PdC1f1C '
Policy No. Company
O fT Certified copy is hereby burnished. RE SPRINK ENERGY T44
Z 2 )Certifier • is 1 with the city inspection division. -
FO Alphcanl bY}lu' MISC.- REFER TO ORD. Y � N� Y � NE]
rn PERMIT ISSUANCE 10.00
LU CIiRTIFICCOMPE IAA IOTI ON FROM WORKERS' FLOOD ZONE A.t.0 c. -
lL � COMPENSATION IdiftheINSURANCE PLG.CONTR. LIC.NO.CL PLG. Y� I4� Y [] N E]
Z hundred
section need not be completed if the permit is for one TOTAL
hundred dollars($100)theoe IcsrJ
U O I artily that in the to employ
an of the wink for which this per- CITY MECHANICAL PERMIT FEE -FEE SUMMARY
LL H mit is issued.I shall not employ any perwn in any manner so as to
U become subject to the N'orkers'Compcnwtion laws of California. �
O U.' Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ m NOTICE TO APPLICANT: If,after making fit,Certificme of Ex-
2 emption,you should become subject to the Worker'Compensation APPLIANCE - 5.00 PLANCHECK 15,50
provisions of the Labor Code, you must forthwith comply with
U 1.0h provuionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 FEE EE
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10000CEM0 6.00 SEISMIC FEE 110.71
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this pemrit is iswed(Sec MICROFILM
3097,Civ.C.). Security PaUi fic HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name- HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC
Lenders Address ,-4th-Fir-.SF-9411 .35
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 .35
hereby authorize R,pusentxlivee of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
above mentioned property for inspection purposes. ;
(We) agrm 10 save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgmenti, costs and expenses which PERMIT ISSUANCE 1000 CONST.TAX
ram .
nay in any way acerae against said City in consequenof the 7.
g f thi permit I MECH,CONT. LIC.NO. MECH.
,C/ TOTAL TOTAL
Si tureof Appl sant/Contractor Dale $1391.29
OFFICE COPY