16959 POST THIS CARD'NEAR FRONT-OF BUILDING
PERMIT NUMBER
CITY OF -CUPERTINO 16959
INSPECTION DIVISION
JOB INSPECTION RECORD
' PER1y11?PIR�T�tN
JOB ADDRESS �0 �--60 �Va - - UNIT# LOT# �I Z�SS )
I - PERMIT EXPIRES IF•WORK
OWNER J �.{ C. v.1 -CONTRACTOR D ",V- ' IS.NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OF PERMIT.ISSU '
FOUNDATION Z� i ANCE OR 180 DAYS FROM
NOTE:. LAST CALLED INSPECTION.
UFER` ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE _ TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS _ ':� 0_
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED, _JAN 3 (/
UNDERGROUND /SLAB. J ,e J(
PLUMBING -2City'ot CUpetno '
ELECTRICAL ISSUANCE DATI)UE
MECHANICAL. TDDG. EVILEr PLG. MEC,+.
�Io
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR. INFORMATION
VALUATION EI ET.
PLUMBINGQ1,OQ0
MECHANICAL �l I '
ELECTRICALPERMIT TO
FRAMING '���
INSULATION STOR &S TYPE CONSTR.
•OCC'GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So.`r.r Lonr+nl+En roTAL nc++EACE
> DIAPHRAGM _ THE CONSTAUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - "Z rj RES IND CON PB o,I,.,'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS PATE. INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING 0133-- ELECT.ENERGY
TUBS HOWER PAN PLUMBING ENERGY TRAa No. PARCEL NO.
MECHANICAL - - MECH.ENERGY
ELECTRICAL ACC.DATE AC LLE NO.
BUILDING ENERGY
FRAMING ELECT.FINAL TEST "
ZONING ENG.SITE NO.
INSULATION - PLUMBING s.
GAS TEST GAS '
• MECHANICAL - EIRE SHRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y FLOOD ZONE Luc
"� N�
EXTERIOR SHEAR ELECTRICAL RELEASE v � N� �uhtNo
INTERIOR SHEAR FIRE DEPT.
SHEETROCK . GRADE FEE SUMMARY
EXTERIOR LATH. BUILDING. BUILDING
INTERIOR LATH - TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GFEE
AS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE A /v
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 3, c}O-
�
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING. 2, U
.0-
_
'PLEASE,GIVE JOB ADD.RESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
, T ,
IMPORTANT! CONST.TAX -�r
PLEASE READ REVERSE SIDE BEFORE TOTAL /-> I
CALLING FOR FINAL INSPECTION.
OFFICE COPY,'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT `'
AM (, o '_ fl C0p�rl,vd BUILDING - ELECTRICAL-PLUMBING-MECHANICAL �• 16959
OWNERS µV�- - PLAN CHECK VALIDATION
CC NA1MErxr� (' r1.jOTY. .ELECTRIC PERMIT FEE
1 .JRn1e5 cr >�oFFmT��/ PNDNE !6-
CONTRACTOR
'S
NAME D OUTLETS-SWITCHES-RECEP 10.00/1.00 F3, OD 1 I7�fQ�
/-I ArrLaS CORP, uc.No, LIGHTING FIXTURES 10.00/1.00 .0 1 Ci
CONTRACTORS
ADDRESS �r�(o--�• PPLIANCES-RESIDENTIAL 4.00
oOQ CI FI L-R -PHONE S�SJ PANELS - 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEEP.C.NO.
NGINE$ .
oR Ow/A( J ; C q/0 PANELS (OVER 200 AMP) 20.00
E `
LIC,c.No. SIGNS TRANS. 3.00
ADDRESS aces. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
1060/ $o,t)_-A,f/Z.A 00P ZIP TEMP. METER OR POLE INS. 20.00 1 - -3 e_
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS y
/606o Lq e-yPoenva SERVICE CHANGE 20.00
0101-- LICENSED CONTRACTORS DECLARATION
u U I hcmby,afOrm that I um licensed un der p ruvi,ior,of Chapter 9 ISSUANCE DATE
¢ 2 w
Icomnannng with Section 7000)of Divixiun 3 of the Business and BLDG. ELECT. PLG, MECH.
D i Professions Code,and my license is in full force and effect.
Z O -�l License ClaV, Lic.Number
O z o Date-Contractor Contractor
,_ V,
y M ; :JAN BUILDING PERMIT
¢ a w¢ OWNER-BUILDER DECLARATION INFORMATION
o " MISC.- R
K
3 a w I hereby afllml that 1 am exempt from the Contractors License VALUATION 5/FT.
F .. aaa law for the following reason.ISec.703L5.BusinnsmdProfessions PERMIT ISSUANCE 10.00 DO AM CIS
Code:Any city or county which requires a permit construct.alter, D V eo 1
Qca O M Improve,demolish,or repair any stmctUm,prior to Its issuance,alio ELEC.CONTR. LIC.NO. ELEC. ['�'f'1 ,Ml
IS requires the applicant for such permit m File a signed statement that TOTAL J J fear PERMIT TO .
Le $ he is licensed pursuant to the provisions of the Contractor's License
rzi Law(Chapter 9(commencing with Section 7000)ofUivisicm3office
¢ Business and Professions Code)or that he is exempt therefrom and OTY. -PLUMBING PERMIT FEE e
¢ I the basis for the alleged exemplum.Any violation ofSeclion 7031.5 STORI B TYPE CONSTR.
by any applicant for u pconit subjects the applicant w a civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dullus($5001.):
❑ I,as owner of the property,or my cmployces with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
their wle 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 in owner of
1 properly who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 I rid so.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees.provided that such improve-
ments are not intended or offered for sale.IL however.the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
orimprovement 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 im- RES IND CON PB Other
for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 Contnuoc is License Law docs not apply �
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
conlraets forsueh projects with a contractors)licensed Pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ Icon exempt under sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
dv-
reason
Owner Dam ` WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORK ERS'COMPENSATION DECLARATIONWATER TREATING EQUIP.. 5.00
1 hereby affirm that 1 have a certificate of consent to self-inalre,
or a certificate of Wofken'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thercof(Sce.3800,Lab.C.L
Policy No. Company--Sly771 Q(IMP
Q ❑ Cerlifledcopy'is hereby( mished. FIRESPRINK ENERGY T-24
Z Z �'Certified cop n fyled th the city inspection division.
O Affplicam �/� 2 MISC.- REFER TO ORD. v ❑ N❑ v ❑ N❑
F- rn TPERMIT ISSUANCE _ 10.00 A.-C1 FLOOD ZONE A.L.U.C.
� CERTIFICATE OF EXEMPTION FROM WORKERS'
LU > COMPENSATION INSURANCE PLG.CONTR. ❑C.ND.- ' PLG. 21 014 Y❑ ry❑ Y ❑ N❑
2 1CL 0 "['his kct iou need not be completed if the pennil ix lot one TOTA V
bandied dollars(S 100)or 1,.1
U O 1 certify that in Ihe.pe,orm uc,of life work In,which this Ilcr- QTYMECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shell not employ any persue in any.mariner w as to
U
U become subject to the Workeri Compenulion Laws of Califonsia.
U.1 Dam Appheaut - ALTER OR ADD TO MECH. 5.00 FELECTRIC
DING l
} N NOl'ICE TO APPLICANT: If,after making this Certificate of Es-
F ? emption,you should become subject m the Workers'Cmnpensalion APPLIANCE 5.00 CHECK
provisions of the labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed rm'oked. - AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)=C.EM.) 6.00 MIC FEE O
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. OFILM3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's AddHEATING UNIT(OVER 100,000 B.T.U.)9.50Lendm's nddress 1 V�
I certify dial l have read thisupplicalion and state that the above VENTILATION FAN (SINGLE) ,4.00 e
information is correct, I agree to comply with all city and county PLUMBING �( V
ordiumccs and state laws relating to building construction, and BOILER-CC"(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of the city to enter upon the BOILER'-COMP Ove,100,01)0 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harinlcss the City of MISC.- REFER TO ORD.
ulverlino against liabilities,judgments, costs and cxpereses which CONST.TAX
ay in an way accrue against mid City in consequence of the PERMIT ISSUANCE 10.00
all
ngo hrlcrmil. MECH.CONT. LIC.NO. MECH. --�
TOTAL16 R TOTAL 3/o I
Signature Apphcan onl ractor ale
OFFICE COPY