16378POST THIS CARD NEAR FRONT OF BUILDING
CITY OF-CUPERTINO
" INSPECTION DIVISION
JOB INSPECTION RECORD
�^r /
JOB ADDRESS �2._i_c�, `e UNIT# _ _ LOT#
- /�
• OWNER `j CONTRACTOR Lk - Cb
PERMIT NUMBER,
16378,
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK'
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM,
LASTCALLED INSPECTION 'I
IN PE TION DATE I IN PECTOR
INSPECTION RECORD
FOUNDATION40
NOTE: -
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTI 0 STANDARDS.
I
UFER - - - -
PREGUNITE -
PERMIT VALIDATION
_ C
{ �'' ... +
issuANce DATE.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND./ SLAB
PLUMBING
-
ELECTRICAL - -
MECHANICALU2�D
' FOOTI ''I NS�xt�o
IILDG
ELECT .
.�
PLG . MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
1410ts'rl l?DoS , PD'%ja �% C jti\
BUN OIRNG MATIONT
WOOD FLOOR
PLUMBING`
V NDe-F L -6R" RgwE E'I•c. L+peS
R'Q-% OULP G{{>Q. C.IaLO L(�C:L
vALUATION
yofto
SIFT.
MECHANICAL _
ELECTRICAL -
b- GI 't" Fo�Ti!-7j o
3 -Z -B -
PErvMIT TO
- L T
STORIES r PECONSTR.
FRAMING 0 -
INSULATION -
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-
OCc. GROUP
RES UNITS
ROOF
NO FINAL INSP. SHALL BE MADE BEFORE
THE C
THE CONSTRUCTION TAX IS PAID
SIR IT CLOOH AREA
/ �
O
TOTAL ACREAGE.
^ �
({{
DIAPHRAGM �
ROOF SHEATHING
RES IND 'LOGON usEFB DO—
0 C, 0 E
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS, . DATE INSP.
ROUGH'
ASSESSORS PARCEL NO.
326�r_ (63
PLUMBING " � �
ELECSAN.T.
ELECT. ENERGY
TUBS &SHOWER PAN
PLUMBING ENERGY'
rHACT NO.
PARCELNO,
MECHANICAL -
MECH.ENERGY -
ELECTRICAL -
BUILDING ENERGY
ACC. DATE
-ACC FILE NO
-
FRAMING ..
ELECT. FINAL TEST
INSULATION � � �
PLUMBING �
ZONING
,
ENG. SITE NO.
'
GAS TEST - - -
GAS
MECHANICAL-
FIRESPRINK
-
Y ❑ N[]
ENERGY T 2
Y [:] NN[:]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING '
EXTERIOR SHEAR -
ELECTRICAL RELEASE
FLOOD ZONE
Y.[:]N❑
A.L U C.'
Y L7'N❑
INTERIOR.SHEAR-
FIRE DEPT.
SHEETROCK - - -
GRADE - -
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
%3.40#1
INTERIOR LATH '.
TEMPORARY APPROVALS ..
SCRATCHCOAT
ELECTRIC -
PLAN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
'SEISMIC FEE
2Z.
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
F ONE WORKING DAY BEFORE REQUIRED INSPECTION., . ;
z PLEASE GIVE JOB ADDRESS WHEN PHONING:
—SEE PERMIT,FOR EXPIRATION DATE —
ELECTRIC
PLUMBING
6` "
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLINGTOR FINAL INSPECTION.
TOTAL
-SK:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION.
allILDING APPLICATION & PERMIT
-°3 6 BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
ALS AvO ATgc.P/.J6 A,
• 'PERMITNUMBER
1 �+� r]
I v
OWNER'S
NAME /Lr/LU,
M G pP� \\ yp/
� i'I-�� 4E G EGPa9- PHONE til' %Plv
GTY ELECTRIC PERMIT FEE
PLAN CH ECK VA LIGATION
DATE OF APPLICATION .
PLAN CHECK FEE P.OZNO.
NAME croRs
NAME
FOG AAI �'Al6i uc.No.-
OUTLETS - SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRADDRESS
Aoonsss ��DD ,��,
10251 /An GN !L. �Zf�NE ;Z57 --,'1L(,
_
OR
OR
ENGINEER (��
�JLO'7%- ,>! IC No.
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
PANELS (OVER 200 AMN 20.00
SIGNS TRANS. 3.00
ARCH, OR ENG.
ADDRESS
O • /✓OX �j ZO /o. CJAk'ATa la %✓O%
T 5.00
PERMIT VALIDATION -
ISSUANCE GATE(conmteocing
POLE INS. 20 A0noness
TaSEE
'5ALaM A./E- LelE
FEE SCH.,2.7378
20.00LICENSED
CONTRACTORS DECLARATIONS
1 hereby affirm that 1 um licensed under prvisios of Chapter1
with Section 7000) of Division 3 of the Business anO
Code, and my license is in full force and efftBLDG.
License Class Lie. NumberDateContractr{yam
DI:CLARA'rIONvW
I hereby affnm that I um exempt four the Contractor's License
Law l'ortheity orcountywhich requiresC. a einessund Professions
Code: Anycity county any requires permit o its mane, alter,
improve, demolish, m repair any slmctam, prior to its issuance, also
requires the applicant for such permit to file .Signed statement that
he is licensed pursuant to the Provisions of the )of1)icmr's License
Law(ChapterProCommenCode) th Section is exempt
Dtheren3 of the
Business and Professions empt or that he is exempt therefrom and
the basis for the alleged exemption. Any violation t to
o action malty
by any care thnt fora u permit dolga, the applicant toe Civil penalty
of not more than five hundred Dollars ():•
❑ Lmyem
as owner the property, or my employees with wages as
their sole compensation, will do the work, and the structure is rat
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon, and who docs such work
himself or through his owemployees, provided that ch improve-
su
mentsarenotintendedorofferedforsale. If, however, the building
or improvement is sold within one year of completion, tire r
e owne
builder will have the burden Of proving that he did not build or am-
Prove for purpose of sale.).
❑ 1.d as owner of the property, am exclusively .coetractaigBu with
licensed contractors m construct the project La 7044, of apply
and Professions Code: The Contractor's License Law does not apply
to an owner of property who hadds or improves thereon,and who
contracts for such projects with u contmetonsl licensed pursuant to
the Contractor's License Law.
❑TRACT
reasonlam exempt under Svu. C. fir this
-e 7-
WS"9,
' J
�Professions
ELECT.
PLO. MECH.
�Y��
QW.OwOWNER-BUILDER
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
PERMIT ISSUANCE I s03
10.00
VALUATION q/FT.
D OQ
ELEC. CONTR, LIC. NO.
ELEC. f �� 1�
OTAL l l
{
PERMtT,jO
�d1/ri-IGr%
/ 4�X
DTV. PLUMBING PERMIT FEE
ALTER -DR AIN&VENT-WATER (EA.) 5.00
STORIES
TYPE CONSTR.
BACK FLOW PROTECTDEVICE 4.00
.
OCC. GROUP
RES. UNITS
2
J
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAPn - 5.00
ser fir. FLOOR AREA
66,65
TOTALACREAGE
V4
GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00
GAS- EA. SYSTEM - OVER 4 (EA.) - 2.00
BUILDING USE
RES IND CON PB other
� ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO._
_(�_IFo3 ,
LAWN SPR IN KLERS- OVER 5(EAJ 1.00�/
SEWER -SANITARY -STORM EA. 200ft/10.00
WATER
WATER HEATER /VENT 6.00
NO,
PARCEL NO,
Owner Date
WATER SYSTEM 5,00
woRKliRs•coMrervsnTlOry DECLARATION
I hereby affirm that 1 have a certificate ofcnnsent to self -insure,
or a certificate of Workers' Compensation Insurance, or a certified
copy thereof(Sec. 3800, Lab.CJ.
Policy No. Company
ACC. DATE
ACC FILE N0.
WATER TREATING EQUIP. 5.00
/- oer
V .] v{,J 'L 13
ING ZON
ENG. SITE NO.
❑ Certilled copy is hereby furnished.
❑ Certified copy is filed with the city inspection division.
Applicant
FIRE SPRINK
YE] N�
_ZONE
ENERGY T 24
v[] No
MISC.- REFER TO ORD.
CFRTIFICA'rl: OP EXHIA17ION PROM WORKERS'
COMPENSATION INSURANCE
(This seclion need not be Completed if the permit is for one
hundred dollars (S 100) or Less.)
I certify that h ] n performance of the work for which this per.
mit is issued, e I shall not employ any person in any manner so is m
Dltcbecome subject to the Workers' Compcmwlion Laws of California.
Date - Applicant
PERMIT ISSUANCE 10.00 1 toe
FLOOD
V N
A.L.U.C.
Y N�
PLG. CONTE. LIC. NO.
PLG
TOTAL 6..11 I
CITY MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING"
I��'3u�
l
cmvision you should become subject to the Workers' Compensation
emplion, TO should scamANT: If, after making this Certificate of ion
you mull forthwith comply with
provisions io the Labor Cit shall
such provisions or this permit shall be deemed revoked.
CONS'FRUC"I ION LENDING AGENCY
1 hereby affirm Char there is a construction lending agency forEXHAUST
lbe.perlurmance of the work for which this permit is issued (Sec.
3097, Civ.C.L
Lender's Name
LCnderi Address
I certify that I have read this upplicalion and state that the above
lafonration is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city 1, Brier upon be
o-
xbovmentioned property for inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of
upertino against liabilities, judgments, costs and expenses which
may in any way accrue against said City in consequence of the
ranting of this permit.
MECH.
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
FEE
_
AIR HANDLING UNIT (TO 10,00DOF.M.) 4.00
AIR HANDLING UNIT (OVER 10,000C.EM.) 6.00
SEISMIC FEE
4G�
HOOD (WITH DUCT) 5.00
MICROFILM
ELECTRIC
/C
�W 113
HEATING UNIT (TO 100,000 B.T. U.1 8.00
HEATI NGUN IT(OV ER 100,000 B.T.U.) 9.50
VENTILATION FAN (SINGLE) 4.00
-
BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00
PLUMBING
j
BOILER-COMP(Ox., 100,000ETUISEEFEESCH.
MECHANICAL
{' 5s1
It
MISC. -� A�'iJC' 'TiE FER TO ORD.
PERMIT ISSUANCE 10.00 �'Zv�
CONST. TAX
CONT. LIC. NO. MECH.
TOTALr,65' `
TOTAL/6,5* 3
TOTAL
'60
Slgnelrrc oI Applicant ,.mmc,, Date
OFFICE
OFFICE COPY' '