16324POST THISTCARD NEAR FRONT OF BUILDING
-
PERM IT NUMBER'
. " . ' CITY OF CUPERTINO
16324
INSPECTION DIVISION
1;
JOBANSPECTION RECORD.
-
/PERMIT'OkPIRATION
JOB ADDRESS -[ (y ;?4L)A:(6_c:SS VlVN' UNIT# _LOT# '.
PERMIT EXPIRES IF WORK
OWNER 'AlD'T - CONTRACTOR
IS. NOT. STARTED WITHIN
1BODAYS OFPERMIT ISSU-,-
ANCE•OR 180 ,DAYS FROM'.
LASTCALL ED INSPECTION'..
INSPECTION DATE INSPECTOR
- INSPECTION RECORD
FOUNDATION
-
NOTE
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLYWITH THE APPROVED PLANS AND CITYOF
UFER � �
PREGUNITE-
PERMIT VALIDATION
'
CUPERTINO STANDARDS.
. ,
GARAGE SLABS ' ''"
.POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
- `�"
UNDERGROUND/SLAB
Is
i..✓' {y, •o,r'+�^t,
- ISSUANCE Onrr
PLUMBING".
..
.. -. �tj� ^�++'�'
ELECTRICAL
MECHANICAL-'
qty Dt CuPBft
Luu
11 LJ
ELECT.
®
"P,yt MECH.
Cc]
DO NOT POUR FLOOR'UNTIL ABOVE HAS BEEN SIGNED
.
-
BUILDING PERMIT
INFORMATION
' WOOD FLOOR'
VALUATION $/FT.
PLUMBING -
-660
MECHANICAL - •
ELECTRICAL ','
`•AWi
. " PERMn TO ,
OE'*0
FRAMING - ....
INSULATION
- -
STORIES
TYPE CONSTR.
-OCC. GROUP
, RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- ROOF -
NOTE'NO FINAL INSP-. SHALL BE MADE BEFORE"'
THE CONSTRUCTION fAX IS,PAID
11 11.0.E AREA
TOTAL Araeace
DIAPHRAGM .. _
•.
ROOF SHEATHING
NUILDINGJ SE -
RES IND •' CON" PE oidn,
❑ El SP ❑ 11
APPLY NO ROOFING UNTIL ABOVEYHAS'BEEN.SIGNED
FINALSa ` •,t,'1' ^; ^DATE" ;: "INSP.
- - , -
ROUGH
SAN.k
- Assessoas PARCEL Na,:
PLUMBING
ELECT. ENERGY'-'
TUBS BSHOWER PAN � �
PLUMBING ENERGY �
IHACT.NO.
-
PARCEL NO
"
MECHANICAL,' - 1'.
MECH.ENERGY
ELECTRICAL ---
BUILDING ENERGY
,Acc. DATE
ACC Elle no
-
FRAMING
ELECT. FINAL TEST'-
INSULATION..
PLUMBING - ..
ZONING
;'ENG. SITE NO.
GAS TEST - '•
GAS
'
MECHANICAL
EIRE SPRINK
Y ❑ NO
ENERGY T 24
Y ❑ 'N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING',.'
EXTERI R SHEAR -
ELECTRICAL RELEASE
TLOODzoryE
- A.L.U.C.'
INTERI0 SHEAR ..
FIRE.DEPT.
SHEETR CK'". - '•GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDI r
"
BUILDING
' G
INTERIOR LATH
TEMPORAR APPROVA
SCRATCH COAT
ELECTRIC- -
PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
'SEISMIC'EEE
.
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR,
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
'ELECTRIC
57�.
NONE WORKING DAY'BEFORE REOLIIRED'INSPECTION. "
,
o PLEASE GIVE JOB ADDRESS.WHEN PHONING.
�
PLUMBING
i
07
I
MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE -.'
CONST. TAX
'
LMPORTANT!
TOTAL
PLEASE"READ REVERSE SIDE BEFORE "
-CALLING'FOR,FINAL INSPECTION.'
.
OF Y s;:
FICE COPY `,
9
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FO
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9
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION
-
APPLICATION &PERMIT
BUILDING - ELECTRICAL -PLUMBING - MECHANICAL
.PERMIT NUMBER -
A n"
2 4
ADDRESS Z0I I Z ��'Vol
-
NAME
NAME
. ►kl. D fA PHONE
Vl5 MI
O ELECTRIC PERMIT FEE
PLAN CHECK VALIDATI0
NAMERncrogs
UTLETS- SWITCHES -RECEP iD=9.00 S�
LIC. NO.
IGHTING FIXTURES 10,00/1.00
ADDRESS ,OR's
APPLIANCES - RESIDENTIAL 4.00
- PHONE
PANELS 10.00
DATE OF APPLICATION
r ARCHITECT !
DR 55o GI
ENGINEER'
41Z&A 0,t LIC. rvD.
-
PANELS (OVER 200 AMP) 20:00
PLAN CHECK FEE P.G..NO.
..
SIGNS TRANS. 3.00
r ARCH. OR ENG
ADDRESS 583n
SPECIALCIRCUIT '�s
A� ERMITVALIDATION
EMP. METER OR POLE INS., 20.00
2hP O
fl -
C�
APPLICANTS s
MOTORS SEE FEE SCH.
QI �//22�5//'"'7T�� o
SERVICE CHANGE - 20.00
LICENSED CON'I'RAC'fORS DECLARATION
I hereby a11w that I am licensed under provisions of Chapter 7
(commencing with Section 7000) of Division 3 of the Business mrd
Professions Code, and my license Is In full force and effect.
License Class Lic. Number -
SSUANCE DATE
BLDG. ELECT.
PLG. 'MECN.
Date.
Date Contractor
t�--r -
OWNER-BUI exc'n DECLARATION
I hereby aollo that 1 am exempt 31.5 the Contractor's License
Law forthefollowingreason.(Sec. 70resa permittocnd Professors
Code: Any city or county which rfractura permit [o is B,u ne.ills,,
t fracture, prior to its iatement also
improve, he applicant
or rep air ;my permit
for such rovisi to file o signed statement Li nsl
,equips liredp pursuant
he is pursuant en the provisions at the Contractor's License
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
PERMIT ISSUANCE
VALUATION $/FT.
�nynyT�
x
ELEC. CONTR. LIC. N0. ELEC. S�
TOTAL
PERMIT TO
(Chapter
Law (Chapter r(commencingwith Section 7000)of DivisionJoftic
Business and Professions Code) or Ihut he is exempt therefrom anA
PLUMBING PERMIT FEE
��Mf��f�y�%11-y
/ 1 11
the iasis for the alleged exemption. Any violation ul Section 7031.5
by any applicant for a permit subjects the applicant to a civil penallyALTER-DRAIN&VENT.-WATF�R(EA.),
of not more than five hundred dollars ($500).):
STORIES
ES
TYPE CONSTR.
❑ I, as owner of the property, or my employees with wages as
their sale compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
' DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and professions
Code: 'fire Contractor's License Law docs not apply to an owner at
,
property who builds or improves Ihercon, aril who does such work
himself Or through his Own employees, provided that such Illlprove.
ments ore not intended mothered farsnle. If, however, the building
.FIXTURES -PER TRAP _r
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
50. FT, FLOOR AREA
_
aJxJ�-
TOTAL ACREAGE
or ingrrovwnent is sold within one year of completion, tire owner-
builder will have the burden of proving that he did not build or int.
GAS - EA. SYSTEM -OVER 4 IEA.) 2.00
BUILDING USE
Pr v I'or purpose ofsale.).
IY I, as owner of the property. and a%CIu51VC1y fantlJL'llllg with
RES IND CON PB Other
0 El 0
INDUSTRIAL WASTE INTER. 30.00
licensed contract.,, to construct the project (See 7044, Business
and Pooessions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for tine Cmmetm,u Licenects Lwithu cnnlractorls) licensed Pursuant In
the Contract. is License Law.
❑ latlh elealAxe.m�^p^t under �Sec ,B.&P.G. I... this
41.
SEWER -SANITARY -STORM EA. 200tt/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
IF
Owner 1.10 Date �-
WORKERS'COMPENSA110N DECLARATION $S
WATER SYSTEM - 5.00-
ACC.OATE
ACC. FILE NO.
'
WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have o c rlificate of consent to selhinsilre,
or a cerlifhcate of Workers' Compensation Insurance, or a certified
ZONING
ENO. SITE NO.
copy thereof (Sec. 3804 Lab.C.).
Policy No. Company
FIRE SPRINK
Y N
ENERGY T 24
Y ❑ N[:)
❑ Certified copy is hereby furnished.
❑ Certified copy is fled wish the city inspection division.
APPlicanl
MISC. - REFER TO ORD.
CERT IFICATC Or EXEMPT ION PROM WORKERS'
PERMIT ISSUANCE P.96 %
FLOOD ZONE
AT.U.C.
COMI'ENSA'I'ION INSURANCE
ffhis section need not be completed if the permit is for one
Y� N�
v� N�
PLG. CONTR.' LIC. NO.
PLG. Qti
TOTAL
hundred dollars (S 100) or less.)
-
1 certify that in the performance of the work for which this per.
mil is issued, I shall not employ any person in any manner so as to
O MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
•) ZJ
�C
become subject to the Workers' Conmetsation Laws of California.
Dale Applicant
' ALTER OR ADD TO MECH.
NOl'IC17 TO APPLICANT: If, after making this Certificate of rix-
'APPLIANCE 5.00
-
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
PLAN CHECK
FEE
caption, you should become subject to lire Workers'Compensmion
provisions of tie Labor Code, You mist forthwith comply will,
such provisions or this permit shall be devote revoked.
CONSTRUCTION LENDING AGENCY
AIR HANDLING UNITIOV,ER 10=11C.F,M.) 6.00
SEISMIC FEE
I hereby affirm that there is.a construction lending agency for
EXHAUST HOOD (WITH DUCT) •b.09
the performance of the work lou which this permit is issued (Sec.
3077, Civ.C.k
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8:00
Lender's Name
Lender's Address
HEATING UNIT (OVER 100,000 B.T.U.M.50
ELECTRIC
3 S�
I certify that I have read this application and slate that lire above
inl'onmalion is Correct. I agree to comply will, all city and county
ordinances and state laws relating to building construction, and
VENTILATION FAN (SINGLE)
PLUMBING
--
BOILER COMP H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
V -
herebynenlloncdPropertytarvesl'eI this
hereby authorize representatives oh This city to chic, upon the
proposes.
(We) agree to save, indrnmlly and keep harmless the City of
MISC. - REFER TO ORD.
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said City in consequence of the
CONST. TAX
71
PERMIT ISSUANCE �a
ranting f thio s permit. ' O / j j , j q is /r,
Si'uVoVcat/ NYfV� L4JY
MECH. CONT. LIC. NO. MECH,
3�
A �i
TOTAL
3�
S .�
Signature of Applica /Contractor Date
OFFICE COPY