16220 POST THIS CARD NEAR FRONT OF BUILDING
• E `l�- ,. PERMIT NUMNER
.: , CITY OF .CUPERTINo ` ( 16220
INSPECTION_DIVISION U7
JOB INSPECTION RECORD Lr �.
l� 6p/ PERMIT EXPIRATION
JOB ADDRESS � 3� 1 �ll C- YJ( �� UNIT# _LOT# '
I,� I/,,-�q //'T�•�I PERMIT EXPIRES IF WORK
OWNER C Y,�' I �VN`• L-^-1, t' ATRACTOR 'e IS'C� V-D W_" IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION 0� NOTE: ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION. ,
\_ ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PErmuT VALIDATION
CUPERTINO STt�1YDAR S.HOI_�
, =,� •�
GARAGE SLABS,.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLABFp•GQi1/
PLUMBING aVh. d VY 7
ELECTRICAL ..
ISSUANCE uarE
MECHANICAL (�.�. ifiFOG ELECT I vLc. MecR.�
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED e � BUILDING PERMIT
'WOOD FLOOR � � v INFORMATION
PLUMBING rJ2
_ VALUATION SIFT.
- lT o � �do
MECHANICAL _
ELECTRICAL �t- S • 8 ':JL ET �L���V.j PLER'MIT ro
FRAMING G'p` % C1RQte b¢,%,Wx�y'f.L-rk �• 'S/"-d ,��
INSULATION 7 '7-6 a 1 w. ci,wilT" STORIES TYPE CONSTR. .
lace 04--, 4 Y1 P 40 �
RES UNITS
,,PLACE NO SUBFLOOPJUUTIL ABOVE HAS BEEN SIGNED
SO.FI.FLOOR ARCA TOTAL ACREAGE
OOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE (,n• -b.w¢^� I
THE CONSTRUCTION TAX IS PAID
DIAPHRAGM
b UHATNG USE
ROOF SHEATHING RES - IND CON Po .0"'1,,
-- APPLY NO ROOFING 1111IIL ABOVEAAS BEEN SIGNED -' FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
R UGH
ASSESSORS PAI CEL NO
SAN.N �Q� Q
PLUMBING'I',� •.126 ELECT.ENERGY 357— "•
TRACT NO, PARCEL NO
' TUBSBSHOWER PAN PLUMBING'ENERGY
MECHANIC �Qj
j-26_ �T Ml ENERGY i
ELECTRICAL BUILDING ENERGY ACC.DATE ACC,FILE NO
FRAMING l
' ZA. ELECT.FINAL:TEST i
INSULATION PLUMBING ZONING ENG.SITE No.
, i.
'GAS TEST GAS
-s r MECHANICAL „ FIRE SPRINK ENERGY T.2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - Y "❑ ` ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FL000 zome ALuc.
INTERIOR SHEAR - FIRE DEPT.. ! `"❑ "N❑ ° ❑ N❑
SHEETROCK GRADE
EXTERIOR LATH - BU LDIN E SUMMARY
BUILDING � �
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC /`,J oto. a PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTORe MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, > ELECTRIC `
;FA+ � !
Ell 1,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
I z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
— SEE PERMIT FOR LXPIRATION DATE — MBCHANICAL
IMPORTANT! oNST.TAx �jgq
PLEASE READ REVERSE SIDE BEFORE TO
CALLING FOR FINAL INSPECTION.
y OFFICE COPY
�4
a ,
APPLICANT TO FILL.IN INFORMATION WITHIN RED LINES -'USE BALL POINT PEN ONLY
t •• � - 1 PERMIT NUMBER
BUL4DI .PROJECT IDENTI FIC TION > - _
ADDRESS ".. APPLICATION & PERM T.' - ^^ ^
A
DDRESS, - - - I `� 6 Z 2 0
Ct - .,•1u, .1BUILDING'-ELECTRICAL-PLUMBING-MECHANICAL "V�+'ERS
- PLAN CHECK VALIDATION
OTV. ELECTRIC PERMIT FEE 4J03
q'
i f
CONTRACTOR'S -
.rvA�m + Cl M/ s 6 OUTLETS--SWITCHES-RECEP 10.00/1.00
1 l Jw, uc,NA!;Zp Z. LIGHTING FIXTURES '10.00/1.00
CONTRACTORS -
ADDRESSAPPLIA
- ut t� . NCES-RESIDENTIAL 4.00
ko u�5 VD-%A.A•L...a►'�.+�NEt{+lS•9 CLL. PANELS - 10.00
DATE OF APPLICATION
ARCHITECT - - - PLAN CHECK FEE P.C.,NO.
OR (� 'PANELS (OVER 200 AMP) ,20.00
ENGINEER f
' X.. LIC.NO. SIGNS TRANS. 3.00
- ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 •-�
IIA05 "61 zIP TEMP.METER OR POLE INS. 20.00 {-
nooaessTs + /n' MOTORS, SEE FEE SCH. J �,
UO - p 'r F SERVICE CHANGE 20.00
in ravl�
M o LICENSED CONTRACTORS DECLARATION D71 3
u F I hereh
v y affirm [baht am licensed under provisions of Chapter 9
a r
mMARISSUANCE GATE
(commencing with Section 7000)of Division 3 of the Business and, LDG. ELECT' PLG. MECH.
F y z Lberaslons Code,ppppppttttttd my license is in full force�tred e et(..� � ,�y5
o m- Licen� Lia Number `'YL- city Q u 1
� " Dalc Con[mdor�,[[L u�
wH
Q r upfflu)J
as st. OWNER-BUILDER DECLARATIo BUILDING PERMIT
- o a ° INFORMATION
w 3 LL 1 hereby aCCirtn that I am exempt O'mn the Contrmlor's License 'M ISG.- REFER TO ORD
LL O Law for the following reason.(Sec.7031.5,Business and Professions - VALUATION $/FT.
L,- g' PERMI, ISSUANCE'- . 10.00
Code:Any city or county whiny structur e per
riot t n consuance,also
ar ¢ ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO: ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL Pit-,
n w m he is licensed pursuant to the provisions of the Contractors License PERMITTO
Uzi
Law(Chapter 9(commencing with Section 7000)o'Division 3 ofthe S�U w�
i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
tG r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n 3 - by any applicant fora permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER'(EA.) 5.00 '
���. i� -i
❑ Las owner at the properly,a workmy,
and
t ees with wager as BACK FLOW PROTECT.DEVICE 4.00 OCC. OUP RES.UMTS
their sole compensation;will(S the works and the sad Prme is not '
'mended or offered for sale (Sec. 7044, nosiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Lew doer not apply loess owner of ,
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP . 5.00 - so.Fr.FLOOR AREA Torg ACREAGE
himself re through his own employees,provided ev such improve-
- 4:k ��yya
mems are not intended or offered for sale,ll',however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner. 6O g),Y) t)
builder will have-the burden of proving that he did not build or Up- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. ,30.00 RES IND CON PB Other
O -1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ * ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPR INKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) - 1.00 ��j7�U�-r
contracts for such projects with a'mnlraclor(s)licensed pursuant to :/
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 . TRACT NO. PARCELNO.
❑ I am exempt under Sec. B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Uale WATERSYSTEM5.00 ACC.DATE ACC.FILE NO.
WO RKERS'COMPFiNSA'fION DECLARATION WATER TREATING EQUIP• 5.00
I hereby affirm that I have a certificate of consent to self-insure, - _
or a certificate of Workers'ComppensaJton In urnnce,or acer�iI d d ZONING ENG.617E NO.
Copy thereof(
Sec.3800,Lab.C.71gO - -
Policy No. Company-1=f "' '
O ❑ Certified copy is hereby furnish'd.
FIRE SPRINK ENERGY T"24
Z Z 'y1 er t t copy Is f d will he C' spection division. . . ❑ ❑ ❑ ❑
� O AlTplic, - MISC.- REFER TO ORD. v N v N
PERMIT ISSUANCE 10.00 Z'g. FLOOD ZONE A.L.U.C.
y IPICA OF'FXRMP I N'PR WORKERS' YV
W � COMPENINSURANCR PLG.CONTE. LIC.NO. PLG.
Z •(This section need not be completed if the permit is for one TOTAL 2�.3 -V❑ N❑ V ❑ N❑
hundred delle,(S I00)or less) ,
U O I certify that in the performance of the work I'or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL l- mil is issued,I shall not employ any person in any manner so as to
U W become subject to the Workers'Compensation Laws of California.
y Datc 'Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /l3���
} y NOTICE TO APPLICANT', I(,after making this Certificate of lix A
♦- ? emption,you should become subject to the Workers'Compensation APPLIANCE '5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.k6,00 SEISMIC FEE oz-1
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 0
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U. 8.00
Leader's Name
Lender's Adilrurs HEATING UNIT(OVER 100,000 B.T.U.)9.50 7 ELECTRIC 129, 3j-
Icertify that l have read this application and state that the above VENTILATION FAN (SINGLE)' -4.00
information n correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.). 6.00 PLUMBING
ordinances end state laws relating m comply
with
constr and c, anti _
hereby authorize representatives of this city,to enter upon the BOILER-COMP IOver`100,0008TUI SEE FEE SCH. MEC HANICAL
above-mentioned property for inspection purposes; - J
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 19 •31 -
upertino against liabilities,judgments, costs and,expenses which CONST.TAX
may'in any wa accrue against said City in conequence of the PERMIT ISSUANCE 10.00 L 1.[0(/ .�
r^^anting of i s mitt �['` Q MECH.CONT. .LIC.NO. MECH.
lY� lame- \,pJ..�ylT,y'a,.n�- ®•-1.';:F TOTAL / tJ' 3i ' T ) �/
` Signature of Applicant Contractor Late l (�f•-3. to
OFFICE COPY
i