16091 POST THIS CARD NEAR FRONT OF BUILDING RN;IT NUMBER
CITY OF CUPERTINO
DIVISION 1.6091
INSPECTION
JOB INSPECTION RECORDi�q�
p PERMIT EXPIRATION
g `
JOB ADDRESS"r1se Vey, W UNIT# LOT#
�—Q�� �� PERMIT EXPIRES IF WORK
OWNER - CONTRACTOR_SttY `''Q IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
LAST CALLED INSPECTION.
LIFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CIN OF PLHNIII VALIDATION
CUPERTINO STANDARDS. _
GARAGE SLABS _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �� � - Z3 2 3 ! n,1; !�,'h.��i(•_•` .
- UNDERGROUND /SLAB �_ -
PLUMBING
ELECTRICAL ' AUDIQQ $ 1SSUANCE UAiE
MECHANICAL - eL ELECL PLG. NIECI-I
My 0 El E
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $SPT.
PLUMBING ^�r
MECHANICAL L1.J .
PER ro
ELECTRICAL - {MIi _
FRAMING - I 1 .T 4I`I
INSULATION STORIES TYPE CONSTR.
OCc,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SU,FT II.UGH ARIA TOTAL ACHEAGL !
•�. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING _ HES.-- IND CON PB Olt-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ' ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH - SANA
PLUMBING ELECT.ENERGY -
TUBS 8 SHOWER PAN - PLUMBING ENERGY TRAci No. PARCEL No
I
' MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE acc.FILE No,
FRAMING, ELECT.FINAL TEST zoNlNc ENG.SITE No.
INSULATION PLUMBING'
GAS TEST GAS
' FIRE SPRINK ENERGY TQ4
MECHANICAL I ❑ N❑ I.❑ „N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE - ELooO toNE A.LUc
o ❑ .
INTERIOR SHEAR FIRE DEPT. N ❑ N❑,
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT . ELECTRIC PLAN CHECK { ,
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE t0
OCCUPANCYOF BUILDING ISNOTPERMITTE DUNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM.
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION.DATE -
•IMPORTANT! CONST.TAX`
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL•INSPECTION. 11. AJC]
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
J
BUI D NG PROJECT I ENTI FICA710N I PERMITNUMBER
BBUILLDI _ APPLICATION & PERMIT t.1 16091
L�pMMo+IJ ~4 46j/'n 22-3 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL f"
OWNER' PLAN CHECK VALIDATION
NAME Ir ELECTRIC PERMIT FEE.
PHONE
2
N°" a.�,�aKy 6,�y-pUTLETS-SWITCHES-RECEP 10.00/1.00
LIc.No. (Jew LIGHTING FIXTURES 10.00/1.00
roNrRA oR' p��/ A PPLIANCES-RESIDENTIAL 4.00
AooRE -vaUJ B-1Q, �'
ONE / ANELS 10.00 GATE OF APPLICATION=
ARCHITECT PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE PC?NO.
OR
EN R n
V.0"ft/�Ltc.No. SIGNS TRANS. 3.00
ARCH,OR ENG. a SPECIALCIRCUIT 5.00 PER MIT.VALIDATION
•DDREp55 � � .,y
WOO TEMP.METER OR POLE INS. 20. -�, 1
APPLICANTS MOTORS SEE'FEE S J -AR
7y Tic
ADDaeo I� 1"'f 1
yo"4E_ SERVICE CHANGE AR 0 I n I LiQ
w o O LICIiN SE IT CONrRACfORS r)ECLARATION
a v u I hereby affurn that I am licensed under provisions of Chapter 9 ISSUANCE DATE _
w Q H Icommencing'with Section 71X10)of Division 3 of the Businessand LOG. ELECT. PLG. - M_ECB.
Hoz I'rofessian. Code nd my license is in full r frfe�le / ❑ ❑ ❑
z o "v{ 0 Licc ss Con Number
9 r u°, Uate Contractor y
< Y E -a / BUILDING PERMIT
wa OWNER-BUILDER DECLARATION INFORMATION
0 W D MISC.- REFER TO ORD
w ; LL N I hereby affirm rte that I vin exempt from the C.IET.r or's License VALUATION S/FT.
H LL o a "w for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 fM�
Cade:Any city or county which requiresa Permit to onstruct,titer, Co W'
QQ ¢ 2 improve, Torpab.aysfracture. foortO its issuance,also ELEC.CONTH. 'LIC.NO. ELEC.
- 0 a requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
w 9 he is licerted pursuant to the provisions Ed the Contractors License �(' \(� All-
BE ,
Hiss Law(Chapter 9(commencing with Section 7000) sf Division 3 of the If ..1)1/7-1/1
a Business and Professions Code)or that he is exempt therefrom and CITY- PLUMBING PERMIT FEE
the basis for the slkgcd exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d � by any appllcam for a pemtit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than Ilve hundred dollen($5001):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 CC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure u oat s
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code'rhe Contractor's License Law docs not apply to an owner of '
properly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intcndedoroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or i.ProvemenI is sold within one year of completion,the owner. GAS EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- - . RES IND CON P9 Omer
prove for purpose of salc.L INDUSTRIAL WASTE INTER. 30.00 El ❑ El 1:1 ❑
❑ 1,as owner of the Property,um 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 Contractor's License Law does not apply
to an owner of property who hudds or improves 0creon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a cortmelorls)licensed pursuant m
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam oxempt tinder sec. ,N.&P.C.for this WATER HEATER W/VENT 6.00
ocasoi
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORK ERS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of convent so w16insum' ZONING ENG.SITE NO.
or a certificate of 3800,ri C.b.Cm yt jrly)ra,c��a ccrrt�yl
copy l No. IScc,3800.Lvb.C. . Tel /
Policy N rt is urpan
hcmb,p
Q ❑ Certified copy is hereby'fr FIRE SPRINK ENERGY LN
Z Z ❑ Ccrtif�y fV file th the 'y s coon�I
O Applma t uW r�spyj, d_wi -pe ps• �Iivisiuo. MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ NE]
� y - CERCTIIFFIICCATTEO�F EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.uc.
LU > COh1PFNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
(L 0 (This wetio r need not M complcled if the permit is for one
TOTAL Y❑ N❑ Y E] N❑
0 Z. hundred dollars IS l DO)or less.)
V O 1 certify that in the performance of the were for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL l- mit is issued,I shall not employ any person in any manner w as to
U become subjcU to the Warkcrs'Compenmtian Laws of California.
ED Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING I co
} ED NOTICE TO APPUCAN 1': If,after making this Certificate of Ex- _
Z emPtinn,you should beconm subject In life Workcn,Cmnpensatiun APPLIANCE 5.00 PLAN CHECK
provisions of the "Isar Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I s '.ZJ
hereby' affirm that them is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the perfomrantt of the work for which this Permit is issued 1Sce. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and slaw that the above VENTILATION FAN (SINGLE) ' 4.00
. information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or t00,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH, MECHANICAL
shove-mentioned Property for inspection purposes.
(We) agree to saveindemnify and keep harmless the City of MISC.- REFER TO ORD.
u 'no agvinst liabilities,judgrnems, costs and cxpenaes which PERMIT ISSUANCE 10,00 CONST.TAX
may irssa, way ccruc against said JAIY in conwquu c o life
rsnln [hu IL MECH.CONT. LIC.NO. MECH.
rap TOTAL TOTAL 11, CJ((]
Si roof Applicant/Contractor 1 lc '
OFFICE COPY