C 8475J_
/ 'POST THIS D NEAR FRONT OF BUILDING
CIT=F CUPERTINO "� PFRN,ITN hiREq
r 847
• •�"..I; INSPECTION DIVISION �-
y,. JOB INSPECTION RECORD •.
PERMIT EXPIRATION"'\
T 'AO� /jam u
JOB ADDRESS LI3C1!!1li-U, .# 1LpT,#.' Y. 'T �'''�; /,�f..,.•• '
J •I . - 1 ° - PERMIT/ EXPIRES'IF'WORKJ
OWNER . CO,NTRACTOR `I / % , I I$ NOT' STARTED WITHIN
INSPECTI ATE INSPECTOR INSP CTION RECORD 180'DAYs_oF'PERMITISSU-
ANCE OR, 180:DAYS FROM
FOUNDATION • r , v . ' i 1�9'Yb',�4ww.¢ :f'CY-'r PO,�iT� co�•-C(e.e;. , ,,
—1 LAST CALLED INSPECTION.
UFER.'��'. / '3-�Jr. G1eJ;Yr:Crsxy-Sec; a.T(o(p{_asT.l�at.c
PREGUNITE` - /, iz (=hero w.C2s<l aote aau=.1. L6L. PERMIT VALIDATION
.POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUNDhSLA6
PLUMBING _;.1
ELECTRICAL t ) t'�A/ :•/p.!p4`%�L-.��+r .. -p.P, !*�95.K.... WG N_':
ISSUANCE
1:'
DATE
MECHANICAL Vac EL CT. PLG. ME1 ,
314
DO NOT POUR FLOOR UNTIL VEHASEN SIG
AB BENED �f >'.�RO/Z-! , a " !.3 , Bul DING ERMIT
��• WOOD FLOOR 0414j";9•yn,,, ..i`. - INFORM TION
vAIDn Lunn UNFT.
PLUMBING
PLUMBING "�� . • 4( . .•/ /7_� r
'i MECHANICAL
• ' - r �� 'PER MIST
� ELECTRICAL b - J � •, i r +�
FRAMING '?C�ufy l Lw _ �.I •�. H_ a_1 .:.�'_'v' G
INSULATION. '•' :> -ti' �'-' STMRIEC
v- ��. cc. UP REs,uNlTs�
.PLACE'N0 SUBFLOOR UNTIL ABOVE HAS BEEN SIGNE 3 -Nd. °.mak .
SOFT.FLOOR AREA TOTAL,ACRLAGE
ROOFr v" �corki'6ot N -r �, y�c-sFd�14-A
rJIAPHRAGM ' ' �'.cw� dt-a✓w{ . 21cLeT Id�CD ILIr p, �:%G' !, Lt"�� , • -
J Pw Z w. BUILD USE .,
.(REs .IND' PeDmP,
s APPLY NO.ROOFING UNTIL ABOVE HAS BEEN SIGNED cc ' J. �� -�.0, •{,.� It•„�
ROUGH �SSessor ARCE LNO. y .
PLUMBINGX/ %.�%+�,tS
GAS TEST -S_ a RACT No. ,, :AR EL NO,
'MECHANICAL
ELECTRICAL - F AL I $p; A CC; DAN Encc. FILE rvG.
,FRAMING _ SAN ,'+
(>. '
ZONING ENG. SITE NO. .� r
INSULATION O PLUMBING. i S
GAS; J.
MECHAN ICAL 67 FIRE $PRINKENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BE SIGNED HEATING Y [] NO Y 0 N❑.'`I
.
LATH—INTERIOR ELECTRICAL FLOOUZONE A:L UC.
LATH—EXTERIOR FIRE DEPT. _ �. ya `;❑ NF . YO NO
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDINGI
- Z3
SHEAR EXTERIOR TEMPORARY' APPROVALS BUILDING
FIREWALLS, ELECTRIC PLAN CHECK
GAS - FEE '
NO TAPE OR PLASTER UNTIL,ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE .
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM �,...
-ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
\ Lu ONE WORKING DAY BEFORE REQUIRED'INSPECTION. PLUMBINGPLEASE'GIVE JOB ADDRESS WHEN PHONING-.
I::?
—SEE PERMIT FOR EXPIRATION' DATE — .; MECHANICAL
r .
IMPORTANT! consT. TAX
PLEASE READ REVERSE SIDE BEFORE. TOTAL
CALLING FOR FINAL INSPECTION. -
OFFICE COPY
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P0ST. THIS ( iD NEAR FRONT OF BUILDING
CITE MJF CUPERTINO
INSPECTION DIVISION =—
c+ JOB INSPECTION ;RECORD ..%}'r_4� �1. ,; ko x {
Yr ; x
JOB ADDRESS��.:p,�'S?',1,1
l ;>•`eu "• �"� ° '�cnt� ' :: t-
OWNER' {-r} CONTRACTORIVa L _-.✓ - 1 _T)l •�
, PERMITN MRER
^ "'"f�,"Y• '
"r: •S+,, �Tr.t,E �=
"�
'PERgMiIIT4EXPIR'aAteTI-O{.Nr�.<\,,-
PERM;TeLEXPIRES,IF..WORKo'
IS NOT'STARTED WITHIN
,eo�DAYS OF PERMITiISSU-
7ANCEE'OR-180bDAYS FROM
J LAST�CALLEDINSVECTION.
_.
INSPECTI ATE INSPECTOR
I INSP CTION RECORD - ''
FOUNDATIQN .-,},c��; .y.i rw:5•+T.��`-•" ',�+"•>>•�,•x"•I%y=Ylp'">r
re•_
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UFER crL �9r.PJ_ ,
'•
PREGUNf7E3 'T '' '-
yj-y�,�
3 2`� epi �IQv�. _ :J
J- ..
PERMIT VALIDATION
kfi`•.'
� ,�,/O; r, ,�i -
rX
I POUR NO CONCRETE UNTIL ABOVE HAS,BEEN SIGNED,
UNDERGROUND./,SLAB �^"-• ± b
PLUMBING\` 30 i. o V.,,i
'
CcE y.
QiS "7IJAN DATE .
ELECTRICAL
MECHANICAL 1
-*1;
P �� i a ` Vis,„
+ y "+-••�'
(!U//� .pt. /G t7�
,-DO NOT POUR'F.LOOR UNTIL=A6 VE HAS.BEEN�SIGNED'
-'BUI DING; ERMIT : ',:
-INFORM TION
,�
WOOD FLOOR ; I
:.yALDATIDNay_, fK $SEPT.
-If�
PLUMBING
gyp _
meq.
' 9
MECHANICAL -47 '
' !ELECTRICAL Q
•r.i•
Pt `- ` �-�.. ', "-•-; N'7 i-
,4
',tA�PERMI rcT'ei- eL
{±
J
T RIs! E c
-FRAMING :'Ja;tAQ U >.7 t." +
INSULATION
"-
pJ�3-k
:71VT' b•�oy- a he
C. UP
- •T,FL
jRES.•UNITSI
w
.PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNE
A% ROOFI ' `l �rY �y tl�,,
`� COr`7A _, r, �� 2 _/ �L� p'�y.
(=Jl"f i,M�•, ctt0 i/4.d: 2:kZer 6d�CU'LL4' •r �*
50 FT"F LOOR ARE
fTJF ,+y �..;�
TOTAL•ACR EAGE
- 4; i,'.1:;�
VIAPHRAGM �i't•[ '> ' '
,,.� � `.-.
=•i '. 1
1 '�
O�,CV-'f I`0 iL T� a% -k f/ir y�,L 1•�%ii.II
ES` INDUILO JPB E401Rer�•
yam/
I APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ',❑'❑!'.❑
•
ROUGH
,¢!2°
/
ASSE550 ARCEL NO
r�St• •�j�t'S?st`.
PLUMBING
GAS TEST•J,
1
0 -
✓"!J} »yam.. .L ..
---
RACT NO.
\ PAR EL N0.
�:r .>•+.:
MECHANICAL
ELECTRICAL
ACC:o E
I . t1�i' r
ACC.FILENO..
'1 S.i'�
FRAMING
SAN# (I -GI . �J')' 1 ss.�.Jy •... �J ,y
INSULATION O
PLUMBING? f 9
ZONING
t
ENG. SITE N0.;•,
i- ° .. . '
GAS:-,... r l' 8a ; t♦ '^ a.•'.t.
MECHANICAL - b r
FIRE SPRINK
Y ❑ N❑
'ENERGY T 24
Y ❑ N❑'.
COVER NO WORK UNTIL ABOVE HASIBE SIGNED
HEATING
LATH -INTERIOR'
ELECTRICAL
FLOOD ZONE
Y❑ N❑
A'L U.C. •,
Y0 .-N❑.
LATH -EXTERIOR �> _y
FIRE DEPT. _�,.
SHEETROCK
GRADE'
'FEE SUMMARY Y
SHEAR INTERIOR
BUILDING 23
BUILDING,,•:
SHEAR EXTERIORTEMPORARY
APPROVALS
FIREWALLS
EL
PLAN CHECK
FEE
-
�.,.•-
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED locCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLEASE GIVE JOB ( ADDRESS WHEN PHONING: 1�
—SEE PERMIT FOR EXPIRATION DATE —
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
I
L_ IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
/
OFFICE COPY /
_ 1
APPLICANT TO FILL IN INF ATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT 1 DENTI FI
APPLICATION &4
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
PERMIT NUMBER
7 5
BUIL NG
BUILDING ,
;(J S'i�YENScREEK
OwNER'S /�
NAME ^rN'
VNON
•CONTRACTORS
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
G
NAME
OUTLETS -SWITCHES. 10.0044.00
LIGHTING FIXTURES 10.00
P%SjV.TcT�J'.�1J I.C. NO.
CONTRA
ADDRESS
PPLIANCES-RESIDENTIAL
APPLIANCES
PANELS 10.00
dj,f'j(��,5Cfj�sONE
DATE OF APPLICATION
ARCHITECT -
ENGINEER /
LIC Na, C' b
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS, 3.00
ARCH, ORENG.
DDRESS
ANE 1-0MA.XD sT
SPECIAL CIRCUIT 5,00
PERMIT VALIDATION
[TEMP. METER OR POLE INS. 20.00
APPLICANTS
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
Q
11O �I
LICENSED CONTRACTORS DECLARATION
TEMP. POLE 30.00
-
I hereby affirm that I am licensed under provisions Of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License ClassLic. Numberfl
Data Contractor
AMAR
BLDG.
LEC
PL MECH,
0 ❑
'DING PERMIT
OWNER.BUILDER DECLARA'T10N
for License
I hereby ultion that I am exempt from the Business
Law fornycitire t llorcountywhi (Sec. 7031.5, aermit tocnstruct, mons
permit to issuance,
Code: Any city or county whiny structure,
improve, demolish, Of repair any StrOCtnR, pllnf IO It515a0llllCe, aISO
requires the applicant for such permit to file a signed statemmnt that
he is licensed pursuant to the provisions of the Contractor's Licenser�
Law (Chapter 9(commencingwith Section 7000) of Division 3 ofthe
Business and Professions Code) or that Ile is exempt therefrom and
I'BU
' INFORMATION;.
MISC.- REFER TO ORD
VALUATION
� Atm A,. -D
OO fir// "' V s/ lJ
$/FT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO,
ELEC.
TOTAL
PERMIT TO
QTY. PLUMBING PERMIT FEE
STOP S
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (5500).):
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
intended Or offered for sale (Sec. 7044, Business and Professions
BACK FLOW PROTECT. DEVICE - 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
Code: The Commctor's License Law does not apply to an owner Of
property who builds or improves thereon, and who does such work
improve.
menta are not hrough ownemployees,fors,providhJ ever, the
mems are not intended or offered If, however, the
FIXTURES -PER TRAP --'5.00
SO. FT. FLOOR AREA
�,��,/"(�-�
TOTAL ACREAGE
GAS - EA. SYSTEM -1 INC. 4 OUTLETS 6.00
year o owneg
or improvement is sob within one year of complel ion, the owner
builder will have the burden of proving that he JiJ not huilJ or im
Pryfor purpose ofsale.).
P.F I, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON Pe Other
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
t0 an owner of pr party who builds or improves thereon, and who
contracts for ss prof cts wit I a contractors) licensed pursuant to
file Contract. iC C Lm
❑ lame u I I,( Ver ,B.&P.C. for this
reason
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT N0.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner')me
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKIiRS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to sel6insom,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copy thereof (See. 3800, Lab.C).
Policy No. Company
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with tire city inspection division.M
Applicant
FIRE SPRINK
V ❑ N❑
ENERGY T-24
V ❑ N❑
SSC. - REFER TO ORD.
CERTIFICATEOF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
PLG. CONTR. bc. NO.
PLG,A
TOT L
COMPENSATION INSURANC,
1'phis section need not be completed if the permit is for one
Y N
❑ ❑
Y N
[:] ❑
hundred dollars IS 100) or less.)
I certify that in the performance of the work for which this per.
mil is issued, I strait not employ any person in any manner so as to
CITY. MECHANICAL PERMIT FEE
FEE SUMMARY.
BUILDING
a
become subject to the Workers' Compensation Laws of California.
Dere Applicant
'1'O
ALTER OR ADD TO MECH. 5.00
NOTICE APPLICANT: If, after making this Certificate of fix.
emption, you should become subject to the Workers' Compensation
APPLIANCE 5.00
PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10000C.F.M.) 4.00
FEE
AIR HANDLING UNIT (OVER 10MIC.F.M.) 6.00
SEISMIC FEEQ�
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency I'or
EXHAUST HOOD (WITH DUCT) 5.00
tire performance of the work for which this permit is issued (Sec.
3897, Civ.CJ,
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
H EATI NO LIN IT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
Lender's Name
Lender's Address
I certify that l have read this application and state that the above
VENTILATION -FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
in:mces and state laws relating to building construction, and
PLUMBING
BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP Chat, 100,000 BTU) SEE FEE SCH.
MECHANICAL
;:D
Il ereby authorize representatives of this city to enter upon the
abavemention J property for inspection purposes.
MISC. - REFER TO ORD.
CONST. TAX
(We) ogre to save, indemnify and keep harmless tire City of
Cupertino a Inst iabilili ,judgments, costs and expenses which
may in w accru gains! said City in consequence of the
PERMIT ISSUANCE 10.00
fro i P iL
MECH. CONT. LIC. NO. MECH.
R
TOTAL
TOTAL
/7,3
Sign tura ppli t ontractor Dale
OFFICE COPY