18725 � � � � � � � : , ' . ' � " ,� �. ����o.
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� � � . wrifng;inconfo�mancewrthapoiicab�asec��onlvotcheSanuC�arsCOUnryOrdindnuGOOS.
=� � APPLICAT;ON F�R BUILUiNG PERMIT �� �
• " HEALTH DEPT. •
�� .DEPT.OF PUBLIC WORKS. SANTA CLARA COUNTY ' '
'� , • SAN�IST . SAN p15T PERMIT SEP TK PERMIT WATER SVPPiV
^'`� BUILDING INSPECtION OIVISION '
" � � 1555 BERGER DR. SAN JOSE CA.95112 TEL.299-2351 , , S E� , , ' NO. ' NO, ' DEV REQ COMP
�' • . - � REQ. ' ' BY: OATE �
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�' 37 REV 4/73
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" APPROVED 6Y: �
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tJ
y STREET h ADDRESS D v ` V� CERTIPICATIONOF COMPIIANCE OA7E
' NEARESTCROSSSTREET
� �- FIRE MARSHAL DEPT. �
. SPEC ICOMMERC�AU DEV RE�COMP
' ►OS7OFFICE(C�TV1 r ' • ziP - $p AEn BV. DA7£
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OWNER Q/� r a 7HONE 0
, MAILING
A�bRE55 G ZIP ',S�J�
APPROVE�BY; �
� C�7v p.',''n� ♦ CERTIFICAT�ONOFCOMPLIANCE pATE
ApCORTECT PHOrve . /�• PLANNING DEPT.�Q �/ � I �
. ENGINEER SET FRONT(FNOM GENTER SIDE R£AR ZONE //��
CONTRAG7pR 9LDG ELEC PLG M£CH SEL OINER 9ACKS ' LiNE OF R/WI �_. �_. �`1�/�
, ' FEET .�.�� J J/
, Y Ge.r'M4 V� LIG.NO. CLASS yqq�qNCE OR DEV RE�COMP
� PNONE��3�9 JO S►£C REQ. �" � BY: •� DATE "'�-
MAII�NG ���O t 1 M 41t�ti'� �L'� G t� qqCN,SITE
� ADDRESS 4 G�"_r1�10 a . Z�P 7-S��T APPROVA�BV: �— �
CERTIFICA710N OF COMPLIANCE�S REQU�SIT.E TO�SSVANC[OF CERTIFICATE OF � �
OCCUPANC�'.CEFItIfICATION SIGNIFIES COMP�IPtJCE W�TH ALL APPLICABLE SANTA v �
. CL4RAGOUNTVORD.CODESUN�EftOE?ARTMfiNiAIPUiiVIEW. - `j QY�/ �1 rjY' !1F'1/�_
BUILDING fNSPECTION DIV. " �
a PIAN CNECK NO. 7 I�'IO"��
LOr 5 TAACT ptCS� qPPROVED BY:
BLOCK 5 A.P.N, �,� � CERYtFICA710N OF COMPLIANCE PA7E
� TVPE OF IMVROVEMENT THiSSPAGE FOft INS�ECTOR'S VSEONLY
� 8UIL0 REMODEL ADD TO AEPAIR MOVE CONVERT DEMDLISN -
' SQ.�T. No,p1 No,vf �_,
. 512E � � O FAMILIES �' STORIES
SPEC ' DEV.REO.COMP. .
. qEp BV: DATE.
• Pe �T V ER use oF INSPECTION RECORD
€ STRVCTURE
DATE t' INSPECTOR REMAqKS
t. FOl1NOATION FpRMS .�r�y CRS
• '��• C �� G n `-'� 2. FORMS
POUR NO CONCF7�ErE VNT�LTIaE ABOVE HAS BE£N SIGNED
, 3. HEATING-OUCTS
AVPROVED BY:
4. COMPOqT COOLING
CERTIFIC.4T10N OF COMPL��+NCE DAT[ 5. GIRDEPS
ENGINEERING SERVICES DIV. UO NOT COVER FLOORS UNflL TME NBOVE HAS BEENSIGNE6
LI�ND DATE�� �� /73 .{/- //��+ / 6. BONO BEAMS ICONC.BLK.)
DEV. �L�/a7C 7C� `-"'•����` AOUGM►LBG.
'� REQ. gy FILE NO. PARCEL NO. 7. VARTIAL
COMP, � � ROUGH PLBQ. '
7A COMV�ETE
1
❑No 8. S£WERINSPEC7
EIR RE�UIREO „n��y�-uo -'- ��.0�'os �en______ ,
9. GAS PRESSURE
ROVGH INCIUOfNG ROOF. G
DINVAPPRO/�CHQ INSP�V DATE 10, FRAME-FLUESANDS�DING /��0�� ♦
CONST. DO NOT WIRE UNT1L THE ABOVE HAS BEEN SIGNED
�NSP. ROAD IMP❑ �NSP BY DATE
COMVLETE FO OCCUP4NCY❑ BOND❑ D4TE 1l. ROUGN EI.ECTRIC WIRiNG
'� APPqOV£D 8Y' /yt� /� /Q COVER NO WALLS UN71L 7HE A60VE HAS BEEN SIGNED
I CEAT�FICATION OF COMPIIANCE DA , 1Z. STUCCO WIflE OR LATN �I' '
� SEP TK F.M.FEE Fo•Fels�ence O�ly �Z'4'SMEEt NOCK �
BLI(.DING
�� FEE FEE E�EC 73. PLUMBING FINAL.(Fi.cures)
, VALUATION
PLAN Svrvey/7 hr, � 14. GAS APPLIANC£5
Q Q �!'� S70 mi�.
' CHECK �� pZ PLB. 15, ELECTRICAI.FINA�.(Fict�re�) O' -7 ♦�
Isawnce � ^ tg, BVILOING COMPLETE
AEFiM1T /,��� Ptrmi(Fee„-�(,�
� �� MECM. NO UTI�lIT1E5 WILL BE CLEARED UNTIL"BVILpING COMPLETE"NAS BEEN SIGNED
� �� THISSPqCE FOR MACHINE VAlIDA710N ONL�
NOTE: TOTA6 FEES Q �J '
EXCLUpE$APPLICABLE TOTAL FEES / 1 � � �
. ELEC?FICAL,PLUMB�NG /1
ANO MECNANICAI PERMIT � " .�V 4�
p�—EE`7 � � � � D � •
p ALFEES � 1 PERMITNO.
' vEAMiTNUMBER �SSUEbBV DATE � � � .,� ..i +� �� �� �� •�(�
_ ,,oG, /o �-lv ° 7 3 � � �
i 8 7 �-� . _
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THIS APPLICATION IS A_VALID PERMI7 tNHEN PROPERLY FILLED OUT,SIGNED,AND MACHINf VAIIDA?EO ItJ THE
SPACE PROVIQ£D. PERM15S14N IS 7HEREFORE GRANTED 70 DO THE WORK INDICATED IN ACCORDANCE WITH�AII
APPLI�ABIE OROINANCES, LAWS AND REGULATIONS•
' PERMIT IS SUBJECT 70 AlL APPLICABlE SECTIONS OF SANTA CLARA COUNTY QRDINANCE CODE.'.'�.d,
THIS PERMIT SHAIL EXPIRE BY LIMkTATION AND BECOME Nt1LL AND VOID IF'WORK IS NOT COMMEfVCEO W{THIN �
60 DAYS. �
' "REfUNO:WHERE N�?ORTION OF THE WORK OR CONSTRUCTION COVERED BY THIS PERMIT HAS BEEN COMMENCED
BEFORE THE EXPIRATION DATE HEREOF, REQUESTS FOR REFUNDS MUST BE MADE tN WRITING 70 THE OtREtTOR OF
THE BUILDING INSPEC710N DIVISION ON QR BEFORE SEVENTY-FIVE (75) DAYS FROM THE DAT£ OF ISSUANCE OF
. . THIS PERMIT"
GRADE lINES AS SHOWiV ON DRAWING ACCOMPANYING THIS APPLtCATION ARE ASSUMED TO BE CORRECT. IF •
. ACTUAL GRADE LINES ARE NOT THE SAME AS SHOWN, REYISED DRAWINGS SHOWING �ORRECT GRADE LINES, CUTS
AND PILLS, TOGETHER WITH COMPIETE DETAIIS OF RETAINING WALLS AND WAIL f00T4NGS REQUIRED, MUST BE
RESIfBMI�TED TO TH�S DIVISION FOR APPROVAL.
INSPECTOR MUST BE GIVEN 24 HOU32S NOTICE FOR EACH INSPECTION. •
IN CONFORMITY WITH TNE PROVI510N5 OF SECTION 7031.5 OF THE BUSINESS AND PROFESSIONS CODE AND SEGTION
3800 OF TFiE LABOR CODE OF THE STATE OF CALIFQRNIA, APPLICANT SHALL FILE WITH THE BUILDING tNSPECTOR
THE CERTIFICATfS DEStGNATED tN (1) AND (2) BELOW AND/OR SHALL INDICATE ITEM (3), (4), {5} OR (6)WHICH-
EVER IS APPLICABLE.
(1) CERTfFICATE OF tONSENT OF SELF-INSURED ISSUED BY 7HE DIRECTOR OF INDUSTRIAL RELATIONS.
{2} ADMIT EDTENS�URER.�CT �UPLICATE COPY) OF WORKMEN'S COMPENSATION INSURANCE ISSUED BY AN
i ,•� : �'•
.�, ;%' �* R�' t.. I3) THE C057 OF THE WORK TO BE PERFORMED IS $100 OR LE55.
� (4) CERTIFY THAT 1N iHE PERFORMANCE OF THE WORK FOR WHICH TH15 PERMtT IS ISSUED, f SHALL NOT
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECi TO THE WORKMEN'S COMPENSATION
LAWS OF CALIFORNtA.
• {5) I CERTIFY THAT THf APPIICANT IS LItENSED UNOER THE PROVISIONS OF CHAP7ER 9 {COMMEHCING A7
SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROfE5S10NS CODE AND SAID APPLICANT'S CALkFdRNtA •
STATE CONTRACTOR'S LICENSE NO. CLA55 IS 1N FULL FORCE AND £FFECT.
�6j SEC710N 7053 OFE HETCONTR LCTOR'SVLICENSEL AW. A(STATE BASISRO�RS O E�OFON;TION 7040 TNROUGH
� APPLICANT'S �y�
S{GWATURE �� `°'�"�`�`""�� PHONE
APPLICANT'S
ADDRE55 ZIP CODE •
,� '
' AGENT'S
SIGNATURE _
DECLARATION OF CONSTRUCTION LENDER
PURSUANT TO SECTION 1193 OF TFtE CODE Of CIVIL PROtEDURES, AN APPIICANT IS RE�UIRED TO .
INDI�ATE 1'HE fOLLOWING:
� 1) NAME OF COfJSTRUCTION LENDER BRANCH �ESIGNATION
ADDRESS ZIP COOE
Z) 7HERE IS NO CONSTRUCTION LENDER. fJ J `
APPLICANT'S SIGNATUR� t�wr`i��••t) DATE
-- - -- . _. . _ _ �1: ' ' - - .- - _ . . _.
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