16075 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
'o 16075
'TNSPECTION DIVISION
JOB INSPECTION RECORb
PERMIT EXPIRATION
JOB ADD ESS Z 4Ve-
UNITff LOT Tif PERMIT EXPIRES IF WORK
OWNER CONTRACTOR' IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION NOTE: ANCE OR 1180 DAYS FROM
LIFER ALL GRADING AND DRAINAGE SHALL 8E.IN.STALLED LAST CALLED INSPECTION.
PREGUNIT'E TO COMPLY WITH THE APPROVED PLANS AND CITY OF PFRMIT VAIJOATION
CUPERTINO STANDARDS.
-EARAGE SL�BS e-- -�t+�
POUR NO-CONCRETE UNTIL ABOVE HAS BEEN SIGNED l!sX--%14-,,I-A\N wilm-c-
UNDERGROUND /SLAB -ewre-
PLUMBING1
ELECTRICAL ISSUANCE DAic
MECHANICAL ELCCT I �L3. NIECH
!'o "10 iu �o
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I u %,eurLDING PERMIT
WOOD FLOOR INFORMATION
It COP
PLUMBING I 1�101UON S/FT
MECHANICAL 12-2--W- 1��
ELECTRICAL
W/
FRAMING
INSULATION STORIES T�LPV. H
G 0
R 3 U T S
PLACE NO SUBFLOOR UNTIL ABOVE HAS B
I ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -�ZZO--,o
WILDING USE
ROOF SHEATkNG I I -ao-Bll xc TIES I NIR CON IF 01,11.1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ROUGH SANJ# ASSESSORS PARCEL NO
PLUMBING ELEC:�:ENERGY -/z/". 063
TRACTNO ARCEL NO
TUBS&SHOWE'A PAN 13 PLUMBING ENERGY
MECHANICAL ;2-27-9M MECH.ENERGY
E ELECTR,CA0 3 1 ke", C ACC LATE ACC.FILL NO
FRAMING BUILDING ENERGY
ELECT.FINAL TEST
NSULATIONJ PLUMBING DIINC ENG SITE NO.
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ASTEST GAS
FIBRESPR NK ENFRGI T 24
MECHANICAL
0 V R U TIL El NO 10 NO
OVER NO WORK UNTIL AE OVE HAS BEEN SIGNED HEATING FLOODZONE A L U C.
0 3
Ex ERIOR SkEAR ELECTRICAL RELEASE
Ll N
INTE OR SHEAR FIRE DEPT. Lj 0 1 L
OC Let j
OC
SHEE R CKI GRADE FEE SUMMARY
OR L TH
EXTER, 0 LATH BUILDING
L T
#tBUILDING
INTERII R LATH TEMPORAR
Co T
SCRATCH COAly ELECTRIC PLAN CHECK
FEE
S
NO TAPE OR P, LASTER UNTIL ABOVE HAS BEEN SIGNED i2oCcUPANCy SEISMIC FEE
OCCUPANCY F BUI�DING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
7
ELI ARRANGE FOR INSPECTION BY PHONING 252-450 ELECTRIC- 90
I.- ONE WORKING DAY BEFORE REQUIRED INSPECTI I PLUMBING'
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
SEE PERMIT FOR EXPIRATION DATE - MECHANICAL �16
A- 7Z71
CONST.TAX
IMPORTANT! R�74U
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.' W7 0- .,
OFFICE COPY.
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date .�.. .... Building Permit No.
The Building Located at, ................
Owned by --- ...... ......
omple—te-d'
Has Been For Use As: ..........
< p' e
......................................
............. ................................... .......................................... ....................................................
................ ..................................................I.................................................................
............. ...............................................................................................................................
........
TCTOR
PD-7 BUILDING
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO`, Bldg.Dept,
_, l Py
E I ❑ Backflow Device �F .Sanitary Permit No
f
e
I El Connection � Plumbing Permit No.
LL '❑ Plumbing Final Lot No.
c I Owner or Tenant
o
o Ati
9 I
Tract {�'y���
N I Date Connected 191?( Date Find1 A-`f= IC:� 19 Q(}�
PLUMBING INSPECTOR
I
ELECTRIC SERVICE NOTICE P G a E COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
�_
To . 4 . 195
You are hereby authorized to Con�neecct electrical service for
Owner or Tenon, `��y Cf i x;y<
0/04 c 9 p-
No.of Wires Size of Wires Size of Switch
Motor Load Voltage - Phose
Heating Load K.W. Voltage
Noof Meters Light 110_New Service 1/' Reconnect
,
Heal 170_Thr<e Will, � More Servrte
No.of Add. Meters Power Three Phase Move Miler
�• ELECTRICAL INSPECTOR
v v
P 6 E /
CITY OF CUPERTINO COPY
GAS SERVICE NOTICE ppq
_31C� s (S
To
You are hereby authorized to connect the GAS service for -
Owner or Tenant _ --z." C I Z�'—
At c� I „ � �s
New Service S
No. of Meters Reconnect
No. of Add. Meters Move Service
Move Meter
.�
PLUMBING INSPECTOR �,�^� \ c\ 7 _�� Oo
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
8�1 LDING PROJECT IDENTIFICATION 'PERMIT rvumREE
BUILDING APPLICATION & PERMIT
ADD Ess
/ BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 'd 16075
OWNER'S PLAN CHECK VALIDATION
"Ralf OTV. ELECTRIC PERMIT FEE
CONTRACTORS 7s� �] OUTLETS-SWITCHES-RECEP 10.00/1.00NAME _W
n 2ue�o G. LIC.NO. 72 /�J LIGHTING FIXTURES 10.00/1.00
C� roNTRAcroR's PPLIANCES-RESIDENTIAL 4.00
AooRfss
�/ETzrn01,4 a1'LPC'oNE Z537-/5&,Y PANELS 10.00 DATE OF APPLICATION'
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE C.NO.
ENGINEf R.
Ir LIc.No. SIGNS TRANS. 3.00
ADD "G' ��.�I SPECIALCIRCUIT 5.00 PERMIT VALIDATION
0 fll/r zIv7J//f EMP.METER OR OLEINS.
20.00 � p
APPucDDREnnrs MOTORS SEE FEE SC X l.C-r�dN-•-s..��
APPLICA
SI�OE 1 SERVICE CHANGE 20.00 /(/
F0 o LICENSED CONIIO
;RACIORS DECLARATN 6 Y
Q V U I hereby Yfllrof that I am licen SL•d Linder provisions Of Chapter 9 ISSUANCE DATE
vHi i (commencing with Section 7000)0l'Division 3 of the Business and
Q x ELECT. PLG. MECH.
F viz Professions Co a my II Li is in full lura W yJ 4y.
z o o - ProfesLicenssions
Class�_Lla.Nualin
t , L 1
a y 4 JS�tvt�l7D.a� db M BUILDING PERMIT
is c w st OWNER-BUILDER DECLARATION r-
u INFORMATION
w ;u H I hereby xtfifn that I am exempt Irunl the Contractor's License MISC.- REFER TO ORD -
VALUATION S/FT..
H LL O j Law for the following reason.(Sec.7071.5.Business and Profusions PERMIT ISSUANCE 7
Code:Any city or county which requimsu perinil mmnMmcl,al[eq
QQ improve,demolish,or repair any structure,prior les its issuance,also ELEC.CONTR. LIC.NO, ELEG. ?�,Q�
a
a- requires the tlpplicant for such perm,,If)fill,a signed flat anent flat TOTAL PERMIT TO
winhews
hmoto thepnwi sionsof theLicense
Law lOopten9(conu.cncinywilh Sculun 70000alfUiNision3fthe - s^Ic=16W/_
Business and Professions Code)of that he IS exenhpt Iherefront and OTV. PLUMBING PERMIT FEE
2Fo the hull,for the Alleged exumplion.Any violulionof Section 7031.5 STORIES TYPE CONSTR.
a ;m byany applicanl for a permit subjects the upplinud to a civil panolly ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not mote than live hundred dollars(3500))': s ti#0-
❑ I,as owner of the properly,or no,employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do lite work.and the structure Is not -
tended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3
Code The Contractor's License Law does not apply to an owner of
Property who huilds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SOq.FT.FLOOBAREA TOTALACREAGE
himself re n t intended
nch his own cmred fors le.[I,ho(hal such ire Prove- oC 7 L-0
maNs are not in mndrdurnfcmdforsal..Ii,howcvc act, building GAS-EA.SYSTEM-1INC-4OUTLETS 6.00 J
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the linden of proving that he did not build or ire- RES Irv0 CON PB Omer
1,aso
Prove r of sale.). INDUSTRIAL WASTE INTER. 30.00 El ❑ El
I,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 Cade:The Contractor's License Law does not apply
to an owner.fp roperly solo huilds or imp Eyes thereon,and who LAWN SPR IN KLEfls-OVER 5 (EA.) 1.00 3s7 ' _ O
the Ccontront sotsuchprojectswithattimmemr/sl licenv:d pursuant to SEWER-SAN ITARV-STORM EA.200tt/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt Linder Sec.-,BAP.0 to,[fill WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM, 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMITNSATION DECLARA1 ION WATER TREATING EQUIP. 5.00
I hereby IGI. that I have a camsilate of consent[o,elf-insure, ZONING ENG.SITE NO.
ora certificate of Worker,Compensation Insurance,or a cerlified
'N copy thencof(Sec.3800.Luh.CJ. - -
Policy N0. Coal Puny
O ❑ Crr[ilied copy is hereby l'uniished. 'S FIRE SPRINK ENERGY T-24
Z Z ❑ Cer[iredh copy is filed with the city in5p«tion division. MISC.- REFER TO ORD.
O� Applicant y N NEI
~ vt ,
� CIi N'I'I PICA'1'Ii OP ISX Ch1 PITON PROM WORKERS' PERMIT ISSUANCE JQA FLOOD ZONE A.L.cele
LU > - COMPE.NSA'I ION INSURANCE PLG.CONTE. LIC.NO. PLG. {�O y❑ N 0 V
CIL (',hies section fired not ba
Z annpletttl iltle Permit is form TOTAL O N
hundred dollars IS 100)or Icss.) a
L) O 1 certify Thal in the purl oneance of Ihu work for which this Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL f- colt is issued, I Shull not employ any Person in troy nhanner so us to
O w becolj�� ' t the Workcra' h� m 11 1 tot�c,ldf.rn
a Dm"'-"� A1i1i1'eant [7/ - ALTER OR ADD TO MECH. 5.00 BUILDING �0�^
} m NOTICE'1 O AI'1'LICANI': IL filter nmking this Certiliculc of Ex-
�.. Z c u'uion,you should hcconre u0v,,t to Ih,Wurkcrs'Comprnaution APPLIANCE 5.00 PLAN CHECK
provisions al [h. [,.hot Cade, you nfust fnrllwith comply with FEE
U ,left provision,or this nnuit shall ho d ."sal ruvokr 1. AIR HANDLING UNIT(TO 10P=MC.F.M.) 4.00 /
CONS]'RUC'I'ION '
NDINO onGIiNCy AIR HANDLING UNIT(OVER 10=C.F.M.).6.00 SEISMIC FEE /S cZp
I hereby affirm that filer, is a cnsvunion lending agency sof EXHAUST HOOD (WITH DUCT) 5.00 -
the prfl'ormanoa of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L 2 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19.50
Lender's Address ELECTRIC O 7S�
information
that
correct,
a Illi o caution:rah nl c tyandlJoruboventy VENTILATION FAN (SINGLE) 4.00
,.� information is correct. 1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinan s and slate lows alining of building cunt/incl ion, and G e
hereby authorize representatives of this city to carer upon the BOI LER COMP (Over 100.000 BTU)SEE FEE SCH. MECHANICAL 0 0 7S^
above ou nlloned properly for inspection purposes.
(Wr) syr c to save, indemnify and keep harnLess the City of MISC.- REFER TO ORD. 7
upertino am%, lialilitirs,judge fits. costs and capcnses which PERMIT ISSUANCE 1AOB o-6 CONST.TAX - 97 D3
may in a way
acerae g7 as,
iJ City in conuyucnce of the
renting This peTnil. MECH.CONT. LIC.NO. MECH.
TOTAL 9075 TOTAL 1607 0
Signature fAp, c [/C ntr for Date t
OFFICE COPY