16439POST THIS CARD NEAR FRONT OF BUILDING
—CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
�.1 ,. / /
JOBADDRESS Z1 S6`� 1 �.C—le llc�ll�tl UNIT# LOT 4f
nI/
OWNER I l� CL V"- a -. CONTRACTOR
SMI�NUMeER
16439
PERMIT. XPI AT
, Z �'
P RMIT IF.IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION -III&
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
UFER "� _
PREGUNITE
PERMIT VALIDATION
/
/J � T
J, To n V C/ /
f
ISSUANCE
GARAGE SLABS Qq - �
POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED
UNDERGROUND/SLAB
PLUMBING
• _
ELECTRICAL
MECHANICAL
-
RLue
X�
k
PATE meeR
4"l3
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING C 1� `7
VALUATION„
�04'
S/FT.
MECHANICAL cj�s
-' ELECTRICAL
WOEBEFOR—ALL
ptP iiry T TO /
�!!7 �•,"AC��i`_ '
FRAMING
INSULATION 27-
_ STORIES
TYPECONSTR
L 1 - c/
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
C GROUP
RES UNITS
ROOFSO
BE MADE
X IS PAID
FT FLOOR ARIA
IOTALACOEAGL
_/'�1DIAPHRAGM
ROOF SHEATHING
BUILDING USE'
1E5 INU CON P8 0"....
❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SqN p
zr�ASSSEESSOR�SIPARCEEL,•�NOO
--''.•�/•'�_r�c-c..t0'�-�J
y (�
ELECT. ENERGY
ER PAN °
PLUMBING ENERGY
TRACI NOf
not
RCEL NO
FILE rvo,
MECH.ENERGY
aGASTEST
BUILDING ENERGY
ELECT. FINAL TEST
PLUMBING • �,
ONING
SITE NO,
GAS -
'
MECHANICAL
TIRE SPRINK
Y ❑ - E]
ENERGY T.24
° ❑ -❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEARFLOODZONE.
- `'� •4'1
ELECTRICAL RELEASE
Y ❑ N❑
ALUC.
° ❑ N❑
L INTERIOR SHEAR
,V
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH,
BUILDING
BUILDING
PLAN CHECK `
FEE
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
JELEURIC
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY
SEISMIC FEE
OCCUPANCY OF BU ILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL ff. LE1
CONST. TAX ".QIP
IMPORTANT!
' PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY
APPL!!jANTTO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
OFFICE COPY E
PERMIT NUMBER
BU11 NG PROJECT IDENTIFICATION
APPLICATION & PERMIT
-ELECTRICAL -PLUMBING -MECHANICAL.
16439 A Q C1
F U`FL1J
'
BUILDING .-�
AD SRESSa1$bS i4GCL-BLL.AN QJ) 'BUILDING
OWrvER'5 -
"AME
d
QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
1II •Ie I, S SAN" e' �r {�./
PHONE 4/3 gfa-3
�7
hl 'L! 1
CONTRACTORS 77 EL DON DR
NAME LDS.4/Ys A
UTLETS!SWITCHES -RECEP 10.0011.00
LIGHTING FIXTURES 0.00/1.00
WIZA1/ �pya!!y!S/ LID No.
�V
DDono
ADDRESS
ARESS
APPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
PHONE
DATE OF APPLICATION
ARCHITECT ``ra�� T
ENGINEER T"t .'IQ�LAI�IN
LIC. No.
PANELS (OVER 200 AMP) 20,00
PLAN CHECK FEE P.C.N.
SIGNS TRANS. 3.00
t
ADDRESS ENG. SAN /JOSE'
ADDRESS113500JT L-eOJ IL C -T zIv
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
r
a(h7phvcL(
_
TEMP. METER OR POLE INS. 20.00
APPLICANT H
Ay-_ 4y $-3s/ b
-77 /3$LTdN 71Q {.OS 41 -T -0S g¢D
MOTORS SEE FEE SCH.
ZZ SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
•�
FAWQ
I hereby affirm that I am licensed under provisions of Chapter 9
ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my ficense is in full force and effect.
License Class Lic. Number
Date Contractor
BLDG.
M
ELECT. I
PLG. MECH.
BUILDING PERMIT
OWNER -BUILDER DECLARATION
I hereby collo that 1 tun exempt from the Contractor's is Liccnse
Law fornthe ycit following countywhihe.uiesa,eusinnssand Professions
Code: Any city or nor rep whiny requirese permit to construct, issuance, asr.
improve, de mulish, nr repair any structure, prior to its temetalso
requires the applicant for such permit to file a signed statement Li that
he is licensed pursuant to the provisions ol'the Contractor's License
Law ( Chapter 9 (cromnrencing with Section 70001 of Division 3 of the
Business and Professions Code) or that he is exempt thelel'ronl and
the basis for the alleged exemption. Any violation of Section 7031.5
INFORMATION
MISC. - ORD
VALUATION
� O
j�
$/FT.
PERMIT ISSUANCE - 10.00 Z,O
ELEC. CONTR. LIC. NO.
TOTAL
TOTAL
QTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty
01 not more than five hundred dollars (S5001.):
ALTER -DRAIN -WATER (EA.) 5.00
❑ 1, as owner of me property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITSy
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code', The Cont rucmr', License Law doer Irnt apply to an owner of
property who builds or improves thereon, and who does such work
Rai or through his own employees, provided that such improve-
ments are not intended or offered for sok. If, however, the building
FIXTURES - PER TRAP 5.00
So. FT FLOOR AREA
O
TOTAL ACH PACK
7:E -u/
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
ilnprovenuent is sold within one year of completion, the owner-
builder will have the burden of proving that be did not build lir im
prove for purpose of sale.).
1, as owner of t he property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Othe,
11 11 11 0
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
tic ed contractors to construct the project (Sec. 7044, Ifusiness
and Professions Code: The Contractor's License Low docs not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for incl projects with it contraztons) licensed pursuant to
tire Contractors Lice nsc Law,
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ lam exemptundcr Sec.-. B &P.C. for this
WATER HEATER W/VENT 6.00
reason
Owner- -�-„_��-r/� Date X7,
WATER SYSTEM 5.00'
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. ` 5.00
WORKERTCOMPENSATION DeCLARAI'[ON
I hereby al firm that 1 have a certificate of consent to self -insure.
or a certificate of Workers' Compeneat ion Insurance, or a certified
ZONING
' '
ENG, SITE NO.,
-
copy thereof (Sec. 3800, Lab.C.).
Policy No. Congmny
O Certiliedcopytsllarebyfumished.
FIRESPRINK
ENERGY T$4
❑ Certilicd c p filed with the City inspection division.
Applicant . -y"s--J,,,�„
Y ❑ N ElY
E)N❑
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
CE:R'I IFICATEOF EXEMPTION FROM WORKERS'
PLG. CONTR. LIC. NO.
P LED TOTAL (a��
COMPENSATION INSURANCE
e pert is for of
I ('Phis section need not be completed if tire mi
V❑ N❑
Y❑ N❑
STV. MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars 1S 100) or less.)
I certify that in the performance of the work for which this per-
not is issued, 1 shall not employ any person many manner so as to
BUILDING 1S•
1:pcome subject to the W orkeri Compensaf ion Laws of California.
Uate Applicant
ALTER OR ADD TO MECH. 5.00
NO1'ICIi 1'0 APPLICANT: If, after making fills Certificate of 1!x-
enlption, you should become subject to the Workers' Compensation
Provisions of the Labor Code, you Most forthwith comply with
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AG17NCY
APPLIANCE 5.00
PLAN CHECK
FEE
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE adrb
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
I hereby affirm that there is a construction lending agency for
the performance of tire work for which this permit is issued (Sec.
3097, CN.C.).
Lender's Name
HEATING UNIT (TO 100,000 B.T.U.) 8.00
H EATING UNIT (OV ER 100,000 B.T.U.) 9.50
qq
ELECTRIC 7r,L
Lender's Address
['certify that l have read this application and state that the above
infoommu n is correct. I agme to comply with all city and county
ordinances and state laws relating to building construction, and
hereby autlmrize representatives of this city m enter upon the
above -mentioned property for inspection purposes.
VENTILATION FAN (SINGLE) 4.0o.
PLUMBING '. Z
BOILER -COMP (3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU)SEE FEE SCH.
MECHANICA r- 2 -
MISC. - REFER TO ORD.
CONS .TAX
(we) agree to save, indemnify and keep harmless the City of
upertino against liabilities, judgments, ,,is and expenses which
may in any way accrue against said City in consequence of the
PERMIT ISSUANCE 10.00
MECH.CONT. LIC. NO. MECH.
TOTy4 r 2S
7 1
TOTAL
ranting of this permit. ,pq
- �=vo -740 1 •
Signature o APpBCant/ .,tractor Date '
OFFICE COPY E
ST THiS G Y.� ON
T �G•4
5-4 na �y „i +: F .� N �.:
.F C i?E tT- IP
a N¢
:�_L r"' *K%.s• -'" ��G' ^�?�.FA('TIO!�7YIVISION T �'ay'•.e,`y";'+., `,si_ `� ..IVY
J l .E iII RECORD r" � �a� w y �' ...'•
�� .y + it.�.r ,e6 t V rr a y. > a.` ` 4 .✓v..', �4 ,: �+ h..
PERMITEXPI%AT4 N
},a� .. r t,' It ar, . >\AA �„� t (�p'4. -1+ s, - •„`' k.. h YG•
J(�B ADOiYE.edi-�, t•.n ' ' Ci 'UMIT#
A^1r 3 r �p ..,,.. ( ' t•-: �! v ., , .: '� ' - `' ,d+ 1 ?C'S'. �l , PEA_ MIT EXPIRES IF WQRK� �•
" ONTRACTOR.NOT. •STARTED"WIHIN:;
IN ECTfON':r + A DATE. „Y SPECTOR !%r - 4NSPECTIONRECORD `c r, r' 180 DAYSOFPERMITISSU
ANC OR;.180 QA, FfiOM
LASTCALLEDINSPECTION `
x" 3yF vFERs ^i+->< '' '''!7-✓ - V(LL'` GRA.71NG'A15WYDRAINAGE SHALL-BE JNSTACL6
PRBGUNITE,"'COMPLY r,.T,i HE APPROVED PLAFIS AND CI OF- vERnIII VAr DAna,
} +1,(":-•+.. - .rsUP£RTK+o �ARDS.
` + `'GAAAG6'91nAoa
7 POUkYO;,MjlRETEUNTIL'A80VEHASBFEN'SIGNEDyf"
+h UNDERGROUND'. SLAB )'- �.--, 7 -ii s+' I,..,.tiJ.,G••E
`..f i4: PLUM4JNS,'ii '.� 'P 'j ��r O.' ! t 'Jv/•' :1 r.. ; + J r
ELECTRICAL' .: .7 ^ CF'�' i rT F +TtcR
suANCG uA4
^D NUPOUR FCDOP.ONT'L 480!/E HAS BEEN SIGNED y _`;,,.Bu1LDIN nlT
���T ,�o� r y o ��
,. WOOD FLOOR _'
�
•
PLUMBING -1.;!
_. MECHAN-CAL '.+
!
y,.�{� SiOPIES TVSEC i5 r�•I. j
7-1
C C 4Y r t IF 'moi c GHOuv RES t•{ a
' isP!l4it NO,sue, 1`JOR 0 IL ABOV I,A ditrt"cIGNED +p`' xRgE'" +..:>s. t -.;- -F.;,�, ,.,.c
$D.GT GICUP pRFA T� TAE A,.le c
�- Y,y- ?y". ''r Il ROOF : � 1 ? :NOTE NO PlAML INSP, 'SHALL BE MADEIF,.FOAE
DIA4itRAGl411'Ir ,-,. , y t S. T•HE GONSTRUC}ION T67C Ic`PfuD a: i. 7 .r
.400FS}lE0T111NG 5e?r. u s't ,i -', x 1 -la.+ mow, .a, �tiSC Es WOkDcu$Enrt S
-.:APPLY NO.RDOFING UNTGL ABOVE HAS °EE.1 SIGNED ? — . RIIJALS `. DATE'
f " '1 n T ASSE�SORSeANr�NO •}
`+� UGH l SA
N.k <'.
PlUMBING'CS ' I L - ELECT ENERGY
> t TUBS $'SHOWER PAN ''*..K- - \ is A.t, PLUMBING ENERGYt Gi
Jf MECHA ICA Cy c' ;-..'•r+ v .x14 MECH. ENERGY--,47`- �;t
L IACC QATE•: ACC G ILf�nQ
t ELECI,ICAL'W—, 'BUILDINGENERGV :<t •..
EAAMING x r • r Jr ' ELECT FNAL•TE10
ST.7
I1J:+ULA'710N 30NING ENG SITE NO R 4
O. 7,a -d• .'% - / PLUMBIN : v� i • E a .� 1
GAS-EFS ��i' t:i .w;- �, ..r GAS'
� - '� � � jGIGEE S�ftINK ' EbFARGV TZA ,
rl�'1 q ..t
f "`COVER'NO WORK UNTIL ABOVE HAS BEEN SLGNED HEATING ::=.:'f p `'! ooD oNc tg C.
''++e F.XTERIOR�4HEAR "�•Kr- G e�( - ECECTRICAL'RELEAS y.- y a -.N
FJRE EP.Tr- CM
SI{EETRQCK.•+
i A r?� EXTERIOR LATHr. .> " -�� i, BUIL c. UILDINGrJ"r",
U r, �CERIOA CATH r-'. EMPORAR.Y.'N _ PLAN CHECKSCRATCH COAT t ` ! •ELECTRIC, r /j� ,. - 1 FEE�r
•
•NDT E O.R PLASTER UNTIL ABOVE HAS BEEN Sia" EO10�WPANC h'� :SEB ,f a
O�rC PPNCy�QF BIII LDIN9,ISNOTPERMTTED U.N.LBUI LDING FINAL J,a N 3 OR. 0,F I'Y
�'_r ARRANGE F,QXi'INSP�CTION BY PI1�N`N �,v?t4505' , w
NO-l'uw vllQNFNIOF3KING DAl(��EFORE REf;P1RE �.,PFaETl�1:y+ yg 4` L'. .�
IV ^',L ASE GIVE_JOB,R$PDRESS WHf;jV_PF.OL_
7i>C '"' ~� .. ',A�ii �t� a, T♦♦�z ,-�P�`,7' *'+a .f'+. '` T.��y!�4.t' -' r
1,11'�v T��" �S.tf F�r C.�.r iv + Yi" � :,L �A^.aS�� =�,Y`� �:.•
,�• , ate--', r ``•+r+t _ > �� y I