06595POST THIS CAR D,NEA FR NTOF. BUILDING
/
CITY „OF' CUPERTINO
INSPECTION DIVISION v' .
JOB INSPECTION RECORD „
:0 O���ea �y e�, ,�
LNIT' LOT #
JOB ADDRESS' #
owrveR� corvrRAcroR.'
PERMIT NUMdEFII I
16595
PERMIT EXPIRATION
1
RK
R�IT �S IF WO.
PE77 IR
�S NOT6XPSTARTED WI THIN
180,DAYS OF PERMIT ISSU.,.
ANCE OR 180 DAYS FROM
LAST CALLED I NSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION -�JQ'
LALL
RADING AND DRAINAGE SHALCBE INSTALLEDPREGUNITE
MPLY WITH THE APPROVED PLANS AND CIN OF
UFER - -�j; -
•' PERMrt v,nnunnoNTINOSTANDARDS.-
- �YV�a '
ISSUANCE DATE
'mECH.
GARAGESLABSPOUR
NO CONCRETE UNTIL ABOVE HAS EEN SIGNEDq_E69
- . .. UNDERGROUND /SLAB
PLUMBING •
f((�y,,�.)) r.MK {T...��qpn,�e��
-
ELECTRICAL
MECHANICAL'
Im
dulc.
EI.EC,T,
PLG. ;
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD.FLOOR.
VALUATION
•��'
SIFT.
-..
PLUMBING -
MECHANICAL-
ELECTRICAL
PERMIT TO 1r
CC'-.
FRAMING
'INSULATION
STORIES
I"E CON",
UCC; GROUP
RES, UNITS
- - '
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• '• ROOF +..
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE_. •
THE CONSTRUCTION TAXIS PAID •
-
sO.rT. FLooR AHEa
.c r^•.
=S"i:�-s'"'3c
,roraLACRE AGE
DIAPHRAGM
.•HES. IND CON O✓- i
'❑
ROOF SHEATHING'I!Z
' APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE' . INSP."�
n55ESSORSPART NO.
!7,
' -ROUGH - -
SAN.4
PLUMBING lcyouM -rj
ELECT: ENERGY_
IHACi NO,
PnHCELNO.
-
TUBS 8 SHOWER PAN /j-12
PLUMBING ENERGY'
MECHANICAL '-p Z- �/
MECH. ENERGY + U
CC DATE
'
"
ACC FILE NO.
ELECTRICAL - -12 •'
BUILDING ENERGY .•
FRAMING' _
ELECT. FINAL TEST
ZONING
-
ENG. SITE NO.
INSULATION ,PLUMBING
GASTEST
GAS
FIVE SPRINK
"
N ❑
ENERGY 1 7
❑ 'N�
MECHANICAL '•
• COVER NO WORK UNTIL ABOVE HAS-BEEN SIGNED
HEATING
FLOOD 20Nf:
YQ' NE]
a. L: U,C.
'
N'.L N❑.
EXTERIOR SHEAR
ELECTRICAL RELEASE
INTERIOR„SHEAR -
FIRE-DEFT.Ij' (
SHEETROCK
GRADE -
FEE SUMMARY
EXTERIOR LATH _
BUILDING
BUILDING �-
INTERIOR LATH -
TEMPORARY AP ROVALS 7,
SCRATCH COAT -
ELECTRIC
-
PLAN CHECK
FEE.
'
`
GAS
SEISMIC FEE
—
NO TAPE OR PLASTERUNTIL-ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCYOFBUILDINGISNOT PERMITTED UNTILBUILDINGFINAL ISSIGNEDBYBUILDING'INSPECTOR.
MICROFILM
7
'ARRANGE'FOR INSPECTION BY PHONING -252-4505,
H ONE WORKING DAY BEFORE. REQUIRED INSPECTION. ,
0�% PLEASE GIVE JOB ADDRESS WHEN PHONING..
Z
—SEE PERMIT FOR EXPIRATION DATE—
ELECTRIC
[�7, �ur
PLUMBING
'MECHANICAL
CONST. rnx
TOTAL
IMPORTANT!
.PLEASE READ REVERSE SIDE BEFORE :r
CALLING FOR FINAL INSPECTION.
OFFICE COPY ,.
I .
A2 PLICANT TO FILLIN INFORMATIONiWITHLV RED LINES - USE BALL POINT PEN ONLY
' -
BUILDING PROJECT IDENTIFICATION
- _
6 I A I '& PERMIT:
1.
BUILDING -ELECTRICAL -PLUMBING' -MECHANICAL
- PERMIT NUMBER
!s
.,
RwaDlrvc
ADOREas /�
azn/w, C -4"!x SQ
OWNEP'S/n/L.` ` If OV
NAME '�i�r, tF.-1 ti!�
PHONE
DTV. � - ELECTRIC PERMIT •FEE
PLAN CHECK VALIDATION
'
CONTRACTORS
NAME
UTLETS-SWITCHES-RECEP 10.00/1.00
`LL
�.I 'j JMN�S sec. No. ��I
.
TIONr
DATE OF APPLICA`
"LIGHTING FIXTURES 10:00/1.00
C.ONTRACTVH's
AnORE55
U: .vHONE I (6
APPLIANCES - RESIDENTIAL 4.00
PANELS' - .10.00
ARCHITECT . ^
OR ���///�r�A.rr J� G'Iq/Z
PANELS (OVER 200 AMPI ,�.. '20.00 -
PLAN CHECK FEE P.C. O.
_ ,. •:�
SIGNS TRANS-, 3.00
}
ENGINEER _• v "�I 1 ` !� • -
LIc.NO,
-
ARCH. OR ENG: - --
ADDRESS
in,
- SPECIAL CIRCUIT. 5.00
PERMIT VALIDATION ,
'
EMP. METER OR POLE INS.. 20.00
APE
ADORE55 ucANrs •, •'
MOTORS SEE FEE SCH.
-
SERVICE CHANGE 20.00
LICIYNSEDCON-IRACI'ORSDECLARATION-
fy' Q �Q
1 hereby afl'inn but 1 am licensed under provisions ol'Chapter 9,
lconun,ncing with Section 7000) of Division 3 of the Business and.
Professions Code ansl my license is in full furt�,J�,t'
License Class _�I_ Lic. Numbery /
Dat<...r�.(_�..COntmemr (��rIT
ISSUANCE DATE
v
LOG. ELECT.
PLG. MECH.
`City of Cup
BUILDING PERMIT.
INFORMATION
OWNER -BUILDER DECLARRArTION
I I hereby affirm IIIRA am exempt from the Con cmr%License
�a
reason. Sec: lures Business JProfessions
La 8 ( 5.
Law orcounty sounce.alo
Code:Any cityor mu npairany struturep prior 1.
improve, demolish, or repair any structure, poor ne its if ranee, also
file a signed stn •ent that
requires the applicant for such permit m M
h, is licensed pursu;ult to the provisions of the Cnntrmb 's License
Law (Chapter 9(commencing wi lit Sect ion 7000) o f Division 3 or t he
Business and Professions Cade) or that he is exempt therefrom and
Itino
- -
MISC.- .REF ER.TO ORD
VALUATION - $/FT.•
_
-
PERMITOT O
`JI ✓ Y�f l.�
PERMIT ISSUANCE ,10.00 TQp
ELEC. CONTR. r LIC. N0. -
,
-
ELEC:
TAL
TO & 2 ,-7S
QTV. PLUMBING PERMIT - FEE I
STORIES
TYPE CONSTR.
the basis for Ihu alleged exeruption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant too civil penalty
of not more than five hundred dollars (SS00)J:
-
-
ALTER -DRAIN -WATER (EA.) 5.00
I❑ I, as owner ol'the property, or my employees with wages as
IAeir sole compensation. will do the work, and the structure is not
intended or offered for sale (Sec. 7144, Business and Professions
BACK F LOW PROTECT. DEV ICE . 4.00 -
-
OCC, GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA, COND. 5.00
Code: The Cnmraclor's.License Law docs not apply to an owner or
property who builds or improves thereon. and who does such work'
hirno,if orthrough his own employees, provided that such improve -
d1 for sale. If, however, the building
r improvement is sold within one year of completion, the owner
builder will have the burden of proving that he did not build or im-
prove for purpose of sale J.
❑ '1, as owner of the property, on exclusively contracting with
-
FIXTURES - PER TRAP - '-q ': 5.00
SO,FT. FI, R AREA
TOTALACREAGE
.
_
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON Pe 'Om.,
'❑ ❑ ❑ ❑
,INDUSTRIAL WASTE INTER. !S .30.00
LAWN SPRINKLERS -.1 INC 5 V.S. 6.00
LAWN SPRINKLERS - OV ER.5 (EA.) 1,00
licensed contractors to construct the project (See. 7044, Business
and Professions Codc:'fhe Contractor's License Law does not apply
to an owner of property who builds or improves thereon. and who
ASSESSORS PARCEL NO.
_'
' 7�ITJI
',JC
contracts for such projects with a contractors) licensed Pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/10:00
TRACT No.
PARCEL NO.
❑' I on exempt order Sec. ,B.&P.C:fu.IIur,
reason
-
WATER,HEATER W/VENT 6.00'
Owner Daze
WATER SYSTEM a .5.00 '
ACC.OATE
ACC. FILE NO.
WORKERS'COMPENSATION DECLARATION -.
WATER'TREATING EQUIP. 5.00
-
I hereby-alfirm that I -have a certificate of consent to self -insure,
or a certificate of Workers' Compensation Insurance, or u ,edified
ZONING
ENG. SITE NO.
copy themof(Sec. 3800, Lab.C.).-
PolicyNo. Company^
FIRE $PRINK
Y ❑ 'N ❑
ENERGY T-24
V ❑. N[]CE-RTIFICA'I'
U. Certified copy is hereby fuirushed.
❑ Certified copy is filed' with the City inspection division.
Applicant -
MISC..- REFER TO ORD.
..-
E OF EXEMPTION PR OM WO RKERS'
PERMIT ISSUANCE -' a 10:00"2-7�0
FLOOD ZONE
A.L.U.C.
PLG. CONTR. _ LIC. NO.
_PLG.
TOTAL' O
COMPFNSAT ION INSURANCE .,
(Ihis secsion need nm be colnpleted if Ih,permit is'fm one-
V ❑ ; -N❑
Y ❑ N❑
-
QTY. MECHANICAL PERMIT-. FEE
• .
FEE SUMMARY
hundred dollars (5100) or less.)
I certify that in the perwnnance of the work for which this per-
mil is issued, I shall not employ any person in aby manner so as to
BUILDING
D
11 12.41,
becmr a su IT t qm the Workers'f� mpema�ra/La 's of California.
Date -I -P Applicum C-.l-_�F4/'
N01'ICIi O 1'LICAN'I': If, oiler eking this Ccrl ificat. of Ex-
emption, you should become subject to the Workers'Compensation
-
ALTER OR ADD TO MECH.- `--5.00
APPLIANCE _s, 5.00
PLAN CHECK
provisions' ol,the Labor Code, you must .forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10=CF.M.) 4.00
FEE
-
AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 -
SEISMIC FEE
16
' CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
EXHAUST'HOOD (WITH DUCT) 5.00
thio performance of the work for which this permit is issued (Sce.
3097, Civ.C.).
MICROFILM
^�
HEATING UNIT (TO (00,000 B.T.U.) 8.00
HEATING LIN IT 00V ER 100,000 B.T.U.) 9.50
ELECTRIC
Aq
Lender's Name
Lender's Address
Iecrify tot llmv,r,ad this application and state that the uhov,
information is correct. 1 agree to comply with all city and county
I .)_'fiances and stat, laws relating m building construction, and
VENTILATION. FAN (SINGLE) .4.00
PLUMBING
- -
a
BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00
- BOILER -COMP IOsrer 100,000BTU1' SEE FEE SCH.
MECHANICAL
`
G a 7
Hereby authorlce representatives of this city to enter ,upon the
aboveanentioned property for inspection purposes.
MISC. - .' REFER TO ORD.
(We) agree.to Save, indemnity and keep harmless the City of
Cupertino against liabiliti • judgments, costs and oxpenses which
may in an way c against said City in wnscyucnce of rite
CONST. TAX
Z C' -j •�'
' PERMIT.ISSUANCE 10.00 Z WD
MECH. CONT. - LIC. NO.
.;
MECH. •
Tc � U Z L7)
'
TOTAL
7 3yI 0/
ranting er-
p �'
Signa I /Contractor. U tc
I
OFFICE COPY