15696I
POST THIS CARD NEAR, FRONT OF BUILDING.,
'
� CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
• -
JOB ADDRESS ��W 3 w�rM' "i VC YUN # LOT#'
OWNER' '% CONTRACTOR -L GL
-
PERMIT NUMBER "I
15696
'
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
- lUU DAYS OP PERMIT ISSU-
PE FROM
LAST AL 180 DAYS
LASTCALLED INSPECTION.
"
INSPECTION DATE INSPECTOR
SPECTION RECORD
FOUNDATION .nRti ,7, L Qj'-� -
NOTE: .-
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CIN OF
CUPER71N0 STANDARDS. -
UFER
PREGUNITE 2
PI ;
'rm9rt vnLlDA nnN
�'•( 4�G'
ISSUANCE DATE
,GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB .
PLUMBING
-
ELECTRICAL
MECHANICAL
ELECT
,PLG. WHICH
YjDO
NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
•,�.
Bu14 G PERMIT T
kORMATION
WOOD FLOOR.' -
IUAT I ON $IPT.
-
PLUMBING - - -
.
MECHANICAL.,
ELECTRICAL -
TERM II T
/L4
'FRAMING
INSULATION
'
,STORIES
TYPE CONSTR,
Ivr
- ,
UCC CROUP
HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED"
-
ROOF -
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
- - -
SO f L FLOOR AREA
TOTAL ACHE AGE
DIAPHRAGM
BUILDING USE '
RES END CON PB OLP"
- El ❑ El El 1:1
ROOF SHEATHING -
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS - DATE INSP.
,ASSESSORS PARCEL NO
"
ROUGH
SAN,#
PLUMBING
ELECT. ENERGY
TUBS & SHOWER PAN
PLUMBING ENERGY
TRACT NO.
PARCEL NO
MECHANICAL =
MECH. ENERGY -
ELECTRICAL -
BUILDING ENERGY
ACC DATE
-
ACC. FILE NO
FRAMING -.
ELECT. FINAL TEST
INSULATION
PLUMBING �.
ZONING
ENG, SITE No.
GASTESTGAS
- /
FIRE SPRINK
v N[]
ENERGY T-24
v ❑ N[]
- -
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR -
ELECTRICAL RELEASE
FLOODZONE
Y ❑ N�
A.L U. C.
Y L1 •N❑
INTERIOR SHEAR
FIRE DEPT.,
SHEETROCK -
GRADE '- -
FEE SUMMARY
EXTERIOR LATH
BUILDING Do L- -Z F
euILnlNc
r?,
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC -
PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY-
SEISMIC FEE
6�
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDI NG FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 2524505,
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.'
PLEASE GIVE JOB ADDRESS WHEN PHONING.
z - SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
���
MECHANICAL
3
CONST. TAX
IMPORTANT!
PLEASE,REAU REVERSE.SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL 4
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON
-
APPLICATION & PERMIT
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
-PERMITNUMBER ...
15696 [ J21s-
msLEANG I
ADOREL
SALJvvv Nx
OWNER'S
"AME'r'pCTE 11n HONE E -c4-1 '
�c eAciORs
-
OTY. - ELECTRIC PERMIT FEE
PLAN CHECK V DATION
pd.
�a G
.,
DATE OF APPLICATION .
M ( uc. NO
1[7C V� 2 �1� WOJZ
OUTLETS - SWITCHES - RECEP. '10.00/1.00'
LIGHTING FIXTURES 10.00/1.00
CONTRAc R'sAPPLIANCES-RESIDENTIAL
M& 11I 5000
�kCIW^,^J vHONE
4.00
PANELS10.00
ARCHITECTPLAN
pq
ENGINEER/f y '(� yy����QQ I-
`- �`/�'•`� LIC. NO.��Q `�I
PANELS (OVER 200 AMP) 20.00
CHECK FEE P.C: NO.
.-
SIGNS TRANS. 3.00
ADOhRESS ENG. �l rte,.,
-I-L L,Q�Yk-Qek) 'ZIP"
k ��-
SPECIALGIRCUIT 5.00
EMP. METER OR POLE INS.. 20.00
PERMIT VALIDATION
-�
APPucANr's-
{`_t,
nZLssUJr,
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
r•.r
LICENSED CONTRACTORS DECLARATION
E[.6z�- �r/R �p L ZjC
I 1 hereby at that I um licensed under provisions of Chapter 9'
(commencing with Section 7000) of Division oft smess mul
prcuessims�qdL� d.nq�[illtse is in full to aaiaY�y,K�ti•
License ClassC��f@UU�((�� Lia Numbe{{{��� --�
Dame Contractor._V(�„1�!pp-p
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License
Law for city following reasonhi(Sec.retuoresa 1.5, Businessand Professions
t u construct, alter,
Code: Any city o' corn pair any structure,
permit prior
improve, de mulish, or repair any structure, prior t0 its issuance, also
requires the applicant for such permit to life to signed statement i tut
he is licensed purnmn[ to.the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
,r�
BUILDING PERMIT
DRMATIGN
V ON S/FT.
/� ,
• PERMIT TO
({/ //y�l.��yv�r
MISC. - REFER TO ORD
PERMIT ISSUANCE 1&00.
ELEC. CONTR. LIC NO. ELTA �CP
TOTAL
1%04
OTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
the basis for the alleged exemption, Any violation of Section 703 L5
by any applicant for a Permit subjects the applicam ma civil papally
of not more than five hundred dollars (S500).1:
ispN'/ % O
ALTER -DRAIN -WATER IEA.) 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
BACK FLOW PROTECT. DEVICE - 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF; AREA, COND. _5DO -
intended or Offered for sale (See. 7044, Business and Professions
�ode: The Contractor's License Law does not apply to an owner of
property who builds or Improves thereon, and who does such work
• nbnself or through his own employees, provided that such improve-
ments are not intended or offered For sale, If, however, the building
FIXTURES - PER TRAP 6.00
SO, FT, FLOOR AREA
TOTAL ACREAGE
GAS=EA.SVSTEM-11NC.40UTLETS 690
or improvement is sold within one year of completion, the owner
builder will Imvo the burden of proving that he did not built) or im-
Prove for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 IEA.) 2.00
-
BUILDING uSE -
RES INP. CON PB Omer
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (Sea 7044, Business
and Professions Code: The Contractors License Law docs not apply
to an owner of property who builds or improves thereon, :cod who
ILAWN SPRINKLERS- 1 INC 5 V.B. 6.00 '
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
-
Contracts for such projects with a conlractoft5) licensed pursu n1 to
the Contractor's License Law. �
SEWER -SAN V -STORM EA. 200th/10.00
TRACT NO.
PARCEL NO,
❑ l um cxempl under Sec.-, R&P,C. for this
reason
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
-ACC.DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPI:NSA'f]ON DECLARATION
1 hereby affirm that I have a ecrtifieate ofconsunt to self -insure,
or cer i 1, m.1�W'��or qqs' Compensation Insurance. or a certified
I Ih', p'$-cinquany i
ZONING
ENG. SITE NO.
amn lli
❑fertiPedy is hereby furor`(.
,.e, CertificJ py is RI),.it wi01,/'t(vlte ity inspection division.
Applicant
FIRE SPHINK
Y ❑ N❑
ENERGY T 24
Y ❑ N❑
MISC- REFER TO ORD.
CERTIr;CATE AO EXEMPTION FROM WORKERS'
PERMIT ISSUANCE q 3.00 12--
FLOOD ZONE
A.L.U.C.
PLG. CONTR. . LIC. NO.,
PLG.
TOTAL
COMPENSATION INSURANCE
(This section need not be completed it the permit is for one
Y ❑ N E]
Y ❑ N ❑
-
hundred dollars (S IOD) or less I
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
-
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
�-
becomesubjecttolheWorkers'Compensal ion Laws of California.
Date ApplicantALTER
OR ADD TO MECH. 5.00
NOTICE TO APPLICANT: If, after mu king this Cerlificate of fix-
emption, ycii should become subject In the Workers'Compensation
APPLIANCE 5.00
PLAN CHECK
provisions of tire Labor Code, you•must forthwith comply with
such provisions or this permit shalf be deemed RIAIR
FEE
HANDLING UNIT (TO 10J100C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE
t�s'
CONSTRUCTION LENDING AGENCY
I Thereby affirm that there is a'construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
tire 3097, performance of the work for which this permit is issued (Sec
MICROFILM'
_ HEATING UNIT (TO 100,000 B.T.U.1 8.00
Lender's Name
HEATING UNIT (OVER 100,000 B.T.U.19.50
ELECTRIC
�
I:
Limner's Address
end
,:
I certify that I have read this application and slate that the above
Information n correct. I s relati comply with al oast and county and
ordinances and irate laws ativesno t0 building construction, and
herchy uutia, igd representatives of this city to enter upon the
abov Icntioned property for inspection purpous.
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER-COMP(3 H.P. Dr 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100, 000 BTU) SEE FEE SCH.
MECHANICAL
MISC. - REFER TO ORD.
-
CONST. TAX
�( C) agree to sav demail'y and keel) harmless the City of
Cup 'tin against Iia flit' , Jud •mints; Costs and expenses which'
Da y in w y.ac no •most aid City in consequence of the
Jm g 1 e'mt
PERMIT ISSUANCE 15:8[T ot-
MECH: CONT. LIC. NO. MECH11,
. -M W 9 j
TOTAL
� '
TOTAL
0
Signator o 'Applicant o racfnr � Uate
„ OFFICE COPY