16964 POST THIS CARD NEAR FRONT OF, BUILDING aMl.NumaER
fi
CITY-' v CUPERTINO 6954
INSPECTION DIVISION.
JOB INSPECTION'RECORD
®
PERMIT EXPIRATION
y "
JOB.ADDRESS l CJ:Ie LIP�� PZ..P"L,P�-� UNIT# - LOT#' _ PERMIT EXPIRES IF WORK:
` OWNER CONTRACTORP ' IS NOT STARTED WITHIN"•
INSPECTION' DATE INSPECTOR _ INSPECTION RECORD I 180 DAYS OF PERMIT ISSU- "
r c' FOUNDATION NOTE _ ANCE OR, 180 DAYS FROM
' ° LASTCALLED INSPECTION.' "
UFER. '� - ALL GRADING AND DRAINAGE SHALL'BE INSTALLED i
PREGUNI'TE '• :• TO COMPLY WITH THE APPROVED PLANS AND CITY OF' PtRMIi VALIDATION i
��' CUPERTINO STANDARDS..
.. GARAGE SLABS • .' 3 1
POUR NO CONCRETE UNTIL ABOVEMAS'BEEN SIGNED Cc/1'- a•�•�• /�s Ap' IL'17 �t-e-✓I
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL IssuAlvcE DATE
MECHANICAL /� .�R!9i✓i�'1g' Q ELECJ. PLc. MECR,,
/ 7. T
r it.: }�
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED •. ' BUILoI. G PERMIT
WOOD FLOOR
INFOFIMATION
• .r'r . . .*'' VALUATIr SIFT,
A•, PLUMBING .p iY
• 'MECHANICAL
ELECTRICAL - - " PERnuT TO . -
- , FRAMING ) ., '. _ •. ` C:���I ' •�
STORIES TYPE CONSTR,.'
INSULATION,: r a;.
- • - OCC GROUP RES UNITS
PLACE NO SU BFCOOR UNTIL ABOVE HAS BEEN SIGNED '
SO.EL.PLOOq ARTA 'TOTAL ACREAGE ,
• - r"^ ". ROOF. `* - k ,NOTE:NO FINALINSP.SHALL BE'MADE BEFORE -
v:• THE CONSTRUCTION TAX IS PAID.• T
DIAPHRAGM'' �L - s
BUILDING USE
ROOF'SHEATHING _ ;Es mD-;coN -^Pn
'APPLYAO,ROOF.ING:UNTICABOVEHAS-8 EN SIGNED ,,',FINALS a, .,.< ...DATE;.. I INSP;''
:.n ssEy sons P
ROUGH SAN.N, ;
PLUMBING, _ ' 'ELECT.'ENERGY "
TRACT NO. PARCEL NO
TUBS&SHOWER PAN - -PLUMBING ENERGY
MECHANICAL' MECH.ENERGY a'-'-
. , I
,• 'ELECTRICAL - BUILDING-ENERGY �•_ ACUDATE ACC, NO
FRAMING +' - ELECT.FINAL TESTY
ZONING ENG.SITE NO, "i
INSULATION PLUMBING 7-1-1 � _ y
GAS TEST,''', GAS- t
MECHANICAL ."IRE SP11I NK ENERGY T 2
"
..',COVER NO WORK UNTIL ABOVE.HAS BEEN SIGNED HEATING . 'I Y,ED "El Y "0•
_ - -
-
EXTERIOR.SHEAR .. � - ELECTRICAL RELEASE FLOOD zCNE 1A.L.U.C.
T '•. �
INTERIOR''SHEAR' .. FIRE DEPT.' �^ ' ..
SHEETROCK` GRADE, - FEE SUMMARY
~ EXTERIOR LATH BUILDING'' ", - _
.INTERIOR LATH BUILDING;
'r,_ . TEMPORARY APPROVALS
SCRATCH COAT - - ELECTRIC ' - PLAN CHECK'
GAS
FEE ,. ...
' .•NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY , SEISMIC FEE•
` OCCUPANCY,.OF'BUILDING IS NOT PERMITTED UNTILBUILDING FINALISSIGNED,BY BUILDING INSPECTOR', MICROFILM
ARRANGE FOR.INSPECTION BY,PHONING.252-4505;: ' ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED"INSPECT,ION_. ' PLUMBING
0 PLEASE GIVE;JOB-ADDRESS WHEN PHONING 1
- SEE PERMIT FOR.EXPIRATION DATE —. akr' MECHANICAL: '�f1ct)z
IMPORTANTI . i CONST.TAX`
PLEASE-READ REVERSE SIDE BEFORE 'le :;
` CALLING FOR FINAL INSPECTION. NOTAL. "
OFFICE COPY
C APPLICANT TOi:FILL IN INFORMATION WITHIN RED LINES - USEBALL'POINT,PEN ONLY
= i - r .PERMIT NUMBER
r iBUI,L'DI NG PROJECT IDENTI FICATION APPLICATION Bf PERMIT '
ADD res . 16'9 6 4
ADD res r - ..
• �� •�� ILDING ELECTRICAL-'PLUMBING=MECHANICAL � '.n. v.
A OWNER'S `r I PLAN CHECK VALIDATION
"AME ,.
QTY.. `d''ELECTRIC PERMIT .f.. tFEE 11 s
(/CYi'l PRONE I
co ACT e"`•, OUTLETS'. SWITCHES. RECEP -10.00/1.00
ME
Lic.Nor - LIGHTING FIXTURES 40.0011.00
CONTRACTOR'S F
CONTRACT ; p �Q�` ' APPLIANCES RESIDENTIAL 400 -
a � PRONE{' � . :v PANELS x' / ` 1006 DATE OF.APPLICATION
ARCHHRCT PANELS VJER'266 AMP) 26 66 , PLAN CHECK FEE' P C NO
ENGINEER I•` -
oR :L,C.NO, t - -SIGNS'TRANS.:.
. . •.
ARCH:OR ENG - -Y " ' r'� 5.66 PERMIT�VALIDATION
ANNREAs - e, SPECIALCIRCUIT- -
zlr', '- - EMP.METER OR)POLE INS: 20.0Q
APPLICANTS ''MOTORS 'SEE FEE SCH
••r ANORESS4 .t:.
SERVICE.CHANGEar
cdz,
D o' "LICENSED CONTRACTORS DECLARATION rDE
< u w g I 1 r by"aforin thnt I al,licensed under pr visa is of Chapter 9 }ISSUANCE DATE -
r Q ( omme i rg wdh.Sectlon 7000) f Division 3 of the Rusino, e d - BLDG .ELECT PLG MECH P
r o_z n I ofeea ons Code and buylicense m full for, nil if r .y -
z o Ltc use Clens/x..Z�' L' Number '`�. ❑-'
o v, H a y Date C ntovlor _ T'
a m E -a < �— - BUILDING PERMIT
¢ ¢ m Q t OWN RtB UILUhR UBCLARA'PION ��//p _ ' -'-INFORMATIONau U ""-
x�3 LL �- I heretiy al Hrm lhet I am'exempt from the Contractor's
Rise MISC .i - - °'REFER TO ORD '
o� Law for the follow'ng'reason-(Sec 7031.S,Business and Profesvons + VALUATION S/FT.
H Codel Any city c unty whwh regmr sa
or,
'0 ' PERMIT ISSUANCE -1000
s¢ ¢ Q improve,-demolish t r repair any ehu [ re poor[a its issuance also ELEC.CONTE LIC NO- ELEC4 -
e(u r'gwresthe apphcantfor suchpern lL tp tiles signed statement tltet TOTAL ,'PERMIT TO
K m he Is licensed pursuant to the provivons of the C t mior s Lmense ' - r k
r'z i Law(Chapter9(wmmencingw lhS Ito ;7000), fU' son3 ofthe
4 Business'and Protesslons Cody ar that he is exeml t themtrom and OTY. PLUMBING PERMIT - "FEE t -
�•�'� Y o ,Rl. STORIES - TYPE CONSTR.
�.¢ r o the basis for the alleged ezemp[ion AnyvioluHon of Section 7011 5 _
'''a ; '� ', by any-applicant fora permit subjects the upphcanttoncivilpenuPy „ALTER-DRAIN&VENT-WATER IEA.15.00 _
of not morclthon five hundred dollors($S00)J'.
❑ I,as owner of the property;or my employees with wages as BACK FLOW PROTECT. DEVICE " 4'.00 _ oeC,GROUP, .RES.UNITS
Iheinsole eoml e'111111eation,.will do the work;-and.the structure is not = - '
in en or,off red'for sale (Sec 7044 Business and Professlohs;' DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law does'no(apply to an owner of -' - - - o
properly who builds or lmprovls thencon,and who does Such work ' FIXTURE$-PER TRAP-., " 5.66 SG:FT.'FLOOR AREA TOTAL ACREAGE .
himself or through"his own employees, that such improve .. - _ a `r
meats me:not intended or offered for sale'lL however,the building .GAS `EA'.SYSTEM-1 INC:4 OUTLETS 6.00
or improvement is sold within one year of completion,the< ue - , »'
builder will have lite hurdcn'of proving thei he did not build or'Im GAS .EA.SYSTEM r OVER ER 4(EA.) '� 2.00 , BUILDING USE,
prove fri purpnsc of sale). - INDUSTRIAL WASTE`INTER: ' .30.00 RES IND 'cON"' APB Omer
M _ •'? ❑••1,as owner of the Property,not exclusively contracting'with - ❑ l ❑ .'"i❑ -'❑ ❑
t licensed'contractors.to'corbstruct the project(Sec. 7044,Business _ - LAWN SPRINKLERS.=1 INC 5 V.B:"•' '6.00 - ASSESSORS PARCEL NO_
-" and Professions Code:`The Conhacbi s License Law'docs not apply' -to an owner oLproperty who builds oriimprovcs thereon,and whoLAWN.SPRINKLERS OVER 5°IEA.). d 00 _
. . - .
contracts fdrsuchcector(a)
projects with pursuant to' . - SEWER-,SANITARY
. . Lite ConLNCENts License Law. Y.; -TRACT NO., PARCEL N0.
❑ I an exempt under,Sec. _ ,R&P.C.for Ibis yygTER'HEATER W/VENT 6.00
reason 'A - x
Owner Date WATER SYSTEM. 15.66 .'ACC.DATE-.' .: ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION.`a WATER TREATING EQUIP, 5.00
I hereby,a l0rm-tliaCl hove acvrh Ecete nfe meat1 'ellb i re . ZONING ENG SITE NO:',
or a certificate of Workers'Compensation Insurance ire certihul _ _ : '
Npythercof(Sec-3800,Lab C1 Y e6�. :r.) - a'ks -y
PolicyN Company ,5"
' f "(] Cl Certified copy is erebyI n '1 d' - "z- " .4 FIRE SPRINK;i 'ENERGYT14'
Z Z` ❑ Certified copy isfiledwith ile'eity Irpcl'o 'div son MISC. REFER TO ORD.
0. Al)Plicant r _ _ ,.�. V ❑ N❑ V ❑ N❑,..
~ W 1.- t '` ° - PERMIT ISSUANCE 10 00 .,,FLOOD zONE 'a C L u cl.
A } CFR77FICATh OF EXEMPT ION P 1,06-
LU
OM WORKS RS'
Ill.'> r1i COMPENSATION INSURANCE :}; Y PLG:CONTE. - LIC No. PLG - V N " V v N
'� Z' .,(This section need not be completed^if.the penmtas for one TOTAL ❑' ❑' ❑ ❑'
hi nil ed'dollars(81001'otlesa) - - .i ..'X y,
`U.O. Iceitll'y,that nthe'perform ince()I tile wnik for wh¢hrihs Per OTY.. .MECHANICAL PERMIT' 'F,EE'. ,r,Frl SUMMARY. "
LLE-,4 mR is issued,I shell of in l any person In any mann�r sea t ,-
U becoige�suIF t to the Worker o t cash a Of ifoul a, - '
`� w Detiy.;( 'ApPlicant�� 1Le� - • ^ ',BUILDING'
11111111CCCC XI'1r '—` ALTER OR ADD T_O MECH 5.00
ld beco is s bje r nt thae this s'Com tc' f io - ,
? en[ption,`you,should become subject theta .kers Compensation. APPLIANCE ' 5.00PLAN CH EC K.
po.vismns of'Ihe H.abor Code you most forthwall onmly with
CJ uch;lmcvielons or this penult hell be devoted Revoked.'' AIR HANDLING UNIT(TO 104MC.F.M.) 4 00 -FEE a
CONSTRUCTION LENDING AGENCY. -- ' AIR HANDLING UNIT IOVER.10,000 C.F.M.1.6.00 SEISMICFEE:,'`
v I hereby''afOnn that there is a 'onstructiod nding agency for 'EXHAUST HOOD(WITH DUCT) 5.00 < _
the performance of the work for which this permit Is issued(Sec., - MICROFILM is
3097, "HEATING UNIT(TO 100,000 B:T.U.) 8.00 _
r
Lender's
- �. _
Lenders Nome t�. .HEATING UNIT(OVER 100,000 B:T.U1)9.50 '
' .. Lenilcr's Addr s - '• - - _ ELECTRIC .
` 1 certify 1h 11 ba rad this appheahon and stat that the above ° VENTILATION FAN,(SINGLEI "',' 4.00
information t. correct. I g eelo omply with all city and county - p PLUMBING „h
ordmsnces and state laws relating to bmldmg construction and 'BOILER-CUM (3HP .100000 BTU:) 6400 )
,tRdby'eafi ri7c rcpresenhdivrs of the city to Lrip''nopon tire BOI L'ER-CO M Ove 1000.00 BTU I S E E F E E SCA. 'MECHANICAL ' W
" above inentioned property forinspection Pomp. a _
(We) agree.to save' mdemmfy end keep harmless the Clly of '" " MISC {y ; t 5 ae"i ",,R EF,ER TO ORD
upertino-against liabilities judgments,-costs and expenses which .CONST TAX
may many way accrue against said City In consequence'at the - PERMIT ISSUANCE
` ng Of this rermiG MECH.CONT.n ,.LIC.NO.l MECH. - st
Ur
TOTAL f y'
i
TOTIAL-
ISTgnature of Applicant/Contractor Dat
OFFICE COPY