16744 • POST THIS CARD NEAR FRONT OF BUILDING
` F - -PERMIT NUMUER
•T
=d -CITY 'OF. CUPERTINO 16744
INSPECTION DIVISION
JOB INSPECTION RECORD
Y ! PERMIT EXPIRATION
JOB ADDRESS •,�U 9:O 0 4L ih>g ��Z UNIT O 'LOT# PERMIT EXPIRES IF WORK'�
OWNER U CI CONTRACTOR 4c{g' T " C IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD180 DAYS OF PERMIT'tISSU.:'
FOUNDATION, DANCE OR 480 DAYS FROM .
i NOTE:' ' LASTCALLEDINSP ECTION: ,
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED I
PREGUNITE TO COMPLY-WITH THE•APPROVED PLANS AND CITY OF PERMIT VALIDATION '
CUPERTINO STANDARDS: _
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ., ' - - _' .•L�-'
UNDERGROUND /SLAB ' ? j
PLUMBING
ELECTRICAL`
ISSUANCE DATE- t.
.. MECHANICAL - �!n BLDG, ' ELECT. PLO. MECH.
rf' El 0
' •DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR �t11� 1 _ INFORMA IpN
PLUMBING'- � IGBttlpO
LUATION; t 'SIFT.
MECHANICAL - - - i,�'' i CITY Ot
1
ELECTRICAL - PERMIT TO
FRAMING , `/`q6
'INSULATION .STD ICS TYEF CONSTR�•
n.
OCC,GROUP RES UNITS
-PLACE NO SUBFLOOR.UNTIL ABOVE.HAS BEEN SIGNED - I '•' -
ROOF SD.FT,FLOOR AREn TOTAL ACREAGE
'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM. - THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING -
RESJ''- IND II,DC NUSEPB O .,•
'APPLY NO ROOFING UNTIL"'ABOVE HAS'BEEN SIGNED ' "FINALS T - "DATE '- - `4NSP: - '❑ q ❑ ' ❑
ASSESSOR S PARCEL NO,
ROUGH - �. : SAN.N'
PLUMBING - q ELECT.ENERGY
TUBS BSHOWER PAN '• PLUMBING ENERGY TNACT.NO. PARCEL NO.
MECHANICAL'` - ,G� _ MECH.ENERGY -
ELECTRICAL _ ACC.DATE ACC,FI LE NO.
- , BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION roNING
PLUMBINGENO:SITE NO.
"
GAS TEST GAS
- MECHANICAL R-sPRwK - ENERGY T.$4
COVER NO WORK UNTIL-ABOVE HAS BEEN SIGNED HEATING. Y ❑ N'❑' Y ❑ N❑
EXTERIOR SHEAR" ELECTRICAL'RELEASE FEOOD ZONE A.L D,C, •
INTERIOR SHEAR FIRE DEPT-. �� Y❑ N❑ ': ❑ -N❑I
SHEETROCK GRADE . :
.FEE SUMMARY �.
EXTERIOR^LATH BUILDING 1 ''
' INTERIOR:LATH TEMPORARY A PR VALS - BUILDING . - /
SCRATCH COAT —I .- ELECTRIC - PLAN CHECK .,
GAS' - FEE _
.• NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - . SEISMIC FEE'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM; •
w. ' " ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
rye'
z PLEASE GIVE JOB ADDRESS WHEN PHONING. .-
- SEE PERIVIMFOR' EXPIRATION DATE - MECHANICAL,
IMPORTANT!''. covsT.Tax.
PLEASE READ REVERSE'SIDE BEFORE �"
CALLING FOR FINAL INSPECTION. TOTAL
;OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
'BUILDING PROJECT IDENTIFICATION • -PERMIT NUMBER
BUILDING APPLICATION & PERMIT 16744 r r� ^ j�
` ADDRESS 0 I `F `F
O� LV . BUILDING ELECTRICAL-PLUMBING-MECHANICAL -
OWNS 'S - PLAN CHECK VALIDATION
NAMME/�(�// ' �j �r fry r OTV. ELECTRIC PERMIT FEE �1r`y, O
.N( =/Lal V PHONE -�il � � • .,1.1T a•�, .,
NOMERAcroRs t,� OUTLETS'-SWITCHES'RECEP 10.00/1.00 "1YVW"11
fr(x'I sec.rvo. d/ JGHTINGTIXTURES 10.00/1.009 1
corvrRAcrons •�ADDRpESSd15� r,
APPLIANCES-RESIDENTIAL 169
N Off 4 PANELS >&BO //—TT=
_
DATE OF APPLICATION
ORRmuTEOT PANELS (OVER 200 AMP) •' .20.00 •PLAN CHECK FEE . P.c,NO. .
ENGINEER '
LIC.NO. SIGNSTRANS. - 3.00.
ARC H.OR ENG. - PERMIT VP LIDATON
ADDRESS - SPECIAL CIRCUIT 5.00 - y
ZIP TEMP.METER OR,POLE INS. :20,00
APPLI
CArvra - MOTORS " SEE FEE SCH.
t
Q a Z /•} SERVICE CHANGE 20.00' `
ADDRESS
'�
o o LICENSED CONTRACTORS DECLARATION
< v I hereby affirm that I am licensed under provisiims of Chapter 9 _ ISSUANCE DATE .+
y a N (commencing with Section 7000)of Division 3 of oo,Business and - B LECT. PLG. MECH.
H w- Professions Code,and my license is in full force and effect.r— _
2 o m License Class_ _Lia Numher � -f-M V v - ❑ ❑ .,❑
m- ° nate - Cn,dG,mr -
M a w a OWNER-BUILDER DECLARATION IRM PERMIT
X ;A < I hereby affirm ing 1 am exec. from the Contr doors Li senns
MISC.- REFER TO ORD Cud "INFORMATION
u O j Law, for the followingreason.(Sec 7031 5,Business to and t r ct,aions ,VALUATION $/FT.
va I- PERMIT ISSUANCE '46;60 /d' '
Code:Any city or county which rcy uiresa permit to construct,alma O
or ELE
¢ improve,demolish,or repair any structure,prior to its issuance,also G CONTR. LIC.N0. ELEC. �
ar O LL reyulres the applicant bor-such permit to tilt a signed stlnemenf that - TOTAL r
awm he Islicensed prusuad to the provisions of tirePERMITTO
Contractor's License tty��s
Fib Law(Chapter 9 fcommencingwith Section 7000)ofl)ivisioa3 ofthe /1 If.l-fY
i o Business and I'rofessiuns Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE, /' I`� I l.�
¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES„ TYPE CONSTR.
by any applicant for a permit subjects the applicant lir a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 '
of not more than five hundred dollars(S500L):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 '
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended'or off'ered lit, sale(Sec. 7044, [business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Codei The Contractor's License Law does not apply to an owner of
properly who builds or improves thereou,'and who does such work FIXTURES-PER TRAP
himself Or through his own employees,provided that such Int prove- BO.FT.FLOOR AREA TOULACREAGE
ments are not intended or offered for sale.If,however,fire building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is Sold within one year of completion,the owner-' GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES ,IND CON PB Omer
;
❑ 1,as owner of the property,um exclusively contracting with ❑ ❑ . ,❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,[business LAWN SPRINKLERS- 1 INC S V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and.who LAWN SPRINKLERS-OV ER 5(EA.) 1.00
contracts for such projects with a eon[metinus)Ilcensed personal to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10:00 TRACT NO. PARCELNO. -
'❑ 1 am exempt under Sec. BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM ' 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP., 5.00 - -
I hereby affirm thin I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insumne ,or,a'c0ified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab L.)t�••rs 0N
Policy No.' Cohere y.7rh7u, s•'1L4tiL-
Q ❑ �ertilleJ copy is hereby"[anti cod' FIRE SPRINK ENERGY T.24 '
Z Z rfjl/Cert ihl py Is filed will ha ill 'nspecumn division. MISE.- REFER TO ORD.
D Applicant - Y ❑ Z N❑ Y ❑ N❑
~ va PERMIT ISSUANCE -1&60
CF:RT'l l'ICA'fM SAEIOTI IRANCE RKER$' el- FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLO.CONTE, LIC.NO. PLG
er .
(This Section need not be completed if the pmit ❑is for one TOTAL Y❑ N❑ - Y N
Z ❑
hundred dollars IS 100)or less.)
U O .I certify that in the performance of the work for which this pery DTV. MECHANICAL PERMIT 'FEE FEE SUMMARY -
LL H _ mit is issucA,I shall not employ any person in any manner sn as In -
Q W become subject to the Workers'Compensation Laws of California.
¢, Date Applicant BUILDING / d4
} so NOTICE TO APPLICANT If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5,00 .
F Z cuiptiim,,y'bu Should heuime subject In the Workers C'ongmnsalion APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwilh comply with - FEE
U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
'CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 600 SEISMIC FEE Q�
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. MICROFILM
3097,Civ.C.Lu/ HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -7 - HEATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC '. C{a�
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
in urination is correct. I agrec,lo comply,wfih it]]city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 •��
hereby authorize representatives,of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for in spection purposes,
(We) agree to Save, indemnify and keep harialcsa the City of MISC.- '.REFER TO ORD:
upertino against liabilities,judgments, costs and expenses which' CONST.TAX
Sir in any way accrue a rift said City in consequence of the PERMIT ISSUANCE 10.00 '
.e 'ng of this permit.jj _ MECH.CONT. _ LIC.NO, MECH. _
TOTAL TOTAL
Signature of ppli ant/C tractor Date •�
OFFICE COPY' a .,