16875 POST THIS-CARD NEAR'FRONT OF,;`BUILDING' „
- -n •^-�'` 1 • .• PERMIT NUMBER.
CITY .-OF CUPERTINO 16$75 i.
'INSPECTION DIVISION
JOB INSPECTION RECORD '
PERMIT EXPIRATION
JOB.ADOR ESS' ( V -� UNIT#t� _LOT#
L• ^ I� PERMIT EXPIRES IF WORK
OWNER 13 V,� kl� Y
.� CENTRACTOR a .(1`- (ti•21cl.J •IS NOT_STARTED WITHIN.,.'
INSPECTION DATE I INSPECTOR INSPECTIONRECORD 180DAYS OFPERMITIssu"a
FOUNDATIONNOTE: - ',.j. ANCE OR•180,DAYS FROM
E CAST CALLED INSPECTI ON.
:UFER' 'T. ALL,GRADING AND DRAINAGE SHALL.BE INSTALLED,'
PREGUNITE _ TO COMPLY WITH THE APPROVED PLANS AND CITY OF = ?ERMIT VALIDATION'
CUPERTINO STANDARDS.
GARAGE SLABS. �.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
_
UNDERGROUND'/SLAB'' '
PLUMBING : a, - ' "+"'^�4�' iL��•
ELECTRICAL' - +•-ISSU nrvcE'oA IT
MECHANICAL BLDG, ELECT PLG. MECR
_ ❑ �' ❑ ❑ •.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED euaowG PERMIT
- WOOD FLOOR . INFORMATION•.
VALUATION $ITT. .
PLUMBING � � _ ,
MECHANICAL
ELECTRICAL - PA,,D PERMIT TO
FRAMING
INSULATIONnl It q 01
n Op STORIES, - TYPECONSTR.
r NYV J JOV T '
OCC.GHOUP. RES UNITS +
AYy of Cupertino
PLACE NO SUBFLOOR UNTIL ABOVE.HAS BEEN SIGNED.
,• ROOF - NOTE:NO FINAL'INSP.SHALL BE MADE BEFORE,. so Pr,PiooR.arna .oT aL acRI:ACE
DIAPHRAGM 7 THE CONSTRUCTION TAX IS PAID +
ROOF SHEATHING BUILDING USE
r Hes • IND CON PR 'umw '
• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS._ DATE, „ INSP.',,, ❑ ❑. -
- R000H - - nssessDRS PA,�cEL rvG
SAN.q . . ..
T PLUMBING, 1. ELECT.ENERGY
TUBS 8 SHOWER PAN - PLUMBING ENERGY - •THACT NO, ,PARCEL An
. MECHANICAL MECH.ENERGY -
ELECTRICAL' ACC.DATE - ACC,FILE NU
z, BUILDING ENERGY + -
FRAMING - - ELECT-FINAL TEST
INSULATION ,,E : PLUMBING zoNING. , eNG.SITE No,
GAS TEST GAS - +
MECHANICAL
FIRE SPHINK - ,ENERGY T'$0
' _ -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ' Y ❑ N❑
EXTERIOR SHEAR ' ELECTRICAL'RELEASE a _ + FLooD ZONE. n.L.u.a
- INTERIOR SHEAR FIRE DEPT:' - °❑ N❑ Y ❑ N❑
" SHEETROCK. ' GRADE •- FEE SUMMARY
EXTERIOR LATH _ - BUILDING ' -
•• INTERIOR LATH : TEMPORARY APPROVALS.'- BUILDING
SCRATCH COAT ELECTRICL.III- _ PLAN CHECK
T' GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
LuARRANGE FOR INSPECTION'BY PHONING 252-4505°' %. ELECTRIC
• � 'ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
C)
Z PLEASE GIVE JOB ADDRESS WHEN PHONING , •.
,SEE PERMIT FOR'EXPIRATION DATE'—, EC
' MHAN ICAL -
IMPORTANT! CONST:.TAX
PLEASE'READ REV ERSESIDE'SEFORE '"u TOTAL' F" "
' CALLING FOR FINAL INSPECTION ` - .
OFFICE COPY. ». ,:
APPLICANT TO FILL IN INFORMATION,WITHIN RED LINES -USE BALL POINT PEN ONLY
-:
BUI LD1 NG PROJECT I DENTI FICATION ':. 'FERMI?NUMBER
BUILDING APPLICATION & PERMIT 16875.-
ADDREss A
BUILDING - ELECTRICAL-' PLUMBING :MECHANICAL a
AER's
NAME PLAN CHECK VALIDATION
N - • CITY. ELECTRIC PERMIT - 4 v • � FEE ,
r _
CONTRACTOR'S
NAME / OUTLETS ECEP 10.00/1.00
sec No. LIGHTING FIXTURES10.00/1:00 - •
(TONTRACTOR'5 - .
ADORE
ss " PPLIANCES-RESIDENTIAL 4.00'
�OIL'✓� 0r. PHONt���g«� PANELS 10.00
GATE OF APPLICATION
ARCHITECT PAN ELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.L.No.
- ENGINEER ,
LIC.NO:; SIGNSTRANS. 3.00
ZRC. OR
ADDRESSENG. , - SPECIAL CIRCUIT _ 5.00 PERMIT VALIDATION
• ZIP - EMP.METER OR POLE INS. 20.00l/'-3 6-�Q
APPLICANTS SEE FEE SCH.
o'j'OgBO A1e,1ee1}r-- - SERVICE,CHANGE 20.00
oar
F'0 0 LICGNSIiD CONTRACTORS DECLARATION
a u'U I hereby affirm hat I am licensed under provisions of Chapter 9 " ARAID _
y rt H Icommemmng with Section 7000)of Division 3 of file Business and ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
w Z Professions Code,and my license is in full force unJ fyy,,c(1,,' - ❑ ❑ ❑
z o w- License Class,��'' Lic.Numhers� _7` Z.. Ut-
0 o Daoe_,t��_3Q Contractor_�/F _� �. -
¢ Q w¢ OWNER-BUILDER DECLARA'PION BUILDING PERMIT
w- o INFORMATION,
g LL H I hereby affirm that I am exempt from the Contractor's License IMISC.t •>
u+0¢ Law for the following lesson.(Sec.703 1.5,Business and Professions - VALUATION -$/FT.
-0 I PERMIT 10.00
3 w� i Code:Any city or county whichrequiresa permit to LUD
2 a ¢ O - improve,demolish,or repair any structure,prior to its issuance,also ELEC.,CONTR. LIC.NO. ELEC �/�
O 0 requires the applicant for such penal to I He a signed statement that' y _ TOTAL' V PERMIT TO
e. w m hns Ie Is licensed Dominant to the provisions ofthe Contractor's License - - -
r z a
Law(Chapter 9( omm-ncingwith Section 7000)of Di is'on 3 of the
E i e liusincsv and I rotessmns Code).or that he is exempt therefrom and CITU. - PLUMBING PERMIT_. ',FEE �j G
IS h o the basis for Ilse alleged exemption.Any violation of Section 7031.5 STORIES TYPE LONSTR.
- ni`= byany aopt mr,t for of permit subjects the app ll cam one civil pon:It, ALTER-DRAIN -WATER (EA.I°5.00 s<''
of not more than five hundred dollars($500).): '
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEV ICE' 4.00
thea sole compensation,will du the work,and the structure is not OCL.GROUP RES.UNITS
intended or offered for sale (Sec. 7144, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 r
- - Code'The Contraatoc.,License Law docs not apply to an owner of
property h builds uilds or improves Thereon,and who does such work FIXTURES-PER TRAP r
himself or who
throughbuil his own employees,provided that such chimprove-
5.00 SO.FT.FLOOR AREA TOTALACREAGE
ments are not intended or offered for sale.If,however,Ne.building GAS-EA.SYSTEM-1 INC.4.0UTLETS 6.00
or improvement issoldwithin one year of completion,file owner-
- builder will have file harden of proving that lie did not build or im- GAS-.EA.SYSTEM-OVER 4(EA.) - 2,00 -y BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER - 30.00 RES IND CON " PB Other
'❑ I,as owner of the property,um excluslvCIY contractin .g with - ,"
licensed contractors to construct the project (Sec. 7044,Business LAWN SPRINKLERS-1'INC 5 V.B., 6.00 ASSESSORS PARCEL NO.'
El El El Q
land Professions Corti: I'he Contractor's License Law does not apply
to rut owner of properly whn builds or improves thereon,and who LAWN SPRINKLERS-OVER'5(EA.) .1.00
contracts fill such projects with a enntraetor(s)licensed pursuant to
file Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 'TRACT No. PARCEL NO. .
❑ lam exempt under Sea ,0.&I'.C.for this' WATER HEATER W/VENT- 6.00
Owner - ,
Owner - Date WATER SYSTEM 5.00 - ACc:DATE Ace.FILE No,
WORK ERS'COn1PFNSA'I 101b DE:CLARAT ION WATER TREATING-EQUIP: 5.00 -
hereby affirm that I haw m e Compensation
of consent or self-insure,
or a certificate of Workers'Compensation Insurance,or it certified ZONING ENG.SITE N0. -
copy The (Sec 3 1.
Policy N m Company,mu, - "
❑ Certified copy is's rebyFiled famish the - FIRESPRINK ENERGY T-24'
Z Z ❑ Certified copy is Filed with file city inspection division. - �
� O Applicant" MISC.� � REFER.TO ORD. Y❑ NY N[
PERMIT ISSUANCE .10.00
LUy CF.RTIFICCOIOFEAEAIPTINS FROM WORKERS' FLOOD ZONE A.L.U.C.
W COMPI!NSA'fION INSURANCE PLG.CONTR. ,LIC,NO.. pec: - -
d (This section need not be completed if file permit is for one TOTAL Y NY ❑ N�
Z h undred dollars($100)or less.)
U 0 1 certify Ihat in the performance of the work for which Has per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL k- mit is issued,I shall not employ any person many manner so as to -
O w hecomesub'rot to the Workcl s'C rape s:dion Lives of Califnrn' . '
D. Dam_/�ijafL A11PIICanl ��- celV(�iw ALTER OR ADD TO MECH. 5.001 - BUILDING '
} w NOTICE O APPLICANT: If,eller making this Certificate of
Ex-emption,you should become subjecLlo the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO'10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10SWO.EM.) 6.00 - SEISMIC F,EE -
I hereby affirm ilial there is a construction lending agency for EXHAUST HOOD(WITH DUCT) - 5.00
file performance of the work for which this permit is issued ISec' MICROFILM -
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.). 8.00 "
Lender's Name - HEATI NG UN IT 100,000.B.T.U.)9.50 ELECTRIC Z
Lender's Address
I certify (hut I have read This application and state that fire above VENTILATION FAN (SINGLE), 4.00 d (/
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building constructi(n, and BOILER-.COMP(3 H.P.Or 100,000B.T.U.) 6.00
herehy malmoDe representatives of this city,to enter upon the
ubuvomenfioned property for inspection purpows, BOI LER-COMP.IOver 100,000 BTU)SEE FEE SCH. ;MECHANICAL
(Wc) agree to save, indenmify and keep harmless the City of MISC:- ,REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which' PERMIT ISSUANCE' 10.00 CONST.TAX
ay in any way accrue against said City in consequence of the
' .. MECH.CONT.' LIC.NO. MECH. • -
ii4re 4r, TOTAL TOTAL 2Y.37.
Signature of Applic' ntractor rate' '
OFFICE COPY''