16727 POST-THIS CARD NEAR FRONT OF BUILDING
, PERMIT NUMBER
CITY OF CUPERTINO 16727
INSPECTION DIVISION,
JOB INSPECTION'RECORD . '
j PERMIT EXPIRATION
JOB ADDRESS Io s`7 b ' I-F ' `I V IL�c 'UNIT# _LOT# -, •I
., PERMIT EXPIRES IF WORK
OWNER - CONTRACTOR ,IS NOT STARTED WITHIN .
INSPECTION DATE INSPECTOR - INSPECTION RECORD 180.DAYS OF PERMIT ISSU-
FOUNDATION ' ANCE OR 180 DAY FROM
NOTE: - LAST CALLED INSPECTION.
LIFER ALL GRADING AND'DRAINAGE SHALL BE INSTALLED
PFIEGUNITE TO COMPLY WITH'THE APPROVED PLANS AND CIN OF " : PT;nnm vnuun MN
CUPERTINO STANDARDS. T i J
GARAGE SLABS - - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - PAIDJ�• E��..i�� °�`�, '
UNDERGROUND /SL'AB
PLUMBING
ELECTRICAL ' _ - - ISSUANCE'IIA rE
MECHANICAL City of Cup RLDG ELECT ,PLG. MEC".
. ❑ ❑ "❑ g N
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - .. INFORMATION
VALUATION" SIFT.
PLUMBING � - � � - '
MECHANICAL
RMIT TD
ELECTRICAL • - _ "
FRAMING (v`�-x
INSULATION
STORIES' IY PE CONSTR,
� -
-
- .VCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 FT,FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGMS - THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING HE.S IND . CON -PB OIIl.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 0 ❑
ASS ESSORSPAHCEL NO.
ROUGH SAN.# '
PLUMBING ELECT.ENERGY
TRACI NO. PARCELNO
TUBS&SHOWER PAN - PLUMBING ENERGY
MECHANICAL MECH.ENERGY -
ELECTRICAL BUILDING ENERGY Acc nnTz ncc.FILE No
I
FRAMING ELECT.FINAL TEST zowmr, ENG.SITE No,
INSULATION PLUMBING ' -
GAS TEST GAS' '
MECHANICAL —Z 2-9'V FIRE SPRINK ENERGY 1 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v N[j v El N�
FLOOD NE
EXTERIOR SHEAR ELECTRICAL RELEASE z AL.u,c.
INTERIOR SHEAR FIRE DEPT. r -N� v ❑ "�
SHEETROCK - - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING:
INTERIOR LATH ' TEMPORARY APPROVALS - rBOwG
SCRATCH COAT ELECTRIC- N CHECK -
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY MIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. OFILM
ARRANGE FOR INSPECTION'BY,PHONING 252-4505, CTRIC
H ONE WORKINGDAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! _ CONST.TAX
PLEASE READ REVERSE-SIDE BEFORE TOTAL
CALLING FOR FINAL,INSPECTION. T
OFFICE COPY .
4DPL,ICANT TO FILL IN INFORMATION WITHIN-RED LINES,- USE BALL POINT PEN.ONLV.
�> BUILDING PROJECT IDENTIFICATION ' - ,. r PERMIT NUMBER -
BUILOINc - r APPLICATION & PERMIT: 16727
• ADDRESS A .
- lV 6 4in15 BUILDING —ELECTRICAL—'PLUMBING—MECHANICAL "'. .
OWNER'S - -
NAME. , , PLAN CHECK VALIDATION.
S ' I ,a g DTV- ELECTRIC PERMIT FEE
f"J PHONE
COMER rolls OUTLETS-SWITCHES-RECEP 10.00/1.00'
f LIC.Na 0 Z— LIGHTINGFIXTURES 10.00/1.00 .
CONTRACTOR'S ;
ADDRESS r q �7 APPLIANCES-RESIDENTIAL' 4.00dkermy r
sr PH ONE?_7�J.0(ZZ PANELS 10.00 DAT EOFAPPLICATION'. -
ARCHJIeUi PLAN CHECK FEE P:C. O. .
OR PANELS (OVER 200 AMP) 20.00 "
ENGINEER '
LIC.No. ' SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG - SPECIAL,CIRCUIT ,5.00 PERMIT VALIDATION,
' ZIP ITEMP.'METER OR POLE INS. 20.00 . -/(-1 I'7]�(�I Y'/� �•
APPLICANT'S cJ /�,I`111�1�<.�-SLJ
ADDRESS MOTORS SEE FEE SCH. /
SERVICE CHANGE 20.Qq
1988
o ¢.z
1=
02 _ LICENSED CONTRACTORS DECLARATION .,
rt u u I hereby affirm that I am licensed under r
a y' pnvisione of Chapter9 '
Z w ISSUANCE DATE
(commencing with Section 7000)Of Division 3 of the Business mrd Ino ISSUANCE
PLG. . '.MECH
0 i Professions sg&, p y license is in full for' - ❑ ❑ ❑
z O w — ' License Class 4=G(,Jr� Lic.Numbe
9 y a, Date_/(�_� Contractor t/('T _
OWNER-BUILDER DECLARATION BUILDING PERMIT
o a u' INFORMATION
X g LL I hereby affirm that 1 am exempt from Ole Contractor's License MISC.= REFER TO ORD
w O Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
� — g Code:Any city or county which requiresa permit to construct,alter,ar PERMIT ISSUANCE 10.00
m7 ELEG CONTR. LIC.NO.
a a improve,demolish,or repair any structure,prior to its issuance,also '
ELEC. "
D m requires Ore applicant for such permit to file a signed statement that TOTAL -
A. YPERMILTO"
K
m he is licensed pursuantthe provisions of the )ofDictor's License _ r-�-
F i st Laiv(Chapter 9(commencingsionso )or Section is exempt therefrom and
E x 0 Business for tPe alleged Code)or that hu is lionaf therefrom and QTV. PLUMBING PERMIT FEE
K 1-p� the basis for fire alleged exemption.Any violation ofSection]031:5 STORIES - TYPE CONSTR.
a ; — by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN (EA.)of not more than five hundred dollars(S500)J: ,
❑ o compensation,
at the property,or my Band tireLitmei wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensatione will property,
the work,and the'x Owjth w is not
intended'., offered for sale (Seca 7044,,Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 r.
Code:The Contractor's License Law docs not apply to an owihcr of _ _ -
property who builds or improves thereon and who Ines such work FIXTURES,PER TRAP - - 5.00 soFrPLoofl aflea TOTAL ACREAGE
himself or,through his own employees,provided that such improve- . . ..
ments are not intended or offered for sale.If,however,the building. GAS-EA.SYSTEM-,I INCA OUTLETS 6.00
or improvement is sold within one year of completion,the owner- -
builder will have the burden of proving that he did not build or On GAS-EA.SYSTEM=OVER 4 IEA.) .. 2.00 BUILDING USE.:
prove for purpose of sale.). INDUSTRIAL WASTE INTER: 3000 RES IND - CON PB- Omer
❑ I,as owner of the property,um exclusively con .
contracting with ❑ El ❑ El .- Q -
- licensed contractors to construct the project(Sec. 7044,Business - LAWN SPRINKLERS-1 INC 5 V.B. "6:00
and Professions Code:The Contractor's License Law'dous ASSESSORS PARCEL NO.not apply r
to an owner of property who builds Or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) ,1.00
contracts for such projects with a contractors)licensed pursuuntto
the Contractor's'License Law. SEWER-SANITARY-STORM EA.200ft/10.00 FRAC,NO. PARCEL NO.
reason '
❑ lam exempt under Sec. • ,B:&P.C.I'at this WATER HEATER W/VENT. 6.00 '
Owner Date WATER SYSTEM - 5,00
ACC.DATE' , Ace.FILE NO,
WORKF.RS'COMPENSATION DECLARATION'. WATER TREATING EQUIP. a . 5.00
I hereby affirm that 1 have a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or o certified - ,jtZONING - ENG.SITE'NO.
copy thereof(Sec.3800,Lab.CJI _ - -t -
Policy No Cmnpony J
�.. ❑ Certified copy is hereby furnished.
x• FIRE SPRINK' ENERGY T24-
Z Z erli(icd 1pq Y is fled with tire my inspection division.
FO Apphcunt_Jj../�' /J - - MISC.- REFER TOORD, ' Y� N� Y ❑, IN
CI R1IFFIICA�TE SOF 17XEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 . FLOOD ZONE" 'A.L U.0 -
W �! COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. .PLG. '
4' O (This Section need not be completed if the permit is,for one - _ TOTAL Y N Q Y-C] ry
hundred dollars(S 100)or less) _
U. I certify that in the performance of the work for which this per- QTV MECHANICAVPERMIT - 'FEE "FEE SUMMARY
ly'I M mlt,is issued,1 eball.,at employ any person in any manner so as to
O DC')�KL�I become subject to the Workers'Compensation Lows of California
Date - Applicant ALTER OR ADD TO MECH. - 5.00 ' BUILDING''
} N NOTICE TO APPLICANT': If,after making this Certi(icdto of Ex- _
_ emption,you should become subject to the Workers Compensation APPLIANCE - 5.00 .PLAN CHECK -
provisions of the Labor Code, you must forthwith comply with - Y FEE
U such provisions or this permit shall be deemed revoked.• AIR HANDLING UNIT(TO 10)000OF.M.). 4,00 '
CONSTRUCTIONLENDINGAGENCY "AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
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(Sec. I MICROFILM,
3097,Civ.CJ. 'HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address - HEATING UNIT(OVER 100;000 B.T.U.)9:50 •s ELECTRIC '
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
's information is correct. I agree to comply with all city and coun D r PLUMBING
conslru '
ordinances and state laws relating to building _'am •a BOILER=COMP,I3 H.P.Dr.100,000 B.T.U.)..6.00
hereby authorize representatives of This city to Boer upon the -
above-mentioned property for inspedionpurpnses. BOILER-COMPIOver LOO,000 BTUI SEE FEESCH. MECHANICAL 'p�I �
(We) a to save, inde ify and keep hvrmlces the City of MISC.- REFER TO ORD. - -
aper o a 1 [ lhill Oe j dgments, costs and expenses which ,CONST.TAX
' may ihi y a rue gu' st said City in consequence of the PERMIT ISSUANCE +an0
mn[in h 1. MECH.CONT. LIC.N0. - MECH. /
A•�- TOTAL ' TOTAL
Signature of Applicant/Contractor'- Date - . I;OQ ( I.iQD
OFFICE COPY