16215 POST THIS CARD NEA,R.FRONT OF. BUILDING PERMIT NUMBER .
J CITY OF CUPERTINO 16215. 1 .
, ' INSPECT'ION DIVISION,
JOBINSPECTIOIN RECORD ,
• ' . - PERMIT EXPIRATION -
JOB ADDR ESS 'A" UNIT#" LOT#
C
PERMIT EXPIRES,IF.WORK
OWNER ' L6-. Cdl- V - CONTRACTOR 0 �.- IS NOT STARTED WITHIN
INS TION DATE INSPECTOR I SPECTION RECORD, 180 Dnvs of PERMIT lssu- I
FOUNDATIONNOTE: ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION. '
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE CUPERTINO'STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'
UNDERGROUND /SLAB ' l+
PLUMBING
EISSUANCE DATE
ELECTRICAL '
y - BLUG. ELEf,T. PLG, MECH.a
MECHANICAL
DO NOT POUR FLOOR'UNTIL ABOVE HAS BEEN SIGNED x' BUILDING PERMIT,*
INFORMATION
WOOD FLOOR - vnwnnoN SIFT.
PLUMBING.
MECHANICAL "
• PERMIT TO '
ELECTRICAL , y
FRAMINGallF+� 'y
• STUHIES TYPE CONSTR. a
INSULATIONot
'
r►ino
OCC.GHUDP HfiS.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' SI),FT:FI.IJOR PHfA TOIflL AGH[AGE
- - ROOF 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
' ROOF SHEATHING HES IND CON PB .OP" '
I. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q El E]ARcO ❑
o.
ROUGH. SAN.W
PLUMBING ELECT.ENERGY. -
THACTNO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY . • ,
MECHANICAL MECH.ENERGY
ACC DATE ACG FILE.NO.
ELECTRICAL BUILDING ENERGY - - -
FRAMING ELECT.FINALTEST " -zowNc ENc.SITE No.
_ INSULATION - - PLUMBING--.
GAS TEST - GAS
, FIFE SPHINK - ENERGY G24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.LUC 1
EXTERIOR SHEAR ELECTRICAL RELEASE
-INTERIOR SHEAR
r FIRE DEPT. - vE] Nv'D NQ,
SHEETROCK - GRADE- FEE SUMMARY
EXTERIOR -LATH - BUILDING TEMPORARY APPROVALS - BUILDING ' "�"'
INTERIOR LATH
SCRATCH COAT - ELECTRIC PLAN CHECK v
.. GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM,
ARRANGE FOR INSPECTION BY PHONING 252-4505; ' ELECTRIC`
Lu ONE WORKING DAY BEFORE REQUIRED'INSPECTION.
,•• ; 00 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBINGZ + - o- MECHANICAL-
= SEE PERMIT FOR EXPIRATION DATE
IMPORTANT! CON ST.TAX'
PLEASEAEAD REVERSE SIDE BEFORE . TOTAL
CALLING'FOR FINAL INSPECTION. -
OFFICE COPY •, ,�
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALLPOINT PEN ONLY,
` - 'v`BUILDING PROJECT I'DENTI FICATIONPERMIT NUMBER
BUILDING APPLICATION & 0PERMIT. 1.0 2,1C
ADDRESS ftffI _1 I J
• BUILDING ELECTRICAL" PLUMBING—MECHANICAL
.g .
OWN
ER'S I PL AN CHECK VALIDATION
(
NAME'-
. CITY. ELECTRIC PERMIT' FEE -
;PHONE 4'
NoMEaCTOR's. OUTLETS-SWITCHES ,RECEP 10.00/100 `
/� .LIC.No. LIGHTING FIXTURES 10.00/1.00
rvTRA Toss g� "'APPLIANCES RESIDENTIAL 400 TEES ^
ry(+V �G!/vI3EJ� -71 PHONE yS/� PANELS, 10.00 DATE OF APPLICATION
ARCHITECT ', " .
OR
_ PANELS (OVER 200 AMP) ..20.00 PLAN CHECK FEE PC NO.,.
ENGINEER
t;�ue No, SIGNS TRANS: - + 3.00 -
ARCR.OR ENG. PERMIT VALIDATION
' ADDRESS � - � SPECIAL CIRCUIT 5.00 I' - _
i,p TEMP.METER OR POLE INS. - 20:00
APPLICANT's MOTORS SEE FEE SCH - _
'
ADDRESS
� - r/
SERVICE CHANGE - 2000
woo, LICENSED CONTRACTORS DECLARATION
It rwi w I hereby affirm that 1 am licensed under provisions of Chapter) - _ ISSUANCE DATE
z (commencing with Seetian 7000)of Division 3 of the Business and
BLDG. ELECT.' "PLG. MECH.
F w i Pmfeselons Code ntl icens'e is in full farcy,ll
o 0 m W License Class Lia Number ,'�
F m r J Date - Contractor
it
rt o OWNER-BUILDER DECLARATIONBUILDING•PERMIT
Iu * INFORMATION
wI hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO,ORD,
uO ¢ Law for the following reason.(See,7031.5,Businessand Professions PERMIT ISSUANCE ' 10.00 - VALUATION $/FT.
t_ — Code',Any city or county which requires a permit to construct,alter, - t
rt ¢0 improve,demolish,or repair any structure,prior to its is also ELEC.CONTR. LIC.N0. „ ELEC. _ .,'
'� Ie requires the applicant for such permit to file a signed statement that TOTAL
In Wpm a- PERMIT O
he is licensed pursuant to the provisions of the Contractors License
z a
Law(Chapter 9(commenciagwith Section 7000)of Division 3 of the - -
i O Business and Professions Code)or that he is exempt therefrom and QTY. 'PLUMBING PERMIT -FEE
the basis for the alleged exemption.Any violation of Section 7031.$ _ STORIES TYPE CONSTR.
u 3 m by any applicant for a permit subjects the applicant to a civil penalty
of let more than flue hundred dollars($500).): ALTER-DRAIN&V,ENT-WATER-(EA.) 5.00 ,
_ - o 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 offered for sale(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF„AREA,COND. 5.00 +
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES'PER TRAP_ - - 5.00 - SO.FT,FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve- _
- ments a or not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS.6:00
or improvement is sold'within one year of completion,the owner- GAS-EA:SYSTEM-OVER 4(EA.) . .2.00 BUILDING USE '
builder will have the burden of proving that he did not build or irm .. •'
Prove for purpose of sale.). REB IND - CON PS Other
. ❑ I,as owner of theproperty,am exclusively contracting with INDUSTRIAL WASTE'INTER. 30.00
- ❑ ❑ - .❑”. ❑ ❑
licensed contractors to construct the priced(Sec. 7044;Business . LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not applywho
to anownerfo ouch ,ortywho witl,, ds oactors)licen -d po and who ' LAWN SPR INKLERS-OVER'5'(EA.)^ 1.00
contracts for such projects whh a coniructorfs)liwnsed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 - ~
' the Contractor's License Law.'" - TRACT NO. + PARCEL NO. '
s reason)am exempt under Sec. ,BARC.I'.,this,, WATER HEATER W/VENT 6.00 "°•y - - I
Owner Date WATER SYSTEM 5.00 - , ACL.DATE Ace FILE No.
WORKERSI'COMPENSATION'DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, • - - ZONING' ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified _
copy there �J.any '
PDE No.� any .. .
❑- Certified c py is hereby furnished. FIRE SPRINK :,.,ENERGY T 24
Z.2 ❑' Certified copy is filed with the city mapection division. FIRE
REF ORD.
O Applicant 'V❑ N❑ Y E] N❑ .
CC n - 1
— • CISRTI PICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE ..FLOOD ZONE' p' A.L.U.C.'
LU > r. COMPENSATION INSURANCE' PLG.CONTR. - LIC.No. @�
- (This section.need not be completed if the permit is for one _ _ _ WTAL " _ _ ❑ :N❑ v [J _ .N❑
hundred dollars($100)or less.) .'. -
U O ,1 certify that in thgperfonnance oLthe work for which this per-,t OTY. MECHANICAL PE MITC� FEE FEESUMMARY
LL I— mit is issued;I shall not any person In any nmnm
ner so.as " ,
V O W become subject to the Workers'Compensation Laws of California. ?O lie BUILDING
y - Date - Applicant' _ ' ALTER OR ADD MECH.
-} m NOTICE TO APPLICANT: If,after making this Certificate 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 ` ^ FEE •'
U such provisions or this permit shall be deemed revoked, .AIR HANDLING UNIT(TO 10=C.F.M.)' 4.00
CONSTRUCTION LENDINGAGENCY AIR HANDLING UNIT(OVER 10PWC.RM.) 6.00 SEISMIC FEE ..
I hereby affirm that there is a construction lending agency for EXHAUSTLHOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. - - MICROFILM'
3097,Civ.C.).' . - HEATING UNIT(TO 100,000 B.T:U.) 8.00 -
Lender's Nam
Address
HEATING UNIT,(OVER 100,000 B.T.U.)9.50
' - Lender's AAddress .ELECTRIC ..
• I certify that l have read this epphcetmo and state tlmCthe above _ VENTILATION FAN (SINGLE),3 4.00
information is correct.1'agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction and BOILER-COMP(3H.P.oilOO,000B.T.U.) 600
hereby authorize representativesofthis city es Lnter'upim'the BOILER-COMP(DVB,100,000 BTU),SEE FEE SCH. .MECHANICAL ' g 4V
above-mentioned property forinsp ofth i purposes ',n
Y (We) agree to.save, indemnify and keep hmin ess,ille-City of ' MISC.- " 'REFER TO ORD.' -
upertino against liabilities,judgments, costs and-expenses which ,', r CONST.TAX -
ay'in any way accru against said City in consequence of the PERMIT.ISSUANCE -
TamingofthispermitM ECH:CONT. .r LIC.NO. MELH.
orAL r i TOTAL .
- Si ore of Ap i M/ t Date - I
> '.OFFICE COPY .