16063 POST THIS CARD NEAR FRONT OF BUILDING ;hRMIT-EXPIRAT'ION
RMIT NUMBER
CITY OF CUPERTINO 16063
INSPECTION DIVISION
JOB INSPECTION RECORD i
1
JOB ADDRESS -/x,;3-3 UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER L 0',,I 6,-Ae-Go4_ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATEA INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF reHn+IT vnuDA nory
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB '
PLUMBING
ELECTRICAL -o- ISSUANCE DATE _
BLDG ELECT PLG", MECH
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR rVALUATION 'SIFT.
PLUMBING - �A V V"
MECHANICAL - - Q
1
ELECTRICAL �,{• .� PERMIT ro g�
-ti
FRAMING �: .�Ce,e �• sT
ITS TYPE CONSTR
INSULATION Ot
�/ OCC GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
tr , SD.FL FLOG DHEA TOT PL ACREPGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE O
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDINGuse
ROOF SHEATHING Hes IND COON ve 0'."
1:1 El El 11 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Assessoas PARCEL NO.
\ ROUGH - SAN.#
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY,
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE NO,
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST - zoNiNc -ENG,SITE NO.
INSULATION - PLUMBING
GAS TEST GAS
FIHESPHINK ENERGY LQO
MECHANICAL Y ❑ N❑ Y ❑ N❑
COVERNO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - -
FLDOD ZONE 0.LUC.
EXTERIOR SHEAR ELECTRICAL RELEASE � b•
INTERIOR SHEAR FIRE DEPT. v❑ N❑ w Lam„ N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING lot* •/b • BUILDING
INTERIOR LATH - TEMPORARY APPROVALS
ELECTRIC PLAN CHECK
SCRATCH COAT FEE
EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
IL ONE WORKING DAY BEFORE RINSPECTION.
•r,, F EQUIRED
PLUMBING '6 OL
OPLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL 7
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALLPOINT PEN ONLY
Bel LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
' "
AooREsS v
Z 3 Q�L1C1JfiP CT BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
�L.W Gp�� MDNE Z �
NOME CTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 34, _�+
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS ACTOR's
APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ORRCHlrecr PANELSIOVER-200 AMP) 20,00 PLAN CHECK FEE P_C.NO.
ENGINEER -
uc.NO. SIGNS TRANS. 3.00
ARCH,OR
ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP TEMP.METER OR POLE INS. 20.00
APPLICANT',
ADDRESS MOTORS - SEE FEE SCH. '
SERVICE CHANGE 20.00Q7'
o o LICENSED CONTRACTORS DECLARATION LdC Ti�/ Li �S �� V/'S Orr ,
H Z W I hereby affirm that l am licensed under provisions of Chaptei9 CDNIr✓/TS VNJ6+ta ISSUANCE DATE [
(commencing with Section 7000)of Division 3 of Business Rod
y Q H ELECT. ;P® MECH.
as z Professions Code,and my license is in full force and effect.
z o as — - License Class Lie.Number
_o y— O' Dide Contractor '
L
H —2 1 DING PERMIT
SE a OWNER-BUILDF,R DECLARATION 5 ` NFORMATION
X g LL I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
aaLLo ¢ Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE x.00 dp{„_ VAL , N $/FT.
Code:Any city or county which requires a permit to construct,alter,
in in ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC,CONTR. LIC.NO. ELEC. /� /
o LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License - -
HZi Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the Sa
— Q Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
aim by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (Eq.) 5.00
t of not more than five hundred dollars($500).1'. '
❑ I,as of the
owner the property,or my employees with wages as
their sole compensation,
will do the work,and the structure is nut BACK FLOW PROTECT. DEVICE 4.00 DCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ..
Code:The Contractor's License Law does not apply to an owner of _
property who builds or improves thereon,and who docs such work FIXTURES,PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building
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 Ile did not build or im - RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 El El El El El1,as owner of the property,am exclusively contracting with -
lice Sed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. it2 -- ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to as 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 pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. - TRACT NO. PARCEL N0:
❑ lamexem tender Sec. ,B.&P.C.far this WATER HEATER W/VENT• 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKF-RS'COMPENSA ON ECLARATION WATER TREATING EQUIP. —SAO.
1 hereby affirm that I have a certificate ofc.nscnt to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING .ENG.SITE NO.
copy thereof(Sec.3900,Lab.C.).
Policy No. Company -
O ❑ Certified copy is hereby furnished.
FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD.
O Applicant q Y [:] N❑ v ❑ N[]
CN CFRTIFICA'TEOFEXEMPTION FROM WORKERS' PERMIT ISSUANCE L FLOODZONE- A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0- Z( This section need not be completed if lire permit is for one TOTAL Y[:] N
N❑ v❑ ❑
hundred doll...IS 100)or less.) -
U O 1 certify that in the performance of the work for which this per, OTY. - MECHANICAL PERMIT FEE FEE SUMMARY
IL I. mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. 1
O w BUILDING
y Durc Applicant ALTER OR ADD TO MECH. 5.00 `J
} w NOTICE TO APPLICANT'. If,after making this Certificate of F.x-
F 2 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
V such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE f�`O
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.CJ. ,
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC s�
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER H.P.or 100,000 B.T.U.1 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
y above-mentioned property for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,Judy ents, costs and-expenses which CONST.TAX .
may in any way,accrue again, said City in consequence of the PERMIT ISSUANCE 10.00
ra gofmit MECH.CONT. LIC.NO. MECH,
OTAL TOTAL
Signature o pplicant/Contractor Date
OFFICE COPY