16669' POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
y JOB INSPECTION RECORD
JOB ADDRESS //GO c1�� �[
"'^�� ��'�/=- c7"UNIT# _LOT#
OWNER V CONTRACTOR '5�:— Z E4 2! CJ
PERMIT NUMBER
16669
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180.DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DA E INSPECTOR
INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL 13E INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
LIFER
PREGUNITE
PERMIT VALIDATION
q .,
e%Q
pf%jpV ISSUANCE DATE
G ELECT PLc. MEC«
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
Of� -
,
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD FLOOR -
PLUMBING
f
VALUATVN V
g+FT.
MECHANICAL
ELECTRICAL
PERMIT TO
c -Fr ELe is
FRAMING. -
INSULATION
STo IES
TYPE CONSTn.
-
OCC. GROUP
RES. UNITS
'
'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SOFT FLOOR AREA
.
TOTALACREALE '
j
DIAPHRAGM
ROOF SHEATHINGRes
INOUILDING USEPa 00oN,I
❑ ❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
-
ROUGH
SANS
ASSESS ORS PA RCE L NO
'
PLUMBING -
ELECT. ENERGY
TUBS & SHOWER PAN
PLUMBING ENERGY
TRACT NO
PARCEL NO
MECHANICAL
MECH,ENERGY
ELECTRICAL
BUILDING ENERGY
ACC DATE
ACC. FILE NO
'
,
FRAMING
ELECT. FINAL TEST
INSULATION
PLUMBING
ZONING
ENG. SITE NO.
GAS TEST
GAS
MECHANICAL
,FIRE SPRINK
v ❑ NF]'
ENERGY 1.74
Y ❑ NO
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
FLOOD ZONE
Y ❑ N❑
A L U.C.
Y ❑ No
INTERIOR SHEAR
FIRE DEPT. -
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
INTERIOR,LATH
,T,EMPORARY APPROVALS tj
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
- -
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505,
F -ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
ELECTRIC
a�
PLUMBING'
MECHANICAL
CONST. TAX
TOTAL
OFFICE COPY
_., -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION
-
APPLICATION &PERMIT
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
PERMIT NUMBER
16669
ADDRESS d
Aon Ess
Q �Y
G
OWNER'$
NAME
l/ /� Q✓•I}. PHONE ✓
CITY- ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
NAME °R5 I
.zG/�Yiii/ uc.Na G.S��
UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS S.y/1�✓i/ G
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
sr Q� ONE
DATE OF APPLICATION.--!
ORRCHITECi
ENGINEER
LIC. NO
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.G. NO:
ISIGNS TRANS. 3.00
nooeess ENG.
SPECIAL CIRCUI 5,00
PERMIT VALIDATION
EMP. METER78 POLE IN 20.00
' ZIP
(\(�//f►`/'C.J,
'-
APPLICANT '$
ADDREss !
r Jy Y S qA i[
MOTORS SEE FEE SCH.
SERVICE CHANGE 20
LICENSED CON TRACTORS DECLARATION
I hereby affirm that I am licensed under provisima of Chapter
(commencing with Section 70001 of Division 3 of the Business and
Professions Code nd my license is in full fort < c
License Class Lie. Nmnber
Date Contractor
ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
0 ❑ ❑ ❑
Cope
v
OWNER BUILDER DECLARATION
I hereby nolle that I am exempt from the Contractor's License
Law( Athe followingreason. (Secuiresa,ernut lssand Professions
Code r Any city or county which requirese permit to construct, ah`q
p �
\tY
BUILDING PERMIT
INFORMATION
MISC. — REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION $/FT.
ELEC. CONTR_ LIC. NO.
ELEC. �Of
TOTAL Q t
improve, he applicant repair h permit toff pa sigmr to its issuance, also
requires licensed the applicant for such permit t° file a signed statement that
License
he is licensed pursuant to the provisions of the ) ofD Division
: inessa and Dtherefrom the
Business and Professions Code) or that he is pt therefrom and
Professions odeng ) or Section is exempt
PERMIT TO
QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption. Any applicant
of Section malty
by any applicant fora permit subjects lheopplicam macivil penalty
of not more than five hundred dollars :
STONES
TYPE CONSTR.
ALTER-DRAIN&VENT-WATER(EA.) 5.00
O _L my em as owner the property, or my employees with wages as
their sole compensation, will Ja the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6,00
$O. FT, FLOOR AREA
TOTAL ACREAGE
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
meritsarenetintendedoroffered for sale. If, however, the building
or improvement is Sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or am-
I GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
Drove for purpose of sale).
❑ L as owner of the property, am exclusively contracting withINDUSTRIAL
RES IND CON PB Gore,
El 0 El El El
WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: T'n
The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
l ASSESSORS PARCEL NO.
contracts for such projects with a contraetons) licensed pursuant to
the Contractor'sLicense Law.
❑ Iamexempt under Sec. - ,B.&P.C. for this
reason
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6,00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE N0.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby affirm that I have acertifrcateofconHot toself-insure,
ZONING
ENG. SITE NO.
or a certificate of Workers' Compensation Insurance, or a ramified
e
ocof Isco 3800, Loh.C.l. Z /
Polleylicy No Compo y
P�Qv�r
❑ Certified copy is her y./' nished.
p/ CerI111' CO y es II I pC IOD division.
Ap'pilcant!
FIRESPRINK
YE] N�
ENERGY T-24
Yo NE]
MISC- REFER TO ORD.
CERTIFICATE, 017 EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
PLG, CONTR. LIC. NO.
PLG.
TOTAL
v ❑ N
Y ❑ N❑
hundred dollars IS 100) or les,)
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any mannerso as to
CITY. MECHANICAL PERMIT FEE
FEE SUMMARY
become subject to the Workers' Compensation Laws of California.
ALTER OR ADD TO MECH. 5.00
Date Applicant
BUILDING
NOTICE. TO APPLICANT: If, after making this Certificate of us-
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10MDCF.M.) 4.00
PLAN CHECK
FEE
emption, you should become subject to the Workers Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall he deemed revoked.
AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.T
EXHAUST HOOD (WITH DUCT) 5.00
HEATING UNIT (TO 100,000 B.T.U.) 8.00
MICROFILM
Lender's Name
Lender's Address
H EATI NG UN IT (O V ER 100,000 B.T.U.) 9.50
ELECTRIC
low
I certify that I have read onsapplicution and smte that the above
VENTILATION FAN (SINGLE) 4.00
information is correct, 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
representatives of this'city to enter upon the
hereby above-mentioned
above-mentioned property torinsp of th purposes.
PLUMBING
BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP IOver 100,000 BTU) SEE FEE SCH.
MECHANICAL
(We) agree to save, indemnify and keep harmless the City of
Cupertino against li ilities, judgments, costs and expenses which
may in any way term` against said ity in consequence of file
g nor %
/a
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.001CONST.
TAX
MECH. CONT. LIC. NO. MECH.
TOTAL
TOTAL��-
S4
Signat re of Applicant/Contractor D'
OFFICE COPY