16555 POST THIS CARD NEAR FRONT'OF BUILDING
• PERMIT NUMBER
r� 7
CITY OF CUPERTINO 16555
INSPECTION DIVISION `
JOB INSPECTION RECORD "
PERMIT EXPIRATION
JOB ADDRESSS`"ILJ" �.t11n1�P �- UNIT# _LOT# '
/ PERMIT EXPIRES IF WORK'.
OWNER - CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECO D 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
LIFER NOTE: LASTCALLED INSPECTION.
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE + TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION --
•
GARAGE SLABS CUPERTINO STANDARDS. �..
4 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
- - PLUMBING - J /ATE
ELECTRICAL, . I SOA
MECHANICAL _ eLoc ELECT PL MECR..
- - ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABCVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR - - - INFORMATION
VALUATION.' $yF T.
PLUMBING ` ,
MECHANICAL -
ELECTRICAL' - PERMITT
FRAMING - �I +
INSULATION - STORIES Jyj CONSTR
+ - ROCC.GROUP RES UNITS
V
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
• -� .
ROOF u NOTE:NO FINAL INSP,SHALL BE MADEBEFORE 50.FTFLOOR AREA TOTALACREAGE
DIAPHRAGM. THE CONSTRUCTION TAX ISP AID` CVQ 01%j ~, BUILDING USE
ROOF SHEATHING •' +' - C1�y G� RES IND CON PB Ou,r•
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ROUGH
ASSESSORS PARCEL NO.
_ SAN.# -
PLUMBING _ ELECT.ENERGY
_ TRACT NO. PARCEL NO.
TUBS&SHOWER PAN ,PLUMBINGENERGY
^ - MECHANICAL MECH.ENERGY. '
., ELECTRICAL `. •' - :BUILDING ENERGY T .ACC DATE ACC,ERE NO.
FRAMING': ELECT.FWALTEST -
t ZONING - 'ENG.SITE NO. '
R INSULATION' '
, PLUMBING ` 2_.��
GAS TEST. GAS
• � FIRE SPRINK ENERGY T 24
MECHANICAL ,. v ❑ N� '„v ❑.. NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L U.C.
EXTERIOR,SHEAR ELECTRICAL RELEASE I
INTERIOR SHEAR FIRE DEPT::. Y ❑ N� Y I] .N❑I
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR"LATH`. TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC ` - PLAN CHECK
GAS FEE' .
' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING•IS NOT PERMITTED UNTILBUILDING FINAL IS SIGNED BY-BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY.PHONING M-4505 ELECTRIC
F� ^ ONE WORKING DAY BEFORE REQUIRED INSPECTION PL.UMBINc
O PLEASE GIVEIJOB ADDRESS WHEN PHONING.
z -'SEE PERM T.FOR EXPIRATION DATE - MECHANICAL
'IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL dC�
,. CALLING FOR FINAL INSPECTION.
OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES — USE BALL POINT PEN ONLY
I BU I LDING PROJECT IDENTIFICATION _ - 'PERMIT NUMBER 11
U,Lp,NG APPLICATION & PERMIT '
16,555
ADDREs' ^1� 6000)<
YdJKGaUVE �lQ BUILDING—,ELECTRICAL—PLUMBING•—MECHANICAL �,5[
5
OWNERS
NI`u
• NAME U - PLAN CHECK VALIDATION
QTY. ' ELECTRIC PERMIT FEE
FGM PIT NE -38
CONTRACTORS
NAME fin/ /Aj q �/ OUTL'ETS-SWITCHES-RECEP 10.00/1,00
1 Ic.rvo Q J LIGHTING FIXTURES. 10.00/1.00
'S
CONTRACTOR - ' '
ADDRES T �J �q•�T. PPLIANCES-RESIDENTIAL 4.00
S L J PHON[j/VJ' U/d•,' PANELS, 10.00 DATE OF APPLICATION
ORRC ITECT PANELS (OVER 200 AMP) 20.00 - PLAN CHECK FEE P.C.No.
ENGINEER '
LIC.No. . SIGNS TRANS. . . 3.00
ARCH.OR ENG. � T-'
ADDRESS S SPECIAL CIRCUIT ' 5.00 PERMITVALIOATf:,;:.Fy+-
'3,P" • EMP.METER OR POLE INS. 20.00
APPLICANT'S
MOTORS
ADDRESS � ° SEE FEE SCH.
SERV ICECHANGE 20.00
o ¢ =
Hao LICENSED CONTRACTORS DECLARATION
a Es w 1 hereby affirm that 1 am licensed under provisions of,Chi pier 9 • - - I SUAN E DATE
(commencing with Section 7000)of Division 3 of the Business and
F w 2 Professions Co c,aI y license is in full for' 3 d e e BLDG. ELECT- L MECH.
oimW License Class -_Lic.Numbertl�� �' ❑ "❑
H w H Date Contractor "
BUILDING PERMIT
¢
OWNER-BUIL
o a DER DECLARA o INFORMATION
X g LL y I hereby affirm that I am exempt from the Contractors License MISC.— -• REFER TO ORD
u 0 rt law for the following reason.(Sec.7031.5,Busmessend Professions - I,"- VALUATION- $/FT.
H — g PERMIT ISSUANCE ' ;10.00
•A � Code:Any city or county which requires aperminoconstruct,alter, '
2 Q ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC..CONTE. LIC.NO. ELEC.
sii:
o,¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w w he is licensed pursuant to the provisions of the Contractor's License _ ^
HiQ
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he is exempt therefrom and OTY. •PLUMBING PERMIT EE
W H $ the basis for the alleged exemption,Any violation of Section 7031.5 - TORIES TVP CONBTR.
n3.- by any applicant fora permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER.(EA-) 5.00 . -
of not more than five hundred dollars(5500).).
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE :00 Roue RES.UNITS
their sole compensation,will do the work,and the structure is not. - - e
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00. Ot
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.06SD.FT.FLOOR AREA ' TOTAL ACREAGE
himself or through his own employees,provided that such improve-
meetsarenotintendedorofferedforsale.If,however,the budding GAS-.EA.SYSTEM-1INC.4 OUTLETS 6.00
."iin provement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). IINDUSTRIAL WASTE INTER ' - 30.00 RES ,. IND -CON PB ' Omer
.
❑ I,as owner of the property,am exclusively contracting with O O
licensed contractors to construct the.project(Sec. 7044,Business LAWN SPRINKLERS-i INC 5 V.B. , •6.00 - ASSESSORS FARDEL NO.
and Professions Code:The Contractor's License Law does not apply - _
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 pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 -
the Contractor's License Law. TRACT NO, PARCEL NO.
tee❑nl am exempt under Sec. ,R&P.C.for this WATER HEATER W/VENT. Q.0atlQ -
OwnerDate WATER SYSTEM' 5.00
ACC.DATE ACC.FILE No..
WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I hav a certificate of consem to self insure,
or a certificate of Workeis' mpensuti Ins once,or certified ZONING ENG.SITE NO.
copy t ( c 500,Lab. ) -
Policy Company
!] ❑ C [ e op is hereby rnahed.`
Z Z Cerlifie py is Bled hit the city inspection'division. - - FIRESPRINK ENERGY T.-24
O Aplicznt MISC.- REFER TO ORD. ; y� N[ ' Y'F ,;.No
~ rn PERMIT ISSUANCE CERTIF C 'I'MOF PENSAEMPTINS FROM WORKERS' CE -LSO• FLooD ZONE A:i.u.c!
UJ OMPENSATION INSURANCE PLG.CONTE. - LIC:N0. PLG. -
1 O .(This Section need not be Completed if the permit is for one a TOTAL77 -'1ff4do Y t N Y Q N13
Z hundred dollars($100)or less.)
U O1 certify that in the performance of he work for which this per-
QTY MECHANICAL PERMIT FEE FEE SUMMARY. `.
LL H mil is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
y Date—ApplicantBUILDING
} So NOTICE TO APPLICANT: If,alter making this Cerfificatc of Ex- ALTER OR ADD TO MECH. _ 5.00 ,
Z_ emption,you should become subject to the Workers'Compensation APPLIANCE
�- provisions of the Labor Code, you must forthwith comply with - 6.00 PLAN CHECK '
U such provisions or this permit Shall be decried revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency I'or EXHAUST HOOD(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
Leader's Name HEATING UNIT 100,000 B.T.U.)9.50 "
Lender's Address ELECTRIC
1 certify that 1 have read Ibis application and state that the above VENTILATION FAN (SINGLE) 4,01)
information is correct. I agree to comply with all city and county 'BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING �J
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city m Cuter upon'[he ,BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby nentlo'm prop rte forinspection purposes. "
(We) agree to save, indemnlQ' and keep harmless the City of MISC.- REFER TO ORD.
upertin.against Babil ies,judgments, costs and expenses-which "pERM1T ISSUANCE 10.00 CONST.TAX• '
may in y way aceta against said City in consequence of the
ranting his permit. , MECH.CONT. - LIQ°NO.'. MECH. '
TOTAL TOTAL DU`
- Signature icant/Contractor Date -
OFFICE COPY