16482 POST THIS CARD NEAR FRONT OF BUILDING � .
a - PERMIhNUMREFi .
CITY OF CUPERTINO 16482:
INSPECTION DIVISION
JOB INSPECTION RECORD'
r
` PERMIT EXPIRATION
rt
JO DO UNITBD _ LOT# *fin
PERMIT EXPIRES,IF,WORK
OWNER 6 r1 _ ` CAS-+ CONTRACTOR FWT l>�u! IS NOT STARTED WITHIN
4L
INSPECTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMIT SSU- .
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:' LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED i.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
- GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
'UNDERGROUND /SLAB Jv��
PLUMBING v v
ELECTRICAL ' ISSUANCE DATE
MECHANICAL BLDG ELECT. PLG. 'MECH
r ..❑ ❑ ❑ .�
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
^° INFORMATION
WOOD FLOOR VALUATION $TET.
PLUMBING -
MECHANICAL
ELECTRICALPERMIT TD
FRAMING
STORIES TYPE CONSTR�
INSULATION ..
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID '
BUILDING USE
' ROOF SHEATHING RES IND CON PB ov—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ �' ❑
ASSESSORS PARCEL NO:
ROUGH SANA ;
PLUMBING ELECT.ENERGY
TRACT NO. PARCELED
TUBS&SHOWER PAN PLUMBING ENERGY _ �;•
MECHANICAL' MECH.ENERGY • '^
L ACC.DATE ALC.FILE NO.
ELECTRICAL BUILDING ENERGY pG ,
FRAMING ELECT.FINAL TEST FEB
ZONING ENc.SITE Eo.
INSULATION PLUMBING I '
GAS TEST GAS .
qft
MECHANICAL FIRE SPRINK. ENERGY T.29
v ❑ N❑ V ❑ N_❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - _ _ 2„
FLD ImrvP A.LUC.
EXTERIOR SHEAR ELECTRICAL RELEASE '
INTERIOR SHEAR FIRE DEPT. _ v❑' N❑ Y ❑ N❑'
SHEETROCK GRADE" FEESUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS . BUILDING
SCRATCH.COAT . ELECTRIC - PLAN.CHECK •
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.• PLUMBING'
z PLEASE GIVE.JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHAwcAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. 1 1
OFFICE COPY
A YL•IGANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER _ _
BUILDING APPLICATION & PERMIT 4
ADDRESS 6
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 6
82 ,
OWNER'S cnr! PLAN CHECK VALIDATION
rvgmE OTY. ELECTRIC PERMIT FEE
1 PHONE
f NOMTRAcroR's - 'OUTLETS-SWITCHES-RECEP .10:00/1.00
i
1 LIC,NO LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL ,4.00 '
DDRESS /] '
PHONE —1 PANELS 10.00 GATE OF APPLICATION.
A .
ARCHITECT +. - PLAN CHECK FEE P.C.ND.
on PANELS (OVER 200 AMP,) 20.00 ..
ENGINEER 1 '
LIC.NO. SIGNS TRANS. 3.007H C '
ADDRESS ENG. SPECIAL CIRCUIT 5:00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPucgrvr's
AMOTORS . . SEE FEE SCH.
DDRESS
q QCA. SERVICE CHANGE •20.00 �%� �-
w O o LICENSED CONTRACTORS DECLARATION
u I hereby affirm that I am licensed under provisions of Chapter 9- r- ISSUANCE GATE `
¢ 1
H<N' (commencing with Section 7000)of Division 3 of the Business and - BLDG„ ELECT. PLG. MECH.
F m z Professions Code, nd y license is in full 1'm, d _ ❑ ,❑ ❑
Z License lass _ Lie Numbe
m F w Date Con Nacmr�y��
¢ x s - ' Own 1 BUILDING PERMIT
¢ a w ¢ OWNER-BUILDER DECLA A INFORMATION
oa" MISC.- REFER TO ORD
X ; y I hereby affirm ingthat
I onexempt front the Contractor's License. VALUATION $/FT.
F n. U. Law(or the following reason. 703L5.Businessland Professions PERMIT ISSUANCE 10.00 -
Code:Any city Or county which requiresit permit to construct,alter, -
QQ Q Q Improve,demolish,or repair any Structure,prior tO its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
IL O LL' requires the applicant for such permit to file a signed statement that TOTAL - PERMIT TO
w m he is Iicensd pursuant to(he provisions of the Contractors License
Fri Late(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢=$ the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(1500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
men's intended or offered for sale.If,however,the building GAS 6.00
men's are
or improvement is sold within one year of completion,the owner- BUILDING USE
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2,00
prove for purpose of sale.). RES IND CON PB Other
INDUSTRIAL WASTE INTER. 30.00
❑' 1.d as owner of the construct
am exclusively contracting with ❑ ❑ ❑ . '❑
linens, contractors m construct the project La 7044,Business LAWN SPR IN KLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
and Professions Code:The Contractor's o License Law does not apply
to tr owner of property who builds tr improvesthereon.n,and who LAWN SPRINKLERS-OVER 6 (EA.) 1,00
contracts for such projects with a confrnetor(sl license,pursuant to SEWER-SAN ITARV-STORM EA.200ft/10.00
The Contractor's License Law. � TRACT NO. ' PARCEL NO.
❑ Iamexemptunder Sec. ,B.&P.C.forthis WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that I have a cerlificate of consent to self-insure,or a certificate of Workers'Compensation Insurance,or a certified - ZONING ENG.SITE NO.
copy Thereof 1�1$ejy�3,�00,Lab.C. 1 e
Policy NOLT�LIetiyompany` r7il
Q ❑ Certifiedcopy is hereby furnished. i1Lf FIRE SPRINK ENERGY T@4
Z Z pro
i1'f CeIrified�Py p�(Ipd with the city inspection division. -
O Applicant !fig[C61._IJ C'— — MISC.- RE ER TO ORD. ❑ N Q y ❑ N❑
CCT CERTIFICATEEXEMPTION FROM WORKERS' PERMIT ISSUANCE ' .FLOOD ZONE A.L.U.C.
LU >_ COMPENSATION INSURANCE PLG.CONTR. LIC.N0, PLG.
CL a (This section need not be completed if lite perDtlt is for one , TOTAL Y❑ N❑ Y❑ N❑
Z hundred dollars 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
U_ j- mi(is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
0 w Date Applicant ALTER OR ADD TO MECH. 5,00 BUILDING
NOTICE TO APPLICANT: If,after making this Certificate of F-x-
F ? emption,you should become subject ratite Workers'Compensa ion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10 FEE
U such provisions or this permit shall be deemed revoke,. ,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MIC-F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) �P650
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000.B.T.U. x..90 MICROFILM
3097,Civ.CJ. -
Lender's Naml a.Ml h e� HEATING UNIT(OVER 100,000 B.T.U.) ELECTRIC
Lender'.%AddresLd2iP ----o-.
I certify that I have read this application and sLje 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 relining to building construction, an, BOILER-CUMPI3 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to'enter upon the
above-mentioned property for inspection put gver 01 LER-COMP IO100, 1 SEE FEE SCH. t(S MECHANICAL (�}�
poses. 3,Sa
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs andexpenseswhich CONST.TAX
ay�paa
against said City in consequence Of the PERMIT ISSUANCE It� 1 ..� MECH.CONT. LIC.NO. MECH.
BqTOTALTOTALntractor Date .I i
LI �-cj 1 1 CBPI�. C.)q 2�-f' d OFFICE COPY