16483 POST THIS CARD NEAR FRONT OF BUILDING - PERMIT NUMBER
CITY-. OF CUPERTINO 6483
INSPECTION DIVISION
JOB-INSPECTION'RECORD .
^PERMIT EXPIRATION.
JOB ADDRESS -� ""'�V �� 7 UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION • DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMITISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: - I LAST CALLED INSPECTION.
' LIFER ' -ALL GRADING`AND DRAINAGE SHALL BE INSTALLED -
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
PLUMBING
ELECTRICAL - ISSUAN
MECHANICAL - BLOC Ecec T. PLG. . MECR
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED S BUILDING PERMIT
INFORMATION '
WOOD FLOOR - VALUATION - $/FT, i
PLUMBING - -
I
MECHANICAL -
ELECTRICAL - PERMIT
�TTO�µ I
FRAMING
STORIES TYPE CONSTR, 1
INSULATION -
Ly - OCCGROUP RES UNITS
I■Ilf �' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •'
_ $O.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 No CON PB OMI,, ;
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE ' INSP.'
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING - - ELECT.ENERGY
I S TUBS&SHOWER PAN PLUMBING ENERGY ` � TRACT NOPARCELNO.
'
MECHANICAL MECH.ENERGY -
ELECTRICAL - BUILDING ENERGY Acc. o
onrE A
FRAMING ELECT.FINAL TEST
ZONING. ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T;24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "o "o
FLOOD ZONE ALUC. - I
EXTERIOR SHEAR ELECTRICAL RELEASE v N� v ❑
No'
INTERIOR SHEAR FIRE DEPT.
SHEETROCK• GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS , BJ)ILOwG�_
r
SCRATCH COAT ELECTRIC - PLAN CHECK
- GAS FEE
NOTAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
�r OCCUPANCY OF BUICDIN G IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM.
ARRANGE FOR INSPECTION-BY PHONING 252-4505, ELECTRIC
UJ
� ONE WORKING DAY BEFORE REQUIRED..INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.`
I .
SEE PERMIT FOR.EXPIRATIONI DATE - MECHANICAL-
IMPORTANT! coNST..rAx
PLEASEREAD REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL! ' . "
OFFICE COPY
OL"Tirlr S I�n�'�' 40 ✓
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL Pt7fNT PEN. L
r "
' BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
N,LEANG APPLICATION & PERMIT q C A Q3
OR s
Dis _ (51 I U`F U
�• K BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
Ly,•.e� PLAN CHECK VALIDATION
`
", 4 E OTY. ELECTRIC PERMIT FEE
•Wf
CONTRACTORS
N ME. OUTLETS-SWITCHES-RECEP 10.00/1.00
moffilIc.No LIGHTING FIXTURES _ 10.00/1.00
GONYTIACTOR's APPLIANCES-RESIDENTIAL 4.00
A�E
FHON PANELS10.00 DATE OF APPLICATION d4
RCNrtECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP)
O 20.00
ENGINEER - -
• - uc,No. ISIGNS TRANS. 3.00
ADDRESS ENO SPECIAL CIRCUIT 5.00 PE MITVALIDATION
-ZIP TEMP.METER OR POLE INS.' 20.00
APPLICANT sMOTORS SEE'FEE SCH.
/
MDOREs '.
SERVICE CHANGE 20.00
S o LICENSED CON'FACTORS DECLARATION
0o 1 hereby affirm that 1 am licensed under provisions of Chapter9 ISSUANCE E -
y z"' (cam me nein with Section 7000)of Division 3 of the Business and
10
N g BLDG. ELECT. PLG. MECH
D i Pmfeseians Code m 1 license is in full to n ❑ ❑ ❑
Z o`,%,- License .la Lie..Natn¢er -
D w w Date - Craumctnr ► SEP 13199
a Y E BUILDING PERMIT
OWNER-BUILDER DECLARATION
a wU INFORMATION
w ;v vHi 1 hereby a(Onn that I am exempt from the Contractors License MISC.- _
uoa Law for the following reason.(Sec.7031.5,BusinesslandPro@scions PERMIT ISSUANCE _ VALUATION $/FT.
3wCode:Anycily orcouity which requires a permit to construct,alter,
Q Q Q D Improve,demolish,or repair any structure,prior to Its IssnallCe,aISO ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file 3signed statement that TOTAL PERMIT TO
e w m he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chapter9(commerciag with Section 7000)of Division 3 ofthe
4 D Business and Professions Code)of that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
X 1- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toss civil penally ALTER-DRAIN -WATER (EA.) 5.00 n
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 ace.GROUP REB.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
T� Code:The Contractor's License Law does not apply to an owner of
V property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 So.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such imp rove GAS-EA.SVSTEM-11NC.40UTLET$ 6.00
mems are not intended or offered for sale.If,however,the building -
V;. =� or improvement is sold within one year of completion,Inc owner GAS-EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
•-,�•
builder will have the burden .en of proving that he did not build or im- - RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he 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 contractor(S)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA,200ft/10.00
TRACT NO. PARCEL NO.
❑ I am exempt no der Sec.-,BARC.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 i ACC.DATE ACC.FILE NO.
WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby atfirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copytiter- Lnb.Ct }���W
1'o1 Nr�,/•(ary'fyM(/$ mPanY-+�' r`
O ❑ Ce tirt red co e by famished FIRE SPRINK ENERGY T-24
Z Z Certi�fied �co�.yy�ias filed'wi I ti y�'q�ec ryh div MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O A hcant_ yir� Y N .Y N
~ rn PERMIT ISSUANCE 10.00 FwoD ZONE A.L.u.c.'
LU CL j' CERTIFICATE OF EXEMPT'TION FROM WORKERS'
COMPENSATION I NSURANCIi PLG.CONTR. LIC.NO. PLG.
tl O (This section need not he completed if the permit is for one TOTAL V❑ N❑ Y❑ N❑
Z hundred dollars IS 100)or less.) G
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT 1.6 FEE FEE SUMMARY
F iss
U_ mit is ued,I shall not employ any person in any manner so as to
U become subject to the Workers m
Copensation Laws Rf California.
0 G.W UMe - Applicant ALTER OR ADD TO MECH. U DING
} W NOTICE TO APPLICANT: If,after making this Certificate of F.x-
♦- Z eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN C ECK
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 LENDING AGENCY - AIR HANDLING UNIT(OVER IOPMC.F.M.) 6:00 SEISMIC FEE.
�1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of hhe work(or which this permit i issued(Sec. MICROFILM
3097,Civ.C.l. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nam 0 K' HEATING UNIT 100,000 B.T.U.)9.50 '
s-, Lender's Address - _ /•� ELECTRIC'
Icertifylhsstlhavereadthis oat dTSIL• ea VENTILATIONFAN (SINGLE) 4.00
A+ S� information is correct. I agree to comply with,all city and county y PLUMBING
ordinances and state laws relating to building construction, and BOILER•COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP DJA68BTU)SEE FEE SCH. �• MECHANICAL o
�• above-mentioned property for inspection purpoxs.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX
may in an way true against said City in consequence of the W
mating is rut. MECH.CONT. LIG NO. "E"L
TOTAL
C �'y� 335
ignamr o ppl an[/Contractor 1 ate Diu
rv- - •
OFFICE COPY.