16668 POST THIS CARD NEAR FRONT OF BUILDING
•, - / I, PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION 668
JOB,INSPECTION RECORD'', `
S PERMIT EXPIRATION
JOB ADDRESS S / 6 �'/�— Q-/'V C*— NIT# _LOT# -
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR � Z.- -6= - IS NOT STARTED WITHIN
INSPECTION D E INSPECTOR INSPECTION RECORD 1801DAYS OF PERMIT-ISSU.
FOUNDATION • _ ANCE,OR 180 DAYS FROM
;
U FER NOTE: LAST CALLED INSPECTION.
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
1 � GL
' PLUMBING 'z , '
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT.I PLG: MECH .
00 NOT POUR FLOOR UNTIL ABOVE HAS BE9N SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $IF T,
PLUMBING
< I
MECHANICAL'
I ELECTRICAL- .. - - /�C PERMIT ro
FRAMING
STORMS TYPE CONSTR.
INSULATION
-OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I
'♦ $O IT.FLOOR AREA TOTAL ACREAGE ,
- '' ROOF' NOTE:NO FINALINSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE.CONSTRUCT ION TAXIS PAID -
RUIICON u5E
ROOF SHEATHING Res IND -cora ve Om�,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El ❑ ❑ ❑
ASSESSORS PAH CE L NO
ROUGH SAN.#
PLUMBING - ELECT.ENERGY -
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY '
MECHANICAL . MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC,DATE ACC,FILE NO
FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS-TEST - GAS
FIRE SHRINK ENERGY T-]G
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED..;:= HEATING
"� •` � "�
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOOD ZONE A,L UC.
INTERIOR SHEAR FIRE DEPT. "� ° L, N❑
SHEETROCK GRADE - FEE SUMMARY
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 NOTPERMIT,TED 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'- MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
I
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTORS NJTICE 1
CITY OF CUPERTINO /I
1 /
� To 9
I( You are hereby authorized to Connect electrical service for
Ii 'Owner ar Tenant i
I+
At
No.of Wires_ Size of Wires
Size of Switch
fMotor Load, Voltage Phase
Healing Load
K W Voltage
i
(
Light I10_New Service Reconnect
i. No.of Meters l(11
Hem 120_Three Wire More Service
(' No.of Add.Meters Power Three Phase Move Meier.
Q• a
ELECTRICAL INSPECTOR -
APPLICANT TO FIL ''J INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BUILDING PROrJECT I IN IFICATION - -PERMIT NUMBER
BUILDING APPLICATION & PERMIT _ , 666
p
1
ADDRESSy I U tt!! O
r Cb BUILDING- ELECTRICAL-PLUMBING-MECHANICAL r..
PLANCHECKVALIDATION
NAME •- ///�' QTY. ELECTRICPERMIT FEE
coNTR DRs OTLETS-SWITCHES-RECEP 10.00/1.00
NAME
v(rj
LIC.ry Q LIGHTING FIXTURES 10.00/1-.00
ADDRESS Tons ort y�� PPLIANCES-RESIDENTIAL 4.00
Ypi ONNE IJ�% PANELS 10.00 DATE OF APPLICALION �'
ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE C.NO.
OR
ENGINEER
- LIC.Na. SIGNS TRANS. 3.00
ARCH.OR END. SPECIAL CIRCUI S,QQ PERMIT VALIDATION
ADDRESS
ZIP EMP.METE R POLE INS. 20.00 �` -
APPLICANTS MOTORS SEE FEES (�c-y.iC-o'r�-4-�
ADDRESS / f
St4)I IV /j SERVICE CHANGE 20.00
ao+o o LICENSED CONTRACTORS DECLARATI
Q U u - I hereby affirm that I am licensed tinder provisions of Chapter 9 C ISSUANCE DATE
w Q y (commencing with Section 7000)of Division 3 of the Business and W BLDG. ELECT. PLG. MECH.
H H i Professions Cod ,a�d JrI license is in full force nit e els. •\x•) ❑ Q ❑ ❑
z o License C es ! Lie.Number 0�
4 m r w Date Contractor
a a, f a BUILDING PERMIT
2 Ic w u OWNER-BUILDER DECLARATION INFORMATION
w0 n 1- 1 herebyaffirm that I um exempt from the Contractor's License MISC.- REFER TO ORD
�+u y P VALUATION $/FT:
k- a. Law for the following reason.(Sec,7031.5,Bminessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires permit to construct,alter,
QQ ¢
improve, or repair any Structure,prior to 115155uance,ahar, ELEC.CONTR. LIC.NO. ELEC. -
y o M requires lite applicant for such permit to file a signed statement that - J. - TOTAL PERMIT TO
x m LL he is licensed pursuant to the provisions of the Contractor's License
F'z i Law,(Chapler 9(commencing with Section 7000)of Division 3 ofthe EM I
Business and Professions Code)or that he is exempt therefrom and. OTY. PLUMBING PERMIT FEE
2_$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN VENT-WATER IEP.) 5.00
of not more than five hundred dollars(5500).1:
❑ I,us.owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or offered for sale (See. 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 F IXTUR ES-PER TRAP 5.00 Sa FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
ments are not intended or offered l'or sale.l f,however,the building GAS-EA.SYSTEM-1INC.40UTLETS 6.00
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 he did not build or int- RES IND CON PB OrbPr
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of tire properly,am exclusively contracting with ❑ ❑ ❑ .❑ ❑
licensed contractors 10 construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply -
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL N0.
❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Data WATER SYSTEM 5.00 ACC.DATE ALL.FILE NO.
WORKERS'COMPF,NSATION DECLARATION WATER TREATING EQUIP. 5.00 -
Lhereby affirm that] have a certificate ejectment to sell'-insure ZONING ENG.SITE NO.
or a Certificate of Workers'Compensation Insurance,or a cerYOcd
Copy thereof(Sea 3800,Lab.C.I� /rr
Policy No. CompunYYLTAideve
O ❑ Certiliedcop Isher � (o niched. FIRESPRINK ENERGY T24
Z Z %Q, Cerlifie y II 'If Ile eaMISC.-ion division. REFER TO ORD.
O Ppbcanl Y [:] N❑ Y E] N[]
Cry CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C_
�_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL a (This section recd not be completed if like permit is for one TOTAL Y❑' N❑ Y❑. IN
0 2 hundred dollars($100)or less.)
U Q 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Conspensalion Laws of Culitornia.
a Date Applicant ' ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APP41CANT: If,after making this Certificate of Ex.
emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
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 AIRHANDLING UNIT(OVER 10,000C.RM.) 6.00 SEISMIC FEE
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(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read thisapplication and state that the aboveVENTILATION FAN (SINGLET 4.00
information is correct. 1 agree to comply with all city unit county - PLUMBING
ordinances and state laws relating-to building constructionH.R.; and BOILER-COMP I3 . or 100,000 B.T.U.) 6.00
hereby authorize representatives of this'cdy to,enter upon the. BOILER-COMP(Over 100,00013TUISEE FEESCH. - MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Caper line against Iisly lies,judgments, costs and expenses which CONST.TAX
may in any way e_ against said City in consequcnre of the PERMIT ISSUANCE _ 10.00
ranlin O thirP �t. D MECH.CONT. LIC.NO. MECH.
TOTAL
TOTAL
Signat yV of Applicant/Contractor Dat -
OFFICE COPY