16881 POST THIS CARD NEAR. FRONT OF BUILDING
PERMIT NUMBER
CITY OF" CUPERTIN0 . 16881
INSPECTION DIVISION,
JOB INSPECTION RECORD
PERMITEXPIRATION
JOB ADDRESS 4q2t
sD- L�,P 4171 zS1 —UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER DC CD CONTRACTOR H e �Y-- �'►� IS NOT,STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS.OF PERMIT ISSU:
FOUNDATION,• ANCE OR 180 DAYS FROM
NOTE:' LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - -P IU L7 `G/,...�(/ �{•L/ I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED t
UNDERGROUND /SLAB APR 191989 ' a
Y PLUMBING j it A ✓w
- ELECTRICAL - -Cj Df C0p"RO ISSUANCE DATE
MECHANICAL - BLDG ELECT i PLG, � El
❑ ❑: El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $LFT. ,
- PLUMBING - }E
lJ v
MECHANICAL '
ELECTRICAL �h veenm To
FRAMING V`-- d
STORIES TYPE CONSTR.
-INSULATION -
OCC.GROUP _ RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
Q FT FLOUR AT FA 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, OL
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑• ❑ ❑ ❑ ❑
ASSESSORS PARCE I.NO
ROUGH SANA - -
PLUMBING ELECT.ENERGY
PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO: -
MECHANICAL - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC,FILE NO
FRAMING - ELECT.FINAL TEST zoNlNc ENG.SITE Na.
'INSULATION - PLUMBING..
GAS TEST GAS
- FIRE§PRINK ENERGY F24
II' MECHANICAL Y [j N❑ Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOODZONL AL U.C.
INTERIOR SHEARFIRE DEPT.
Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE FEESUMMARY
. EXTERIOR LATH BUILDING-
BUILDING I01
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT'- ELECTRIC PLAN CHECK
GAS ��
FEE
'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY` F SEISMIC FEE 1 7a/
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUIL DING I NSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, - ELECTRIC
�'� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
._ o 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
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT IDENTIFICATION ;PERMIT NUMBER
BUILDING APPLICATION & PERMIT 16881
ADDRESS �. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL `
OWNER'S . PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
/,F, OIL Co, C�dsl9 -
�'. NAMERAcron's UTLETS-SWITCHES-RECEP 10.00/1.00
�ErC 6t` 'Mo.;ffIc-,NO _5bS__2_2,f LIGHTING FIXTURES. 10.00/1.00
DDRESS DroR's
AAPPLIANCES-RESIDENTIAL 4.00
ADDRESL` 4/1
•Q,[�iX 6.S`9SJiWJVsa PHONE{X/ PANELS 10.00 DATE OF APPLICATION
APCNIrECT - $%S!
PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.CNO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADO RESSs END' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
zip EMP.METER OR POLE INS. 20.00
AvvuCANrs MOTORS SEE FEE SCH. ( 1 ( V
AOGRESS
SERVICE CHANGE —., 20.00
O o LICENSED CONTRACTORS DECLARATION
< u v Jige-
I hereby affirm that I am licensed under provisions of Chapter 9 - {� Q �Q ISSUANCE DATE
<n (commencing with Section 7000)of Division 3 of the Business and r+--+-WV BLDG. ELECT. PLG. MECH.
i Professions Co e,and my license is in full fur a and e(1'ec ❑ ❑ ❑
Z o - License Clns Lic.Number�O�2 - - City Of Cupe IIC
z r Date Contract{1I�, /•��✓•
I- `n - J b Ir'T'Nai,--DTr�Fr-
¢ m J !�/y— d DQ.Ua = BUILDING PERMIT
¢ wo O NER-BUILDER DECLARATION INFORMATION'
w0 MISC.- REFER TO ORD
u y I hereby affirm that I am exempt from the Contractors License VALUATION $/FT.
LL O a Law for the following reason.(Sec.7031.5,Business and Professions �O O
_ J g PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to consuanc,also
¢ ¢¢Q improve,demolish,or re p,ir,ny structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC.
K m¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT;O
u w he is licensed pursuant to the provisions of tire Contractor's License
- i Law(Chapter 9(commencingwith Section 7000)of Division 3 of the
i o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE Of 11 L 0
14
rc I- the basis for the alleged exemption Any violation of Section malty STORIES, TYPE CONSTR.
by any applicant fora permit dullarxf$500plicam toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(55001.1: '
❑ 1,as owner of the property,or my einployctes with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is nut
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,Had who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided Dour such improve-
menis are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or Improvement is sold within fine year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving that he did not build or hit- . . .
- RES IND CON PB Omer
. .
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 -
❑ 1,us owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed Contractors to constrtmt the project(See 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does riot 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 contortions)licensed ponu,nt to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I amexempt under Sea ,B.&P.C.for this 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
I hereby affion Had I have a"Hificale of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof fSee.3800,Lab.C.).
Policy No. Company,4rF f'YNA
O ❑ Certified Copy is hereby furnished. - FIRESPRINKENERGY T-24
Z'2 ❑ Cenified�,lgpy is�4ltd with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O Applicant '�'-7T/Y-_4�� PLS'•- Y N Y N
CC N CE RTI FICA'IT OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
tU > COMPENSATION INSURANCE PLG.CONTE, LIC.NO, PLG.
1 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ No
D Z hundred dollars(S 100)or less.)
U O 1 certify that in the performance of tire work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
U became subject to the Workers'Com enation Laws of California.
O w Date - / - Applicant p BUILDING 10001
C. ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex.
F ? emption,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 of this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4,00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER I0=C.F.M.) 6.00 SEISMIC FEE r Z�
I hereby affirm that there is a construction leading 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
Leltdcr's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have real this application and state that the above VENTILATION FAN (SINGLE) 4,00
information is correct. I agree to comply with all city and county BOILER,OOMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
Hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep armless the City of MISC..- REFER TO ORO.
upertino against liabilities,judgments, costs fid -xpenses which CONST.TAX
I"
in a way accrue against said City i consequ nee of PERMIT ISSUANCE 10.00
r�rltiy� 1" permit ',rMECH.CONT. LIC.NO. MECH.
TOTAL TOTAL �/� ��
Signatu a of Applicant/Contractor Datc
OFFICE COPY '