16650 `+ POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
665
INSPECTION DIVISION ;
JOB INSPECTION RECORD
III . ( / . „ I� PERMI_T•EXPIRATION
JOB ADDRESS 1X"1 p�_4 1( I IT LOT#
PERMITEXPIRES IF WORK .
OWNER CONTRACTOR ( IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD Tao DAYS OF PERMIT ISSU-
FOUNDATION . ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAS TCALLEDINSPECTION.
PREGUNITE� ' TO COMPLY WITH THE APPROVED PLANS AND CIN OF PEHmFr VALIIIAnoN
_ CUPERTINO STANDARDS.
GARAGE SLABS. - , I t� cL•� '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB.
PLUMBING FEB L
ELECTRICAL ISSUANCE DATE
MECHANICAL - City Dt Cupertino BLoc ELECT PEG, mecH.l
❑ -❑ ❑ ;
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
'w INFORMATION
WOOD FLOOR - VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL •
FRAMING I '
' STORIES rvpE CONSTR.
INSULATION
OCC GROOP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so,Fr,111C11 AREA ro*Ac ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HES. IND 'CON Pe - On...,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. , El
ASSESSORS PARCEL NO
ROUGH .SAN.# '
I
PLUMBING ELECT.ENERGY.
' THACi NO PARCEL NO
TUBS IS SHOWER PAN PLUMBING ENERGY f
MECHANICAL MECH.ENERGV Acc.onre ncc FILE No.
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
•ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK, ENERGY T]<
MECHANICAL - v_/tS
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "� Y "�
EXTERIOR SHEAR _ ELECTRICALRELEASE _ FEooD zone A.L.0 c.
INTERIOR SHEAR FIRE DEPT. - v N� •' Y'D N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR. LATH TEMPORARY APPROVALBUILDING
S
SCRATCH COAT- ELECTRIC 11 11 PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY . SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE— MECHANICAL:
IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
CITY OF CUPERTINO vcopyE
GAS SERVICE NOTICE
19
:, To
You ore hereby authorized to connect the GAS service for
o' Owner or Tenant C//�.Gl�: - /%cJr /Jr;> ,✓
At /J cf%' / AI
New Service
No. of Meters Reconnect
No. of Add. Meters Move Service--
Move
ervice Move Meter
PLUMBING INSPECTOR _ ✓� — — pp .
I
APP 1I"ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
BUILDING PROJECT IDEN7I FICATION APPLICATION '
ADDRESS - -16650
ADDRESS - '
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'�yI ...yy�x/ PLAN CHECK VALIDATION
NAME /,A.IK(�.r/L �$Ercoan
�_ s OTV. ELECTRIC PERMIT FEE
LONTPAC
r CA-,-o NE
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
P L LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS APPLIANCES-RESIDENTIAL 4.00 -
U O'Y'Y PHONE yBI� PANELS 10.00 -DATE OF APPLICATION
OR
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C:NO.
ENGINEER
- LIC.No. SIGNS TRANS. 3.00
FRDOHESS LNG. PERMIT
CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 1 '
APPLICANT
ADDRESS MOTORS SEE FEE SCH. 1
L
SERVICE CHANGE 20.00 0� "T.-nL`
Ir o J LICENSED CONTRACTORS DECLARATION E
< U I hereby affirmthat I aln licensed under provisions of Chapter 9 ISSUANCE DATE
rt i (commencing with Section 7000)of Division 3 of the Rosiness and r BLDG. ELECT. PLG. MECH.
H w i I'mfiessions Code, d nsc is in full to Apl.yfy.,y7 �j U,1
oi o o License ss Lie.Number G2iUZi ❑ a �, .
T H w Data Contractor
< y s �� ,'�/y 11� BUILDING PERMIT
¢ 2 w OWNIi R-BUILDER UF. 2 INFORMATION
X I- I hereby affirm that I am exempt from the Co actor's License MISC.- REFER TO ORD
3 u VALUATION S/FT.
w j Law for the following reason.(Sec.7031.5,Busmessand Professions PERMIT ISSUANCE - - 10.00
Code:Any City or county which nyulres a permit to construct,alter,
6 Z ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. UC.NO. ELEC.
S c IL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
e w m he is licensed pursuant to the provisions of the Contractor.x License
H z a
Law(Chapter 9(commencingwith Section 7000)of Division 3 of the
E 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
M H the basis for the alleged exemption.Any violation M'Seclion 7031.$ 1 STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant to a Civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).1:
❑ I,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 Ilia 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 F IXTUR ES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
menu arc not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-111NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA) 200 BUILDING USE
builder will have the burden of pr . . .
proving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business ILAWN 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 property who builds or improves Thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmctotsl licensed pursuant to
the Contracmr's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&I'.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dare WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORK Ii RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that 1 havea certificate of consent to selumoure, -
or a certificate of Workers'CoWished,
p nsa in Insurance,or u certified ZONING ENG.SITE NO.
r d�{ypgB/Y✓[.. 0,Lab.C.I
D611!¢t66!%�/ ompany KCLL(/
O ❑ ertilied copy is hereby mni511 the FIRE SPRINK ENERGY TY4
Z
2 Certified op filed,>0 the city inspection division. MISC.- REFER TO ORD. y ❑ N❑ y ❑ N❑
O Applicant
CCN CI?R'rIFIkZel FROM WORKERS. PERMIT ISSUANCE -10.00 FLOOD ZONE A.L.Uc.
W COMPENSA N INSURANCI? PLG.CONTR. LIC.N0. PLG.
-CL 0 ('Phis section need not be completed if the permit is for one TOTAL V❑ N❑ V❑ N❑
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
fL )- mit is issued,I shall not employ any person in any manner so as to
U ' become subject m the Workers'Compensation Laws of California.
a Data Applicant ALTER OR ADD TOM CH. 5.00 BUILDING
>- carNOTICF'TO APPLICANT: If.after making this Certificate DI'Ex-
f- ? enhptlon,you should become subject to the Workeri Compensation Z 11PPtFR/i(sE i+'46 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
(� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY
AIR HANDLING UNIT(OVER 10=C.ENL) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the
eri performance of aMICROFILM
3097, tire work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's
Address
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify That l have read this application and SWIe that OIC above VENTILATION FAN (SINGLE) 4.00 Aly
• information is correct. I agree to comply with all city and county 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 (Over 100,000 BTU)SEE FEESCH. 'MECHANICAL S {y
above-mentioned property for inspection purposes. r
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expense which CONST.TAX
may in any way ac against mid City in nse bran of the PERMIT ISSUANCE 10,00
tanto MECH.CONT. LIC.NO. MECH.
orA�� TOTAL
Si a pp is Conlmclor ate
OFFICE COPY