16841 POST THIS CARD NEAR FRONT OF-BUILDING PERM IT NUMBER 4
CITY,,-OF CUPERTINO 16841
INSPECTION'DIVISION
JOB INSPECTION RECORD
v�q(_j�J. �kv�_ ,Q�r�j ITPERMIT EXPIRATION.
' JOB ADDRESS./_ # LOT f�j ,+�]
ORK
OWNER CONTRACTOR .919
IIS NOIT STA�ED WIT HIIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-,
FOUNDATION - ". ANCE OR 180 DAYS;FROM
NOTE: - LAST CALLED INSPECTION."
UFER ALL GRADING AND'DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS'AND CITU OF PERMIT VALIDATION
PR EGUNITE - CUPERTINO STANDARDS.
GARAGE SLABS - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT PLG. MECR:.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD.FLOOR VAwATION SIFT.
PLUMBING '
MECHANICAL
ELECTRICAL - - - PAlUWf PER UT TD
FRAMING. Vw !
"INSULATION noV21
STORIES TI#PECONSTR.
�ot uupeqlflo OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
. ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE . sn.Er aoDR AREA TOTAL ACREAGE
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID
- .BUILDING USE
ROOF SHEATHING I I ' I RES IND. CON BE Go—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' EI 0 ❑ ❑
ASSLSSDRS PARCEL.NO
ROUGH SAN.#
PLUMBING —2. ELECT.ENERGY TRACT No. PARCEL,NO.
TUBS&SHOWER PAN - - PLUMBING ENERGY '
MECHANICAL MECH.ENERGY
ELECTRICALACC DATE ACC.WLE NO
BUILDING ENERGY .
FRAMING - ELECT.FINAL TEST -
ZONING ENG.SITE NO.
' INSULATION - PLUMBING
" GAS TEST . GAS "
MECHANICAL EIRE SPRINK ENE RGY T.24
COVER NO WORK UNTIL ABOVE HAS�BEEN SIGNED HEATING, Y ❑ N❑ Y "�
' EXTERIOR SHEAR ELECTRICAL RELEASE , FLOOD ZONE. Aluc .
INTERIOR.SHEAR FIRE DEPT. Y❑ N❑ vL 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 - 1 . SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
11 ONE WORKING DAY BEFORE REQUIRED INSPECTION. a
_ . o' PLUMBING JAL . OD
PLEASE GIVE JOB ADDRESS WHEN PHONING.
z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
!MPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL oD
CALLING FOR FINAL INSPECTION. ! l
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL-POINT PEN ONLY
BU LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER
ADDRSG APPLICATION & PERMITSS
,
_ N• BUILDING-ELECTRICAL-PLUMBING-MECHANICAL i?: 16841 Q1
OWNER'S
vAME � PLAN CHECK VALIDATION'
/� PRONE% CITY. ELECTRIC PERMIT FEE
CNT
NAME ncroRs _ OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. , LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
/ c�yEZLsvp['$�JPHONE�Z�'Sal PANELS 10.00 GATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
off PANELS (OVER 200 AMP) 20.00 •. r
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00 -
AMOTORS SEE FEE SCH.
ADDRESS OREss
9/J61'YE.CSu�'CL-�/ r zJfZ r SERVICE CHANGE 20.00
00 LICENSED CONTRACTORS DECLARATION ,
a U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N<y (commenting with Section 70001 of Division 3 of the Business and ) BLDG. ELECT. PLG: MECH.
M z Professions Code,and my license is in full force and effect. ._ .. ❑ ❑ ❑
z O m - License Cluss_G+.} Lic.Nnnber_40_,Z�7/ '
9 w r Dale Z/ZZ,��o Contractor pity aL Cu .k.,,
a m s -+ Y [Cup BUILDING PERMIT
g: s, w
OWNER-BUILDER D ATI - INFORMATION
Aoa MISC.- REFER TO ORD
X LL I- I hereby affirm that 1 am exempt from the Contractor's License VALUATION
u.o a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 SIFT.
iw Code:Any city orcounty which requires a permit to Construct,alter, _
ELEC.CONTR. LIC.NO.
S, a o improve,demolish,or repair any structure,print to its issuance,also ELEC.
ni
D LL requires lite applicant for such permit to file a signed statement that TOTAL PERMIT TO
w z a he is licensed pursuant to the provisions of the Contractor's License / IIllsIs-
N i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the V
Business and Professions Code)ar that he is exempt therefrom and OTY. PLUMBING PERMIT FEE IA
a r the basis for the alleged exemption.Any violation Of Section 7031.5STORIES TVIaE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.)2-00 Dl ,
of not more than five hundred dollars(55000.):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their ante 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. TLOQ • D
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thercan,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
• menta re not inthrough ended
own employees,provf,ed however,the
improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 �Sl 00 _
menta are mens is sold or within
erect year c.
If,mpleveq the building
nr improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
buiidcr will have lire burden of proving ilia,he did not build ur im- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 El El El ❑ El
1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Se C.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 property who builds or improves thcrrun,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ tum exempt under Scc. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
s Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy i5 hereby furnished. FIRESPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. misc. REFTRD
ER O O . Y
O Applicant [3NNE] Y ❑ NN[3H My PERMIT ISSUANCE 10.00 2a DV FLOOD ZONE A.L.U.C:
CER'I']P1CA'fli OP EXEMPTION PROM WORKERS'
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need no, be completed if the permit is for one TOTAL '�9 Y❑ N[:] Y ❑ N❑
Z hundred dollars($100)orless.)
U O I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in an so as to
U become softerto he Workers'Compensalion of California.
0. Dat4&p
�.�/� Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} h NOT'�CB Tf5 A�PLICAN'I' a nr g this Certificate o ' -
? emption,you should hoc the tject to,he Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Lab 'Code, you must forthwith comply with FEE '
(� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r-F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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.) 9.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
`. 1 certify that I have read this application and state 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 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 (OVBr 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, casts and expenses which CONST.TAX
may in any way aceru against said City consequence of the PERMIT ISSUANCE 10.00
mntingofthis Tamar MECH.CONT. - LIC.NO. MECH.
ox-Vcs- TorAL TOTAL
glare - pplcant/Contractor Date
OFFICE COPY