16883 POST THIS CARD NEAR FRONT OF BUILDING. PERMIT NUMB ER
CITY.'OF CUPERTINO . . 16883
INSPECTION DIVISION
7 JOB INSPECTION RECORD .
PERMIT EXPIRATION
JOB ADDRESS I0 ( l 1V • .e /' h z� tl UNIT# - LOT#
d� ' . C V�/1 p b PERMIT EXPIRES IF WORK
'
OWNER coNrRAcroRW 0 l/ IS NOT STARTED WITHIN •
INSPECTION DATE INSPECTOR INSPECTION R CORD 180 DAYS OF'PERMIT ISSU- '
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED:PLANS AND CITY OF Pe RnnT vAunanoN.
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTILA86VE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING' �""' "'{'t-Z'�-' •
ELECTRICAL ISSUANCE u�jl i
R ELECT PLG.i
Meng
MECHANICAL ,
r
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR' - vawnnoN, SIFT.
PLUMBING -
MECHANICAL
ELECTRICAL - •- PERITO
FRAMING cl 4
STORIES TIPE CONSTR
INSULATION'
t
OCC.GROUP ES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT FLOOR AREA TOTAL ACREAGt
ROOF NOTE:NOTINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES INO CON PB ow., `
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 D 0 0 0
ROUGH SAN.N ASSESSORS PARCEL NO
PLUMBING /L-2 -406 ELECT.ENERGY
TRACT NO. PARCEL NO,
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH ENERGY
h
ELECTRICAL BUILDING ENERGY. Acc DATE - Acc.FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING', ZONING -ENG.SIT E.NO.
GAS TEST GAS -
MECHANICAL FIRE SPRINK ENERGY r.za
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "�
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOOD ZONE ALUC
INTERIOR SHEAR FIRE DEPT. v NE] ° IN
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING,
INTERIOR LATH - TEMPORARY APPROVALS - BUILDING
1 " SCRATCH COAT ELECTRIC PEEN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING•INSPECTOR, MICROFILM
' w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING mp
a PLEASE GIVE JOB ADDRESS WHEN PHONING.•
Z r MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! '
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTALl'0�
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
!• BUILDING PROJECT IDENTIFICATION IPERMIT NUMBER.
BUILDING O D N APPLICATION & PERMIT �I 83
ADDREE I V
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OW��N++�EER'S , PLAN CHECK VALIDATION
P ACE
" ,A R 111.0 j TO QTY. ELECTRIC PERMIT FEE
71CY 7l'Vft ) UTLETS-SWITCHES-RECEP 10.00/1.00
uc.rvo LIGHTING FIXTURES 10.00/1.00 .
CINNTARCTOR'S PPLIANCES-RESIDENTIAL 4:00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .C.NO.
ENGINEER
UC.No. SIGNS TRANS. 3.00
ARCH,DR ErvG. 'PERMIT VALIDATION
AooPEss SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00
. APPLICANTS MOTORS SEE FEE SCH. C 1-
ADDRESS
SERVICE CHANGE 20.00
w o a LICENSED CONTRACTORS DECLARATIONLa
-
u 1 hereby effort that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w < w (commencing wish Sectyyiyyyyn 7000)of Division 3 of rhe Business and - DG. ELECT. PLG. MECH.
r us z Professions C license is in full fn+pyaprfe e
z O m - License Cie s _Lic.Numbe 52 7
9 w t w Date_ll o �Cmnract
Lr a w¢ /, OWNER -BOILDFR DECLA IoN BUILDING PERMIT
INFORMATION
w ;LL I- I hereby affirm that 1 am exempt from the Contractor's License
MISE.- REFER TO ORD
R.O a Law for the following reason.(See.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION SIFT.
� - Code:Any city or com ly which regniresa permit to construct.alter,
a
IS ¢ improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC.
LL requires the applicant for Such permit t0 rite a Signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractors License 'E�1 v
r I a
Law(Chapter!) with Section 7000)of Division 3 ofthe 1N V,Vk- t
Business and Professions Code)or that he isteempt therefrom and OTY. PLUMBING PERMIT FEE
H$ the basis for the alleged exemption.Any violation of SCct inn 703 1.5 STORIES TYNE CONSTR.
w. 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)J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work; structure
and the is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS.FLOOR,ROOF,AR EA,CON D. 5.00 +
Code:'rhe Contractor's License Law does not apply to an owner of
Properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP S.QD �� SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
ments are not intended or offered for sale.If,however,the budding
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 hu did not build or im- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of rite property,am exclusively contracting with C1 El El E) ❑
licensed contractors to 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 property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with acontmcfods)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ lam exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 d
feasor
Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKFRS'COMPF.NSATION D17CLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to set Ginsmut, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ j unified copy is hereby furnished. FIRE SPRINK ENERGY T-ZA
Z ZO 1fl(.Cenifie co s Icd 'tl th ly ins ecUon divisimr. MISE.- REFER TO ORD. ❑ ❑ ❑ ❑
hLant v N V N
I-" y PERMIT ISSUANCE 10.00 1+01) (1001 ZONE A.L.U.C.
CERTI 'ICATE OI'FXF PTION FROM 0 ERS'
W �_ COMPEN SATI ON INS N PLG.CONTR. IJC.NO. PLG. ''��,,xx
6. O I Mix section need not be completed if the permit is for one TOTAL.2,d-o b Y❑ N❑ Y ❑ N❑
Z hundred dollms($100)or less.)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL P not is issued,I shall not employ any person in any manner so as to
U become Subject to the Workers'Compensation Laws of California. BUILDING
UJ Date Applicant ALTER OR ADD TO MECH. 5.00
>- vii NOTICE TO APPLICANT: If,after making this Certil'icutc of Fs-
F. Z emotion,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 10AW C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 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,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that have read this application and ouncoal the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING UL if
ordinances and stale laws relating to building construction, and I BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 P
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 harmless the City of MISE.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in conseyuence of the PERMIT ISSUANCE 10.00
ra 'ng of I pe 't MECH.CONT. - LIC.NO. MECH.
II TOTAL. 1 TOTAL �•4�
Si fume of pplicant/Contractor Date
OFFICE COPY