16884 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINOQQ
INSPECTION DIVISION �UV�
JOB INSPECTION RECORD
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G - PERMIT EXPIRATION
:?TY JOB ADDRESS 1� C ( 1" e �'E" US- —UNIT# LOT
• PERMIT EXPIRES IF WORK
OWNER corvrRAaoR e_c �d1�Lo 1D IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMITISSU-
FOUNDATION - NOTE: ANCE OR 180 DAYS FROM
UFER � ALL GRADING*AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
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
fill
.. PLUMBING � ttc ,
ELECTRICAL
issuANCE OnrE.
MECHANICAL BLDG. I ELECT. IPLG, MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - • BUILDING PERMIT
WOOD FLOOR . INFORMATION
V ALUArION SIFT.
PLUMBING
MECHANICAL -
ELECTRICAL - y� PEaM1 TTU
FRAMING - W ej
INSULATION STORIES T CONSTR. .
OCC.GHOUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sn IT aooH nHeA roTAl neRenee
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res Irvo CON ve om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ' ❑
nsSESSORS PnRCF.I.NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO PARCELNO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
acc °nreAcc.PaE No.
ELECTRICAL BUILDING ENERGY _
- FRAMING ELECT.FINAL TEST ZONING ENG.SITE No. ;
INSULATION PLUMBING Ila-8q
GAS TEST GAS .
FIRE SPRINK ENERGY T-24MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y EI N❑ v ❑ NE
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE A,L UC.
INTERIOR SHEAR' FIRE DEPT. v NE •Y ❑ N0
SHEETROCK . GRADE FEE SUMMARY
EXTERIOR LATH w BUILDING
INTERIOR LATH' TEMPORARY APPROVALS BUILDING-
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED 11OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDINGINSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION'. PLUMBING d19
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! " . coNST.TAx
PLEASE READ REVERSE SIDE BEFORE TOTAL ,QQ1 i
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER.
wLOINc
APPLICATION & PERMIT ' 16884
DDRESS
�� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,,,,
OWNER'S r♦�' PLAN CHECK VALIDATION
NAM AIW A ]1 ?NDIL4�'1L'� QTY. ELECTRIC PERMIT FEE ..
,IFv1, ) 'FyJ UTLETS-SWITCHES-PIECED 10.00/1.00
M� LIC.N S LIGHTING FIXTURES 10.00/1.00
ro RACTOR's PPLIANCES-RESIDENTIAL 4.00
PANELS 10.00 DATE OF APPLICATION
ARCHITTEECCTT,J�`l/ ''I{�• '��•/•~E,1v'(V " " - PLAN CHECK FEE P.C.NO.
OR PANELS(OVER 200 AMP) 20.00 ,
ENGINEER
LIC.No. SIGNS TRANS. 3.00
AARCH.OR DDRESS ENG. SPECIAL CIRCUIT • .5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20,00
ADDRESSS
APPLICANT MOTORS SEE FEE SCH. ( l�
SERVICE CHANGE 20.00
Ciotti
Oo LICENSED CONTRACTORS DEPCLARATION
a u u I hereby affirm that I mn licensed under Provisions of Chapter 9 ISSUANCE DATE
N Z Ill (commencing wish Sectio 7000)of Division 3 of the usine55 aW -
¢A BLDG. ELECT. PLG. MECH.
0 io i Professions CodA' en Li is in fol ❑ ❑ rTa ❑
z o,A - License s („e 'a Num `Q,f
9 m Dare J� 3d _Contractor
L BUILDING PERMIT
¢ w u O N'F.R-BUILDER DECLARATION INFORMATION
WD°' y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u VALUATION $/FT.
.. 0¢' Law for the following reason.(Sec.7031.5,0usinemand Professions PERMIT ISSUANCE 10.00
, Code:A ny city or call n ty wh fell req urns a Perm it to construct,alter,
ac p < p Improve,demolish,or repair any at NCt 11 re,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL PERM T TQ
w9 he is licensed pursuant to the provisions of the Contractor's License
r Z i Law Wharf.,9(commencing with Section 7000)of DoiS n3 oftte v j
¢ Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE
Y STORIES TYPE CONSTR.
ae r the basis for[an alleged exemption.Any violation olo a, on 7031.5
i ; .- by any applicant fora hundred
subjects rheapplicannau civllpenalty ALTER-DRAIN -WATER (EA.) 5.00
of not more titan five hundred dollars(5500).):.
❑ I,as owner of the property,-or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their safe 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. 5.00
1 Code:The Contractor's License Law does not apply ID as owner of
/y:j p5 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered for sale.If,however,the huilding GAS-EA.SYSTEM-I INC.4 OUTLETS.6.00
�T or improvement is sold within one year of Completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
A� builder will have the burden of provingthat he did not build or im- RES IND CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the properly,am exclusively contracting with ❑ Cl ❑ ❑ ❑
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 a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,- B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner [)are WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sell-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,LAC.), '
Policy No. Company
O (]/Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z Gottfried 'npy I' fit w' t cit inspection divisma MISC.- REFER TO ORD.
O PPicanl_ Y ❑ N❑ Y ❑ N❑
Fw PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU ? CERTI 'A li OP EXEMPTION PROM RK RS'
_ COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG.
CL 0 (This section need not be completed if rile permit is fur one TOTAL Y❑ N❑ Y❑ N❑
Z hundred dollars($100)or less)
U O 1 Certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 sllall not employ any person in any manner so as to
U become subject to the Workers'Compensaam Lawful`California. BUILDING
ED Date Applicant ALTER OR ADD TO MECH. 5.00
} m NOTICE TO APPLICANT: If,after making this Certificate of fix-
Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of 11m Labor Code, you most larthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IO=C.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 oLthe work for which[Itis permit is issued(Sec. MICfl OFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
-
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 countyPLUMBING
ordinances and Stale laws relating to building construction, and BOILER-OIOMP(3 H.P.or 100,9021
U.) 6.00
hereby authoriae representatives of this city to enter upon the 801 LER-COMP (Over 100,000 BTU)SEE FEE S .1
C . MECHANICAL
above-mentioned property for inspection purposes. '
(We) agree to save, indemnify and keep harmless the City of Misc.-
Cupertino
ISC.-upertino against liabilities,judgments, costs.and expenses which CONST.TAX
may in any way accrue against Said City in cI,`
ymuse of the PERMIT ISSUANCE 10.00
r of t 's -r it MECH.CONT. LIC.NO. MECH.
1 TOTAL : TOTAL X030
Signatureof p icant/Contractor Date
OFFICE COPY