16692 POST THIS CARD NEAR FRONT OF BUILDING NDN,III II
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
• .100 HOOK ESS 21/Q 11_lN_ Oma-/ UNIT 1l _LOT 1f PERMIT EXPIRES IF WORK
11111111 FAIN m bz� CIINTDACIMI AI bE IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
LAST CALLED INSPECTION.
U FER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PI I+Na r VALIDA nuN
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL Issu Amct uAlt.
MECHANICAL BLUO 1 ((LCI I PLO
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING vA LDA 111111 Seo-T,
MECHANICAL
ELECTRICAL PLUNnI ID
FRAMING
INSULATION STuDILS IVPE CUNSI II
111:1; I;IIMI` FES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
5) I I I LLIDN AHI A INI,L ACAI:<cL
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
•� DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USI,
ROOF SHEATHING ul5 IND CON PB pr,..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. 0 El E) ❑ El
ROUGH SAN.0
nSSI.SSOHS PAIIC!L NO
PLUMBING ELECT. ENERGY
111 n,:I No PnuCI L NO
- a.SHOWER PAN PLUMBING ENERGY
MEE CHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ncC DATE Acc VILE NO
FRAMING ELECT.FINAL TEST
1.ONING
INSULATION PLUMBING ENG SITE NO.
GAS TEST GAS
Mua'Brnm� I NI nOv r.pn
ECHANICAL
'zq
COVER NO WORN UNTIL ABOVE HAS BEEN SIGNED HEATING _j N❑ , ❑ No
A
EXTERIOR SHEAR ELECTRICAL RELEASE ILOODVONL LUC
INTERIOR SHEAR FIRE DEPT. ❑ `I❑ ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH _ TEMPORARY APPROVALS BUILDING
SCRATCH COn.I ELECTRIC PLAN CHECK
CAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
111��I i':... j.•.\ � � /L__,;-r...,.,_��
CONST.TAX
I'I_IE:�'r;: =-i l_'� Fi f_•.. _I::,I: ;:I i .E F-C!-'.1 ,
f-(:;_ 1 talc- ::.Ip : ,"II I,ISE ;:; TION. ; TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
f BUILDING PROJECT I DENTI FICATI ON -PERMIT NUMBER
BUILDING APPLICATION & PERMIT 16692
ADRESS D .
BUILDINGELECTRICAL-
OWNERS ate SPLAN CHECK VALIDATION
Na. c�
•� I 7 orb/ QTY. ELECTRIC PERMIT FEE
LNONE . b/
CONTRACTOR OUTLETS-SWITCHES-RECEP 10.00/1.00 .
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRES�S
svMONE /JJD PANELS 10.00 DATE OF APPLICATION
OAR RCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE PO-NO,
ENGINEER'
LIC.NO ISIGNSTRANS. 3.00
ADDRESS ENC. _ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
GRESS
AORE55 Ts
AP ' MOTORS SEE FEE SCH.
�J(/ '
SERVICE CHANGE 20.00
w o oSEDCON'1'RACfOR DECLARATION '
<<J UF1 hereb'yEvi thal 1 am licensed under provisions of Chaplet 9 ISSUANCE DATE
a,,z (conuncnctn with Section 7000)of Division 3 I'Thu Burin s and
Q u g BLDG.- ELECT. PLG. MECH.
] LicenPric,fese C1.Codc 1 yt I' cnse is in full force uDJ •{1y.,� ❑ ❑ ❑
ED i= W License Clasx m/LyL� Lic Not,,Per
Late 2_� Contraclor��`
,s u f BUILDING PERMIT
a OWNI!R-BUILDER DECLARATION INFORMATION
o a v
A
w ; n 1 hereby affirm lira! 1 am exempt from the Contractor's License IMISC.- REFER TO ORD
LLo¢ Law for the following reason.(Sec.7031.5,Busineasund Professions PERMIT ISSUANCE 10.00 YAwATION 5/FT.
Code:Any cilyor county which requiresa permit toconstrucl,alter.
QQ¢ 0 Improve,deramish,Of repair any structure,prior to it56suance,also ELEC.CONTR. LIC.NO. 77
ELECT
E u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n Lu m he is licensed pursuant to the provisions of Ore Contmotor's License
H t Law(Chapter 9(e nmmncing will,Section 7000)of Division 3 ofthe
io Business and Profession Code)or that he is exempt thcrcfrom and QTY, PLUMBING PERMIT FEE
It
I- o the basis for life alleged esennption.Any violation of Section 7031.5 TORIES TYPE CONSTR.
Ate _ by any applicant for u permit subjects the applicant to a civil ponalty ALTER-DRAIN -WATER (EA.) 5.00
of not more then five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do lire work,and tire structure is not
intended or offered for sale(Sec. 7044, Business unit Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and wlm docs such work FIXTURES-PER TRAP 5,00 50-PT.FLOOR AREA TOTAL AOREAGE
himself re throughhisown cmred forssle.if.edthmsuch imprmx GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 -
menls are ret intended or offered for sale.IC mpleveq the building
improvement is e harder,within one year of compid ion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will hove the ade. . of proving that hddid not build or im-
prnacfarpurposeoll Lire 1' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ L as owner of the construct
he erojectvelySe . 7044, Bu with ❑
El 1:1
licensed colons od.:' construct the project La 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
ton owner of Code: ty Contractor's License Law docs not apply
to an owner of property who builds t r improves rased p,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
con tons for such cenjec is with a contradoD sl IicrnscA Pursuant to
the Conlmcter's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERs'COMPIiNSA1'ION DECLARA'I ION WATER TREATING EQUIP. 5.00
I hereby'!firm That I have acc,hff, lc of consent to silt-inure, _ ZONING ENG.SITE NO.
or a ccTilicale of Works,,'Comps Llan Inisuruncc,or u ertified
copy there f 00,Lu2C.1. -
Policy No cc. Cmupany- ` ,
U Com Ned<)+y is hereby "..
z 2 ::,r:-it f file the city inspection division. FIRE SPR INK ENERGY T"Yd
O Applicant _ w MISC.- REFER TO ORD. Y� NE] YE] NE)
~ r2 PERMIT ISSUANCE . 10.00
� - C IEIGTIi OF Ii%IiAIPTION PROAI WORKERS' FLOOD ZONE A.L.u.C.
LU > CONiITNSATION INSURANCE PLG.CONTR. _ LIC.NO, PLG. Y J N 0 V
Za.)
Z (This section need not be completed if the permil is far one TOTAL N
hundred dollars(S100)orless]
U O 1 certify that in the Pertbnn;mce of the work b.r which On,per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is ismed,I shall nal employ any person in any In anner...as to
Wbecome subject to the Workers'Compensation Laws of California.
ED Date Applicant BUILDING
}'0 NOTICE TO APPLICAN"r: If,after making Ili,Certificate of Ex ALTER OR ADD TO MECH. 5.00
♦- ? emptier,you should became subject to the Warkeri 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.0=11F.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00GF.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a conduction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
- the Performance of the work for which this permil is issued(Sec. MICROFILM
3097,Civ.CA HEATING UNIT(TO 100,000 B.T.U.) 8,00
Lender's Name
NHEATING UNIT(OVER 100,000 B.T.U.)9.50
Tonder',NameAddress ELECTRIC
I certify that l have read this application and slate that life above VENTILATION FAN'(SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00
1 hereby euthoruc representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. z f.Vt
above-mentioned property for inspection purposes. MECHANICAL
(We) agree to save, i demnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liali cs,judgments, costs and capenscs which CONST.TAX
may in any way c nguinst if y conscqun<c of the PERMIT ISSUANCE 10.00 oil
la)of this t / MECH.CONT. - LIG NO. MECH. L
/ �" roTAc TOTAL
Sign u pplicanllC ontrxcl Dat (i xclu
OFFICE COPY