16611 POST THIS CARD.NEAR FRONT OF BUILDING eAn,ITNDti,eEA
�- CITY OF CUPERTINO 16611
INSPECTION DIVISION
JOB,INSPECTION RECORD
PERMIT EXPIRATION
v ' JOBADDRESS -7J r3 �•D�C-G'�� UNIT# LOT#
_ - - - - PERMIT EXPIRES IF',WORK
OWNER C c 0 CONTRACTOR 2.6 p IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION NOTE: ANCE 01!T 180 DAYS FROM '
UFER
ALL GRADING AND DRAINAGESHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF v[ReTn VAE DATION .
CUPERTINO STANDARDS.
GARAGE SLABS
�r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � ..
UNDERGROUND /SLAB
' PLUMBING I
ELECTRICAL y CUQ \�O
ISSUANCE DATE F'
MECHANICAL BLDG. ELECTPLG. &IECR,
o .
- El ❑ . .
00 NOT POUR FLOOR UNTIL ABGVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING
VALUATION SIFT.
�
MECHANICAL
ELECTRICAL - - PE"^'}I TO
FRAMING
INSULATION , STORIES TYPE CONSTR.
OCC GROUP RES.UNITS
�
yPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED L � SU.FI,FI.0011'1I11A TOiAI.AC1if.A(iL
iq\ ROOF NOTE:NO FINAL NSRSHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
1 ✓ - - BUILDING USE -
ROOF SHEATHING - - ' Ii Es IND CON PIT olio.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE . INSP. ❑ ❑ ❑ ❑ ❑
ASSESSCHS PARCEL
ROUGH NO
SAN.4
PLUMBING - ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS A SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY ki 1)
ELECTRICALBUILDING ENERGY ACC,DATE ACC.FILE NO.
FRAMING ELECT.FINAL TEST
INSULATION - PLUMBING ZONING, ENC.SITE NO.
,
GAS TEST ' - GAS -
FIRESPRIFIK. ENERGY T 24
- MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED- HEATING - ` ❑ N❑ ` ❑ No
EXTERIOR,SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L.0 c.
INTERIOR SHEAR FIRE DEPT, Y❑ N❑ YL-1„ ND
SHEETROCKGRADE FEE SUMMARY
EXTERIOR LATH BUILDING Elf
INTERIOR LATH TEMPORARY APPROVALS BUILDING a�e
SCRATCHCOAT ELECTRIC PLAN CHECK
- GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM'
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� -A-
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE,GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL'.INSPECTION.
OFFICE COP11
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
+� pWEI . APPLICATION & PERMITFzll1 C[�
/ 1 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 6" I U o I
OWNER 5 F- PLAN CHECK VALIDATION
NAME "6-OZ90 QTY. ELECTRIC PERMIT FEE
-6-2t&;
CONTRACTOR 5 OUTLETS-SWITCHES-RECEP 10.00/1.00
Doivov,a Oc. -,67N 6 3 LIGHTING FIXTURES in nnr+,00
cDDREss ons "s 9563 APPLIANCES.RESIDENTIAL' 4.00
AGoness
/-39S,5 / vrwNE �y�-/J� PANELS 10.00 - 'I
�u C 6LV DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE
ore PANELS (OVER 200 AMP( 20.00
ENGINEER
LIC.No, SIGNS TRANS. 3.00
goo'ESS ENG. - _ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
AFRucaurs
ADDRESS MOTORS SEE FEE SCH. Q
'
SERVICE CHANGE 2(1.00 [v/
�0 2 LICENSED CONTRACTORS DECLARATIONt� ISS/ANCE
(10
a u v I hereby efllrnn that I am IicenseJ under provisions of Chapter 9 DATE
m < i (commencing with Section 7010)of Division 3 of the Business and - BLUC. EL CT: PLG. MECH.
s- D i Pro ePtions Code,' d my'licemw is in full fort e fe \ ❑ ❑ ❑ ❑
Z
o r$ - Lieen le Lia Number
I, H )a1cConlraclor
m M BUILDING PERMIT
M ¢ OWMCR-BUILDER DIiCLA RATION -
o a o INFORMATION
X ; LL y I hereby u.1lo ing I am except from the Contractor's License MISC.- REFER TO ORD
u0 Low for the following reason.(Sec.7031.$,business and professions VALUATION ' $/FT.
H - g PERMIT ISSUANCE .49,00.
Code:Any city or county which structure
permit Tu is HeRanc,arm
ac Q o improv0.Demolish,or repair any slmclurc,prior lO its issuance,also ELEC.CONTR. .LIC.NO. ELEC.
Ey O u requires lire applicant for such permit to File a signed riatcment that. TOTAL �Ok fv PERMIT O
K
he is licensed pursuant to the provisions of the Contractor's License �[
or Law(Chapler')(commencing with Section 7000)of Division 3 of the �Cfje
a Business and Professions Calc)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
r $ the basis for the alleged eeem tion.An
g p violation to ction 703L$ STORIES TYPE CONSTR.
e; by any applicant fore permit subjects theheepplinnt to acivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more Than five hundred Dollars(5$001.):
❑ I,as owner of the proi or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
Their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF;AREA,COND. 5.00
Cale:The Contractor's License law does not apply to an owner of
profRrly who ba11d5 or Improves feneoa,and who does sNdy work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or of rote his own employers.provided that Poch i ve-
rrus aye...Ifo thumigndcd oro ffered for oyeesvl,.lned thathowever.thebuildingGAS-EA.SVSTEM-11NC.40UTLETS .6.00
or improvement is sold within one year of completion,The owner- GAS-EA.SYSTEM-OVER 4 (EA) 2.00
builder will have The burden of proving that hu did rot build or im- BUILDING USE
prove lot purpose ofsale.l. INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
ID . .
,1,as owner of the property,am exclusively contracting with ❑ ❑ ,❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and professions Calc:The Contractors 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 conte etods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200k/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W'ORKERS'COMPENSATION DECL\RATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self insure. -
or a certificate of Workers'Compensation Inmrance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Crrtilietl copy is hereby furnished. FIRE SPRINK ENERGY T34
Z Z ❑ Cerlificd copy u Filed with the city in,eetioli division. MISC.- REFER TO ORD.
F C) Applicant Y ❑ N❑ Y ❑ •N❑
I w CE R'fuFICA'1'1i OF 1:xh;MPT1ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
ED > COMPENSATION INSURANCE PLG.CONTR. LIC.NO.IL PLG.
Z ('this section need not be completed it the permit is for one TOTAL Y❑ N❑ V E] N❑
hundred dollars IS 100)or Irv.)
U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
•U_ U mit is issued,1 shall Pat employ any persue in any manner su us to
hcom• T eWo'kc- California.
LU
Uatc_ Applicant BUILDING
} to No'I'ICIi f PPLICANT: If,a cr m Certificate of Ex- ALTER OR ADD TO MECH. 5.00
? empt ion,you should become subject 10 the Workers'CompensationAPPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith courtly with FEE
U such provisions or this permit shall be deemed®yoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGIiNCY AIR HANDLING UNIT(OVER 10000CF.M.) 6.00 SEISMIC FEE rJ^O
I betray affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of tie work for which This permit is issued(Sec. MICROFILM
3097,1 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's N,nAddHEATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's AAly ess ELECTRIC �a
I "nil,atio Blot I havo read this o cannily and acro ty a the above VENTILATION FAN (SINGLE) 4.00
indinances s erred. I agree to comply with all city ural county.. anPLUMBING
ordinances o slam laws relating to building construction, and BOILER-COtvP 13 H.P.or 100,000 B.T.U.1 6.00
hcrchy in.thentionire roperty for
of this city to enter ufNm lira BOILER-COMP (Over 100,000 STU)SEE FEE SCH. MECHANICAL
above-meNiarheJ properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue a said City in consequence of the '
mnG MECH.CONT. -LIC.NO. MECH.
TOTAL TOTAL
late of of Applicant/Contractor a e
OFFICE COPY