16681 POST THIS CARD NEAR FRONT OF BUILDING, PER&IITNUMBER
CITY OF CUPERTINO 16681
INSPECTION DIVISION
JOB INSPECTION RECORD
• .r
p PERMIT EXPIRATION
JOB ADDRESS �Q.;/ F,�,�„�-<-d�L�F UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER ,� L CONTRACTOR+ IS NOT STARTED WITHIN,
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:' LASTCALLED INSPECTION. .
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHn+n VALIDATION,
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "
UNDERGROUND /SLAB
PLUMBING + R /•'- l.. ' / ��, !• ' .
ELECTRICAL•
ISSUANCE DATE -
MECHANICAL - - LDGI ELECT I PLG MECR.
X
' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED t'1 - BUILDINGEPERMIT
INFOR ATION
WOOD FLOOR VALUATION SIFT.
PLUMBING - ,{ry
MECHANICAL -
ELECTRICAL - PERIO T TO
FRAMING
INSULATION - c� 7vap at, STORIES TYPE CONSTT+
occ m+OUP HES uwTs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5O-IT FLOOR AI,cA TOTAL ACREAGE.
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
B W.: LONG USE
ROOF SHEATHING Res Irvn ON
Pe oln.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 ❑ 0 0
ROUGH #
ASSESSORS PA14CEL NO
SAN. _
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO.
TUBS BSHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
.A=DAlE ACC FILE NO
ELECTRICAL - BUILDING ENERGY
FRAMING ELECT.FINAL TEST
].ONiNG ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
' - MECHANIC FIRE SPRINK ENERGY TOA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y L] NO Y 0 N[]�
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOOD ZONE -A.LUC.
INTERIOR SHEAR FIRE DEPT. ` "❑ - "❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR.LATH BUILDING II
INTERIOR LATH - - TEMPORARY APPROVALS BUILDING
SCRATCH COAT . . ELECTRIC PLAN CH ECK
GAS FEE . I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY_ SEISMIC FEE
OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ELIARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC C
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING I Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL S U ,
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE 'TOTAL v
' CALLING FOR FINAL INSPECTION. ---�-
-OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 16681
ADDREss BUILDING-ELECTRICAL-PL _
UMBING 'MECHANICAL '
10' O /•c, )1zo ki
� OwrvER'S PLAN CHECK VALIDATION
AME D- //A 'a //�� L OTY. ELECTRIC PERMIT• FEE
/• V�/��•-1�' PHONE /� -�L Q
i NTRACTOR'S / (- . UTLETS-SWITCHES-RECEP 10.00/1.00 3 "�
V1 C-A
NO. S6 q✓/ _9_ LIGHTING FIXTURES 10.00/1.00
ADDRESS
ORa APPLIANCES 4.00
ADDREss _
S �PHONE�? � PANELS . s 41�13710.00 DATE OF APPLICATION (...
OR ORT PANELS (OVER 200 AMP) 2.0,00 PLAN CHECK EEEP.C.No.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
AOGRi'ESS ENG' � SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 1
Arvrs MOTORS SEE FEE SCH.
ADDRESDDRESS
Oft! SERVICE CHANGE 20.00 e•
w o o LICLNSIiD CONTRACTORS DECLARATION P t vJ�
U,L~i I hereby of ria that l am licensed under provisions of Cha
pmr 9 7 ISSUANCE DATE
Z "' (commencing with Section 7000)of Division 3 of the Business and
G ¢ y BLDG. ECT. PLG. MECH.
,o In r W Profession,Code,gpyamy nL C.
in f all ford��
z o H- License ss_G__�(s Lie Numbe
Dote Gust meter ��sMf
¢ Y ¢ a OWN[i R-BUILDF,R DECLARATION \s.' BUILDING PERMIT
a o v INFORMATION
X ; LL I- I hereby affirm that I am exempt from the Contractor's License MISC,- REFER TO ORD
I- ooj Law for the following reusnn.lSec.7031.5.Business and Professions PERMIT ISSUANCE VALUATION E/Fi.
m0 Crede:Any city orcounty which myuires a permit to construct,alter,
¢ ¢o improve,demolish,or repair any structure,prior to its issuance also ELEC.CONTR. LIC.NO. ELEC. o -
O ¢ requires the applicant for such pemlil to Pit,a signed statement that TOTAL
w 9 m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Fz >
Law(Chapter 9(commencing with Section 7000)ofDivision3ofthe _ �•
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ t the basis for the alleged exemption.Any violation of-Section 7031.5 STORIES f TYPE CONSTR.
a ; by any applicant for a permit subjects the applicant to acwil penally0)-) ALTER-DRAIN -WATER (EA.)
of not more than five hundred dollars(550 :
❑ 1,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole eompenation,will do the work,and the structure 6 not
intended or offend for sale (Sea 70,L4, Business and Protessions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'Fla,Contractor's License Law does not apply to an owner of
O property who builds or Improves thereon,and who doessuch work FIXTURES-PER TRAP - rOrb SD,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such approve-
Hunts are not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner-
bit
wner- GAS-EA.SYSTEM OVER 4 IEA.) 200
builder will have the burden of proving that he did not build or ire- - . . BUILDING USE
prove for purpose of mlc')' INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Omer
❑ 1,as owner of the prnpcny:ani uxclusivcly contracting with ❑ ❑ ❑ '❑ ❑
licensed contractors to construct the pokes(See 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:l'he Contractor's License Law dun not apply
to an owner of Property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5IEA.) 1.00
contracts for such pmjccts with a contractor(,)licensed pursuant to
the Convector's License Law. SEWER-SANITARY-STORM EA.200ft/10:00 TRACT NO. PARCEL NO.
❑ lam exempt under See ,BSP.C.for this WATER HEATER W/VENT 6.00 -
reason
0w'ner Pate WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby alflrm that 1 have a cenific is id-consent to wfiNnuue, -ZONING ENG.SITE NO.
or a artm.1 cu W'orkcrs'ComlprS5gqinion Inwralke,orcertified I
ropy thereof)Sac_3800.Wb.C.)SJ Y `/g' P '
Policy No. Com wry //�C�E q-
Z ❑ Certified P by Tum FIRE SPRINK ENERGY T 24
Z 2 )IC Certif s file frI��'tion division.
MISC. REFER TO ORD.
O/' Appla,", of Y ❑ N❑ Y ❑ N❑
MN CF.RTIFICA :Of
EXEMPTION FROM WORKERS' PERMIT ISSUANCE lr FLOOD ZONE A.L.U.C.
LU > COMPIMATION IN'SURAN'CE PLC,CONTR. LIC.NO. PLGCIL . ❑ ❑ ❑ ❑
Z (This 5eeticip aced not he completed it the permil is lir one TOTAL V N V N
hundred dollars IS 100)or less.)
V O 1 certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE
mFEE SUMMARY
EL U mit is issued,1 shall not empty any proton in any manner so as to
becoe subject to the Workers'Compensutiun Laws of California. /
O 2Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING pQ`
} res NOTICE '10 APPLICANT: If,after making this Certificate of Ex-
H ? c,nption,you should become subject to the Workeri Compensation APPLIANCE _ 5.00 PLAN CHECK
Provisions of the Labor Code, you Most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.)' 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.F.M.) 6.00 SEISMIC FEE
I hereby afroo that there is a construction Racing agency for EXHAUST HOOD (WITH DUCT) 5.00 '
the perfammnce of the work for which this Per,nit is issued(Sec. MICROFILM
3097,Civ.CL HEATING'UNIT(TO 100,000 B.T.U.) ' 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
. 1 certify Ihat I have read this application and ,are that the above VENTILATION FAN (SINGLE) T? �"y�1.
information R correct.1 agree to comply with all city and county PLUMBING 4G —
ordinances and slate laws relating to building co..for.mm, and BOILFA-CCMP(3H.P.or100,0D0B.T.U.) 6.00 .i
hereby authorRe representatives of this-city m ..oleo upon tire BOILER-OOMP IOwr 100,000 BTU)SEE FEE SCH.
above-mentioned property for irespectionprumse,, MECHANICAL 6
(We) agree to save, indemnif and keep hamucv the City of MISC.- REFER TO ORD.
Cupertino ' St li' 'lines,j no rets, costs and expends which PERMIT ISSUANCE .}g-00 ` CONST.TAX
may i ny a msl ily in cpnsequenct,of the - yi_
\ n of cit JU 2e MECH.CONT. LIC.NO. MECH
TOTAL S`= . TOTAL
Igniture of cant/Contractor Date -
OFFICE COPY