16820 POST•THISICARD NEAR FRONT OF BUILDING
PERMIT NUMBER
. CITY OF CUPERTINQ, : 1' s:. 16820
INSPECTION DIVISION
r'w• JOB INSPECTION RECORD .
,, ,, PERMIT EXPIRATION
"�'Y4F•Y" JOB ADDRESS �p—/� [S6•Ct7L- _ + UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER• %Q L CONTRACTOR r - - IS NOT STARTED WITHIN
I PECTION DATE INSPECTOR INSPECTION RECORD 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 PERMIT VALIDATION
CUPERTIN_O STANDARDS.
GARAGE SLABS '
POUR_ NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED II-I . _5'r OV -i- jo 1(-(,i 9-
UNDERGROUND /SLAB
PLUMBING , ...1 /o Px.7 m.t... ^34S �•�i - �• %. ,
ELECTRICAL (L - CtISSUANCE DATE'
MECHANICAL . - CLOD. ELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
' WOOD FLOOR - vnwnnory - slFr.
PLUMBING -
MECHANICAL - --ZE05 - '-•
ELECTRICAL
PERMIT TO
' � - � D
FRAMING - ,O
INSULATION
STORIES TYPE CONSTR.
•' � � 1 v
1�
' • OCC GROUP RES UNITS
PLACE NO SUBFL06R UNTIL ABOVE HAS BEEN SIGNED \ T • �� uQ
$O,Fi.FLCOX AREA TOTALACREAGE
OV ROOF I NOTE:NO FINAL INSP.SHALL BE MA E BEFORE, - P . .
DIAPHRAGM THE CONSTRUCTION TAX IS PAID' _
BUILDING USE
ROOF SHEATHING t - I'ES IND CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ Q El
ASSESSORS PARCEL-NO
ROUGH SAN 11 p •• a,
PLUMBING //� ELECT.ENERGY
TUBS B SHOWER PAN A PLUMBING ENERGY T"ncr No, PARCEL NO
MECHANICAL - MECH.ENERGY '
ELECTRICAL -/'y BUILDING ENERGY ACC,DATE. ACC.FILE No.
FRAMING ELECT.FINAL TEST ZONING
ENG. NOL�
INSULATION PLUMBING rj ti -
GAS TEST GAS
MECHANICAL - _rQmFIHE SPRIHK ENENGY Na
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ( Y - "� NE]
FLOOOZUNE A,L.U.C.
EXTERIOR,SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR - FIRE DEPT, - -
❑ No ❑ No.
SHEETROCK GRADE , FEE SUMMARY
EXTERIOR 'LATH BUILDING -
INTERIOR LATH - -- TEMPORARY APPROVALS . BUILDING
SCRATCH COAT ELECTRIC PLAN'CHECK
NO TAPE OR PLASTER UNTIL ABOVE HAS'BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC.
o� ONE WORKING DAY BEFORE'REQUIRED INSPECTION. PLUMBING l
z PLEASE,GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE— MECHANICAL
IMPORTANT! CONST. rnx
/
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY-
PG.BE
CITY OF CUPERTINO COPY
GAS SERVICE NOTICE
To
• � You ore hereby authorized to connect the GAS service for
�Owner or Tenant biI
` At -2t 1 '7 G 2 _Dr, Avg
q New Service
No. of Meters I -Reconnect u
ii
No. of Add. Meters
Move Service
� Move Meter
i
PLUMBING INSPECTOR
APPLICA!" TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION -PERMIT NUMBER. _
BooW's p APPLICATION & PERMIT 1 �+O O
BUILDING=ELECTRICAL—PLUMBING—MECHANICAL IDU
OWNER'S
NAME PLAN CHECK VALIDATION
•�( \ �f+d6�gg59 OTY. ELECTRIC PERMIT FEE
Ilii �, (�ltx1,�\ 'TO PHONE
CONTRACTORNAME
UTLETS-SWITCHES-RECEP 10.0011.00 ,
LIC.NO.. LIGHTING FIXTURES 10.00/1.00 '
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS E
PHONE PANELS 10.00 DATE OF APPLICA TION '
ARCHITECT PLAN CHECK FEE P.C.,NO.
OR PANELS (OVER 200 AMP) 20.00 e
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
ARCR'E R ENG. SPECIAL CIRCUIT 5,00 - PERMIT VALIDATIONSS
-,
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT s I MOTORS SEE FEE SCH.
AOOREss
�J
SERVICE CHANGE 20.00 F =
o ¢i
0 1 o o LICGNSIiD CONTRACTORS DECLARATION.
^Q U I herchy Arne, Ilial I am licensed under provisions of Chaplet 9 - ISSUANCE DATE
u rt y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r m z Professions Code,and my license is in full force and effect.
z o m - License ClassLie.Number
Z - o ❑
@ m H w Date. Contractor r ❑ ❑
H _ _
5 Y 4 - BUILDING PERMIT
¢ ¢ w OWNER-BUILDER DECLARATION
A o a INFORMATION
X ; w I hereby af6nu that I um exempt from the Contru'ctoh License MISC.— REFER TO ORD
.. o J law for the following reason.(Sec.7031,5,Bosinessxnd Professions VALUATION /FT.
'I- - PERMIT ISSUANCE 10.OD
ami Code:proe,y mulish county whiny res,oustructesap prior
its issuance,
also
¢ ee ¢ improve,demolish,or repair any structure,prior tO its issuance,aim ELEC.CONTR. LIC.NO. ELEC.
e, requires the applicant for such permit In flu a signed statement Ilial
K
PERMIT TO he is licensed pursuant to the provisions of the Contractor's License ix ) -
F z a
Law(Chapter 9(commencing with Section 7000)of Division Sof the
4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
w r$ the basis for the alleged uxemplion.Any violation of Soclion 7031.5 STORIES TYPE CONSTR.
e 3 by any applicant for a permit subjects the applicant to a civil pretty
of not more than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER (EA:) 5.00
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCR GROUP RES.UNITS
sole compensation,will do the work,and the stricture is not
` intended or of1'ured for sale (Sec. 7044, Rosiness and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to at owner of
• property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 Sa FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
mems are not mounted or offered tier sale.If.however,the huilding GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.( 2.00
builder w01 have the burden of proving that he did not build or im BUILDING USE
p . .00 for purpose of sale). INDUSTRIAL WASTE INTER30RES IND CON PB Omer
Ll 1,as owner of the property,am exclusively contracting with El, ❑ ❑ ❑ ❑
licen rd contractors to constructthe project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO. -
' and Professions Cale: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.
contracts for such projects with a contmctorix)licensed pursuant to
the Convector's License Law. SEWER-SANITARY-STORM EA'.200ft �' TRACT NO. PARCEL NO.
❑ lose exempt underSec ,B.&P.C.I'or,his
nr- -�r . WATER HEATER W/VENT
owe
-
WATER SYSTEM0' ace.oATE ACC.FILE No.
WORKERYCOMPENSA'fION DF.CI.ARAI'ION WATER TREATING EOUIP. 5.00
I hereby affirm that I have a certificate RI comsem to sel4imiure, p
or acrffi,atc of Workers'Compensation Imuruncc,a certilicd G� ZONING ENG.SITE NO.
- copycthereof]Sec.3800,Lab.C.). - -
Policy No. Company '-
0 ❑ Certified copy is hereby furnished.
Z Z ❑ Ccrtificd copy is File(] with the city inspection division. FIRE SPRINK. ENERGY TY4 _
.,FO A,dicum MISC.- REFER TO ORD. Y ❑ IN Y ❑ N❑
N CERTIPIC\TE 01'IiXF,MPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
Lu COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
O (This section need not'be completed if the permit is for tome TOTAL ✓ - Y❑ NE] Y❑ NE]
2 hundred dollars IS 100)or Icss.)
U O 1 certity that in theperformanceof the work for which this per- OTr MECHANICAL PERMIT - 'FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any pervm in any manner Vo as to
O W become subject to the Workers'Conipenmlion Laws of Californiu.
Q. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING-
- } Us NOTICE TO APPLICANT': If,after making this Certificate of lux-
(_ Z emption,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 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNrf(OVER IOAOOC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the Perlormance of the work for which this permit is issued fSea MICROFILM
3197,Civ C:). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name. HEATING UNIT(OVER 100,000 B.T.U.)9.50
' Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
F informationis correct. 1 agree to comply with al`city and county (3 H.P.or 100,0008.7.U.) 6.00
y PLUMBING
�. ordinances and state laws lacing to building 'onstruellon, d -
above-hereby entioed representatives lotivs of this city es enter upon the BOILER-COMP tOcer,100,000 BTU)SEE FEE SCH. MECHANICAL'
above-mentioned property for inspection purposes.
IWO agree.to save, indemnify and keep hannlrn the City of MISC." REFER TO ORD.
Cupertino against liabilities,judgeicnls, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way race against said City in consequence of the .
tooling of this triMO.ECH.CONT. LIC.NMECH. '
/ UL- �klS,l4l�{ TOTAL TOTAL
Signature of Applicant/Contractor Dale
OFFICE COPY l