16052 IPOST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY 'OF CUPERTINO 16052
` INSPECTION DIVISION
JOB INSPECTION'RECORD k
-PERMIT EXPIRATION
JOB ADDRESS 756 LUNIT# _LOT#
- 1 • PERMIT EXPIRES IF WORK '
OWNER . 11) CONTRACTOR .[, �/ - IS NOT STARTED WITHIN
INSPECTIO 'DATE INSP CTOR INS CTION RECORD leo DAYS of PERMIT ISSU `
FOUNDATION ANCE OR 180 DAYS FROM
UFER - ZLi A L GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
70 COMPLY WITH THE APPROVED PLANS AND CITY OF PE
RMIT VALIDATION
GARAGE
- ' ARAGE ITE SLABS CUPERTINO STANDARDS.
'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ¢�2
UNDERGROUND /SLAB
f9 F3 IM
PLUMBING ' ` „ �p�'3 ® �/
ELECTRICALISSUANCE DATE
MECHANICAL ? OG; ELECT I PLG. MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDf r ILDING PERMIT
WOOD FLOORQINFORMATION
VALUATION, SIFT.
PLUMBING -
MECHANICAL
ELECTRICAL - •, '/PIE MIITTTO
FRAMING - - �" /'7, -"
INSULATION - - STORIES TYPE TYPE CONSTR, -
S&/lk
OCC GROUP FRES UNITS
i PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE , / -
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID _ C ll cp
BUILDING USE.'
ROOF SHEATHING HE IND LON- PB Oilier
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑
.. _
ASSESSORS FAMCEL NO.
1:1
ROUGH SANK
PLUMBING ELECT,ENERGY
I TUBS IS SHOWER PANPLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ACC DATE ACC.FILE No.
_• FRAMING - - ELECT.FINALTEST - ZONING ENG SITE NO,
INSULATION PLUMBING
PLUMBING -
GAS TEST GAS
�' �'r Q MECHANICAL /,2 .� FIRE SPRINR ENERGY T-ZA
Y 10
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "0 NEI
FLOOD ZONE A L.0 C..
EXTERIOR SHEAR ELECTRICAL RELEASE v NQ v L .N�
INTERIOR SHEAR FIRE DEPT.
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING Q.�}o-
SCRATCH COAT ELECTRIC ' PLAN CHECK"
GAS ' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDINGFINALISSIGNED BYBUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC a q
fONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
yt Z�. PLEASE GIVE JOB ADDRESS WHEN PHONING.
' — SEE PERMIT FOR EXPIRATION DATE MECHANICAL -9V0 Q
IMPORTANT! coNsr.TAX
{ PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY.
API 1CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,
-PERMIT NUMBER
UILDING PROJECTiDENTI FICATION APPLICATION & PERMIT 16052
NUMBER-
BUILDING
Aoory 7 O I ING -ELECTRICAL-PLUMBING-'MECHANICAL -
OWNER'S ! - PLAN CHECK:WON
NAME - TY. ELECTRIC PERMIT FEE .fes
(V�✓V PHDN �— /3/✓�
NDAmERAcroR's UTLElL -SWITCHES-RECEP .10.00/1.00 . ,
LIC.ND. S LIGHTING FIXTURES 10.00/1.00 r�
rorvTRAcrOR PPLIANCES-RESIDENTIAL -4.00
ADDRESS
PW
E 2Sr III"Sit IPANELS 10.00 DATE OF APPLICATION
ORClsrtscr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.CiNO.
ENGINEER'
LIC.NO. SIGNS TRANS. - 3.00
ADDRESS ENG. PERMIT CIRCUIT PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS: 20.00
APPLICANTS
- MOTORS SEE FEE SCH.
DRESS
ADDn ESa
SERVICE CHANGE - 20.00 rt
woo LICENSED CONTRACTORS DECLARATION ry(1 J
a U U I hereby affirm that I am licensed under provisions of Chapter 9 �`T'' ISSUANCE DATE
H Q (commencing with Section 7000)of Division 3,of the Buldin and BLDG. LECT. PLG. MECH.
F 2. Professions Code��anQQ my license is in full force ❑ r—1
z o= - dcense CI s-�--(_Lic.Num - PQ
o m H w Datee�Q-�' Contractor
a x f BUILDING PERMIT
rc a a OWNER-BUILDER D17CLARATIO
Ic w D INFORMATION
X o a r 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO OR
a b VALUATION $/FT.
r a o er Law for the following reason.(Sec.703 LS,Bummessind Professions PERMIT ISSUANCE
mw Code:Any city or county which requires permit to construct,alter, _ 7
2 ¢Q improve,Demolish,or repair any structure.prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
aContractor'sS / / ��
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m m he Is licensed pursurat la the provisions of the License
is 0 Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe —b 0 J7-L VI Jr
a ' Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
Ic o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE.CONSTR.
a ;F by any applicant for a permit subjects the applicant loo civil penalty
of not more than five hundred dollars($5001.): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for Sale(Sec. 7044, Business and Professions , DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00 -
Cade:The Contractor's License Law does not apply to an owner of
property who builds or improves Ihercon,and who'does such work - FIXTURES-PER TRAP 5.00so:FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended or offered for salei F.however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6,00 r / G
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) . 2.00 - BUILDING USE
builder will have the burden of proving that he did not build or ins- RES. IND CON PB Clubs,
for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ El El
licensed contractors to construct the project(Seo 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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
C] lame script under See. ,B.&PC.for this WATER HEATER W/VENT 6.00
e reason
Owner Date WATER SYSTEM 5.00 r ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to selpinsurC, '
or a certificate of Workers'Compensation Insurance,or a ce lifted ZONING ENG.SITE NO.
�.� copy thereof(Sec.3800,Lab.C.L
Policy No. Company Q
Q ❑ Certified copy' hereby rami, d. FIRESPRINK ENERGYT-24
Z Z ❑ erlifie is file w'I tl dy inspection division.
O Applican MISC.- REFER TO ORD. y❑ IN C]
Y❑ N❑
~ rnIiRTI FICATEPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
W
LU EFROM WORKERS'_ COMPHIiNSATIOTION TION INSURANCE PLC.co NTR: LIC.NO. PLG.
n• (This section need out be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
D Z hundred dollars IS 100)or less.
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ H mil is issued,I shall not employ any person in any manner so as to
U became subject to the Workers'Compensation Laws of California.
!7 w Datc Applicant BUILDING �&0
a ALTER OR ADD TO MECH. .�a,90
} to NOTICE, TO APPLICANT': If,after making this Certificate sa lix-
F ?
Collation,viion you the L become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, ll b must forthwith comply with - FEE
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0004C.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 ol''the work for which this permit is issued(Sec HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATING UNIT(OVER100,000 B.T:U
Lender's Address
.)9.50 ELECTRIC
'
I certify that I have read this application and state that the above - VENTILATION AN (SINGLE) 4,00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
P' hereby authorize representatives of this city to enter upon thefy-4z
IL' BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. ,i
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.''
upertino against liabili ti ,judgments, costs and expenses which PERMIT ISSUANCE t3 CONST.TAX
ay in an ay accru gat said,City in consequence of the
ranlin his permit. MECH.CONT. LIC.NO. MECH. /
TOTAL �- TOTAL f'
8' store of plicanl ontraclor Date -
OFFICE COPY