16165 POST-THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
r= CITY OF. CUPERTINO 16165
INSPECTION DIVISION
J013 INSPECTION RECORD.
JOB ADDRESS 613 6 • 4-� 'T.Cn-c '�'N - PERMIT EXPIRATION
UNIT# LOT*f PERMIT EXPIRES IF WORK'!
owNER !/1/ -L,Te 'CONTRACTOR �,��„gd� I,8 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: •
UFER � - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CIT/OF PERMIT VALIDATION
C.UPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ..
UNDERGROUND /SLAB
PLUMBING - -
ELECTRICAL ISSUANCE DATE
MECHANICAL - RLOc ELECT PLG. MECH,
❑ 1 a o ❑ .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING - VALUATION SIFT.
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP ,RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO FT,FLOOR AREA -TOTAL ACREAGE
DIAPHRAGM 1 THE CONSTRUCTION TAX IS PAID •y
ROOF SHEATHINGRES IND ILDCOON USE
PB Oma, .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP, Q. ❑ 1:1 0 ' ❑
ROLIGH SAN.# ASSESSORS PARCEL NO.
PLUMBING - ELECT.ENERGY
TRACT NO. PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
- ELECTRICAL BUILDING ENERGY - ACC DATE Ace FILE No
FRAMING • ELECT.FINAL TEST zoNlNc. ENG.SITE No.
INSULATION PLUMBING -
GAS TEST - GAS .!yb-
MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "� ° [D "�
EXTERIOR SHEAR' ELECTRICAL RELEASE FLOOD ZONE A,L UC.
INTERIOR SHEAR FIRE DEPT. Y❑ ,'I, y L,. N❑
SHEETROCK - GRADE FEE SUMMARY.
EXTERIOR LATH _ BUILDING - -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JUCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTE D UNTILBUILDING FINAL ISSIGNE D BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, , ELECTRIC
F�. 'ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING . Qi
z 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 COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN�gNLY
13UI LDI NG PROJECT I DENTI FICATION :�',,,yr, 4ERMITNUMBER. ,
AWEss APPLICATION & PERMIT x. '1 1 C 1 C C
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I v I vJ
OwNER'a PLAN CHECK VALIDATION
10 COW PHONE7^ 9 QTY. ELECTRIC PERMIT FEE -
e/'` r y14
NAM TRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00
17Md LIGHTING FIXTURES 10.00/1.00
ONTRACTOR'S
ADDRESS � PPLIANCES-RES IDENTIAL 4.00
*0/tPHONESW PANELS 10.00 DATE OF APPLICATION
RRCNrtECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE _CJNO.
OR
ENGINEER LIC.No, ISIGNS TRANS. 3.00
ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
. zIP EMP.METER OR POLE INS. 20.00
ADDRESS
Ars MOTORS - SEE FEE SCH.
ADDRESS
- _ SERVICE CHANGE 20.00
0
'02 LICENSED CONTRACTORS DECLARATION
Q U w 1 hereby affirm that I am licensed undei provisions of Chapter 9 ISSUANCE DATE
v, (commencing with Section 7000)of Division 3 of the Business and
<n BLDG. 'ELECT. PLG. MECH.
O'^ Professions Code a license is in full for' �•f ❑
z OR°-'L�License. u Lic.Number lI ❑ ❑ '
qDate Contmcto
a x E BUILDING PERMIT
¢ ¢ w 4D O NER-BUILDE RATION ' INFORMATION I
wS u w I hereby al firm Thal l am a from the Contractor's License MISC.- REFER TO ORD ygt,UATION SIFT.
HwoJ Law for the following reason.(See.7031.5;Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
QwX Q G 20 improve,demolish.or repair any structure,prior t0 Its Issuance,also ELECONTR. LIC.NO. ELEC.
O¢ requires the applicant for such permit to file a signed statement that TOTAL w PERMIT TO m he is licensed pursuant to the provisions of the Contractor's License - yl� p
Fi >
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe IY 9
< Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT F F�
M ¢O STORIES TYPE CONSTR.
¢ I-$ the basis fur the alleged exemption.Any violation of Section703L5
n3 � by any applicant for a permit subjects the applicant loacivilpenally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE4.00 1 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,AREA,COND. 5.00 t171\U
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 6 FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improv'e- -
mems sale.If,however,the building / GAS EA.SYSTEM-11 NC.4 OUTLETS 9.96 .2
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 im- RES IND. CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the properly,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 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 SEWER-SANITARY-STORM EA.200ft/10.00 TRACT N0. PARCEL NO.
the Contractor's License Law.
❑ I 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'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of Consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
.� copy thereof(Sec.3800,Lab.C.I -
Pn1�icy��Y�'O. Company KI"s9n
O Alfie yis here fur . FIRE SPRINK ENERGY T 24
Z Z Certifi d with the city To ec Sion.
O Applicantel MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
~ va PERMIT ISSUANCE 10.00 / FLOOD ZONE A.L.U.C.
'(r C: TIFICATEOFEXFMPT10NFROM ORKERS•
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 6V
1 O (This section need not be completed if ore permit is for one TOTAL /7 ►r Y❑ N❑ Y ❑ N❑
D Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
O y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of lix-
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
(� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 70,000 C.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 of the work for which this permit is issued(Sec. MICROFILM v.
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-CONIP(3 H.P.or 100,000 B.T.U.) 6.00 ...J
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes,
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. '
Cupertino against liabilities,judgments, costs Snit ex prepe,which CONST.TAX
may in any way ace against sa" 'ty-in comseq ce of the PERMIT ISSUANCE 10.00
m n f this permit. MECH.CONT. UC.N0, MECH.
TOTAL TOTAL
alum of A licant(Contrector Dat
OFFICE COPY