16347 POST THIS CARD NEAR FRONT OF BUILDING '
- � PERMIT NUMBER
CITY OF CUPERTINO 16347
INSPECTION DIVISION
JOB INSPECTION RECORD
• 1 / PERMIT EXPIRATION
JOB ADDRESS_ Un/7c R-�aN �L, UNIT t# LOT# '
PERMIT EXPIRES IF;WORK
" OWNER L LSZr CONTRACTOR ;Ej, iiCTCI IS NOT STARTED WITHIN
INSPECTIO DATE INSPECTOR INSP TION R OR 180 DAYS OF PERMIT ISSU-
FOUNDATIONNOTE: ANCE OR 180 DAYS FROM
'
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS:
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED •��
. - Y
UNDERGROUND /SLAB
PLUMBING 4al
26`
ELECTRICAL S.% E Dore
MECHANICAL RLI :'r PLI MecR.
w[ U ❑ 1:1E:].
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOORINFORMATION
PLUMBING
VALUATION I., SIFT,
MECHANICAL �
ELECTRICAL - - ,��PE/RpuTyT�q /
FRAMING O.A.J l A/7"1 �/,'e/T'fdde-4
INSULATION O -�� r,A'�/ STORIES TYPE CONSTR.
. y1V OCC GROUP. RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 111,11,PLO11n APPA TOTAI.AC1LAOL
�- DIAPHRAGM, THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING - BUILDING USE
RES IND CON V6 Upnr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH $AN.p AS5LSSORS PARCEL NO
PLUMBING / — — ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO.
MECHANICAL MECH.ENERGY '
ELECTRICAL -l/- BUI-DING ENERGY ACC,OArE ACC.PILE NO
FRAMING -� ELECT.FINAL TEST !XIAI
��INSULATION QPLUMBING - A- 2ONi NO ENcSITE NOGAS TEST GAS
MECHANICAL P RE SPRINK ENERGY Tia
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ° ❑ N❑EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE - A,L U,C,
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ N❑SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH -9� BUILDING
INTERIOR LATH TEMPORARY APPROS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR.PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 3�
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGN ED BY BUILDING INSPECTOR. MICROFILM,
'ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F— ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Od '
PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR-EXPIRATION DATE — MECHANICAL
IMPORTANT! coNs7 TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL S7J3�'
CALLING FOR FINAL INSPECTION.
\ OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
9111
1. LDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 16347
FILDIN
OGRESS
113 2kn eP 2
An Ce BUILDING - ELECTRICAL-PLUMBING-MECHANICAL P
1 OWNER' PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
Mctw G[. Q PHONE /(1
CONTRNCTO 'S
NAME PF OUTLETS-SWITCHES-RECEP 10.00/1.00 (
M mhAY JIMCIW.G. ' LIGHTING FIXTURES 11000N'T .00/1.00
R/re`n�,s ons PPLIANCES-RESIDENTIAL - 4.00
PANELS 10.00 DATE OF APPLICATION
A CHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP( 20.00
ENGINE€
N' C 0- LIC.No. SIGNS TRANS. 3.00
R . ENG
ADDRESS SOf-t P 22B SPECL CIRCUIT 5.00 PERMIT VALIDATION
✓C T U nv S(9 EMP.IAMETER OR POLE INS. 2000.
APPLICANT'$
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 �j
Foo LICENSED CONT'RACT'ORS DECLARATIONto
a U w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE _
¢a (commencing with Section 7000)of Division 3 of the Business and
F N'^ Professions Co and my license is in full(or a C U BLDC. ELECT. PLG. MECH.
zo o,m to License Cl s Lin.Number / ❑ ❑ ❑ ❑
m Date Contractor ren Q
It rt w 4OWNER-BUILDER DECLARATION • ,xtBUI LNG PERMIT
E:
;' y I hereby affirm that I en exempt from the Contractor's License MISC.- REFER TO ORD j�UINFORMATION
IL o ¢ Law for the following ncoson.(Sec.7031,5,Business and Prnl'assions 86 VALUATION $/FT.
r - Code:An cit or coum which na uiresu PER ISSUANCE
Y Y Y 1 permit to construct,alter, ASL(,
2¢ 4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO. ELEG
a, requires the applicant for such permit to file a signed statement that TOT A Lp�J PERMIT T
n w m he is licensed pursuant to the provisions of the Contractor's License
FiQ Law(Chapter 9(commencing with Section 7000)oCDivisiun3ofthe /1]A/7Ld-V/1��/ �O
4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 1714"
¢ I-m the basis for the alleged exemption.Any violation of Section 7031.5
III 3 .- b do a lienor fora STORIES TYPE CONSTR.
Y' Y or pcmne objects theapplicum toacivil penahy q ALTER-DRAIN -WATER IEA.) 5.00
of not more than Ove hundred dollars the ap.li 2
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00
their sole comp,malion,will do the work,and the structure is mol . OCC.GROUP RES.UNITS
intended or offered lir, sale iSec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: 'rhe Contractor's License Low does not apply to an owner Of
property who milds or Improves 11hronn,and who Inc, tch work FIXTURES-PER TRAP So FT FLOORAREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or Offered 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- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden ot'proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Diner
1 ❑ I,as owner of the property,am exclusively contracting with ❑
om
licensed cr.emrs to construct the project(Sec. 7044,Business LAWN SPRINKLERS 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
El
and Professions Code:The Contractor's License Law does not upply -
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-STORMEA.200f1/10.00 TRACT NO. PARCELNO.
❑ hum exempt under sec. ,B.S.P.C.for Ibis WATER HEATER W/VENT 6.00
0 '
o
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate of consent to self-insure.
r a certificate or Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
'opy thereof(SCc.3800,Lxb.C.),
Policy IN.. Con.pmry
C) ❑ Certified copy is hereby furnished
Z Z ❑ Certified copy is fled with the city inspection division. FIRE SPRINK ENERGY T 24
F to Applicant MISC.- REFER TO ORD. Y ❑ N Y ,Is
- CERTIFICA'I E CI:EXEMPT'ION PROM WORK Ii RS' PERMIT ISSUANCE �' PLO
zo NE A.L.0 c.
LU - COMM'NSAT'ION INSURANCE PLG.CONTE. LIC.No. PLG.
CL a (Jets section need not bu completed if the permit is for one TOTAL Y N� V
Z N
U O hundred dollars in the or less.)
I certify that h the t employ an of the work for which this per OTV MECHANICAL PERMIT FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner sit as to FEE
becom UJ a Workers' umnsalion Laws alilo ia. G
a Dan PP Can • z[ ALTER OR ADD TO MECH. BUILDING / (1
} m NOTICE APPLICANT: If,alter mak ng this erli icat,of 5.00
F ? Ex-
emption,you should become subject to the Workers Compensulimn APPLIANCE PLAN CHECK
5.00
provisions of the Labor Code, you must forthwith comply with -
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10FEE,
000 C.F.M.) 4,00 9
CONSTRUCT'ION LENDING AGENCY AIRHANDLINGUNIT(OVERIQOWGFM.) 6.00 SEISMIC FEE ,33
1 hereby affirm that then, is a construction lending agency lot EXHAUST HOOD(WITH DUCT) 5.00
the performancc of the work Jnr which this permit is issued(SCC.
30197,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) MICROFILM
8.00
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T619.50 ELECTRIC �✓
ormtiio that correct.
read agrees application and all c that and
VENTILATION FAN (SINGLE) 4.00
information n correct. I agree to comply with all City and county PLUMBINGBenny ems anJ stale laws reveling m building construction, and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00hereby authorize repres,nllives of this city to ,mer upon theabove-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. in
(We) agree to save, indemnify and keep harmless te City of MISC.-upertino against liabilities,judgments, costs and expenses which ay m any way accrue against said City in o nse uenc of the PERMIT ISSUANCE 10.00•,notingoriapemit. MECH.CONT. LIC.NO. MECH.
A( TOTAL '
Sign tureof Applic nt/Conrado, ate -
OFFICE COPY