16839 L
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER,
CITY OF CUPERTINO 1 689
INSPECTION DIVISION
JOB INSPECTION RECORD
((�
D PE(11(MIr44JJE XPIRATION
JOB ADDR _ O Ik #UNIT _LOT#LN* (p�MITIEkPIRES' F,WORK 1
OWNER V" S (� CONTRACTOR �„� IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS-AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. J
GARAGE SLABS - / 2— —
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - I
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - - IssuarvcE uarE T
MECHANICAL BLDG ELECT- PLO I MECH.
. �].
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED . BUILDING PERMIT
.WOOD FLOOR INFORMATION
'VALUATION SIFT.
PLUMBING
MECHANICALPAID
ELECTRICAL- - - PERMIT TO
FRAMING
INSULATION - -•STORIES r
City 0 Cupertino
UCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - •NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.Er.ROOK AREA .TOTALACREAGE. ;
DIAPHRAGM THE CONSTRUCTION TAX IS PAID y
BUILDING USE
ROOF SHEATHING - RES IND CON Pa 0"",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN:a
PLUMBING - j/ ELECT.ENERGY
TNACi NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL '2 JL BUILDING ENERGY - - ACC DATE ACC.FILE NO
FRAMING - G ZONING ENG,SITE NO..
` ELECT.FINAL TEST
INSULATION PLUMBING1
GAS TEST GAS '
MECHANICAL FIRE SPRINT( ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ .N❑ Y E] NE]
EXTERIOR-SHEAR ELECTRICAL RELEASE PLoou ZONE A,l.u.c.
INTERIOR SHEAR - FIRE DEPT. >'❑ N❑ Y N
SHEETROCK GRADE -' . FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH - TEMPORARY.APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS 'FEE fir
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE y
. OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. JEU
MBING p0
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
'I I' Z
- SEE PERMIT FOR EXPIRATION DATE -. CHANICAL
IMPORTANT! NST.TAX
PLEASE READ REVERSE'SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. /, -
OFFICE COPY
AP,RLICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE,BALL POINT PEN ONLY -
BUILDINGPROJECTIDENT]FICATION ^ PERMIT NUMBER
\/
BUILDING APPLICATION & PERMIT
ADDRESS R
Q�rp Lj�� BUILDING—ELECTRICAL—PLUMBING—MECHANICAL ' 1 I/'��v 8�S'
r
OWNER'S
NA/M�/a / /1 - - PLAN CHECK VALI,D.4TION
�� ✓ / � f /ff r,�s—z—y0 TY ELECTRIC PERMIT FEE
LSV/d -CJ PHON 1 G � /� n I
NgMERnc7oas , OUTLETS'-SWITCHES-RECEP, 10.00/1.00
LC.NO. LIGHTING FIXTURES 10.00/1.00 Lo
Rs - APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 1 10:00 - DATE OF APPLICATION -
0 OfNEECT' PANELS (OVER 200 AMP) 20.00 ,
PLAN CHECK FEE P.C.NO.
O
ENR GINEER//_2, - Lt� /DSIGNS TRANS. _ 3.00 _
NO.
ARCM.OR ENG. '
AOORF ��/WA SPECIAL CIRCUIT 5.00 '� ,:' PERMIT VALI CATION
� iIvLel-�< nP TEMP.METER OR POLE INS: 20.00
noon SS MNT S OTORS - ' SEE FEE SCH. .
Xe~ LL o't-C - SERVICE CHANGE - 20.00'
0 ¢z
.00 LICENSED CONTRACTORS DECLARATIONPAILI ,.
a z w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
Q N (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT, PLG. MECH.
r G z' Professions Code,and my license Is in full force and effect, f i
o i=D License Class Lie.Number. - ❑
r w H J Date Contractor
Q y J p
¢ ¢ w OWNER-BUILDER DECLARATION .C� BUILDING PER
E
;,`� N 1 hereby affirm that I am exempt train the Contractor's License MISC.- REFER O INFORMATION
H LL o¢. Law for the following reason.(Sec.703 L5,Business and Professions - VALUATION. . $/FT.
Code:An count 0 PERMIT ISSUANCE 10.0
Hwy Any or y which requires a permit to construct,alter, _ Talft
¢ K Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.GONER. LIC.NO. - ,
ELEC.
n
D ¢ - requires[he applicant for such permit to file a signed statement that _ TOTAL ',TDD PERMIT TO _
So
m p he is licensed pursuant to the provisions ol'the Contractors License _
Hzi
Law(Chapter 9(commencingwlth Section 7000)of Division 3 ofthe -
i c Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT_ - FEE -
mi-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i3 .-. by any applicant for a permit subjects the applicant toacivil penalty VALTER-DRAIN&VENT-WATER IEA.) 5.00 1
t more than five hundred dollars($500),): -
110
I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not -OCC,GROUP, RES.UNITS
intended or offered for sale (Sec. 7044, and
and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00
Code:The Contractor's License Law does not apply to an owner of lCtIa
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.PT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
mentsare notintended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- -
builder will have the burden of proving that he did not build or im- ' GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 - BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON . PB Omar ^
❑ 1,as owner of the property,am exclusively contracting with' �-
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS:,1 INC 5 V.B. 6.00 �A66ESSORSPARCELNO.
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(EAX ,1.00
contracts for such projects with a contrmlor(s)licensed pursuant to ¢
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL rvo.
❑ lam exempt under sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason ;
Owner Dat WATER SYSTEM 5:00
'70ACC.DATE ACC.FILE NO, _
WORKERS'COMPENSATION DECLARATro WATER,TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,,or a cerlil'ied ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). '
Policy No. Company
0 ❑ Certified copy is hereby furnished. -
Z Z ❑ Certified copy is filed with the city inspection division. FIRE SPflINK ENERGY T-24
O Applicant MISC.- REFER TO ORD. v N❑ vEI NEI
DCy CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ' FLOOD ZONE A.LU.C.
LU > COMPENSATION INSURANCE , PLG.CONTE. ,LIC.NO. PLG.-
- FIL - '
1 (This section need not be completed if the V ')❑ N V
p permit is for one TOTAL
0 Z hundred fy thatlars in the
pe less.)
U O 9 certify that h the performance of the work for which this per- QTY- MECHANICAL PERMIT FEE FEE SUMMARY
0 I.U mit is issued,I shall not employ any person in any manneror ram
0 W become subject to the Workers'Compensation Laws oCCalifornla. _
Q. Date - ApplicantALTER OR ADD TO 5,00 BUILDING �dp
} W NOTICE TO APPLICANT: If,after making this Certificate of F:x-
I— _ emption,you should become subject to the Workers Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply.,with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MDC.F.M)' 4.00 FEE e
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 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
3097,Civ-C,). '. HEATING,UNIT(TO 100,DDD B.T.W) 8.00 '
Lender's Name - HEATING UNIT 100,000 B.T:U.)9.50
- Lender's Address � ELECTRIC.
I certify that I have read this application and state that the above VENTILATION FAN (SINGLEI .. .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-CDMP(3 H.P.Or 100,000 B.T.U.) 6.00 T
hereby authorize representatives of this city to enter upon the Over 100,000 BTU)SEE FEE�SCH. _ MECHANICAL
above-mentioned property for inspection purposes. BOILER-COMP ,
(We) agree ao save, indemnify and keep harmless the City of ,MISC,- - REFER TO ORD.
uperInto against liabilities,judgments, costs and expenses which CONST.TAX
any way,accrue against iit Cit n consequence of the PERMIT ISSUANCE 10.00 -
anti
or"is
nni MECH.CONT. LIC.NO. - MECH.
TOTAL. - TOTAL r
gnaune of Applicant/Contractor I Dider
— OFFICE COPY "'