16126POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS ' V ` O F `^' "'� `''�
% n _UNITA_ LOT #S'
OWNER 5 �, CONTRACTOR (,(�j/lijU/Jli/U.`V1X
PERMIT NUMBER
16126
PERMIT EXPIRATION
PERMIT
S NOT STARTED WT HIIN
180 DAYS OF PERMIT ISSU.
ANCE OR 180.DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITU OF
CUPERTINO STANDARDS.
UFER
PREGUNITE
I'PHm11T VALIDATION
_
c Ja i 4 c_ •—}
1
ISSUANCE DATE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED^
PAID
UNDERGROUND/SLAB
PLUMBING
UG 10 1998
ELECTRICAL
MECHANICAL
City'of Cupe
.e +
ELECT
E)
PLC. mea+
1:1❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
B PERMIT
INFORMATION
INFORM
W OD FLOOR
PLUMBING
.y vALun TION
SIFT.
MECHANICAL
ELECTRICAL -
PEH M1111 i0
t-
fly ilii
FRAMING
INSULATION
STDRIES
IY PE CONSTR
UCC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
50 1i FLOOR PRI''.n
,
iOinL ACR EGCf
DIAPHRAGM
ROOF SHEATHING
BUILDING. USE
HIs IND CUN PR um..
❑ El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ASSESSORS PARCEL NO
SAN.N
PLUMBING
ELECT. ENERGY
IHACi NO
PARCEL NO
TUBS & SHOWER PAN
PLUMBING ENERGY
MECHANICAL
MECH.ENERGY
ncc Ohre
ncc. Fn.e No
ELECTRICAL
BUILDING ENERGY �'— ��'b"
FRAMING
ELECT.FINALTEST
ZONING
ENG. SITE NO.
INSULATION -I -
PLUMBING
GAS TEST
GAS
FIRE $PRINK
„C N
ENERGY i 24
' ❑ No
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
FLOOD ZONE
Y[] NE]
A L U C.
I ❑ NEI
EXTERIOR SHEAR
ELECTRICAL RELEASE
INTERIOR SHEAR
FIRE DEPT.
FEE SUMMARY
SHEETROCK- ,S8 C
GRADE
EXTERIOR LATH
BUILDING -
BUILDING
3,UU
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
FEE PLAN CHECK
GAS
SEISMIC FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
JOCCUPANCY I I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LOING INSPECTOR.
MICROFILM
ELI ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
—SEE PERMIT FOR EXPIRATION DATE —
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
- -
OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT 1 DENTI FICATI ON
APPLICATION & PERMIT
ILDING - ELECTRICAL - PLUMBING -MECHANICAL
PERMIT NUMBER
16126
BUILDING
ADDRESS
O p '
OWNER'S
NAME
PRory72
TV. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
CONITacTORs
NA E A /ten!'-/`
UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
C✓q/�/J T.i
DTORS
AOnEss �5"'�a b.Q
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
JIDADDRESS
DATE OF APPLICATION
ARCHITECT
OR
ENGINEER
LIC. NO,
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
Aooa Ess ENG .
ZIP
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
ljrl
�`� ��`�µ
EMP. METER OR POLE INS. 20.00AI-iiVt
APDRESS r$
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DLCLARA'I'ION
1 hereby affirm that I am licensed under provisions of Chapter 9
ISSUANCE DATE
(commencing w Sectio 7000) of Division . I r us ss and
Professions Cmdet 1d iftYwense is in full ft f
License Cl's_"!'� Lic. Nmober
Dale�(e;✓�_ennlmetnr
•���''
AUG I
BLD
ELECT.
❑
PLG. MECH.
❑ ❑
Cjtr' of
BUILDING
L OWNFR-BUILDER DECLAARRATION
I hereby affirm That I am exempt from the Contractor's License
Law I: Athefollowingreason(Sec.7iresa Businessand Professions
mconsuanc alter.
Cnpr Any city or county which structure.
mPruve, demolish, or repair any etructure.prior to its issuance. also
tru tune. prior t
INFORMATION
INFORMATION
ER I
MISC.- REFER TO OR
VALUATION
Qt
f U
$/FT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO..
ELEC.
squires the applicant I'., such pen. if to file a signed statement that
pursuant to the provisions of tire Convectors License
Leis (Chapter f 7 of the
Busi (Chapter 9 (commencing with Section 7000).E t therefrom
Business Professions Code) or that he is therefrom and
TOTAL
PERMIT TO
<�
J
DTV. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
for tion of
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penally
of not mor, than five hundred dollars ( $5001.):
ALTER -DRAIN & VENT -WATER (EA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, anti who does such work
F IXTUR ES - PER TRAP 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
himself or through his own engrloyucs, provided that such improve-
mentserenotintendedorofferedforsale. ll', however, the building
GAS - EA. SYSTEM -11 NC. 4 OUTLETS 6.00
or fn, proveme I is sold within one year of completion, the owner-
builder will have tire burden of proving (hal h e did not build or im-
prove for purpose of sale.).
❑ I, as owner of the property, Lm exclusively contracting with
. ..
GAS - EASYSTEM -OVER 4 (EA.) 200
BUILDING USE
RES IND CON PB Omer
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS -J INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 IEA.) 1.00
ASSESSORS PARCEL NO.
licensed contractors to construct the project (Sec. 7044, business
and Professions Code: I'he Conductor's License Law does nut apply
to an owner of property who builds or improves thereon. and who
contracts for such projects with a contractorts) licensed pursuant to
the Contractors License Law.
SEWER-SANITAR V -STORM EA. 200Ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
❑ l am exempt under Sec.-. B.&P.C. for this
n•Lson
Owner Dale
WATER SYSTEM 5.00
ACC. GATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORK ERS'COMPFNSA'I' ION DECLARATION
'
1 hereby affirm I a 1 It Olifieare of cousenl to self -insure,
ora �M/ ,pcnsalion U urmc, or crti" J
r
Lou I L. ).
ZONING
ENG. SITE NO.
Pn1iDF ompany _
pp Certified copy is hereby furnished.FIRE
SPRINK
ENERGY T-24
!Q_,eemfied copy is filed with ore city inspection division.
Applicant
Y ❑ N❑
v ❑ N❑
MISC.- REFER TO ORD.
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
CERTIFICATE OF FXEMPFION 17ROM WORKERS'
PLG, CONTE. LIC. NO.
PLG.
TOTAL
COMPIiNSAI']ON INSURANCE
('Phis Section need not be completed if the Permit is liar one
v❑ N❑
Y❑ N❑
DTV. MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars(S I OO) or less.)
I certify that in ate performance of the work for which this per-
mit is issued. 1 shall not employ any person in any roamer so as to
BUILDING
(�
become subject to tic Workers' Compensation Laws of California.
Late Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICANT: It, Lifer making Ihis Certificate of Ex-
emption, you should become subject to the Workeri Compensation
APPLIANCE 5.00
PLAN CHECK'
provisions of the Labor Code, you amst forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00
FEE
U.
AIR HANDLING UNIT (OVER I0,000C.F.M.) 6.00
M ICFEE
,
CONSTRUCTION LENDING nGIiNCy
EXHAUST HOOD (WITH DUCT) 5.00
OFILM
1 hereby affirm that there is a construction lending agency for
the performance of ole work Im which this permit is issued (Sec.
7097, Civ.C.).
HEATING UNIT ITR 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
tELECTRIC
Lender's Name
Leneri Address
VENTILATION FAN (SINGLE) 4.00
I e,rIfy that I have read Ihis application and stte Ihm the above
information fs correct. 1 agree to comply with all city and county
and state laws relating to building consatoneandhereby
gO1LER-COMP13 H.P. or 100,000 B.T.U.) 6.00MBINGordinances
BOILER -COMP (Over 100,000STU)SEE FEESCH.
HANICAL
authorize representatives of this city to upon the
above -menti. ed property for inspection purposes
MISC. - REFER TO ORD.
(We) agr to save, indemnify d keep It mlo. the City of
upertino mina liabilities, jud- ats, cost and penses which
o way are a aga' said Cil n - sequence of the
CONST. TAX
PERMIT ISSUANCE 10.00
CONT. LIC. NO.
MECH.
on u fth¢CH.
zlzolkl
t o p icint/ omract D e
TOTAL
TOTAL
OFFICE COPY