16346 y POST THIS CARD NEAR FRONVOF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 1.6346 .
INSPECTION DIVISION
JOB INSPECTION RECORD
!� • PERMIT EXPIRATION
JOB ADDRESS ���6`3 !w/c"rPZ Li UNIT# LOT#
�.` � PERMIT EXPIRES IF WORK
OWNER D C GU/ nJ coNrRAcroR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-.
FOUNDATION 'ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION. ,
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE •• TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.' - . +•""'. •�
GARAGE SLABS rI
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL ISSUANCE DATE -I•
MECHANICAL - - - ` slur, ELELCr PL❑O._ MEC
i
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR G f� ORMATION
PLUMBINGunr�,ON SIFT.
MECHANICAL N
UT'
ELECTRICAL - PERMIT TO
FRAMING.
STORI 5 TYPE CONSTR.
INSULATION
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' .ROOF NOTE:NO FINAL WSO FT FLOOHAREA TOT Al ACREAGLSP.SHALL BE MADE BEFORE, '
. DIAPHRAGM THE CONSTRUCTION TAX IS PAID
IIUILDING USE
ROOF SHEATHING - RCS No CON PI ,Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE. INSP. L ❑ L L E
ASSESSORS PARCEL NO
ROUGH SAN.#
. PLUMBING - ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN , PLUMBING,ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC.DATE ACC.PILE NO
FRAMING ELECT.FINAL TEST ' '}
TONING ENG.SITE NO:
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINIC ENERGY T.24 i
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y • NL Y [:] , NL
'i
EXTERIOR SHEAR � - ELECTRICAL RELEASE ' FLOOD ZONE A.L.UC,
INTERIOR SHEAR FIRE DEPT.
YL N�
SHE ETROCK GRADE FEE SUMMARY
T EXTERIOR LATH BUILDIN
INTERIOR LATH - TEMPORARY APPROVALS ' BUILDING .fes-' {
I
SCRATCH COAT ELECTRIC PLAN CHECK / 7(`
GAS FEE p fc=
NO TAPE OR PLASTER.UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYbF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F�. ' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
° PzLEASE GIVE JOB ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL oZ y-
OFFICECOPY, .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON -PERMIT NUMBER
aooREN: ,} hie-
'y/I APPLICATION & PERMIT 1 (� A
3 hie-he(/L �•Q� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I U Y
OWNER PLAN CHECK VALIDATION
• NAME
OTV, ELECTRIC PERMIT FEE
I1 /�'f l0(Jf duP»GNE T
NAMECONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1-.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONT ACTOR'S PPLIANCES'-RESIDENTIAL 4.00
ADDSS
PHONE - PANELS 10.00 DATE OF APPLICATION
OR
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE PX.NO.
NGINEER
I-C.NO. SIGNS TRANS. 3.00
ARCH OR ADDRESS ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP - EMP.METER OR POLE INS. 20.00
nooeess T.s MOTORS SEE FEE Lf CH.
(�.^'C�y-•�`�_ '�
SERVICE CHANGE . 20.00x/ /Gd
,09 LICENSED CONTRACTORS DECLARATION
¢ H
° 1 hereby affirm that I am licensed under r3 ofthe of Cha ren d
Z, w P P ISSUANCE DATE
(commencing with Section 700e i of Division 3 anti
the Business and
r � < u - BLDG. ELECT. PLG.. MECH.
l F z Professions Code,and my license is in full force and effect, ❑• ❑ ❑' ❑
a i W License Class Lim.Numher
F w H J
Date Contractor
Pin{C7
< r E BUILDING PERMIT
¢ ¢ w ¢
OWNER-BUILDER DECLARATION INFORMATION
w ° r' MISC.- REFER TOO
; e w I hereby affirm that I am exempt from the Contr:mtor's License VALUATION $/FT.
I a. o ¢ Law for the following reason.(Sec.7031.5,Businessand Professions '
PERMIT ISSUANCE 1
� w> � Code:Any city or county which requires a permit to construct,
¢ improve,demolish,or repair an structure,prior to its issuance,also ELEC.CONTR. LIC.NO. (� s� _
¢ ¢ o P P Y ELEC. City ut `nus'
°¢ requires the applicant for ilial permit to file i signed statement that TOTAL Y PERMIT TO /
T.
$ he is licensed pursuant to the provisions of the Contractor's License //�f N
riQ Business
(ChapterndProfessions
Cing ode) r Section is 00)exempt
Division and tile s"/}-T�L(�•TL�-'�/Kj
f 4 o Business and Professions Code)on that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ I- m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i;- byany PPlicant for a permit suhjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 '
of n ore than five hundred dollars($500).1:
1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law does not apply m an owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS-EASYSTEM-OVER 4 IEA1 200
builder will have the burden of proving that he did not build . . .
or im. BUILDING USE
prove for purpose of sale.). - RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 Cllicensed conUaclors m construct the pmjecI(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does not apply
to an owner of property who builds or improves thereon,and wit. LAWN SPRINKLERS:OVER 6(EA.) 1.00
contracts for such projects with a contractor(s)licensed PUrslmnf to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
Cl I3
exc pr under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
mast
Owner - WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO.
WORK h:RS'COMPENSAT N DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to self-asure,
or a certificate of Workers'Compensation Insurance,or a certified 20NING ENG.SITE NO.'
copy thereof(Sec.3800,LAC.). ,
Policy No. Company _
0 ❑ Certified copy is hereby furnished. FIRE$PRINK ENERGY T.24 '
Z Z ❑ Certified copy is Bled with the city inspection division. Y N Y Q NQ
Fp Applicant MISC.- REFER TO ORD.
CC T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > � . COMPENSATION INSURANCE PLG.CONTR. _ _LIC.NO. PLG.
d a' (I his section need not be completed if the'permit is for one TOTAL Y 0 N❑ Y f] IN
Z3 Z hundred dollars(S 100)or less.
U O I certify that in the performance a!the work for which this pmt- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner m as to
0 W become subject to the Workers'Compensation Laws of California.
O• Datn Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- -
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 b "�
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 SEISMIC FEEL
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,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state thus the above VENTILATION FAN (SINGLE) 7 4.00
. imonnatlon is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMp 13 H.P.or 100,000 B.T,U.1 6.00
hereby authrove representatives of this city to enter upon the BOIL
above-mentioned properly for inspection purposes. ER COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
Y in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
1a 9 o this permit. - C ' MECH.CONT. ,LIG NO. TOTAL
1 "� TOTAL ;,)CZ aS'�
ure of Applicant/Cont for Date
OFFICE COPY