16922 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
�-. 169'ZZ
w' INSPECTION DIVISION
JOB INSPECTION RECORD
3 D { PERMIT E)xPIRATION
JOB ADDRESS 11) r_ /` /l.-�-�_. ekn Ip UNIT# _LOT# pERM1TEII
XpIHrES'PF WORK
OWNER J e,-V+�BS SIS l CONTH C10P $ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I I SPECTION RECORD 180 DAYS OF PERMI7ISSU�
FOUNDATION ANCE OR 180 DAYS FROM
LIFER - NOTE: LASTCALLED INSPECTION.
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND^C� C
CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. o
GARAGE SLABS 56 d�, N WJ NJ �° 'G _ ..
1 PW, bQgQjAin
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r !
UNDERGROUND /SLAB �}
PLUMBING - � • 1T ✓1Tt N I%L O' /
ELECTRICAL
ISSUANCE DATE
MECHANICAL BLoc ELECT PLc. MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $/FT.
MECHANICALQj 1''
ELECTRICAL f I'LlIM11 TO
FRAMING U IA
' INSULATION STUDIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
•SO FL FLOOR AREA iOtALACHE4GE
ROOF NOTE:NO FINAL INSP.SHALL MADE BEFORE _3_vJl(�p�
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEBUILDING USE
ATHING Q r ..O INR -ON O UID,
- 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. +,,EE orvSPAr�1 No
ROUGH SAN.a
PLUMBING *Ro%5'c T ELECT.ENERGY
,
T
BSFiOWE PA o O PLUMBING ENERGY PARCEL NO
TRACT NO
ANICAL 'Z MECH.ENERGY
ELECTRICAL BUILDING ENERGY - ACC DATE ACC.FILL NO
FRAMINGOkaELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIDE SPR INK ENEDGv T 2
MECHANICAL v E N� v N❑'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ' ELECTRICAL RELEASE FLOOD ZONE A L U C.
INTERIOR SHEAR Q, FIRE DEPT. rEj NE] vo No
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH 'Z BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CH HECK " •
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC* r
UJ
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE �
CALLING FOR FINAL INS P CTION. TOTAL i6lf^ D
OFFICE COPS o- `T
11PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•'• BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
II: BUILDING APPLICATION & PERMIT C(� I�
Apoeeii ar ia.e,�[(S AN E-7. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL �, CJJG
OWnER'B 12
PLAN CHECK VALIDATION
NAME 5 U � 4�8'ZSS TG7g CITY, ELECTRIC PERMIT FEE
•1. �� PHONE
CONTRACTORS 1
NAME
AA UTLETS-SWITCHES-RECEP 10.0011.00 ./7 CVVVJ I �v+
/.t g .�� LIC.No.5 07.9 S5 LIGHTING FIXTURES 10,00/1,00
CONTRACTOR s ,,11 fAL PPLIANCES-RESIDENTIAL 4.00
O 'S!'!'x PHONE SS' PANELS 10.00 DATE OF APPLICATION
ogcmTecT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEERKA60t4 E!
n 7.LI uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADOREssA_ I �sf �
eT LN�
'FS EMP.METER OR POLE INS. 20.00
/ hDOREss Tg MOTORS SEE FEE SCH.
SERVICE CHANGE 20,00 ` `
At o o LICENSt:1)CONTRACTORS DCC LARA'1'ION J 4lry1 N v LG�
N Uw I hereby of ire that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commenemg with Section 7000)of Division 3 of the Business and
H<,A BLDG. ELECT. PLG. MECH.
F o z Professions Co andmy-license is in full f
o i=a License Class_ Lin.Nm El ❑ ❑ 11
QY �j Uale��^]�4:9--L-Conlracl �p
" : ¢ ¢ OWNFR-BUILDER DE ' ATION City'at NOR BUILDING PERMIT
It ,-o a U INFORMATION
E:
y I hereby affnu that 1 am exempt from the Contractor's License MISC.- REFER TO ORD' VALUATION
u o< Law for the following reason.f Sec.7031.5,Business and Professivas Z 0 0 $/FT.
_ PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
p improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. q f.
A G u requires the applicant for such permit to file a signet slalement that TOTAL / o PE MIT TO
u A, m he is licensed pursuant to the provisions of the Contractor'.,License ' I�r
r• z a Law(Chapter 9(commencing with Section 7000)of Division3of the
4 e Business and Ponfiessiuns Code)or that he is exempt therefrom!aid QTY. PLUMBING PERMIT FEE
I[F , the basis for the alleged exemption.Any violation of Seclion 7031.5 STORIES TYPE CONSTR.
by any applicant for a pennant subjects the applicant(oa civil penalty ALTER-DRAIN -WATER IEA.) $,00
of not more than five hundred dollars 15500).):
❑ 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 riot
intended ur offered for sale Sec. 7044, Business and Proleasi.m DRAINS-FLOOR,-ROOF,AREA,COND. 5.00
Code:The Contractor's License Law dues not apply to an owner of
properly who builds or mipmecs thereon,and who does such work FIXTURES-PER TRAP 5.00 5 EA TOTAL ACREAGE
himself or throughrote his own employees,provided that such improve-
ments ere nor intended or od'ereoyee sale.If,ed that such
he building GAS•EA.SYSTEM-1 1 NC.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 of proving that he did not build or im. BU ILOI NO USE
Drove for purpose of sale.)' INDUSTRIAL WASTE INTER. 30.00 RE IND CON PB GO.,
❑ 1,as owner of the properly,um exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct lam 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 of improves thcremi.and who LAWN SPRINKLERS-OVER 5(EA-) 1.00
contracts for such projecli with a eontraclurs)deenwil pursuant to SEWER-SANITARY-STORM EA.200ft 10.00
the Contractors License Law, ANIT / TRACT NO. PARCEL NO.
❑ 1 an,exempt under Sec. B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a re,ifinafe orconsent t0 self-insure, ZONING
or a certificate of Workers'Compensation Insurance,e a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.
Policy No. Company
❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z C "•d py is filed ditIbe cil mspec ion.division.
O AppOca --�-j � MISC- REFER TO ORD. y ❑ N❑ Y N❑
CC S2 - 'I'IFICATI:OF EXEMPTION FROM WORKIiRS' PERMIT ISSUANCE 1000y0` ,Z,-.D�j FLOOD ZONE A.L.U.C.
d � COMPfiNSAI'ION I NSU RANCC PLG.CONTR. uC.NO. PLG. ' �aS3 Y❑ N❑ v ❑ N❑
CL Z 1'This section need not be Completed if the peen it is fo"One TOTA
hundred dollars IS 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 U mil is issued, I shall not employ any person in any manner so as to
become subject to life Worker'Compensation Laws of California.
U y Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICAN"f: If,after making this Certificate of Ex-
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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M,) 4.00 G
CONSTRUCTION LENDING AGENCY' AIR HANDLING UNIT(OVER I0,000GEM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction leading agency I'or EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)Lender's Address - _ ELECTRIC
I certify that l have read this application and state that Om a be" VENTILATION FAN (SINGLE) 4.00
in formation is correct. I agree to comply with all city and county PLUMBING 6 r�
ordi nanevs and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon lite ,g01 LER COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL ,
alpve-mentioned property for inspection purposes.
(We) agree to area, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 12.pd CONST.TAX 3 OZ.d 2
may in any way accrue against id City In consequence of the
m gof Ibis erm't. ��� MECH.CONT. LIC.NO. MECH.
q'`
TOTAL /6,r3 TOTAL l8'3yf
Si arum of ApplicanllContmctor ale
OFFICE COPY