16644 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER,
CITY OF CUPERTINO 16644
INSPECTION DIVISION
JOB INSPECTION RECORD
. APERMIT EXPIRATION
JOB ADDRESS (//0 /9(00 1W1A4MO'V TL- ��✓) UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER - MA fi6e-6-4 CONTRACTOR � � IS NOT STARTED WITHIN '
INSPECTON DAT INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- '
FOUNDATION: - - ANCE OR 180 DAYS FROM
NOTE: ILAST CALLkO INSPECTION.
LIFER ALL GRADING-AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
N ., �, GARAGE SLABS - - 4'
-POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,,,_., •„i'�
UNDERGROUND'
/SLAB G :
PLUMBINGa�A(D +
ELECTRICAL ` ISSUANCE DATE
MECHANICAL ELECT PLG. MECH .
'C� O -❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBT UIL DI NG PERMIT
WOOD FLOOR C11y o INFORMATION
PLUMBING VALUATION SIFT,
MECHANICAL
ELECTRICAL PERMIT ATO i
FRAMING e ' � IVT V14L4- I .
INSULATION
$TDHIES TYPE CONSTR.
� a
OCC GHOOP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE CONSTRUCTION
SP,SHALL BE MADE BEFORE
so FT.aooR AREA TOTAr4cREACE .
DIAPHRAGM THE CONSTRUCTION TAX IS PAID ,
.BUILDING USE
ROOF SHEATHING + HES TOO CON PB 011-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ E El El El
ASSESSORS PARCH.NO,
ROUGH SAN.# . , I
PLUMBING. ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
I. MECHANICAL, MECH.ENERGY
ACC FII,[ O.
ELECTRICAL BUILDING ENERGY ACC.DATE_ 4r�.,F,`f•1-
FRAMING - ELECT.FINAL TEST ZONING- ” ENG,SITE No. -
INSULATION- PLUMBING -.�•'+'
GAS TEST - GAS
MECHANICAL. 'FIRESPRINK a ENERGY.T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N❑ Y ❑ NE)
EXTERIOR SHEAR- ELECTRICAL RELEASE FLO
- OZONE A.L.UC.
INTERIOR SHEAR. FIRE DEPT. YEI
NO L NO
SHEETROCK GRADE I FEESUMMARY
EXTERIOR LATH BUILDING
'INTERIOR LATH TEMPORARY APPROVALS BUILDING 0
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMICFEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL-BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
I
Lu
ARRANGE FOR INSPECTION BY PHONING,252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
a�•. PLEASE GIVE JOB ADDRESS WHEN PHONING.
4
- SEE PERMIT FOR EXPIRATION DATE -• MECHANICAL
IMPORTANT! covsT.TAX11
PLEASE READ REVERSE SIDE BEFORE TOTALp
CALLING FOR FINAL INSPECTION. da ;
OFFICE COPY
APPLICANT TO FILL IN IN WITHIN RED LINES - USE BALL POINT PEN ONLY
';UI LDI NG PROJECT I DENTI FICATION .PERMITNUMBER
FoILDING _ APPLICATION & PERMIT _ [� /�
ADDRESS
6o BUILDING-ELECTRICAL-PLUMBING-MECHANICAL o 4
owrvER'sOFPLAN CHECK VALIDATION
AM QTY. ELECTRIC PERMIT FEE
HACTVR sf OUTLETS-SWITCHES•RECEP 10,00/1.00
LIC.No, LIGHTING FIXTURES 10.00/1.00
ADDREtrov's
S5 PPL-IANCES-RESIDENTIAL 4.00
CONT - -
PHONE PANELS "10.00 DATE OF APPLICATION ' -
ARROHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE _P.C.NO.
ENGINEER :
LIC.NO. SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS .. SPECIAL CIRCUIT 5.00 ,
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 �Q/,�I/�
o o LICENSIiD CONTRACTORS DECLARATION„ OV ,
< i L I hereby af0rn that I am licensed under provisions of Chapter 9 • O ISSUANCE DATE
(commencing with Section 7000)of Division 3 o the Business and BLDG. PLG. MECH.
F i
as Z Professions Code,and my license is in full force and effect. �U Q ❑ ❑ ❑
o 0 License Class - Lic.Number
o ^`
Date Contractor V
a x s �' - '• BUILDING PERMIT
¢ ¢ ¢ OWNCR-BUILDER DECLARATION -
o a INFORMATION
X ;e-y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u o Q Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
0 Code:Amycity orcounty which requiresa permit toconstruct,alter, PERMIT ISSUANCE 10.00 0 �
¢ Q O, improve,demolish,or repair any structure,prior to its'issuance,also ELEC.CONTR.at LIC.NO. ELEC.
iO ¢ requires the applicant for such permit to file a signed Statement that ,. TOTAL
w$ a- he is licensed pun cant to the provisions of the Contractor's License . PERMIT TO
F z ¢ Law(Chapter 9(commencing with Section 7000)of0ivision 3 of(be w�/,f
4 O Business and Professions Code)6;r that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
(c the basis for the alleged exemption.Any violation of Section 703 1.5 STORIES TYPE CONSTR.
by any applicant-for a permit dollars(he0).): am macivil penalty ALTER-DRAIN 5.00 .
of more than five hundred dollars(8500)J: � '
1,as owner of the property,or my employees with+wages as BACK FLOW PROTECT. DEVICE ' 4.00 . Oce.GROUP RES.UNITS
'herr sole compensation,will do the work,and the structure is not
intendedoroffered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
?e property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
4'y
mhimself or through his own employees,provided that such improve-
or
are not intended or offered for sale.If,ltowcver,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner.
builder will have tireBUILDING USE burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 - RES IND' CON PB . OIM1er
prove for purpose of soled. INDUSTRIAL WASTE INTER. 3000 ❑ ❑ - ❑
❑ as owner of the property,am exclusively contracting with .
licensed
contractor to construe' the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cole:The Contractor's s License s therces not apply
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
con tincts for such projects with u hm'ractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No.
❑ I amexcmplundcr Sec. ,B.&P.C.,Fo,li,iS WATER HEATER W/VENT - 6.00
reason
Owner ate WATER SYSTEM 5;00 ACC.DATE ACC.FILE NO.
l,"
WORKERS'COMPE ATION DCCT. RATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a Certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sce.3800,Lab.CJ. -
Policy No.- Company
0 ❑ Certified copy is hereby furnished. '
Z.Z 13 Certified copy is filed with the city inspection division. FIRE SPRINK ENERGY T24
O Applicant MISC - REFER TO ORD- Y ❑ N❑ Y [3 NE]p: m - IT ISSUANCE - 10.00
Lu CERTIF'ICATEOFEIFROMW'URKERS' FLOOD ZONE A.L.ILC.
W COMPENSATION
INSNSURANCIi PLG.CONTR. LIC.No. PLG,
CL2 (This Section need not be completed if the permit is for one TOTAL - Y❑ N❑ Y E] N❑
U O Hundred dollars(S 100)or less.)
I certify that in the performance of the work for which this per- FEE SUMMARY
LL mit is issued,I shall riot employ any person in any mannerso as to DTV. MECHANICAL PERMIT FEE
O W become subject to the Workers'Compensation Laws of California.
Date Applicant IALTER OR ADD TO MECH. 5.00 BUILDING Q7
>_ y NOTICE TO APPLICANT: If,after making this Certificate of I.x.
F ? sorption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MCF.114) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1041MC.F.M.) 6.00 SEISMIC FEE 4 -0
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance'of thowork for which this permit is issued IS". - MICROFILM'
3097,Co,.C.L ' HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address - ELECTRIC
•Y.
1 certify that have read this application and all
c that the above VENTILATION FAN (SINGLE) 4.00
\ information is Shred.I agree to comply with all city and county PLUMBING
hereby eau and state laws relating to building construction,upon and BOILER•COMP(3 H.P.or 100,000 B;T.U.I 6.00 ..
hereby authorize representatives inspection
this city to corer upon the BOILER-COMP Dae,100,000 STU)SEE FEE SCH. MECHANICAL
above mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which
may y way scene, against s''If City in consequence of thPERMIT ISSUANCE 10.00
of flhis pe
e CONST.TAX
m re,
/ ror ni - MECH:CONT. .. LIC.NO. MECH. -
TOTAL TOTAL 0�`f0
Signature mf Appllcan/Co rctor Date
OFFICE COPY