16553 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
6553
INSPECTION DIVISION
JOB INSPECTION RECORD
• 10 KC� ^ _ PERMIT EXPIRATION
JOB ADDRESS— �' / ,A-H'�`Cl'NIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER - I CONTRACTOR �L. IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE 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.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �• ( '�
UNDERGROUND /SLAB /
PLUMBING
ELECTRICAL €lsugNCE UATE
BLDG ELECT PLG- M+ECR
MECHANICAL
F-1 1:1Al ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUAIION SIFT.
PLUMBING
MECHANICAL
vERn)n To
ELECTRICAL - 0•'i'•� .1%L64
FRAMING ,C Qa
INSULATION `,; y sioHreI TvvE CONsnv
Cil] O` „ OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED l
50 IT ROOF AREA roigl ACN ENCE
. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - Res IND CON PB o.o..
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ASSESSORS
ASSESSORS YgHCF.L NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY : '
TRACT NO PARCEL Np ~
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY 4
FRAMING ELECT,FINAL TEST zoNiNp emc.SITE,NO.
INSULATION PLUMBING Zyj
GAS TEST GAS
F IRE SPRINK ENERGY T.74
MECHANICAL Y L I NL v L NL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FL000��orve q.L IT C,
INTERIOR SHEAR ' FIRE DEPT. r rvL v L NL
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o0ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �d .
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNST TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL p(>l
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT , ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT [
J
ADORE
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL if' J
i
OwNER'S PLAN CHECK VALIDATION
"ores Y. ELECTRIC PERMIT FEE
• P... - /
CONTRACTORS OUTLETSG-SWITCHES-RECEP 10.00/1.00
NA /J �j'
ter. p LIGHTINFIXTURES 10.00/1.00
ADDRESS oR's PPLIANCES-RESIDENTIAL 4.00
ADDRESS ��
1!5;7L
PHOry PANELS 10.00 DATE OF APPLICATION' S
ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE D.C.NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARC
ENG. PERMIT VALIDATION
ADDRESS
ss SPECIAL CIRCUIT 5.00
zip TEMP.METER OR POLE INS. 20.00 '
ADDRESsTs MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
0 0 o LICIiN$ISU CONTRACTORS DECLARATION !�/UA//N//`�_
4o U1 hereby affirm that 1 am licensed ander provisions.1 Chapter 9 I
y a N (commencing with Section 7000)of Division 3 of the Business and BLDG. .ECT. L MECH.
F h z Professions C,gde..y�J�Iy license Is in full f r n a
z O m - License Cla(r �G�I.ic.Numb ❑ ❑ ❑
2 m H Dale Contravto
a y BUILDI G PERMIT,
a w a OWNER-BUILDER DECLARATION INFORMATION
o A U MISC.- REFER TO ORD
E
, 1 hereby affin,that I am exempt from the Contractors License
r v. 604 Law for the following reason.(See.7031.5,Busimosand Professions PERMIT ISSUANCE 10.00 VALUATION
Cnde'.Any city or county which requires a permit to construct,alter.
Sir
I,2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC,NO. ELEC.
D 4 requires the applicant for SUCK permit t0 OIC a signed statement that TOTAL 'PER T T
wm he is licensed pursuant to the provisions of the Contractor's License tL
Hzi Law(Chapter9(commencing with Section 7000)of Division 3 ofthe
- a Business and Professions Code)or that ha is exempt therefrom'and DTV. PLUMBING PERMIT FEE
ce F o the basis fur the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
A � l2 by any applicant l'or a permit subjects the applicant a civil penally
gLTER-DRAIN&VENT-WATER IEA.) 5. 0
of net more than Fee hundred dollars($500).7:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4. OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
tended or offered for sale (Sea 7044, Business and Prul'assious DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 115:00 p �SpUfT.FLOOR AREA TOTAL ACREAGE
. himself re through his own employees,foprovided that such improve- VY t
rents aro not intended or offered for sale.If,however,the building ' GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4'(EA.) UILDING USE
builder will have the burden of proving that he did not build or ire- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑I ❑ ❑ ❑
licensed eontraclnrs to construct the P oject(Sec. 7044,13tviness LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cnde:The Contractor's license Law docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under sea. .B.&P.C.tin this WATER HEATER W/VENT 6.00 QQ
reason
Owner Dam WATER SYSTEM 5.00 ACC.DgTE ACG FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. .5.00
1 hereby uffirn that 1 have a certificate of Licen,vint 1.sclt in,urc, ZONING ENG.SITE NO.
or a ce'li0cale o Werke Compensation Insurance,or�aperti flet
copy th r /Lab.C.;4i4_/1-// � - 7{
Policy 46A iy /�'GL
Q ❑ Ccrlit copy is hereby lurnishcd. FIRE BPRINK ENERGY TQ4
Z Z
lit - 't t.tI• c' it re'Iiol Jivisi n. V I N V N
O A cant A _ MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Fy PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU ] IF ICA'1'li OF EXEMPTION I R WORKIiRS'
LU _ C(1MPENSA'I'ION INSORA V:E PLG.CONTH. LIC.NO. PLG.
CL 0 (This section ,evil not be completed if file pe nn it is for one TOTAL Y❑ I N❑ V❑ N❑
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performmrce of the work for which els per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any boner so as to
U become subject to Ole Workers'Crmpeaw
ation las of C.Id.nua.
to Dire Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
CL
} to NOTICE TO APPLICANT: IL after,making this Certificate of lix-
F Z chiptlon,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Cnde, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1OSWC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby then, that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 I
the performance of the work I'or which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,CN.C.).
Lender's Name HEATINGUNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
- Lender's Address
Icerdly that l huveread this appli<aion and Ovate corfimtlhcahove VENTILATION FAN (SINGLE) 4.00 .I
information is rect. I agree to comply with all city anJ county PLUMBING Q
ordinances and slate laws relating to building construction, and BOILER-COMPI3 H.P.or100,000B.T.U.) 6.00 /U
hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep Ilannless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
y in any way accrue against said City in consequence of the
,tin t 's pcn,iL MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL /
gnature of Applicant/Contractor Date r "
OFFICE COPY