16108 POST THIS CARD NEAR FRONT OF BUILDING
� PERMIT NUMBER
CITY OF CUPERTINO . 1.6108
INSPECTION DIVISION:
JOB INSPECTION 'RECORD.
L/`/ PERMIT EXPIRATION
J013 ADDRESS/ate �<✓dL'/ ""`z UNIT# -LOT# �' �' ; iI I'iA I
PERMIT EXPIRES IFIWORK
OWNER d:b(� UA CONTRACTOR IS NOT STARTED WITHIN'
INSPECTION IDAYE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION -� O NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION,
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION ;
GARAGE SLABS
CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J `_
UNDERGROUND /SLABX
PLUMBING
ELECTRICAL v - ISSUANCE DATE
MECHANICAL ELer.T, rLc, MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED SING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING city.01 / )R /N� 51 0MECHANICAL - �><✓�-+' FU
ELECTRICAL - - PERMIT TO )I
FRAMING i LQ, ,J ,
INSULATION STORIES TYPE CONSTR.
-
OCC.GROUP RES UNITS
PLACE NO SUBFLOORUNTIL ABOVE HAS BEEN SIGNED
ROOF' NOTE:NOF I INAL INSP.SHALL BE MADE BEFORE SO FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID
BUILDING IISE
ROOFSHEATHING REs INO CON PB
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP: ., 0 Q El 13 11
ROUGH SAN.N ASSESSORS PARCEL NO.
PLUMBING ELECT.ENERGY
•THACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY' -
ELECTRICAL' BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING -a - ELECT,FINAL TEST
INSULATION O aL PLUMBING - Z_ _ ZONING eNc.SITE No.
GAS TEST a � � _ GAS FIRE SPRINK ENERGY T24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "[D NE Y E] N�
FLOOD ZONE A.L U C`
EXTERIOR SHEAR, - _ -rT. � 7 ELECTRICALRELEASE �. Y❑ N,❑ Y ❑ N❑
INTERIOR SHEAR FIRE DEPT.
SHEETROCK _ GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING' J
INTERIOR LATH TEMPORARY APPROVALS 3 e `
SCRATCH COAT • 12^IZ- ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY,OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ' MICROFILM
.T,
ARRANGE FOR INSPECTION BY PHONING 252-4505„ ELECTRIC 3 '
o� _ ONEWORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING,.
v I Mwu� Z - MECHANICAL
� - SEE PERMIT FOR EXPIRATION DATE- -
IMPORTANT!' CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 6,
CALLING FOR FINAL INSPECTION.
` OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT-PEN ONLY .
PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT 161 0(7
BUILDING
ADDRESS l l ^� L'M�t�
TI`/. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
owNER'a . r1M.252-0593 PLAN CHECK VALIDATION
NAM
4,1�MU P_.P WIc 40'S OTY. ELECTRIC PERMIT FEE (�
r PHONE �' 1 31 , +
- CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 '`` �f ��77��Op
rN
LIC.NO. LIGHTING FIXTURES 10.00/1.00 �- FV'�Y L1j i..lJ
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 '
ADDRESS
PHONE PANELS 10.00 S. DATE OF APPLICATION r
ARCHITECTLAN PCHECK FEE .c.-No.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER l -` \�
l-t�/tfl lJ 1'`Er4 sec.rvoL L4 5 ISiGNS TRANS. 3.00
aRCH OR
ADDRESSErvG. • SPECIAL CIRCUIT SAD - PERMIT VALIDATION
nPEMP.METER OR POLE INS. 20.00
APPLICANT S MOTORS SEE FEE SCH.ADDRESS
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
E,u I hereby affirm that I mu licensed under provisions of Chapter 9 VVV ,OISSUANCE DATE
a a. (commencing with Section 7000)of Division 3 of the Business and
G OG. ELEG PLG. MECH.
r 7 z Professions Code,anA my license is in full force and effect. A1(W�CI{JV1J`
o
i0 W License Class Lic.NumberFU
m r DateContractor
¢ w ¢ OWNER-BUILDER DECLARATION - BUILD(y ERMIT
•w ;LL I hereby affirm that I con exempt from the Contractor's License
MISC.-' REFER TO ORD MAh�ATION
Fa. 04 Law forthe followingmuson.(Sec.7031.5,Business and Professions PERMIT ISSUANCE o2 wnTION $/FT.
Code'.Any city or county which requires a permit to construct,alter, '7,Q CD
2 ¢¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / S� WO v
¢ requires the applicant for such permit to file a signed SGdement that TOTAL l0
u w$m he is licensed pursuant to the provisions of the Contractor's License, PERMIT TO
Hz >
Law(Chapter 9(commencing wit t Section 7000)of0ivision 3 ofthc
4 o Business send Professions Code)or the he is exmnmt therefrom and QTY. PLUMBING PERMIT FEE
¢ 1-m the basis for the alleged exemption.Any violation of Section 7031.5 ' STORIES TYPE CONSTR.
u ; � by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN& VENT-WATER (EA.)-500 _
of not more tban five hundred dollars(1500).):
O I,as owner of the property,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 Contractors License Law does riot apply to an ownerof -
property who builds or improves thereon,and who does Such work J,, FIXTURES"-PER TRAP -5-,M SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
ments are not intended or offered for sale.Il',however,the huilding GAS-EA.SYSTEM-11NC.4 OUTLETS•6-.G0 02 —
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or air- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
p Ove r purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Orbe,
L as owner of the property,am exclusively contracting with 11 ❑ ❑ ❑ ❑
ece sed contractors m construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cade:The who
License Law doesnotapply
to an r owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
tine Co is actor's h projects with a conlractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. 'TRACT NO. PARCELING.
❑ 1 a opt un ' c. ,BAP.C.fur this WATER HEATER W/VENT 6.00
reason
Owner Date - WATER SYSTEM 5.00 Ace.DATE ACC.FILE NO.
WORK HRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to setrinsure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). ,
Policy No, Company
O ❑ Certified copy is hereby furnished. RE SPRINK ENERGY T-Z4
Z Z ❑ Certified copy is Bled with the city inspection division. MISC.- - REFER TO ORD.
0 Applicant Y ❑. N❑ Y ❑ N❑.
~
CC ✓+ CERTIFICATE PERMIT ISSUANCE
- IE EXEMPTION IrROM WORKERS' FLOOD ZONE .A.L.U.C.
CL MPECONSATION INSURANCIi PLG.CONTR.CL if LIC.NO. i PLG. �}i�
Z This section need not be completed tine permit is for one TOTAL QV❑ N❑ E3Y N❑
hundred dollars(S 100)or less)
U O 1 certify that in the perfornnunce of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I dmil not employ any person in any manner so as to
O ED become subject to the Workers'Compensation Laws of Calitorma.
0. Date—Applicant BUILDING
} to NOTICE:TO APPLICANT: If,after making this Certificate of nix- ALTER OR ADD TO MECH. 5.00 336 sfo
?
carrion,you should beco ne 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 shill be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE az
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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) -B:Bf) --
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 3
Lender's Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) - 4.00
information is correct. I agree to comply with nil city and county PLUMBING ,d
ordinances and stSte,law$ relining to building construction, and BOILER•CDMPI3H.P.or100,000B.T.U.1 6.00 •
hereby authorise this
f representatives oths"city lit) enter.upon the
above-mentioned Property for representatives
inspection purposes. ver . MECHANICAL BOILER-COMP (O 100,000 BTU)SEE FEE SCHa -0
a save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
ainsl 'udgments, costs and expenses which. PERMIT ISSUANCE o2— CONST.TAX
nay in any a a true 'd City in consequence of the
Or lin o ren MECH.CONT. LIC.NO. MECH.
TOTAL-LJ�) /O�. TOTAL
Signature of pplicant/Cont r 'Date !
OFFICE COPY