16104 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NIIMBF.H
CITY OF CUPERTINO 6104
INSPECTION DIVISION
JOB INSPECTION RECORD
! - III .
PERMIT EXPIRATION +,
JOB ADDRESS itofs- UNIT# _LOT# I
ppL PERMIT EXPIRES IF WORK
owNeH W CONTRACTOR V U OU LP/U S NOT STARTED WITHIN
INSPECTI DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 1BO DAYS FROM
NOTE:
UFER ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED 'LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. _
GARAGE SLABS: ;.-•^^
.POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - . . L. r --•�` - - -'f
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE DATE'
MECHANICAL eLuc ELEcr PLc. MecH
❑. ❑' Ell
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
-WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING - ' - //,�2 qqmm ca
ELECTRICAL MECHANICAL - Ua OQ�J 4 c a
ELECTRICAL - vERmfr ro -
FRAMING -�- Ib L -v.,j
INSULATION sroRlEs TWA-
C.
CONSTR. I
v A-
O C.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.Ii DOR AREA TOTAL ACREAGE ,
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID I
r
ROOF SHEATHING - ` v RES IND ILO`Oc,USE Olm.•
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS , DATE INSP. .0 El El .El El
ROUGH sAN.a ASSESSORS PARCEL NO
PLUMBING jdy _ �-1 _ ELECT.ENERGY
THACT NO. PARCEL NO
TUBS&SHOWER PAN p' - PLUMBING ENERGY ./d"�904,111
MECHANICAL -yam0,3 MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ACC,DATE ACC FILE NO
FRAMING ELECT.FINAL TEST ZONING ENG SITE NO,
INSULATION PLUMBING
GAS TEST GAS '
MECHANICAL
FIRESPRINK' ENE.RGY T-]4
' ^/U -�'f � � Q
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v � NL v ❑ N
EXTERIOR SHEARELECTRICAL RELEASE ^ p' FLOOD ZONE AL U C.- I
INTERIOR SHEAR _�� +L FIRE DEPT. r ❑ N❑ v L NL
SHEETROCK - I GRADE FEE SUMMARY:''
EXTERI OR+LATH 'T BUILDING
} INTERIOR'LATH TEMPORARY APPROVALS . . BUILDIivG A
SCRATCH COAT ELECTRIC PLAN CHECK
' GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE p2
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC W
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PwMewc
z PLEASE GIVE JOB ADDRESS WHEN PHONING'.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL d�
IMPORTANT!
CONST,rnx
PLEASE READ REVERSE SIDE BEFORE
TOTAL
CALLING FOR FINAL INSPECTION. p�
OFFICE COPY
;APPLICANT TO FILL IN INFORMATION WITHIN REDDLINES — USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION -PERMIT NUMBER
aI„LD,NG /� /I,- APPLICATION & PERMIT 1 /h1 [Aj
ADDREas /'�/S � �jA /I/,4y 2,& - BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 16104
OWNER'S (� //�/ PLAN CHECK VALIDATION
"A/N'-E /G b�k-A I Y Z-LANA Z yAk'OTY. ELECTRIC PERMIT FEE p(-� '{ys
PHONE 03
CONTRACTORS ��p�y '/ '
rvAME `-Y�7 �7� OUTLETS-SWITCHES-RECEP
OpGGr�l �yaoLt�/ uc.No. ' LIGHTING FIXTURES 10:9071:001
GONTRACTORs
J APPLIANCES-RESIDENTIAL 4.00ADORESS
I/ / � /,AA If'fP kVX'pHOrvE zCy/J Z
'
PANELS 10.00 PATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
onr� PANELS (OVER 200 AMP) 20.00 ,
ENGINEER [ M�uC. o. ISIGNS TRANS. 3.00
1 ARCH.OR ENG. PERMIT VALIDATION
ADDREsa SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00 p.�,
APPLICANTS MOTORS SEE FEE SCH. -2 — �,,C,Tx-�'---
ADDRESS
SERVICE CHANGE 20.00 / �
woo Pr
LICENSCU CONTRACTORS DECLARATION /fib
a 5 U 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
er w (commencing with Section 7000)of Division 3 of the Business and
ru Q va BLDG. ELECT. PLG. 'MECH.
r m Z Professions Code,�Wd my license is in full forj' @nit If E-1
❑0 i m a Licensc lass Lic.Numhc Ar�2�/ -I�
F a r J Date. _ Cm to ctor A
a a or a OWNFR-BUILDER DECLARATION BUILDING PERMIT
EO.- INFORMATION
X g u y 1 hereby affirm that I am exempt from the Contractor's License MISC.-' REFER TO ORD
VALUATION $/FT.
Fu0J Law fortis following reason.(Sec.7031.5,Businessandl'rofessions PERMIT ISSUANCE
0 Code:Any city orcounty whichrequiresaper it toconstrueLalten, �h /,rxyA�'�)
G ¢ ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - UG NO. ELEC. /�., GG1 ODD
a. ¢ req Wles the applicant for such permit t0 rile a signed statement fiat TOTAL
X m" he is licensed pursuant to the provisions of the Contractor's License �( PERMITFT�Of,
Fii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe •`�wl -'
14 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H pm the basis for the alleged exemption.Any violation of SvcHoa 7031.5 STORIES TYPE CONSTR.
a3'_^ by any applicant for a permit subjects the applicant to a civil penalty ALTER �
-DRAIN -WATER (EA,) '5.00 A/ r
of not more than five hundred dollars(5500).): rV
-- ❑'I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,unit the struCmre is not OpCCC.GROUP , RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00 /r`- 3
Code:The Contractor's License Low does not apply to an owner of
property who builds or improves thereon,and who does such work ,� FIXTURES-PER TRAP , SO.FT.FLOOR AREA TOTAL ACREAGE
1� himself ments re of rote his own employees.provided that such improve TQ _
himself
through
rlmmnded it offered nes,or pe.ILhowhat such
building GAS-EA.SYSTEM-11 NC.40UTLETS 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 huild or inn BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON Pe Other
.
❑ I,as owner of the properly,can exclusively contracting with 0 ❑ ❑ ❑
licensed contractors to construct the 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 or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 -
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITAR V-STORM EA.2001t/10.00
,i the Contractor's License Law. TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,R&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPF-NSATION D17CLARATION WATER TREATING EQUIP. 5.00
1 herehy affirm that I have a certificate of consent to self-insure ZONING ENG.SITE NO.
or a Certificate of Workers'Compensaf io urunce,or a certified
copy Ihereof(See.3800,Lah.C.).
Policy No. COmrany
O ❑ Certified copy is h reby furnished. FIRE SPRINK ENERGY T 24
❑ Cetlid ll ry ti wit t c'y --tion division.
Z p Applicant MISC.- REFER TO ORD. Y.❑ N❑ Y ❑ N❑
~ rnPERMIT ISSUANCE 360
9 FLOOD ZONE A.L.U.C.
CIi R'I'I FICATE OP,EXEAIPTION PROM WO KERS'
W 5; COMPIiNSATION INSURANCE PLG.CONTR. ,LIC.NO. PLG, n
•? z (Phis section need not he completed if the Introit is for one TOTAL OC Y❑ N❑ Y❑ N❑
hundred dollars IS 1000A,IessJ
U O I Certify that in the performanoe if IIIc work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W 1- mit is issued,1 shall not employ any person in any manner so as fo
O W become object to file Workers'C'ampensation LawS of Calil'nrnia.
Dat, Applicant ALTER OR ADD TO MECH. "Loo BUILDING .�
} N NOTICE- TO APPLICANT: If,alter making this Certificate of Ex-
? e,option,you should become subject m the Workers Compensmi u, 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.1 4.00
CONS'FRUCI'ION LENDINGAGENCY - AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE �' a
- 1 hereby oflirm 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.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 pZ
Lender's Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
I` information is correct,I agree to comply with all city and County PLUMBING
l ® ordinances and state laws relating to building construction, and BOILER-CUMP(3 H.P.OT 100,000 B.T.U.1 6.00
herehy authorise representatives forms of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE BCH'. MECHANICAL 1
above-mentioned property for inspection purposes,
(We) agree tD Save, indemnify and keep harmless the City of MISC.- - REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE _10.00 CONST.TAX
may in any way accrue against said Cif in consequence of the -- -
da"tft oft s pennit, C� p� MECH.CONT. LIC.NO. MECH.
8- O TOTAL a)/' TOTAL 7� �
Signature Applicant/Contractor Date
OFFICE COPY