16092 POST THIS`CARD NEAR FRONT OF'BUILID ING
CITY OF -CUPERT"INO PERMIT NUMBER
6092
INSPECTION DIVISION
1 1 J�O�B}INSPECTION RECORD
- 'JOB ADDRESS `� gn `"' , PERMIT EXPIRATION
UNIT I#�n�- _LOT# , PERMIT EXPIRES IF WORK
TOWNER �,JI l/UILVv CONTRACTOR fj"{7(/pV j . , .IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM'
- NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASLCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIL VA L CATION
GARAGE SLABS CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED peck n0.1 I Car byTick
UNDERGROUND /SLAB
r �yP 'GJcC�
PLUMBING ... '
�wd
ELECTRICAL ISSUANCE DATE' . I
MECHANICAL PND PLUG ELECT PLG. - MECH
❑ O ❑' E
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED AUGBUILDING PERMIT
WOOD FLOOR - IN RMATION
PLUMBING .VAwA pN S/PT.
I f
MECHANICAL ' - � Mo � I '
- V PERMn i0
ELECTRICAL _
FRAMING..
INSULATION 'STORIES TYPE CO STB.
DEC GROUP , FES.ONITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT FLOOR AREA :rornL ncREACE
DIAPHRAGM . THE CONSTRUCTION TAXIS PAID
BUILDING USE.
ROOF SHEATHING RIs INC CON Peom „
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.- ❑ ❑ ❑ ❑ ❑
ROUGH SAN.# ASSESSORS PARCEL NO
PLUMBING - - ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHAN ICAL' - MECH.ENERGY
ELECTRICAL - BUILDING ENERGY - ACC.UATE ACC FILE NO
FpAMING ELECT.FINAL TEST
ZONING ENG SITE NO.
' INSULATION - - PLUMBING � � - "
GAS TEST GAS
i• MECHANICAL -EIRE SPRINK ENERGY T2
;COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 'Y ❑ N❑ T ❑ N❑
-
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUCP
IN RIOR SHEAR FIRE DEPT. ❑ -❑ Y ❑ A
SHE -TROCK - GRADE - FEESUMMARY
EXTE IOR LATH BUILDING -
INTER OR LATH , TEMPORARY'APPROVALS BUILDING 0-I Y "1
SCRATCIlj COAT ELECTRIC PLAN CHECK
t GAS FEE
NO TAPE OPPOLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF'SIUILDING ISNOT PERMITTED UNTIL BUILDING FINALIS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRAFOR INSPECTION BY PHONING 252-4505, ELECTRIC
IW—� Iti!GE ONE WOfi,KING DAY BEFORE REQUIRED INSPECTION. 'PLUMBING
z PLEASE GNB I.E JOB ADDRESS WHEN PHONING.
— SEEERMIT FOR EXPIRATION DATE— . MECHANICAL
'
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALL NG FOR FINAL INSPECTION. TOTAL IJ
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY r
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
BUILDING
ADDRESS APPLICATION & PERMIT
1 /M�VO
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 '^9
^/
U
OWNER'S PLAN CHECK VALIDATION
/ "1AMMEEr� TV. ELECTRIC PERMIT FEE -
PHONE
CONTRACTOR'S OUTLETS-SWITCHES-RECEP 10.0011.00
LIC.N LIGHTING FIXTURES 10.00/1.00
ADDRESS oR's PPLIANCES-RESIDENTIAL 4.00
ePHONE 67-8I I/ PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE .C.!NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARC H.OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00
AZIP EMP.METER OR POLE INS. 20.00 ,,,�11 , 1f YY• '
/Uy IVI`�13y-�
ADDRESS
MOTORS SEE FEE SCH. J
ADoP p
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
a u 5 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y<w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F m z Professions Co^c,and my tic se Is in full fo Ed of�e
2 O w License Class Lic.Number//! 3 ❑ ❑ ❑ ❑
O H O Date Contractor
AUG
a 'F 1869 BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION O
ORMATION
MISC.- REFER TO ORD INF
X
0 u-y 1 hereby affirm that I am exempt from the Contractor's License" VALUATION $/FT.
F u O er Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE
Code:Any city or county which requires permit to construct.alleq
ar > 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. / (�JLJ
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
K $ he is licensed pursuant to the provisions of the Contractor's License VFAI
La
Z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe67 h�MPI
s 4 D Business and Professions Code)or that Ile is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CO STR.
d';� by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner Of the property,or my employees with wages as BACK F LOW 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,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 60.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own emptuyecs,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
orimprovement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE
bu . . .
ilder will have the burden of proving that he did not build or im- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the properly,am exclusively contracting with 1:11:10 El 11Iicenud contractors to construct the project ISec. 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 iLAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACO.FILE NO,
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate.fco.wot to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy Chep% RgQ}0p Lab.C.). '
Policy Nif•"�' 'z aY'ompany
O ❑ Cend-i pr herebyfur bed. / FIRESPRINK ENERGYT24
Z Z !❑__Ce mit , is '1 vN III pection division. MISC.'- REFER TO ORD.
O Applicar Y ❑ N❑ Y ❑ N❑
2y CERTIFICATE OP EXEMPTIC ROM WORKL'RS• PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O.
W D COMPENSATION( URANCE PLG.CONTR. LIC.NO. PLG. y❑ N❑ V ❑ N❑
n'
CI his section need not he completed if the permit is for one TOTAL
Z hundred dollars IS 100)or less.)
U 0 I certify that in the performance of the work fur which this per DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
U y Dam ApplicantBUILDING
ALTER OR ADD TO MECH. 5.00 I r
>_ 0 NOl'ICE TO APPLICANT: If,after making this Certificate of Ex-
F ? 00-
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
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
(lie performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(70'100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4,00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMPI3 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
BY in accrue a t Said Coy in nsequence of the
r ng of this MECH.CONT. LIC.NO. MECH.
TOTAL , TOTAL '1171
pp Ica on rector - Date
OFFICE COPY