16425 POST THIS CARD NEAR FRONT OF BUILDING
• PERMIT NUMBER
CITY OF CUPERTINO 16425
INSPECTION DIVISION
JOB INSPECTION RECORD
• D - - PERMIT EXPIRATION
JOB ADDRESS� �`� � ✓Ct,�•y� ��• UNIT# _LOT#
PERMIT. EXPIRES IF-WORK
T
OWNER ! O CONTRACTOR SOU`TH 4 Ley'(f' IS NOT STARTED WITHIN
INSPECT ON DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 'NOTE:. ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION. :
- UFER � � - ' ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION. ;I
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ?
PLUMBING -^-
UNDERGROUND /SLAB P j1�Cti+
'
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG eLECT PLG. MECR
it of Cube 1110 ❑ 101 ❑
00 NOT POUR FLOOR UNTIL ABGVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TD
FRAMING' -
INSULATION STORIES TYPE TYPE coNsrR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE NO FINAL INSP.SHALL BE MADE BEFORE SD.1 T PLooR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 4
BUILDING USE
1
ROOF SHEATHING - - RES IND CON PB OP"APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 ' ❑ L c 11
ASSF:SSORSFAHCELNU
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TUBS PAN PLUMBING ENERGY TRACT mo. PARCEL No
S
MECHANICAL MECH.ENERGY
ELECTRICAL. BUILDING ENERGY ACC.DATE, ACC Fn.E NO
FRAMING - - ELECT.FINAL TEST I
zoNING ENG SITE NO.
INSULATION - PLUMBING
GAS TEST GAS -
FIRE SPRINK+ ENERGY T24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y NE] Y
.
EXTERIOR SHEAR � - ELECTRICAL RELEASE FI.000ZONE A.L.0 C,
INTERIOR SHEAR FIRE DEPT. v "El Y L NL.
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
.INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Dom'
o. PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z -MECHANICAL
-.SEE PERMIT FOR EXPIRATION DATE -
I
CONST.TAX
MPORTANT!
:PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. .
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING - APPLICATION & PERMIT
ADDRESS 16425
`L'Z-4 Z3 R\�ER$IQC BUILDING — ELECTRICAL—PLUMBING—MECHANICAL t"
OWNER'S PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
MR. •ry`'j' PHONE
cAMERncTOR's (, OUTLETS-SWITCHES-RECEP 10.00/1.00
'OJTH (,A(lii6f K%JJ%%1?I;406x LIC,NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESCTOR's _ APPLIANCES-RESIDENTIAL 4.00
lcl -- 11 pp
O DI� IV � PHONEJ705JS PANELS 10.00 DATEOFAPPLICATION
-
OR
HITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. O.,
ENGINEER, - '-'
LIC.NO, JSIGNS TRANS. - 3.00
ADDRRESS ENG' - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
NT
APPLICAS
ADDRESS MOTORS SEE FEE SCH.
^
SERVICE CHANGE 20.00 �/
,02 LICENSED CON'T'RACTORS DECLARA'T'ION
a u U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N a N (commrncing with Section 7000)of Division 3 of the Business and BL ELECT. PLG. MECH.
H D z Professions Code,en 1 my license ix in full Cora and •f'ct�
z o — License Class_^ Lie.Number
o w r Date_C ZI� ,._Cont Tactor�r.�PJj.I.Q
¢ x 7 Q DING PERMIT
¢ o d O OWNER-BUILDER DECLARATION - 8
w3 u y I hereby affirm Ihnt I am exempt from the Contractor's License MISC.— REFER TO ORD NFORMATION
u O ¢ Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT. -
r — PERMIT ISSUANCE 10.00 (�\
Code:Any city or county which requires n permit to construct,alter,
¢ er ¢ 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. ELEC.
— DLL requires the applicant for such permit to file a signed statement that TOTAL
•' w m hPERMITTO
is licensed pursuant to(lie provisions of the Contractor's License _
R z i Law(Chapter9(commencingwltit Section 7000)o'Division 3 ofthe
i o Business and Professions Code)or that he is exempt therefrom and CITV. PLUMBING PERMIT FEE Cr
LE r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
y ; by any applicant for it permit subjects the applicant lea civil penalty
of not more than five hundred dollars(S500).): i ALTER-DRAIN&VENT-WATER IEA.) 5.00
❑ 1,i s owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP EES.urv1T5
their sole compensation,will do time 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 docs not apply to an owner of
Properly who builds or improves thereon,and who does work suchch woFIXTURES-PER TRAP 5.00
himself orth buil his own employees,provided that such work S0.FT.FLOOR AREA TOTAL ACREAGE
ments are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion, Lite owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00 -
builder will have the bonito of proving that he did not build or ter BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB GO.,
❑ 1,as owner of the property,am exclusively contracting with - ❑ 11 ❑ E
license l contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cade: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 conlractorfs)lieensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l unto exempt under Sec,—,H.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM --6:08 ACC.DATE ACC.FILE NO.
N'ORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
-� copy there.((Sri,3800,I"Oh C.). —fes
Policy No. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY TQ4
Z Z '� Certified.¢�uQy is filed wit I • city inspection division.
F p ApplZam�_l_�A�_ MISC I REFER TO ORD. YE] IN� Y � N�
M'— . CI?Rl'114CA'I'Ii OF ExEm PYLON FROM WORKERS'u 1 PERMIT ISSUANCE �'� FLOOD ZONE A.L.U.C:
W COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL0 (This section need not be completed if the permit is for one TOTAL C..� Y❑ N� Y � NF]
U O hundred dollars(S 100)or less.)
I certify that in the performance of tint work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W F mil is issued,I shall not employ any person in any Turner so us to -
O do become subject to the Workers'Compensation Laws of California.
IS. Date Applicant BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of lis- ALTER OR ADD TO MECH. 5.00
emption,you should become subject to time Workers'Compensation APPLIANCE 5.00 PLAN CHECK 'I
provisions of Lite Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1001C.F.M.) 4.00 '
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000QEM.) 6.00 SEISMIC FEE
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,Ci,C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 -
Lender's Nam
Lender's Add
ss HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Li s AAddre -
I certify OUR l have Ral an,application and Slumffiat llie Shove VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city.and county PLUMBING Try
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter Inion.the BOILER-COMP lover 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby
autioncd property fmiseor sp of this
puny to
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - .. CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10,00
fanli��+•�this permit /9MECH.CONT. LIC.NO. MECH.,
I V-1CIA,re K-/.', tlo S—z�—p�• TOTAL TOTAL
Signature of Applicant/Contractor Date
OFFICE COPY