16954 POSTTHIS.CARD.NEAR FRONT OF BUILDING PE NiTNun,eEN
CITY OF CUPERTINO 16954
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIIT--EXPI�,p ON
JOB ADDRESS Tl 5W+-3O UNIT# _LOT# y✓rY '' I'^' '��f
PEES RMIT EXPIRES IF WORK
OWNERI r, CONTan Toa �� CI�-�.n-v UU - IS NOT STARTED WITHIN
r} INSPECTION • DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION l NOTE:. p ANCE 'OR 180 DAYS FROM
LASf CALLED INSPECTION."` '
UFER < ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN.OF PERNUT VALIDATION
- CUPERTIN STANDAR S.. .�• 3:801
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED cON'
UNDERGROUND /SLAB - LOW .+ p T c— �lh'FiGF�
PLUMBING
ELECTRICAL- - ISSUANCE DATE
MECHANICAL BLDG ELECT I PLG, YECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 5A1,4 t `J BUILDING PERMIT -
WOOD FLOOR - / INFORMATION
•PLUMBING - .VALOAr ION '15
1 S/FT.
MECHANICAL �! f _ ,�(�f, ��'I +�•� � "
YEHMII'TO
- ELECTRICAL � @1�F�
FRAMING _ • / pTYJ41•,\f i .
INSULATION ' �' Gvp�` a sTORIes TYPE CONSTR.
1s y2�1�P Q I�WO- I
q�
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so IT FLOORARCA TOTAL Acaence
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
e b ROOF SHEATHING — E IND I'"ICON USE
00—
I {f APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE. INSP. KL s0ssUR El Cl
❑
ROUGH SAN.N
I. NLUMBING - ELECT,ENERGY
TRAGI NO. TPARCELNO
T'FIQS&SHOWER PAN PLUMBING ENERGY
MECNHANICAL - MECH.ENERGY SACC DATE ACC,FILE NO
ELEMTRICAL BUILDING ENERGY ,
FRAMING _\ �DL ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULA ON PLUMBING CI -Qpuggliflo—
GAS TEST�AN GAS \ A J'
d MECHANICAL q PgINK / ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, - r ikt�o ` !/"' Y E] NE]
EXTERIOR SHEAR — — a ELECTRICAL RELEASE +4 �'�k' - . f,OODZONE A.LUC.
r
INTERIOR SHEiiR - _ FIRE DEPT. - -'(/'` f ^�/`'T Y ❑ N❑ r ❑ ^'❑'
SHEETROCK , k9S GRADE .• FEE SUMMARY
EXTERIOR LATH (�®' BUILDING -
INTERIOR CATH (, � � TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC (Y PLAN CHECK.
GAS FEE,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE h •
OCCOPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY,BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC (gyp B
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE'GIVE JOB ADDRESS WHEN PHONING.
Z — SEE PERMIT FOR EXPIRATION DATE - MECHANICAL .
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION,' TOTAL
OFFICE,COPY
APPJ_ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
,DtLDING
16954woo,Ef§,IQ� C� f�Kn -- ,� ^ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
,.
OWNERS`+• wF�wv PLAN CHECK VALIDATION
w = "G i1�i Rab -389 '7 CITY. ELECTRIC PERMIT FEE
PHONafl
E }1
' COO�N1QQTH,�AAC��T//OR s ' ,1 tA-:, OUTLETS-SWITCHES-RECEP 10.00/1.00
N 4G/( CA Lf DVId Lt. ND. 7Ll LIGHTING FIXTURES 10.00/1.0 1 lQ
C NTRACTOR'S ea APPLIANCES-RESIDENTIAL - 4.00 6 a
ADDRESS �A,11 G1� .y��' q
1639q Iµa �A��F PH-HO eJ Lj _251& .� PANELS 10.00 tear 0 DATE OF APPLICATION
ARCHITECT I' I PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
,NO.��lJ
SIGNS TRANS. 3.00 � - '
uc.No. y
ARCH,OR SPECIAL CIRCUIT 5.00 �• PERMIT VALIDATION
AD°REE J 1����9
• - •• 10I g f•7D ZIP f432P EMP.METER OR POLE INS. 20.00 - I
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS / �� V I- _
A
Sem �c�C�j SERVICE CHANGE- 20.00 - �-s`•�OI
o �z
Foo LICENSED CONTRACTOR$DECLARATION
a v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H wi I'rofesslons Code,and my licensee Is in full force end effect
z 0 m - License Class Lie.Neither.
0 zH w Date Contractor
I= " BUILDING PERMIT
wOWNER-BUILDER DECLARATION INFORMATION
MISQ- REFER TO ORD
wu„ I hereby affirm that I am exempt from the Contractor's License) VALUATION $/FT.
Fu0 Law for the following reason.(Sec.7031.5,Businessand Professions .PERMIT ISSUANCE 10.00 -2,005
us Code'.Any city or county which requires a permit to construct,alter, 3
za ¢O improve,demolish,or repair any structure,Prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. [ �Y ?
- u requires theapplicant for such Permit to file a signed statement that • TOTAL 6�i46 PERMIT TO
o w P a he is licensed pursuant to the provisions of the Contractor's License-
to Law(Chapter 9(commencing with Section 7000)ofl)ivision3of the /\L�0{t l(S R
F i C Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
II ¢ r m the basis for the alleged exenhption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 - by any applicant for a pemtiI subjects the applicant to a civil penally ALTER-DflAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
(heir sole compensmion,will do the work,and the structure is not
! intended or offered for Sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cade: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 SO.FT.F LOO,AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
..hems are not intended or oft'ered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im. ES 'IND CON PB Ohba,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00 ❑ ❑ ❑ ❑
❑ I,as owner of the property,am exclusively contracting with
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 ^ C
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS,OVER 5(EA.) • 1.00 ZJ57- j 5 �T✓
contracts for such projects with a conlructor(s)licensed purant to
the Contractor's License Law. suSEWER-SANITARY-STORM EA.200ft/10.00 I.Inlo TRACT NO. PARCEL NO.
❑ I am exempt under Sea ,B.&BC.I'or this
_LIWATER HEATER W/VENT 6.00 'bD ,
reason
Owner Date WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO.
WORKS RS'COMPENSATION DECLARATION WATER TREATING EQUIP., 5.00 �'
I hereby affirm that 1 have a certificate of consent to self-insure, as ZONING ENG.SITE N0,
or a certifmate of Workers'CompensationInsurxnee,or a certified
copy thereof(Sec 3800,LAC.). h'
Policy No. Company V
Q ❑ Certif,edcopylSherebyfurnished, - FIRESPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. R TO ORD.
0 Applicant MISC.- C, v ❑ N❑ v ❑ N❑
CCN CERTIF)CA'IT OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE - - .00 ��(p FLOOOZONE A.L.U.C.
LIU > COMPENSATION INSURANCE PLG.CONTR. -LIC.NcL PLG.
d a (This section need not be completed if the permit is for one TOTAL 100 Y❑ N❑ Y ❑ IN
� Z hundreJdnllurs IS 100)or less.)
U O 1 certify that in the performance of the work I'or which this per, CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H . mit is issued,I shall not employ any person in any manner so as to
Ow become subject 1.Ole Workers'Compensation Laws of California. BUILDING GO /aJ
nate Applicant ALTERORADD TO MECH. 5.00
}-tan NOTICE TO APPLICANT, If, it,,making this Certificate or Ex-
♦- ? emption,you should become subject to the Workers'Compensution 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 LF.NUINO AGENCY AIR HANDLING UNIT(OVER I0,000ORM.) 6.00 - SEISMIC FEE7a
I hereby affirm that ihere 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
w Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 _ ELECTRIC r
Leader's Address GOY o
a• I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
Information is correct. I agree to comply with all city and county =BOILER-COMP(3 H.P.Or 100,000 B,T.U.) 6.00 PLUMBING •1
ordinances and stale laws relating to building construction, anti OLbti
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100.0006TU)SEE FEESCH. MECHANICAL
above mentioned property for inspection purposes.
_ (We) agree to save, indemnify and keep hnrmless the City of MISC.- REFER TO ORD.
r o �j Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
1 may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 ��,aC'�
granting of this permit. .. MECH.CONT.- LIC.NO. MECH. 1L
TOTAL
Signature of Applicant/Contractor DTOTAL �
at. l`�D
OFFICE COPY