16086 POST THIS CARD NEAR FRONT OF BUILDINGPERMIT NUMBER
" . CITY .OF. CUPERTINO . 16086
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS v _S0— zc- C'T UNIT# _LOT# pERM1T EXPIRES IF WORK
OWNER CONTRACTOR -n.-� TE IS NOT STARTED WITHIN
I SPECTIO DATE INSPECTOR - INSPECTION REC RD '180 DAYS OF PERMIT ISSU.
FOUNDATION " ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL-BE INSTALLED
PREGUNITE' - ' TO COMPLY WITH THE APPROVED PLANS AND CITY OF, PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - - - . . ISSUANCE DATE
MECHANICAL', BLDG ELECT PLG- �MECR
- ❑ ❑ ❑ '®
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING VALUATION STFT.
MECHANICAL -
- PENMII TO
" ELECTRICAL ..
FRAMING-- / •�
INSULATION STORIES TYPE CONSTR
. pU
DCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - IIFS IND .CON ' 'PB O'l—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. . ❑ ❑ ❑ •❑ ❑
. ASSESSDRS PARCEL NO.
ROUGH SAN.N
PLUMBING - ELECT.ENERGY
IRACI"NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY '
ELECTRICAL BUILDING ENERGY ACC.DATE ACC F{ILE NO
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING zoNlrvc ENG.SITE No.
GAS TEST - GAS - -
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] "❑ ❑ "❑
FLoon zoNE n.L u.c.
EXTERIORSHEAR - - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. '
❑A N❑ ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH ' - BUILDING
INTERIOR LATH '- TEMPORARY APPROVALS BUILDING '
SCRATCHcOAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE -
OCCUPANCYOFBUILDINGISNOTPERMITTEDUNTILBUILDINGFINALISSIGNEDBYBUILDINGINSPECTOR. MICROFILM It
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
1-- ONE WORKING DAY BEFORE.REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB-ADDRESS-WHEN PHONING.
- S EEPERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! '
CONST.TAX
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
BU I LDING PROJECT I DENT]FICATI ON PERMIT NUMBER .-.
A, sm APPLICATION & PERMIT 16086
ADREss
3 Sc I BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'5�y11 L, PLAN CHECK VALIDATION
NAME /(ICH HO 6'044 I 7zs= 3 DCITY. ELECTRIC PERMIT FEE
PHONE
NDAMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
`�-��•`I "- /cam uc No. I LIGHTING FIXTURES ' 10,00/1,00
CONTRACTOR PPLIANCES-RESIDENTIAL 4.00
AOOREss
N OrvEb0��QQ PANELS 10.00 DATE OF APPLICATION
RCH1TEcr - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.,
O
oft
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
noo Ess ENPERMIT CIRCUIT 5.00 PERMIT VAU pATION
zip TEMP.METER OR POLE INS. 20.00 n -�
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS
T SERVICE CHANGE 20.00 Q/f 4
QQ
Foo LICCNSIiD CONTRACTORS DECLARATION /!
¢u w I'hCreby affirm that I am licensed underpruvisionsof Chapter9 ISSUANCE DATE
N (commencing with Section 7000)of Division 3 of the Rusiness and
4 n BLDG. ELECT. PLG. MECH.
F y z Professions Code,' d ¢ansa is in full force a die L — ❑ ❑ ❑
z 0 at License CIa Lic.Numbe'
20
m F'w Data_jgg--GDI1trnC(Or ! 11 -
a y s BUILDING PERMIT
¢ ¢o u OWNER-BUILDER DECLARATION INFORMATION
wi: to I hereby affirm Ihat 1 um exempt front the Contractor's License MISC.,- > REFER TO ORD
uo4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION /FT..
Code:Any City or County which requiresn permit to construct,alter,
ac ¢ ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
So
iL u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
X C, he is licensed pursuant to the provisions of the Contractor's License _
Lose Law(Chapter 9(commencing with Section 7000)of Division 3 of the
io Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE I
¢ I- m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
t i ; •. by any applicant for a permit subjects the applicant to a civil penalty
ofnot more than fivehundred dollars(S500).1: ALTER-DRAIN -WATER IEA.) 5.00
❑ 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 ilia work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's.License Law does not apply to an owner of
40 property who hinds or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
occurs are not intended oroffered for sale.If,however,ilia building GAS-EA.SVSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion, theowner- GAS-EASYSTEM-OVER 4 IEA) 200
builder will(lave the burden of proving that he did not build or ins- . . . BUILDING USE
'
prove for purpose of sale.). RES IND CON PB OtherINDUSTRIAL WASTE INTER. 30.00 F-1 El ❑ El 13❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct Ota 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-OV ER 5(EA.) 1.00
contracts]or such projects with a contractors)licensed pursuant to SEWER V-STORM EA.200f1/10.00
the Contractor's License Law. TRACT N0. PARCEL NO.
❑ l am exempt tinder Sec. ,B.&P.C.for this
WATER HEATER W/VENT 6.00
reason
Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING
Or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.
Policy No. Co ton
O ❑ Certilicd copy fprni ed.
9i - FIRESPRINK ENERGY T 24
Z Z ❑ Certified c 1 - -d wi c city inspection division.
O_ ppplica b.. MISC.- REFER TO ORD. v❑ N❑ v ❑ N❑
y. CIE 11%CA'fIi 01 EXI: FROM WORKIiRS• PERMIT ISSUANCE 10,00 FLOOD ZONE A.LU.c.
W COMPENSATION INSURANCE PLG.CONED. LIC.NO. PLG.
� Z CIL 0 ('Phis section decd not be completed if the permit is for One TOTAL y El NEI y 1:3 NEI
hundred dollars(S 100)or less.)
L) O I certify that in the performance of the work lot which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
EL F mit is issued, I shall not employ any person in any manner sit as to
O w become subject to the Workcrs'Compensation Laws ol'C;dihnnia.
Data Applicant - BUILDING
} GO N01'ICE'1'0 APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. - 5.00
F Z eruption,you should become subject to the Workmi Compensation APPLIANCE 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 ) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000 C. .Maj SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the Perfornance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.y HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.0.50
Lender's Address ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree t0 comply with all city odd county PLUMBING
ordinances and stale laws relating to building constrmtmo, and BOILER-cUMP I3 H.P.Of 100,0008.T.U.1 S1y9$
f hereby authorize representatives i
this
of thpurposes. x!s city to enter upon the
above-mentioned property for insp ofBOILER-COMP(over 100,000 BTU)SEE FEE SCH. ,MECHANICAL, 0I
(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 it, any wit dc. City in consequence of tine PERMIT ISSUANCE :-iArOB
laming of Ill nit MECH.CONT. LIG.NO. MECH. -
S_6 TOTAL. a ! TOTAL
Sign re o ApplicanU ontr, tor Date
OFFICE COPY