16155 POST THIS CARD NEAR FRONT OF BUIILDING AI
PERMIT NUMBER
CITY.�OF- CUFERTINO p 16155
J' ;2,11 INSPECTI DIVISION
�LCL�
JO SON RECORD, ' ' 1
`7�'!_ - _ ��• pL p PERMIT EXPIRATION•
JOB ADDRESS
UNIT'# _LOT# PERMIT EXPIRES,IF WORK �J
OWNER CONTRACTOR C IS NOT STARTED WITHIN
IN PEC 10 DATE INSPECTOR INS EC ON ECO D. 1 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
' NOTE: - " LAST CALLED INSPECTION.
LIFER ALL GRADING AND-DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PR EGUNITE CUPERTINO STANDARDS.•. - -
GARAGE SLABS - _ _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ,•,J .•A�.� ` 1
PLUMBING
UNDERGROUND /SLAB _ 4
- - n � L� .F I �L.•LJ
ELECTRICAL - - -ISSUANCE DA{
MECHANICAL BLDG ELECT. PLG. MECN,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - "' BUILDING PERMIT
" INFORMATION'
WOOD FLOOR DEC oo VALUATION SIFT.
PLUMBING - 00
MECHANICAL C_
ELECTRICAL - ' - PERM I T.TO
.F _FRAMING �,6 '{ l 1E14 7 f-nom.
INSULATION "aSIORIEs TYPE corvsTR.I
•1� OCC GHOUP RES.UNITS
PLACE NO S6BFL06R UNTIL ABOVE HAS BEEN SIGNED
- Sp.FT FLOOR Al1Ea 101aL ACREAGE
ROOF NOTE:.NO FINAL INSP.SHALL BE MADE BEFORE.
DIAPHRAGM' - THE CONSTRUCTION TAX IS PAID,
_ BUILDING USE 1
ROOF SHEATHING 1 - HCS •IND .CON PB 0,I,. '
APPLY. NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L ❑ 0 1 -
ASSESSORSPARCELNO F
- ROUGH - SAN.a -
PLUMBING ELECT.ENERGY .
iRACI NO. PARCEL NO
TUBS 8 SHOWER PAN .' � � PLUMBING ENERGY .
MECHANICAL MECH.ENERGY;
ACC.DATE ACC.FILE No.
- ELECTRICAL BUILDING ENERGY
FRAMING . - ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION - PLUMBING '
"GAS TEST GAS
- - - FIRESPRINK 'ENERGY T.24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NL [jA I NL,
E Loop zoNE - Ai1
' EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR„ FIRE DEPT. YE] N' ❑ ` N[]t '
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH .-. BUILDING - � BUILDING
INTERIOR LATH ' :TEMPORAR APPROVALS
SCRATCH COATELECTRIC. PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY'' SEISMIC FEE u '
OCCUPANCYOF BUILDING.IS NOT PERMITTED UNTIL BUILDIN G FINAL-.IS SIGNED BVBUI LDING INSPECTOR. MICROFILM
4R RANGE FOR INSPECTION B.Y. PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED-INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING:'
l•IZMECHANICAL
— SEE.PERMIT FOR FOR DATEj—
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 -
BUILDING PR2,IF:CT IDENTIFICATION - FPERMITNIIMBER
BDLLDING APPLICATION & PERMIT 1 [[
` I U I J J
ADDRESS C1
� �r� S �� �• BUILDING —ELECTRICAL—PLUMBING—MECHANICAL +
ONNER's*IP110
NAMEPLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
" PHONE BOO
NAMERAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00
sec.NO LIGHTING FIXTURES 10.00/1.00
r,GrvrRAcrGR's
Aooaess APPLIANCES-RESIDENTIAL 4.00
7ZC �p� yy�
� vH /4/
Orve l�N PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
Ic.NI�ID SIGNS TRANS. •3.00 .
ARCH OR EENNGG SPECIALCIRCUIT 5.00 PERMIT VALIDATION
EMP.METER OR POLE INS. 20.00 `
APPLICANT MOTORS SEE FEE SCH.
ADDRoR �3• I�'���—�—�1
SERVICE CHANGE - 20.00 - I21I�I
¢ ¢ i
r o o LICENSED CONTRACTORS DECLARATION
Fi L.I hereby alfirm that I am licensed under provisions of Chapter 9 - _V- 'ISSUANCE DATE
a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG.. - MECH.
vl License Chess—
F m i Professions Code.and nay license is in full force and effect. ..) 1:1 El 1:1o i o Lic.Number +
Date Conl rector
fEC 2 .s
BUILDING PERMIT
P
x .< DEC 1 9
ce a OWNER-BUILDER DECLARATION
¢w U INFORMATION
w ;u. F 1 hereby nIfRR that 1 um exempt from the Contractor's License MISC.— REFER d0 ORD -
N - VALUATION. $/FT.
F u_w g Law for the following reaon.(Sec.7031.5,Business and Professions PERMIT ISSUANCE (400 n ertln
Code:Any city or county which requires a permit to eonstrucL uler,
a 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. w�✓ ^—
w—o R0 requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
$m he is liscrad pursuant to the provisions of the Contractor's Liaa n
F z¢ Law(ChupterYtext nmenacing will,Section 7000)of Division 3 oldie Y 'IAM
i o Business and Protesamn,Code)or that he is exempt theretrom.,,it QTY. PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation nf5ection 7031.5 STORIES TYPE CONSTR.
o by any applicant for a permit objects the applicant m a civil penalty gLTER-DRAIN -WATER (EA.).5.00
-
01 not mon than five hundred dollars(S5001.):
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP " RES.UNITS
their sol,co n,cre.tice,will do the work,nod 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(hereon,and who does such work FIXTURES-PER TRAP 5.00 so.Fr.FLOOR AREA TOTAL ACREAGE.
himself or through his own employees,provided that such improve
ants are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM INC. OUTLETS 6.00
r improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving that he did not build or int- GAS . - . .
- RES IND D CON APB Other
for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
D h as owner of the property,am exclusively contracting with ❑ ❑, ❑ ❑ ❑
licensed contaomrs or im,Tuht the p,opet(Sec. 7044,Business LAWN SPR IN KLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thcreun,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 _
contracts for such projects with a contmetml,)licensed pursuant to
the Contactor i Liecnse Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑n
ow l am exempt under Sec.—,BAP.C.for this WATER HEATER W/VENT 6.00
rea"•r Date WATER SYSTEM .5.00 ACC.DATE ACC.FILE No.
u'ORKF,RS'COMPI?NSATION DECLARATION WATER TREATING EQUIP. 5.00 _
I hereby affirm that I have a certificate ofcunsent to all-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a Certified
copy th,reof(SCc.3800,La ,C.). - - '•
Policy No. Company -
O ❑ Certiticd copy is hereby I'urnisfied.
Z 2 ❑ Certified copy is filed with the city inspection division. FIRE$PRINK ENERGY T-24'
F O Applicant - MISC.- ' r REFER TO ORD: Y ❑ N❑ Y ❑ No -
W CERTIFICATE 01'EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 a FLOOD ZONE A.L-U.C.
LU1 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLQ -
j Z (This section e'd.nut be coo mp let, it the permit is for one TOTAL Y❑ N❑ V E] N❑
hundred dollars 15100)or l".)
L) O 1 certify that in the purformance of the work for which this per QTY. - MECHANICAL PERMIT FEE FEE SUMMARY
LL U mm
it is issued. I shall not employ any person in any manner so as 10
become subject to the Workcrs Conapcnsmien Laws of Culifomiu. q
UJ Date npplicum ALTER OR ADD TO MECH. 5.00 BUILDING
} Go NOTICE '10 APPLICANT: Ih after making this Certificate of lix-
? eruption,you Should become subject to the Workers Compenmtion APPLIANCE 5.00 PLAN CHECK �s
provisions of the Labor Code, you most forthwitho comply with
U such provisions or this permit shall he deemed revoked, AIR HANDLING UNIT(TO I0=C.F.NL) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.),6.00 SEISMIC FEE
I hereby affirm that mere is a corstruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
' the performance of the work for which this permit is issued(Sec. -
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U') 8.00 MICROFILM
Lender's
Address
HEATING UNIT
Nam
Leendere IDV ER 100,000 B.T.U.19.50 ELECTRIC
m • -
I certify a
s I hav,read this apphcalmn and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county
,
i ari tiBOILER s and state laws relating to building construction, and COMP(3 H.P.or 100,000 B.T.U.) 6.00 'PLUMBING
J y;-mentioned
representatives for ins ul this nposeu ewer ufwn the BOILER-COMP (Oxer 100,000 BTU)SEE FEE SCH. MECHANICAL
ai e-mentioned properly for inspections city to
(We) agree to save, indemnify and keep harmiss the City of MISC.- ' REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ranting of lhi •nn - MECH.CONT. LI C.NO. MECH.
TOTAL TOTAL
Signatureofcant/ rammer., Date slt•1
OFFICE COPY
;1 ELECTRIC SERVICE NOTICE OFFICE COPY
e _ BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
�1 ti 29� 19
TO `�
r�~ You are hereby authorized to Connect electrical
service
for
I Owner or Tenant GYM 01y[`�I ct-e of /
At i'c �c1s.J• • '4P) - -7 S i t� Yam
'j—
Nor of Wires
—
NorofWires Size of Wires Size of Switch
Motor Load Voltage Phase
Heating Lood K.W. Voltage
1 Lighr 110_New Service Reconnect
No.of Meters Heat 120_Three Wire More Service
No.of Add.Meters Power Three Phase-Mo"Meter
ELECTRICAL INSPECTOR •'"
.. .�•J.A;nn• .:at:r....:Aw la:.:.1.k.:.•y...+..,...:....Jar:.:.:.:.'....: °✓.'m:...yg4.. ...L_+.A.nop_.4.\:.o L..:... .