16089 a POST THIS CARD NEAR IFRO NT OF BUILDING' PERMIT NUMBER
-CITY OF CUPERTINO, 16089
INSPECTION DIVISION �3R �b
JOB INSPECTION RECORD .2 y a.3
, PERMIT EXPIRATION
ra� As� n JpIijMT 3V6
JOB ADDRESS U # LOT#
7
�GQ PERMIT EXPIRES IF WORK
0WNEi+ Ca" CONTRACTOR50,41" - - IS NOT STARTED WITHIN
INSPttTIbN DATE I INSPECTOR - INSPECTION RECORD 180 DAYS of PERMIT ISSU
FOUNDATION - 'ANCE OR 180 DAYS FROM
.NOTE: LASTCALLED INSPECTION. .
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED •+
PREGUNITE TO COMPLY WITH.THE APPROVED PLANS 4B(LI180F _ PeRruT vnuoA�IDN
CUPERTINO STANDARDS. . � +I•
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED --�¢ 1J '1oY_,Z;IZ - , • .S ;' w,l•I:'�,;,, ,
UNDERGROUND /SLAB
PLUMBING .\
ELECTRICAL' - - 3 '� — �/ ISSUANCE DATE
MECHANICAL' +Luc. ELECTPLC,, MEC.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Z\AC Ct BUILDING PERMIT
WOOD FLOOR _ FORMATION
L IATION SIFT,
PLUMBING O�^,��� �i '�I�I� M 1• -v_ .
MECHANICAL "`•"'�9 �' �iC�%1�.1..��
ELECTRICAL. - PERn�n ro -
FRAMING . r.'
INSULATION - STO. IES- Tv ECONSTR.
' - Occ GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEE GNED19
ROOF OTE'NO FINAL INSP.SHALL BE MADE BEFORE so ET.FLUOR AREA TOTAL ACREAGE
•' DIAPHRAGM HE CONSTRUCTION TAXIS PAID
.BUILDING USE
ROOF SHEATHING • RES IND CON PB QM
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 0 ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY LRACiNO, PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE.NO.
INSULATION. PLUMBING
GAS TEST - GAS -
FIRE SPRINK ENERGY'L]<
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ °� ` "[
BLOOD 20M1E 0.L V C:
EXTERIOR SHEAR � . ELECTRICAL�RECEASE
INTERIOR SHEAR FIRE DEPT. - v� N� ❑ N�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING •�$
INTERIOR LATH - TEMPORARY APPROVALS BUILDING C'5o :�?
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
'NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE I_, YL`.
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION' BY PHONING 252-4505,
�� ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED'INSPECTION. PLUMBING
1, PLEASE GIVE JOB ADDRESS WHEN PHONING. .--
— SEE PERMIT FOR EXPIRATION DATE = MECHANICAL
IMPORTANT! coNsr.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL r ="
CALLING FOR FINAL INSPECTION. +c44N,—"
OFFICE COPY
' ti
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
+ BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
Rl1ILOIsrvG� .I�
o APPLICATION & PERMIT 3 ""
'L'IO� / '�i BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �' 16089
PLAN CHECK VALIDATION
Cep q TV. ELECTRIC PERMIT FEE
PnorvE ( (6' ( Z
CONTRACTOR'a
UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.0OI1.00
roNTRAcroRs. �, PPLIANCES-RESIDENTIAL 4.00
TUtit/�[1 PHONE ! _ q PANELS 10.00
.r�` DATE OF APPLICATION -
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR_ d PANELS (OVER 200 AMP) 20.00 -
I R /" uc.No. SIGNS TRANS. 3.00
ARCH.OR ENGPERMIT VALIDATION
oR
' AaEss � A�-_ SPECIAL CIRCUIT 5.00
;'. 6,AN Iffy xI S EMP.METER OR POLE INS. 20.00 '
ADDRESS
NT5 MOTORS SEE FEE SCH. J. " R
SERVICE CHANGE 20.00 IE�'I
woo LICENSED CONTRACTORS DECLARATIONgees ?IC�
a.u AU
1 hereby affirm that I am licensed under provisions of Chaptcr 9 .ISSUANCE DATE
a L (commencing with Section 7000)of Division 3 of the Business and ELECT. PLG. - MECH.
r D z Professions Calc,and my license is in full for��y d effeety
e0t3 Licen P LieNuantaC '19601 - El
0
H o Datc Contractor
a m BUILDING PERMIT
¢ ¢ ¢ a OWNER-BUILDER DHCL.ARATION
I, - INFORMATION
w3 a H 1 hereby affirm that I am exempt from tint Contruaor's License MISC,- REFER TO ORD
L o a L w far the followmg seasoa.(S,c.7031.5,Businessxnd Professions PERMIT ISSUANCE 1000 - VALUATION'- - $/F7.
Code:Any city or county which rcyuiresa Pennil to
construct.alter,
/�/��
T ¢ G impinvo,demolish,nr repair any itmdure,prior to its issuance,also ELEC.CONTR. LIC.NO., ELEC. COD
a
¢ requires the applicant for such pemtit to File a signed statement that TOTAL
w $ he is licensed Pursuant to the provisions of the Contractor's License, _ PERMIT TO
H z i Baynes and ProeommenC de)th Section is exempt
therefrom
o and - I
E 4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE,
¢ H $ the basis for the'alluged exemption.Any violation of Section 703 LS STORIES TYPE CONSTR.
; -. by anyapplicant for a Pemail subjects the applicant to a civil Penalty ' ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($50R.): -
❑ more
owner of the properly,or nty.cntployces with wages as BACK FLOW 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 t
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who d«s such work FIXTURES-PER TRAP 5,00 Sa IT,FLOOR AREA TOTACACREAGE
himself or through his own employees,provided that such improve
menu arc not intended or offered for sale if,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
build,,will have the burden of proving that he did not build or nn_ BUILDING USE
prop
ve for urpose INDUSTRIAL WASTE INTER. 30.00 RES IND CON PR oma,
❑ I,as owner of the property,u exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Prefix ions Code:The Contractor',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 contraclons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lamexemptunder Sea ,B.&P.C.lorthis WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK F,RS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have u certificate efcor rattry�el(-ireure- - - ZONING ENG.SITE NO.
or a cc,tific.t,o(JM4Jptp P6illpe�ot�Ar nsum®,yr a certified
copy thereeGe�SHOQ ' _
Policy No Compuny_1i/,a,Ct�p�.-+ X&L�A _
O ❑ C,rtili,d copy ish crc by fumishcd. FIRE SPRINK NERGY T34
Z Z ❑ Certif op filed with th-e rnY`in"Tion division. MISC.- REFER TO ORD.0 AP, can y� V ❑ N❑ YE) N❑
CC T ; C17RTIVICATF OF EXEMPTION FROM WORKERS' '- PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG.
0- 0 (This salon need not be completed if the aenmit is for one TOTAL V❑ N❑ Y ❑ IN
:D Z hundred dollars IS 100)or less.) -
U O 1 certify that in the perfomunce of the work for alodl thisper- DTV. MECHANICAL PERMIT FEE - FEE SUMMARY
EL I-' mit is issued,1 shall nut employ any person in any manner so as to
00becontesubjecttothc Worker Compensation Wwsof Cahfomia.
Lau o_ Dale Applicant ALTER OR ADD TO MECH. 5.00 c 'BUILDING
- - W NOTICE '1'0 APPLICANT'. If,after making this CLUificatc of Iix-
(-.. Z emotion,you should become subject to me 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 he deemed revoked AIR HANDLING UNIT(TO 10,0WC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10.131 6.00 SEISMIC FEE 19-
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 t
the perfommnce of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
U
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)8.50
Lender's Address HEATING
1 certify Ilial I have read this application all state that the above VENTILATION FAN (SINGLE) 4.00 _
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building ronstrunian, and BOILER-COfsR 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city,to enter Rano the
above-mentioned property for inspection PuTo.ws. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD: -
ilities,judgments,"cents and expenses which PERMIT ISSUANCE 1-00 CONST.TAX
Niay any way awme against said City in and ex m� of the _
nl f t erns it. MECH.CONT. LIC.NO. MECH.
8'` TOTAL TOTAL : 6AC 20
SI tu¢o(Applicant/Contractor )ate IIITJ
OFFICE COPY