16090 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
' -CITY OF CUPERTINO J 16090
INSPECTION DIVISION
JOB INSPECTION RECORD E
Jy�Q � �a7'�I 1 PERMIT EXPIRATION
JOB ADDRESS.UJ_ �11 I UNIT# LOT# � O^ p
C /�y1�� PERMIT EXPIRES IF WORK
n '
OWNER CONTRACTOR (5YD^' IS NOT STARTED WITHIN
INSPECTION DATE 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
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIUA'ION
CUPERTINO STANDARDS.
GARAGE SLABS :.
- - � .
• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - of Zaa-�PAl • .J, , .All I�! -1L.LJ �
UNDERGROUND /SLAB
PLUMBINGS-{
-.1 D
ELECTRICAL � AUG 8 IssunrvcEDATE
----- ELECT. PLG. MECH.:
MECHANICAL - /��/�
City of Cope fiW ❑ ❑ .� ..
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
,WOOD FLOOR VALUATION S/FT�
PLUMBING,
MECHANICAL �'"" 4//
ID
• PERMIT TO
ELECTRICAL
FRAMING LrrAi II, -
- STORIES
TYPE CO TR.
INSULATION
OCC.GHOUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
S0,IT,FLOOR<REA TOTAL ACREPGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 1
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES .IND CON PB 0111.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN.SIGNED FINALS DATE IN SP. ❑ .❑ El El E
ASSESSORS PARCEL NO
• ROUGH. - SAN.4 I ;•
PLUMBING - ELECT.ENERGY
IHACTNO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
' ACC DATE ACC.FILE NO
ELECTRICAL - BUILDING ENERGY
FRAMING L ELECT.FINALTEST
-
ZONING ENG.SITE NO.
INSULATION - � PLUMBING
"GAS TEST - - GAS "
FIRE SPRINK ENERGY T.24'
• - MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED, HEATING y ❑ r ❑ Nom.
FLOOD ZONE ILL u c -
- EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. °❑ NE) ❑ N❑,
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING •,*
-APPROVALS BUILDING'
INTERIOR LATH - .TEMPORARYa�
SCRATCH COAT - ELECTRIC PLAN CHECK
- I GAS . .. FEE ..
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE 7 ��
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. . MICROFILM
LU- - ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
NONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
ZO� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE� MECHANICAL y ,
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY.
GQrs zj -zs&, �y�� -z�gL ass as7,�r�,�sy�z6y, `�Qt�/' 3.7� - 379 39J4 'fo6
-91 37/APPLICANT TO FILL IN IN MAT WITHIN RED LINE - USE BALL POINT PEN ONLY
PERMIT NUMBER
a ILoBUI TNG PROD CT IDEN IC TION
APPLICATION & PERMIT O 1 L+O [�O
U DING - ELECTRICAL-PLUMBING -MECHANICAL - I J
OWNERS PLAN CHECK VALIDATION
bhp . O V. ELECTRIC PERMIT FEE
PX°NEM
CONrNA/ME.RaA�C,TOR�S_�a ^J_� UTL ETS-SWITCHES-RECEP 10.00/1.00
R - 'e+W 1�W uc.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
0 -1VeA1 oV�bSayc_),44e,,* G
6fF M4 PHON S- 6O PANELS 10.00 DATE OF APPLICATION .
CAHrtECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
uc.No. SIGNS TRANS. 3.9f 1AID
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS _ SPECIAL CIRCUIT 5.00
'�lcPOLrlio 40 / EMP. METER OR POLE INS. -,{-�� "�� �y+(� '
APPu ESS MOTORS SEE FE 8 J , /\(`)ix--I ACU1,�
AooRESS �
�i �"14F SERVICE CHANGE no
' I
0 0o LIC14N S ED COAUR ACTORS DEC LA RA'f I ON
a Ea w I hereby 111irm that I oto lice.sed undo provisions of Chapter 9 ISSUANCE DATE
N (commencin with Section 7000)of Division 3 of the Business and
¢ n g BLDG. ELECT. PLG. MECH.
H m i I'ro(rssions Codc,a d my license. in full f�effec. ❑ ❑ ❑
Z i u, o Lice. Lie'.Number
m H w Dute Contractor
a r E - BUILDING PERMIT
¢ ¢ ¢ OwNIi R-BUILDGK UIi CLARATION
¢ al 0 INFORMATION
wAr- I hereby affirm that I an exempt from the Contractor's Licerrse MISC.- REFER TO ORD
iso¢ Law for the following reason.(Sec.7031.5,Businessand Professors PERMIT ISSUANCE 10.00 , -VALUATION S/FT.
� - Code:Anycity orcounty whichoequiresupennit toconslruct,alter,
¢ improve,demolish,or repair uny structure,prior to its issuance,xlw ELEC.CONTR. LIC.NO.
¢ ¢ o ELEC.
D ¢ requires the applicant for such permit to File a signed statement that T
A OTAL PERMIT TO
w he n licensed pursuant 1.the provisions of the Contractor's License
Hii L.-(chapter 9(Commencing with Sen ion 7000)of Division 3 of the I
¢ Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant fora pcmnt subjects the applicant to civil penalty
of not more than live hundred dollars(S500).): - ALTER-DRAIN& VENT-WATER (EA.) 5,00
❑ 1,as owner of the property,or my employers with wages as, BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP REB.UNITS
Iheir sole compensation,will do the work,and the strEeturc is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: Thu Contoctor'r License Law does not apply 10 an owner of
Property who builds or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 S°,FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees provided that such improve-
mmselfonotimendedoroffered oyeesarovile however.thatsthc building IGAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or Impoorni Is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 ,-
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale'). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar
❑ I,as owner of the poopeTty,am exclusively contracting with 11 1:1' El 0
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 dos not apply
to in owner of property who builds or improves lhcoun.and who LAWN SPRINKLERS-OVER 5(EA.) 1.D0
ell.I.Cls on loch projects with a contructorfs)hcenrcd pursuant b,
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 - TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec ,B.&P.C.for this WATER HEATER WNENT 6.00
reason
Owner [)are WATER SYSTEM 5.00
/ ACC.DATE ACG FILE NO.
WORK FRS'COMPIiNSA'I ION DI?CLARATION WATER TREATING EQUIP. .5.00 _
I he by from that I have a certificalu of consent to self-insure' ZONING ENG.SITE NO.
ce I e f o ns�i�Insurance,or certicertified' `g��r °.�a .
Policy CD.sulSr
ompany _
❑ Ccnenifcd 'opY is hereby furnished.
Z Z ❑ Cent 'd�op�i filed Q; 1 ' y s on division. FIRE SPRINK ENERGY TPO
O App[ie.ntjpbji. _ MISC.- REFER TO ORD. YE:] NE:] Y [:] NE]
~ ran PERMIT ISSUANCE 10.00
� - CIiRT11lC OM ENSATI N ION NSURAFROM WORKERS' FLOOD ZONE A.LU.C.
' W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. '
L 0 (This staid. need not be completed if the N...i in is I., one TOTAL Y❑ Y E]' N❑
hundred dollan(S100)or less.)
U O 1 certify that in the Performance of the work for which this per- Q1-y. MECHANICAL PERMIT FEE FEE SUMMARY
LL F not is issued, I shall not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws of California. =
IL. Date Appl,cunt ALTER OR ADD TO MECH. 5.00 BUILDING
- w NOTICE TO APPLICANT': If,after making this Certificate of fix-
. ? emption,you should become subject to the WorkersCompemsatlon APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you must forthwith comply wit11 FEE
CJ inch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Op00C.F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10pWGF.NL) 6.00 SEISMIC FEE _
1 hereby atfinn 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,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
NHEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Name ELECTRIC
I a«ity that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city'and county PLUMBING
ordinances and state laws relating to building construction. and BOILER-IX)IvP(3 H.P.orlD0,000B.T.U.) 6.00
�#1� hereby authorize represenlalives of this city to
enter upon the BOILER-COMP IOwr 100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(we) agree t0 save, indemnify and keep harm. the City of MISC.- REFER TO ORD.
tine against liabilities,judgments, costs and enpenses which PERMIT ISSUANCE 10.00 CONST.TAX
ey t an way accrue against said Ci y in conseq nee of the
anting his onil MECH.CONT. LIC.NO. MECH.
TOTAL
TOTALgT
Si m o Applicant/Contractor pwcii,
OFFICE COPY