16826 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 16826
INSPECTION DIVISION
JOB INSPECTION RECORD
3,n,n(j PERMIT EXPIRATION
B
JOADDRESS & p d-I 5149 -" `lA'e i'U G' CT #
UNIT# _LOT U
PERMIT EXPIRES IF WORK
OWNER C'T CONTRACTOR -'Z �'G,�Z av IS NOT STARTED WITHIN
INSPECTION ATE 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 AND CITY OF PERMn•vnuonnON
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE Un EE
MECHANICAL ELECT PLG MEC.
❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED \tBUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING G SIFT'
MECHANICAL
ELECTRICAL
FRAMING
INSULATION STORY TYPE CONSTR
OCC GROUP RES.UNITS
- -� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
+
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT FLODR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PR om.., .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED T FINALS DATE INSP. Ll El ❑ E) ❑
ROUGH I SAN.p nsStbSUHS PARCEL NO
PLUMBING I ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL No
MECHANICAL MECH.ENERGY '
ELECTRICAL BUILDING ENERGY - ACC DATE ncc FRE No
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENc SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.')a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ No Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC
INTERIOR SHEAR FIRE DEPT. v❑ N❑ v ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING'
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
6UILDING PROJECT IDENTI FICATIO✓N -PERMIT NUMBER
rr APPLICATION & PERMIT 1 C� �C
U
ADD
RE55 v/ I
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL U
OWNER'S c/ PLAN CHECK VALIDATION
NAME
QTY. ELECTRIC PERMIT FEE
6--r PVOr I 14121FICNE
CONTRACT $
NAM q UTLETS-SWITCHES-RECEP 10.00/1.00
L l.• u/PG /Lr Lia Nqf S? LIGHTING FIXTURES 10.00/1.00
CONTRACTORS ss TAPPLIANCES-RESIDENTIAL 4.00
t �{(1J.s� PRONE PANELS 10.00
f DATE OF APPLICATION '
ORRCRI ECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP EMP,METER POLE INS. 20.00
APPUCANrs
AooRFss MOTORS SEE FEE SCH.
it ! �l,. S,11 rrn )SERVICE CHANGE 20.00 /
F o O LICENSED CONTRACTORS DECLARATIO wpley
�
u I hereby affirm that I am licensed under provisions of Chapter 9
,so a aa. (commencing with Section 7000)of Division 3 of the Business and BL ECT.CE DATE MECH.
H D z Professions Code d m I�cesse ism full fort 'ed ❑ ❑
z o m - Data C CI s '� O Lic.NumbeeS? s \q
9 y r w Data Contractor.
a se a a OWNER- BUILDING PERMIT
BUILDER DECLARATION
C W D MISC.- REFER TO ORD INFORMATION
Is g s- 1 hereby affirm that I am exempt from the Contractor's License
H sL o J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION 5/FT.
w '^ Code:Any city or county which requiperunitto construct, 1Q.OQ
res a
oimprove,demolish,or repair any structure,prior to its issuance,also ELEG CONTR. LIC.NO. ELEC.
o u requires the applicant for such permit to file a signed statemmnt that TOTA
u w m he is licensed pursuant In the provisions of the Contractor's License PERMIT TO
HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the -
i D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
(: Hp the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 ,•
of not more than five hundred dollars t$500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (See. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law does not apply to an owner of - :�t
property who builds Or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or of intended
his own employers, le,If,ho that such improvo
maimprovmentisn old or within
red one or year
l Lhowetion tire the owner-
GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or Improvement is sold within one your of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or inn- BUILDING USE
prove for purpose ofsaleJ' j INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
O 1,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.
an I Professions Code:The Contractor's 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 contructons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,8.&P.C.for pis
reason WATER HEATER W/VENT 6.00
Owner Data WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK FiRS'COMPIiNSA'HON DECLARATION WATER TREATING EQUIP, 5,00
1 hereby affirm that 1 have a certificate of consent to sol Girsur .
or a certificate of Workers'Contpen Blinn Insurance,or a certified ZONING ENG.SITE NO.
copy themuf(Sec.3800,Lah.CJ. .-�
Policy No. Company
z ❑ Cetlilie yis he,ebyy yr s cd F FIRE SPRINK ENERGY Z �Cetlifi• i SSvv I tic city I pr I n division. as
(- O pplicam t I -/� MISC.- REFER TO ORD. Y [] N❑ YE] N�
it CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COSiPEN'SATION INSURANCE PLG.CONTR. LIC.NO PLG
d 0 (This section need not he completed if the permit is for one TOTAL Y❑ N❑ V
� Z hundred dollars IS 100)or less.) N I
U O 1 ccrtity that in the perl'onnance of Om work for which this par- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL I- mit is issued,I shall not CnsploY;my person in any manner so as In
0ULL1 became subject to ilia Workeri Connpessut ion Laws of Calilisrnia.
0. Dat` Appbe°m ALTER OR ADD TO MECH. 5.00 BUILDING
} to NO1'ICf' TO APPLICANT: If,after making this Certificate of Ex-
F ? mnption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, You must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MQF.M_) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm 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
Lende'r's Address HEATING UN IT(OVER 100,000 B.T.U.19.50 ELECTRIC a� ems'
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
Informntion n correct. 1 ogres to g it) b with all city and county PLUMBING
ordinances and stem hives relating bi building construction, and BOILER-CDMP(3 H.P.or 100,0000.T.U.1 6.00
hereby authorize representatives al' this city to enter upon the
above-mentioned property for inspection purposes. 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.
[Siug4re
pertino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way true against said Cit} in consequence of the PERMIT ISSUANCE 10.00
tf`h aJnL /� MECH.CONT. CIL.NO. MECH.
/IAf�l TOTALTOTAL
of A pphcan Ocon tractor at
OFFICE COPY