16218 POST THIS CARD NEAR FRONT OF BUILDING Hp11T NlIMRr
CITY OF CLIPPRTINO 16218
INSPECTION L . . .o UN
JOB INSPECTION RECORD
yPERMIT EXPIRATION
JOB ADDRESS (�I �l.l� �-'� UNIT# _LOT#
• -- PERMIT EXPIRES IF WORK
OWNER C` l 1 � CONTRACTOR y/ l IS NOT STARTED WITHIN
INSPE ION DATE > INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PEHM17 VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS /
POUR NO CONCRETE UNTIL-ABOVE.HAS BEEN SIGNED
UNDERGROUND /SLAB ,
PLUMBING -
ELECTRICAL ISSUANCE DATE
MECHANICAL .
BLDG ELECT PLGMECH
❑ ❑ L
❑
DO NOT-POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT,
WOOD FLOORS"INFORMATION'*;:�;..,y
VALUATION S/FT.
PLUMBING
MECHANICAL +,:�I'. •:'C%Y+..�
ELECTRICAL Pf4dll y":" ' ERMIrTo
FRAMING [- 4K\W%:C'E'
INSULATION �1 �1/ TO IES 'TYPE"CONSTR.
l 2, 1114 1988
OCC.GROUP RES.UNITS
City of Cupertino
,PLACE,NO SUBFLOOR UNTIL ABOVE RAS BEEN,SIGNED,
SO FT.FLOORAREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSO. .SHALL BE MADE BEFORE
,{ DIAPHRAGM THE CONSTRUCTION TAX IS PAID
IILOUSE
ROOF SHEATHING RES ND CON PB O'l-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ;, ;r; FINALS'"" DATE INSR. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO
,
FRAMING ELECT.FINAL TEST ZONING ENG.SITE N0.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NY ❑ N�
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A U
INTERIOR SHEAR FIRE DEPT. E] NE Y L 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 OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LuARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
• PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 7
,IMPORTANT!
CONST.TAX V
PLEASE READ REVER�IDE BEFORE TOTAL
CALLING FOR FINALTNSPECTION.
OFFICE COPY
'PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENT(FICATION PERMIT NUMBER
BUILDING
APPLICATION & PERMIT 16 218
ADDRESS
U/f�s� cTnL�Hi VL1 BUILDING - E: ECTRICAL-PLUMBING -MECHANICAL
NAMEMS -yF PLAN CHECK VALIDATION
• s 1.1 d11(/N _ ✓ ,S]TY. ELECTRIC PERMIT FEE
NAMERADTaRs 1 UTLGETS-SWITCHES-RECEP 10.00/1.00
J� E.A. HathawayS Co. LIC.NO. 99257 LIGHTINFIXTURES 10.00/1.00
ADO Ess TOR Santa Clara JAPPLIANCES-RESIDENTIAL 4.00
65 Laurelwood Rd. PHDNE998-4200 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER The Steinberg Gro
uPC13447 SIGNSTRANS. 3.00
C� ADDRESS ENG' 60 Pierce Avenue SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
San Jose, CA TIP 95110 TEMP. METER OR POLE INS. 20.00
ADRErs
MOTORS SEE FEE SCH.
ADDRESS SN565 LaurelwOOd Road
Santa Clara, CA 95050 SERVICE CHANGE I'�r20
D D o LICENSED CONTRACTORS DECLARATION
< is I.i I hereby affirm that I am licensed under provisions of Chapler 9 14 U V r E) ISSUANCE DATE
u' w Icommencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
i_ H z Professions Code�vnd_myJiicense is in full force
i w W License Class fifi Lie NumM1er l ❑ ❑ ❑
Z2 m F )ate IJ--%�- : Conttador �'4 . Y. of Cupert no
- f � BUILDING PERMIT
M w a OWNER-BUILDER DECLARATION INFORMATION
E 0t0 MISC. REFER TO ORD
K3
3 LL r 1 hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
x0¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct.alter.
rt K¢0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ,LEC. IPJ {G VL�j
O , requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m Q.m he is licensed pursuant to the provisions of the Contractor's License
F >
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
F i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 6V� I 'VULn• CftiTr
M t- m the basis for the alleged exemption.Any violation o(Section 7031.5 STORIES TYPE CONSTR.
a ; _ by any applicant for a permit subjects the applicant loacivil penalty ALTER-DRAIN -WATER (EA.) 6.00
ofnot more than five hundred dollars(S5001.1:
❑ I,as owner of the property.or my employees with wages as BACK F LOW 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
Code:The Contractor's License Law does not apply to an owner of
• property who builds 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-
mentsamnotintendedoroffered for sale.If.however,the building GAS-EA.SYSTEM-t INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that lie did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
RES IND CON PB Otner
U prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
C1 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
•4 licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
LD and Professions Code:The Contractor's License Law does not apply
IT to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OV ER 5 (EA.) 1.00
CO contracts for such projects with a contractords)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I no exempt under Sec. .B.AI'.C.for this WATER HEATER W/VENT 6.00
�( reason
U Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
C WORK ERS'COMPENSAI"ION DECLARATION WATER TREATING EQUIP. 5,00
1 hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certll',,d
copy thereof(Sec.3800,Lab.C.).
Policy No. Company Aetna
0 Certified copy is hereby furnishedFIRE SPRINK EN ERGYT-24
Z Z 13Certif copy is filed w I the yy mspec Yt, vision.
F- - Applicant .-' / - /-e-� LTJ MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
w CERTIFICATE OF IiXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.u.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO, PLG. Y[:] N❑ Y ❑ ❑
a- Z (This section need not he completed if the permit is for one TOTAL N
hundred dollars IS 100)or Iczs.I
U O 1 certift that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not em Ployany pcnon a any munnul sr is to
O W become subject to the Workers Compeluutiun Laws of C'ahlornia.
CL Date Applicant ALTER OR ADD TO MECH, 5.00 BUILDING
>_ ril NOTICE TO APPLICAN"I': If.alter making his('enit'icaw of lix-
Z emption.you ztoold became sunjcn us the Waders'C'onlpensalion APPLIANCE 5.00 PLAN CHECK
- provisions of the Luhor Code, you nwst Inrthwllh c0nlply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONST RU( I10NLENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I li,cby aflunt thus there is a amavunlnn Iendmg agency for EXHAUST HOOD (WITH DUCT) 5.00
the p th,no,no, of the work for which thls permit is issued IScl, I MICROFILM
3091,Civ.C.l. HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's ddy AHEATING UNIT ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
Ic,nd, that llive readOusappHLvlion and stwc lhm the a hove VENTILATION FAN (SINGLE) 4.01) (�
• information is correct. I agree to comply wilt,all oily and county PLUMBING \•
ordinances and state laws relating to building construc(ion. and BOILER-COME 13 H.P.or 100,000 B.T.U.) 6.00
hereby aUthentioriec roperty tatfives ec this city LL. enter upon the BOILER-COMP (Over ID0,000 STU)SEE FEE SCH. MECHANICAL t
above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep ha nn less the City of MISC.- REFER TO ORD.
Cupertino against [abilities,judgments, costs and expenses which PERMIT ISSUANCE 10.001CONST.TAX ✓
May in any way accrue against sa' City in con IT ce of the
lanlin. g of this permit / L_.�9 MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL ,
.1(\ Signature of Applicant/Contractor Date
OFFICE COPY