17161 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17161
INSPECTION DIVISION
J BIN PEC ION RECORD
am// `V PERMIT EXPIRATION
JOB ADDRESS "yvX- UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE "INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREG E TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
TA?A SLABS "
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,,��.�
UNDERGROUND /SLAB yj — 1 �1UL
PLUMBING i '`•'�
ELECTRICAL ISSUNCL J7*LJ7*
MECHANICAL _ BLDG I ELECT PL MECH
. El ❑ :. El
E]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDn' BUILDING PERMIT
WOOD FLOOR AIV 3 NFORMATION
1ATION SIFT.
PLUMBING
MECHANICAL City Of
ELECTRICAL PERMrr ro
FRAMING
INSULATION I STORIES TYPE CONSTR
/p-r!(-a� C OL OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 94rr
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sU Pr 'I.11111 nlIFn TorAL ncRE:nce
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - IFES IND CON PIT On,..
APPLY NO ROOFING UNTIL-ABOVE�HAS BEEN SIGNED FINALS DATE INSP. 0 ED El Q
❑
ASSESSORS PARCEL NO
ROUGH SAN.a.
PLUMBING „— 6— , ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY, =27— TRACT NO PARCEL No,
MECHANICAL MECH.ENERGY
Arc onrE ncc.FILE No,
ELECTRICAL
BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG.SITE No.
INSULATION PLUMBING -�Z— 0 ..�_
GAS TEST GAS
MECHANICAL , FIRE SPRINK- ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . . Y ❑ N� Y ❑ ND
EXTERIOR SHEAR ELECTRICAL-RELEASEFLOOD ZONE AL UC.'
❑i. ❑.
INTERIOR'SHEAR FIRE DEPT. Y [] .N Y ❑ 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 /I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB\ADDRESS WHEN PHONING.
Z � ,
— SEE PE MIT FOR EXPIRATION DATE = MECHANICAL �
PORTANT.! coNsr.TAX'
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE,COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - LISE,BALL POINT PEN ONLY
BUIL I GP T N I
.111.1 PERMIT NUMBER 71 [�1
APPLICATION & PERMIT G I v I
An
Does$ • BUILDING —ELECTRICAL—PLUMBING—MECHANICAL �"
OWNER'S PLAN CHECK VALIDATION
""M� OTY. ELECTRIC PERMIT FEE
I
PHONE
c RA -RECEP
R OUTLETS SWITCHES 10.00!1.00
E
uc.No. �(� LIGHTING FIXTURES 10.00/1.00
r,ONfRACTCP APPLIANCES-RESIDENTIAL 4.00
MQ\o Ess HONE K I J /��Tx�r•�(/�
\ V VI PANELS - 10.00 DATE OF APPLICATION
ARCHITECT I I 1PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. O.
OR
ENGINEER
LIC.NO SIGNS TRANS. 3.00
I ADDHEss E"D� - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 . '
ADDRESS \ O - MOTORS SEE FEE SCH. ��]^f=• -Jyl,'T/11 II�/I
ADDRESS, �l./I— ,`I'I IU'A -1
- SERVICE CHANGE 20.00 I z
Fo O LICENSED CONTRACTORS DECLARATION
FI w 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE 1_G e (commencing with Section 7000)of Division 3 of the Busences and BLDG. ELECT. PLG. MECH.
F i Professions Co e, y license is in full force and ' cc '
Z O'� — License Clus�_Lic.Nulubtl
9 v,r w Datc _ Commctnr
CE > � `-� V S r,�AN BUILDING PERMIT
CE as OWNER-BUILDER Df:C1.ARATION
M
a v INFORMATION
K
to y I herellyth affirm that 1 so exempt from the Contractor's License MISC.— REFER TO ORD _
no VALUATION $/FT.
I- LL0 Code!Law Any city Or iounty whictie7iireso Business ttocon.Professions PERMIT ISSUANCE 1
Code'Any city sr county which requirese permit Loco issuance,also
< improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
0,
requires the applicant for such permit to file a signed statement that TOTAL PE MIT TO
n x m he is licensed pursuant to the provisions of the Contractors License
F z a
Law(Chapter 9(commencing with Section 7000)of Division 3 of
4 e Business and 1'ro1'elumus Code)or fhul he is exempt therefrom and OTY. PLUMBING PERMIT FEE
M H rottie basis for Orn alleged exemption.Any social ion of Section 7031.5 STORIES TYPE CONSTR.
is. by any applicant for a permit subjects the applicant tou civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).1:
O 1,as owner of the property,or my employees with wages asBACK FLOW PROTECT. DEVICE 4.00 '1, OCC.GROUP RES.UNITS
their sole compensation,will Jo the wurk.and the Structure is nut
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to on owner.of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.Pr.FLOOR AREA TOTAL ACREAGE
himself re of ughrote his own employees,offered
lots provided whet such improve-
or improvement
or within tune year o Icompleveq thebuildingow ung GAS-EA.SYSTEM-1INC.4OUTLETS 6,00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Oma,
❑ I,as owner of the property,um exclusively canlrneting with ❑ ❑ ❑ ❑ ❑
licensed contactors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such Projects with a contractor(s)licensed pursuant To SEWER-SAN V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO,
❑ Ium exempt under Sec. ,R.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACG DATE ACC.FILE NO.
WORK F-RS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate'ill'consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a Certified
copy thereof f Sec.3800,Lab.0). -
Policy No. - Company -
O ❑ Cc r fief opy is herehy furnished,
{ FIRE$PgINK ENERGY T-24
Z Z i14' Ce If Iccopy is /'i6yd the , y mine ton division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O Apple.n Y N V N
~ PERMIT ISSUAN E 10.00
LO CIiRTIEICATEOIsSWIO'I'INS FROM WORKERS, FLOOD ZONE A.L.0 c.
W COMPIiNSATION INSURANCE P O \ IC.N a, PLG. r
CL Z( This section need not be completed if [It, permit is for one 1 'Q et TOTAL V❑ N❑ V ❑ N❑
hmtdred dollars(S 100)m less.)
U O 1 certify that in the performance of the work for which this perDTV. FEE SUMMARY
U_ F- mit is issued, I shall Hill employ any Parson in any manner so as In CHANICAL PERMIT FEE
O W become subject to the Workers'Compensation Laws of California.
a Data ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE '1'0 APPLICANT: If,after making this Certificate of Ex-
'� ? - emption,you Shohdd become subject to the Workers'Conhpensation APPLIANCE 5.00 PLAN CHECK
previsions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed(evoked, AIR HANDLING UNIT(TO 10,000QF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.F.M.) 6.00 SEISMIC FEE'
I hereby affirm that there is.'
consHoctinn 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,Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender Address ELECTRIC
I certify that 1 have read this application midsmte that the above VENTILATION FAN (SINGLE) 4.00 ,
i icnimfion is correct. I agree to connply with all city and courtly PLUMBING
ordinances and slate laws relating to building construction, and BOILER-W MPOH.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this City to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify-and keep harmless the City of MISC.- REFER TO ORD.
aperture,against liabilities,judgments, costs and expenses which CONST.TAX
sy in any way accrue against said C'y in consequence of the PERMIT ISSUANCE 10.00
ni of this nf. MECTCONT. LIC.NO. MECH. ,
—31 TOTAL TOTAL
Signature of Apphcan! ontractor Date
OFFICE COPY