16144 p POST THIS CARD NEAR FRONT OF. BUILDI,NG� . PERMIT NUMBER -
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CITY OF CUPERTINO 16144
INS_P,ECTION..DIVISION. '!,
J0134NSPECTION RECORD
lcyl(_ ,�/f�/ ,� U ''PERMIT EXPIRATION
JOB ADDRESS-_I �' " "��"'• - � UNIT# `LOT# j
• '� np('1 PERMIT EXPIRES IF WORK '
a
IiwrveR. IC>J ., coNTR ACTOR i r '/Lw„/!,1./ tIS NOT'STARTED WITHIN ,
INSPECTION. DATE INSPECTOR INSPE ON RECORD - a,BD'oAyVOF PERMIT ISSU-
FOUNDATION'' - .ANCE OR 180_DAVS;FROM ! '.
- NOTE: - °j 1-4STCAL12 DINSPECTION. '
UFER - ALL GRADING`AND'DRAINAGE SHALL BE INSTALLED
+ - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDP
ATN • _
PREGUNITE ^, ':� 5 - +CU - .
PERTINO STANDARDS
GARAGE
,. c
POUR NO CONCRETE UNTIL ABOVE HAS BEEN
EEN SIGNED
UNDESLAB - .. PAID.
•,..� j tVI(���.k-•l I
PLUMBING � � � .: .a, � AUG,
, t ��,!
' ELECTRICAL ,AUG,12 1 ISSUANCE DATE
I
MECHANICAL:_ - - •,, BLOC ELECT, PLG MecR ,
City.of CUpe 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT;
• . - INFORMATION
WOOD,FLOOR VALUATION 9/PT.
PLUMBING
MECHANICAL ' lr•�-.' -...
Pf NMIT TO
ELECTRICAL
FRAMING. ` ,. '.. a"P. L .•k ..;..a 1
.. 'INSULATION-' ,sTOHiEs -TYPE CorvsTH: I
UCC,GROUP RES,UNITS
- PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - '�''" `-•'" -
` ROOF u- NOTE:NO FINALINSP.SHALL•'BE MADE BEFORE. so.rr.E,.00R ,EA mTnLcaccE
.' DIAPHRAGM - - + -THE CONSTRUCTION TAX IS PAID
',BUILDING USE
ROOF SHEATHING "` '' HES IND CON . PB Of .•, ,
;'APPLWNO-ROOFING UNTILABOVE HAS BEEN SIGNED FINALS DATE INSP: El ❑ ' FK ❑ '0
ASSESSORS PARCEL NO. , yF
' ' ROUGH SAN.N
R _ .
PLUMBING ' ' ELECT.ENERGY,
TRACT NO. PAHCECNO.•-
. TUBS&SHOWER PAN PLUMBING ENERGY -' -
MECHANICALMECH,ENERGY ' t
•+.ACC..DATE ACC,FILE NO..
. ELECTRICAL BUILDING ENERGY -
- FRAMING. - - ELECT.FINAL TEST
v ZONING ENG.SITE NO.
INSULATION -� PLUMBING -
GAS TEST GAS
MECHANICAL '• .+ FIRESPHINK ENERGY T-2n
COVER NO WORK UNTIL ABOVE HAS-BEEN SIGNED HEATING E - v �, "a -"'Y Q 'N Q'
FLCODZONE -1
A.L.U.c.
EXTERIOR SHEAR , ELECTRICAL RELEASE — Y❑. , NO Y Tl .NO
INTERIOR SHEAR"' - - FIRE DEPT. _
SHEETROCK ` ' GRADEFEE SUMMARY
EXTERIOR LATH' - BUILDING'
INTERIOR LATH - TEMPO RARY`APPROVALS BUILDING ,117-•7 t-k•'
SCRATCHCOAT I ELECTRIC PI-AN'CHECK
. . FEE
GAS
!. ,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY J, o SEISMIC FEE .'•_,��•���
OCCUPANCY OF.BUILDING IS NOT PERMITTED UNTI L BUI LDING.FINAL IS SIGNED BY'BUI LOING INSPECTOR. 'MICROFILM
ELECTRIC
uJ "• ' ARRANGE FOR I,NSPECTION.BY PHONING 252=4505,
H� ONE WORKING'DAY BEFORE REQUIRED INSPECTION PLUMBING
` RLEASE.GIVE JOB ADDRESS WHEN PHONING. fI
z - MECHANICAL
-'SEE,-PERMIT FOR.EXPIRATION• , TE
IMPORTANTI coasr.rnx ', t
PLEASE READ,REVERSE SIDE BEFORE.'Y o
CALLING FOR FINAL INSPECTION. :TOTAL. _
t bFFICEiCOPY -:{
r,
APPLICANTITO FILL IN INFORMATION WITHIN R'ED'LINES -.USE BALL POINT PEN ONLY -_
,
BGUILDINPROJECTlDENTIFICATION PERMITNUMBER
& PERMIT
BWLD'"° 16144
ADDRESS , = .
- G BU LDING - ELECTRICAL=PLUMBING-MECHANICAL , '�.
PLAN CIECK VALIDATION
DTV. ', � ELECTRIC PERMIT - .FEE ,
10.. < :fill s�• ONE 'S S7o
ry°MERAcroRs OUTIGHTI NG FIXTLETS-SWITCHES-RECEP 10.00/1.00 -
lJI, [ LIC.No. LURES 10.00/1.00 '
CONTRACTOR '
ADDRESS 1 _ PPLIANCES-RESIDENTIAL 4.00
PRONe PANELS -. 10.00 PATE OF APPLICATION f.
ARCHIT CT - PLAN CHECK FEE .C.NO.
OR• - ' - PANELS (OVER 200 AMPI 20.00 i. C
NGINEER
SIGNS TRANS. 3.00
ADDR.SS PERMIT VALIDATION
r ADDRESS - V7\• 01_t - SPECIAL CIRCUIT 5.00 ,
1 -V"1 - zIP EMP.METER OR POLE INS.- 20.00
ADDRESS •,
APPLICANT s
ADDRESS,-, MOTORS .� SEE FEE SCH.
.
- - SERVICE CHANGE 20.00
-
F o o CICI NSI D CONTRACTORS DECLARATION ti '
T 6 i u I hereby aflum thut'1 am,licenacd under provisions of Chrimer 9' ISSUANCE DATE.
• .y'4 vAi (enmmenerng with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F D z Professions Code,and my license is in full force and effect: •* ,❑ ❑ ❑
o 0 y.o Liccoxe Class - Lic.Number .,
Date contractor AUS 2 1`�6
H N E J .
I w a OWNFR-BUILDER DECLARATION _ BUILDING PERMIT
w ;e Fri I hereby affirm that I am exempt front the Contsractor's License
MISC.- REF TO INFORMATION,
u O ¢ Law Ibr the following reason.(Sec 7031,5,Business and Prolessions VALUATION. $/FT.
Pi '-' PERMIT ISSUANCE
Code Any city or comity which strrequcturer"a,
permit tots j,Smjnee (alsoter, �� ,��•
¢ ¢p0 improve, or repair any structure,prior t0 its issuance,also ELEC.CONTR. .r LIG NO. ELEC._ 0 -
m re4uirus the applicant for such permit to file it signed s6tenlent that TOTAL ,PER IT TO _
a be is licensed pursuant to the provisions of Om Contractor's License _ '
Law(C6apter9(commencing with Sect tan 7000)of Division'3 of the
Business and-Prolessions Code)or that he is exempt Bmrefrom and CITY. PLUMBING PERMIT FEE
- w H the basis for the allege'''exemption.-Any violationofSection 7031.5 STORIES TYPE CONSTR.
n3E by any applicant for.,permit subjects the applicant to a civil penalty - ALTER-DRAIN -WATER (EA.) 5.00 1
four more than five hundred dollars,5500).1:' -- bAA Ll
.❑ L as owner of the property,or nry•employees with wages is BACK FLOW PROTECT. DEV ICE 4.00 OCC.GROUP ,qES.UNITS.
their sole compensation,will do the work,and the...Ron,is nut
` intended of offered I'm Sale (Sec_'•7044, Busincas'and Professions DRAINS-FLOOR;ROOF;AREA,COND. 5.00
Code:The Contractor's License Law docsnot apply to an owner of "oll
•' property who bnllds nr imprOVCs then on,and who VOCs stich work FIXTURES:PER TRAP' n 5,00 'SO.FT.FLOOR AREA -TOTAL ACREAGE
himself or hMali his own employees,provided.that such improve-
mems are notintendedoroffared for sale.If,however,the building GAS=EA.SYSTEM-11NC.4OUTLETS 6.00 A 0(D
or improvement is.sold within one year of"completion;,Ilse owner- YL
builder wi Lhave tire burden of proving that he did not build or inn- GAS_EA.SYSTEM-OVER 4.(EA.) 2.00 BUILDING USE
prove purpose of salu.l. - INDUSTRIAL WASTE INTER. 1 30.00 - RES IND CON PB ' one:
L as owner of the property,am exclusively contracting with ' 0 ❑ 2❑ El
licensed contrectors"lo construct the project(Sec.7044,Business' LAWN SPRINKLERS-1 INC'5 V:B!. : '6.00 ASSESSORS PARCEL NO.
r. ' and 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 it contraaods)licensed pursuant to
the Comonnor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO.
❑ 1"am exempt under Sec." ';e,&P.C.her this WATER HEATER W/VENT' 6.00
reason
Owner Date - WATER SYSTEM - 5.00
ACC.DATE ACC.FILE NO.
O
WRKERS'COMPEN'SATION DECLARATION. 5.00
't WATER TREATING EQUIP. '
I hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurnnec,or a certified ZONING ENG.SITE NO.
copy thereof(
No thercof(
I Sec 3800,Lab.C.). -
olicy Con.
Party -
0 ❑ C rtified copy N hereby fromitHd y ' FIRE SPRINK ENERGY T-24
z Z 11Certified copy is Ned with the city rasp ,,tion division.'
O Applicant - t - - MISC.- REFER TO ORD. v Q N(] V'[:] N[:]
CERT 1171CA'1'IIOP EXEMPTION 17ROM WORKERS, PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W15 COMPENSATION INS URANCI7 PLG.CONTR. LIC.NO. PLG '
CL O fl'hissectimi
on need snot be completed if the pert is for one r - TOTAL' V O ,.NF] V F] ,NC]
.'� 2 hundred dollars IS 100)or less)
U O 'I ccrtity.tlmt in the performance of(lie work Ifor which this per- QTY. �,MECHANICAL PERMIT ' • " FEE - FEE SUMMARY'
LL H nn it is issued,1 shall not employ anylperwn in any manner so ax to .
U hecome subject to the Workers'Compensation Laws oLCalifornlu.'.
0 Date Applicant
CL - - BUILDING �y�
} rn NOT'ICI: TO APPLICANT: If,Abe,making this Certificate of lex, ALTER OR ADD TO MECH. 5.00 t'--V
Z emption,you should become subject to(he Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provkmP,;of'the Labor Code, you must 16,11twi0n comply with FEE
U such provisions or this permit shall be deemed revoked.' AIR HANDLING UNIT(TO 10=11F.NL) 4.00
•
,,CONSTRUCTION LENDING AGENC ' AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that [here is a construcCq
tion lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -
the performance of the work'lint'which this permit is issued(Sec. - MICROFILM
3097,civ.C.). _ HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50
Lender's Andres, r ELECTRIC
I cehify thoi'l hove read this application and 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 construction, and BOILER-COMP(3H.P.Or100,000B.T.U.) 6.00
hereby-;mllmrire representatives Of-this,city to enter upon (Int BOILER-COMP SEE FEE SCH.
above-mentioned property for inspect ion purpoxs. MECHANICAL
(We) agree In save„Ipdcmnify.and keep'tartness the City of MISC.-. REFER TO ORD. •-
t,r Cupertino against liabilities,judgments, costs und,expenses which 110.00 CONST.TAX
may PERMIT ISSUANCE-in any way accrue against said City in consequence of the. •'
ranting of this perntil -
MELH.CONT. '.y LIC.NO. MECH ,
p TOTAL . TOTAL
IDt Signature of Applicant/Contractor Date �' � '• - ,
OFFICE'COPY .