16660 POST•THIS CARD NEAR FRONT OF BUILDING
... - PERMIT NUMBER
'CITE OF CUPERTINO 16660
INSPECTION DIVISION
JOB INSPECTION RECORD
I--� E- n 2� 'PERMIT,EXPIRATION
JOB ADDRESS�7=p V��✓�� ` �K /cJ�✓1�1IT# LOT# '\
. PERMIT EXPIRES IF WORK
OWNER ' 'CONTRACTOR t`'S'� IS NOT STARTED WITHIN
I SPECTIO pl(irmuDATE INSPECTOR INSPECTION RECORD 180 DAYS of PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLEDINSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.'
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL - ISSUANCE UATE
MECHANICALBLuc ELECT PLG. MECH.
�g6a [I El ❑ El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED G BUILDING PERMIT
1. O \n
WOOD FLOOR INFORMATION QQe� vnwnnON sIFT.
PLUMBING _ `:\
MECHANICAL ,
ELECTRICAL - - PERMIT TO
FRAMING,, L4aT
INSULATION STORIES ,XTYPE CONSTR. -
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.or,FLOORA.REA TOTAL ACREAGE -
T DIAPHRAGM THE CONSTRUCTION TAX IS PAID .'
BUILDING USE
ROOF SHEATHING Res INO CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE 'INSP. ❑ ❑ ❑ ❑ 'E
ROUGH SAN.N - - ASSESSORS P ARCEL NO.
PLUMBING
ELECT.ENERGY '
TRACI NO- PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY _
MECHANICAL - MECH.ENERGY
ACCDATEACC,FI LEE NO,
ELECTRICAL, BUILDING ENERGY
FRAMING ELECT.FINAL TEST zow Nc ENc.SITE No.
INSULATION PLUMBING .,/
GAS TEST, - GAS -
MECHANICAL . . FIRE SPRINK ENERGY T-aA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ No ` ❑ IN
FLOOD ZONE• A.L.0 C.
EXTERIOR SHEAR ' ELECTRICAL RELEASE -
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
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR, . MICROFILM
ARRANGE FOR]NSPECTION BY PHONING 252-4505, ELECTRIC
T F ONF WORKING'DAY BEFORE REQUIRED INSPECTION. PLUMBING �d
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE
'IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE,COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
Bm LDING APPLICATION & PERMIT 16660[U+�� O
ADDRESS
ZO b BUILDING—ELECTRICAL—PLUMBING—MECHANICAL =
OWNER'S PLAN CHECK VALIDATION
NCITY. ELECTRIC PERMIT FEE
TUS PHONE
CONTRACTORS - OUTLETS-SWITCHES-RECEP 10.00/1.00
.V /"/EC uc.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTerR'S �Ct. APPLIANCES-RESIDENTIAL 4.00 '
ADDRESS
G S3 S N PHONEd PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P:C,NO.
OR 1 - PANELS (OVER 200 AMP) 20.00
ENGINEER 1A O
uc.No. ISIGNS TRANS. 3.00
ARCH,OR ENG. - PERMIT VALIDATION
AOOR SPECIAL CIRCUIT 5.00
AN nP EMP. METER 08 POLE INS. 20.00 _ v
APPLICANT s
ADDRESSMOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
00 A LICENSED CONTRACTORS DECLARATION d//0-��(�(�
< i W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
G m i Professions Cod• m license is in full fryqµa��yy1Nr1�aK�aII''�el1,L ❑ ❑ ❑
o i n o License hiss ' Lie.Nember7�J�_
a,H Dale Cnldruclor
Q y f J
Ix rt a OWNI:R-BUILDER DECLARATION BUILDING PERMIT
K o al U, INFORMATION
w 3 LL 1- I hereby affirm that I am exempt from the Contractors License MISC.— REFER TO ORD
Fw04 Law forthe following reason.(Sec.7071.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
Code:Any city Or county which requires a permit to construCt,alter,
re ¢G 00 improve,demolish,or,repair tiny slmclare,prior Ili its isseaacc,also ELEC.CONTR. LIC.NO. ELEC.
O a,requires the applicant for such permit to file u signedstatement that TOTAL PERMIT TO
u w m he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chapter 9(commencing with Section 7000)of Division J oftle [�
4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIp A,O FEE
r o file basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR.
a,; '�2 by any applicant for a permit Subjects the applicant to a civil penalty ALTER-DRAIN&VENT-
of not more than live hundred dollars(3500).):
❑ I,as owner of the property,or my empluyees with wages as ggCK FLOW PROTECT. D 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,CO
Code The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP , 5,00 SD.FT.FLOOR AREA TOTALACREAGE
meatshimself or through his own employees,provided that such iia Provo- _
menismenot rmot attended or within
One year
o I howevei,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 200
builder will have the buNen of proving[hal h - . - . .
e did not buil)0r iia- BUILDING USE -
prove for purpose of sale.). flEs IND CON PB Other' INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
and Professions
colons oCode: conatmd Tho project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 q&&Es&ORS VARCEL NO.
nota Professions proprty Contractor's License sfl docs not apply .
to tr owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuasl to SEWER-SANITARY-STORM EA.2001t/10.00
Ole Contractor's License Law. TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,B.&P.C.for this
rl'atiWATER HEATER W/VENT 6.00
nll
' Owner Data WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION` WATER TREATING EQUIP. 5,00
1 hereby affirm that I have a certificate of commis toself-insure,
or it certificate of Workers'Compensation Insurance,or a certitied ZONING ENG,SITE NO.
' copy thereof fScc 3B00,Lab.C.l. - - -
Policy n.` Company '
❑ Crti(ied copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 Certified copy is fled with rhe city inspection Aivision. ❑ ❑ ❑ ❑
F O Applicant MISC.- REFER TO ORD. v N v N
CCy CERTIFICA'IF OF EXEMPTION PROM WORKERS' - PERMIT ISSUANCE FLOOOZONE A.L.O.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. TOPLG.
CL Z 1'1'his section need net be completed if the permit is for one TAL 3 Y[:] N❑ Y E) N❑
hundreddollars IS 100)or less.)
U O I certify that in the performance of ilia work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I slmll not employ any person in any manner set as to
O w become subject to ilia Workers`Compensation Laws of California.
y Umc AppllcaN ALTER OR ADD TO MECH. 5.00 BUILDING
>_ m NOTICE TO APPLICANT: 11,alter making this Certificate of Ex- - -
F. emotion,you should becomesubject to the Workers'Compensal ion APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with H FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affinn 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9,50 ELECTRIC _
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
inion is correct I agree to comply with all city and county PLUMBING
ordinances and slam laws relating to building construction, and BOILER-COMM H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives t of this purposes.s city to enter upon the
above-mentioned property for insp ofhi BOILER-COMP lover 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep iwr,nless the City of MISC.- - REFER TO ORD.
Ino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX'
ay 1 any way accrue against said City in consequence of ilia
rami g of this permit. MECH.CONT. LIC,NO. MECH. -
rorAL TOTAL
1 ure ol'Applocapriaeontfactor Mta
OFFICE COPY