16658 T '
�^ n POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
=CITY OF CUPERTIN'O 16658
" INSPECTION DIVISION '
JOB INSPECTION RECORD
- 22 ,1 - PERMIT EXPIRATION
JOB ADDRESS X06 rrP o 4.s inlJ' 'C�GK UL'1/WNIT# _LOT#
PERMIT EXPIRES IF.WORK I
OWNER CONTR AcroRCA ✓: IS NOT STARTEDWITHIN
INSPECTIO DATE 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 I
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF : PERMIT VALJ NATION
CUPERTINO STANDARDS. -
GARAGE SLABS
- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB'
PLUMBING q 1
ELECTRICAL - C \� ISSUANCE DATE
�MECHANICAL RL i. ecErr vu;, .Medi.
\� g4Q El El E]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR vnwnnON slFr.
PLUMBING 6'G
MECHANICAL
ELECTRICAL - - c+` I_EI+mIT To _
FRAMING
INSULATION STORIES TYPE CONSTR. I
-OCC GROUP RES,UNITS
v'P,L^ACENO SUBFLOOR-UNTIL ABOVE HAS BEEN SIGNED
SO,1 T FLOOR AIiEA TOTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' -
DIAPHRAGM - ' THE CONSTRUCTION TAX IS PAID
BUILDING USL
ROOF SHEATHINGRES
IND❑ LON 1PH 1 1-1.APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS'' DATE INSP- El AssessORSPARCELNo.-
:ROUGH SAN.q
PLUMBING ' ' - ELECT.ENERGY -
TUBS 8 SHOWER PAN � � - PLUMBING ENERGY TRACT NO. PARCEL I.NO
MECHANICAL - - MECR ENERGY
ELECTRICAL BUILDING ENERGY - Acc,Dore ncc,FILE NO
FRAMING - ELECT.FINAL TEST -
ZONING ENG,SITE NO.
INSULATION PLUMBING -
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NEJ Y ❑ N
EXTERIOR SHEAR _ ELECTRICAL RELEASE 4 LOOP ZONE AL'UC
INTERIOR SHEAR FIRE DEPT. - Y I] N0 Y ❑ N❑
SHEETROCK•: GRADE + .FEESUMMARY ,
EXTERIOR LATHBUILDING, -' n/ - o-§"�._ BUILDING OO _
INTERIOR LATH _ TEVIPORARY APPROVALS
SCRATCH COAT ELECTRICPLAN CHECK
GAS FEE
_ NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY- - - - SEISMIC FEE e,�d
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o� PLEASE;GIVEJOB.ADDRESSWHEN PHONING.
Z —
SEE PERMI'T'FOR EXPIRATION DATE - MECHANICAL
C
IMPORTANT! ONST..TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL'INSPECTION. TOTAL
OFFICE COPY -
,f APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING,
6I,DING PROJECT IDENTI FICATION PERMIT NUMBER
APPLICATION .& PERMIT 1 ^h�hL r1, R
nggEs _ ` BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 V V.V V
GWN�'6 /Y+ PLAN CHECK VALIDATION
�. NA E - CITY. ELECTRIC PERMIT FEE
• X Pss, PH�
CONGo
N
- OUTLETS-SWITCHES-RECEP 10.00/1.00
/ ' .
L LIGHTING FIXTURES 10.00/1.00
CONT.ACTURS
ADDRESS APPLIANCES-RESIDENTIAL 4.00 -
AOORE
PANELS 10.06 DATE OF APPLICATION
ARCHITECT - .
oR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGIN r
uc.NO. J ISIGNS TRANS. . 3.00 '
AD °R N SPECIALCIRCUIT 5.00 PERM IT VALID ATION
ZIP TEMP.METER OR POLE INS. 20.00 , ,�'
APP
MOTORS SEE FEE SCH.
Ao
SERVICE CHANGE 20.00 to J�/J,{,y,{/�
Ooo LICENSED CONTRACTORS DECLARATION �� rhe \QQ`(// `'""
<u I hereby affirm that I am licensed under provisions of Chapter 9 V, E Y ISSUANCE DATE -
z u (conlmenuing wi l Sac' n 7000) it,Division 3 of the Business and
In Q - BLDG. ELECT. PL❑G. MECH.
H o i , Professions C. accusers in 1,4,
Z i= W License C Lie.NI�11
u,L
Date Lie.N ctor
a m 2 'BUILDING PERMIT
w Q _ OWNER-BUILDER DECLARATION
A O u O INFORMATION
w ; u r 1 hareby affirm (tut I am exempt from the Contractor's License MISC.- REFER TO ORD
Oa Law for the following reason.(Sec.703 1.5,Businessand Professions - PERMIT ISSUANCE VALUATION $/FT.
wy Code:Any city or county which requiresa permit to construct,alter, `� �3- /tea L�77
ac improve, Or repair any structure',prior to its Issuance,also ELEC.CONTR. LIC.NO. ELECr
aw O u requires the applicant for such permit to file a signed statement that TOTAL �"---
n w m
he is licensed pursuant to the provisions of the Contractor's License t� PERMI TO
crit Law(Chapter 9(commencm,with Section 7000)Rfl)ivision 3 cflhe Ol�
s o Business and Professions Code)ar that he isexenlpt Iharcfrom and OTV. PLUMBING PERMIT, FEE
n: H m the basis for the alleged exemption.Any violation ol'Sect ion 703 1.5 STORIES TYPE CONSTR.
e3 _ by any applicant for a permit subjects the applicant boa civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500F):
O I,as owner of the property,or my employees with wages as BACK FLOW 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,CON D. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who build,ar Improves IIICROn,aad who docs fuch work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
..rents are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4(EA) 200
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 Omer
ID 1,as owner of the property,mu exclusivCly contracting with O
:
licensed contractors I. construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEN0.
nail Professions Code:The Contractor's Licensc Law docs 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 contractors)licensed pursuant to
the Contractor' icenso Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam • pt under Sec. ,IL>kP.C.for this WATER HEATER W/VENT 6.00
Owner_ Date 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 consent to self-insure,
.r a ce,fficat o I Workers'CWo�, , r e• or a rertilinl ZONING ENG.SITE NO.
PolicINoPolicy eC il'in ry' bzZctlifi 'ninspection division. FIRE SPRINK ENERGY T-24
Hp Applicant MISC.- REFER TO ORD. Y No Y ❑ ' N[_]
0: LO CERTIFICATE 01'EXEMPTION 17ROM WORKERS' PERMIT ISSUANCE .10.00 FLOOOZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Q. 0 Hhis suction need not be completed if the perllil'is for one TOTAL Y[-] N� Y IN
Z) Z bundled dollars IS 100)or loss.)
U O I certify tha the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is iss all not employ any person in any mummers.as 1.
O w become o the Workers'Compensation Laws of California.
y Due Applicant 'ALTER OR ADD TO MECH. 5.00 BUILDING O.O .
> W NOTI 17.'10 APPLICANT If,after nuking this Cemil'icame of E.
F ? emlptim,you should become subject to the Workers Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of Dlc Labor Code, you must forthwith comply with 3a
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 101 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER l0,000GEM.) 6.00 SEISMIC FEE .S=
I herebyeffma there is a construction Icnduu agency for EXHAUST-HOOD(WITH DUCT) 5.00 _
the perfnrman a work for which this permit .ixloid(Sec. MICROFILM
3097,CNC.). I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Na H EATI NG U N IT(OV ER 100,000 B.T.U.)9.50
Le
nder'sA dress ELECTRIC
I certify 11,311 haveread Misapplication and state lhattd1u ve VENTILATION FAN (SINGLE) 4.00 . -
information n correct I agree to comply with all city and county PLUMBING
ordinances and slate lows relating rm building construction, and BOILER-COMP I3 H.P.Or 100,0008.T.U.) 8.00
hereby authorize representatives or tll is city to enter upon the BOLE COM (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
ab.ve.menlloned property for inspection purposes.
(We) agree to save, indemnify and keep harmless Doe City of MISC.- -REFER TO ORD.
-uperh o a ainet liabilities,jud ents, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may an way accrue agal said City in co Fcquan<e.of the `
rB
g r MECH:CONT. LIC.NO. MECH,• _
�Q./GCJ/YK TOTAL TOTAL
Sr na rc of plicant/Contractor Data
OFFICE COPY