16207 POST THIS CARD NEAR FRONT OF BUILDING' PERMIT NUMBER
CITY OF CUPERTINO 16207
INSPECTION DIVISION'
•' JOB INSPECTION RECORD
' / l PERMIT EXPIRATION
JOBADURESS 16a AG I�rS71�P �� - UNIT# "_LOT#
PERMIT EXPIRES IF WORK
OWNER U 7C d,,V-r CONTRACTOR - IS NOT STARTED WITHIN'
INISOECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. i
GARAGE SLABS `..-
POUR NO CONCRETE UNTIL ABOVE,HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING I" • 1
ELECTRICAL ISSUANCE UATE
MECHANICAL BLDG ELECT. PLG. NECK.
1:1, LI ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING e j
MECHANICAL -
ELECTRICAL o 'A PERMIT TO
FRAMING ` •.1 BVI C
INSULATION \,`•'STORIES TYPE CONSTR.
• C.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED Oki rat - ,
$O,IT FLOOR AREA TOTAL ACREAGE
0I . ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -
BUILDING USE .
ROOF SHEATHING RES IND CON PB OIA.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ' ❑ ❑' ❑ ❑
ROUGH SAN.q ASSESSORS PAR CEL NO
PLUMBING ELECT.ENERGY -
TUBS.B SHOWER PAN PLUMBING ENERGY, TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY -
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
INSULATION ZONING ENG.SITE NO. ,
PLUMBING -
GAS TEST GAS
MECHANICAL . �/' FIRE SPRINK ENERGY T-24 -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 7 �tt❑ v 0 "❑E A L U.C.
EXTERIOR SHEAR ELECTRICAL RELEASE -INTERIOR SHEAR FIRE DEPT. ❑ Y ❑ N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING 1
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 FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
•� z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
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 -
BUI LDI NG PROJECT I DENTI FICATION .PERMIT NUMBER
BUILDING APPLICATION & PERMIT 1116 2 0 7
aODRESS
1 b JkL& (�n BUILDING-ELECTRICAL-PLUMBING-MECHANICAL K:
OWNERS rY PLAN CHECK VALIDATION
AME �a [ QTY. ELECTRIC PERMIT FEE
' PNONE d-15_O6
NgMERacroRs UTLETS-SWITCHES-RECEP 10.00/1.00
} LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR ADDRESS oRs -
PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS ' 10.00 DATE OF APPLICATION f
ARCHITECTon PLAN(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. 0.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDESS ENG' SPECIAL CIRCUIT, 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS ,
$ - SERVICE CHANGE 20.00 p/l/
0 Do LICENSED CONTRACTORS DL'CLARATION
iw I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a n (consmeneing with Section 7000)of Division 3 of the Rosiness and BLDG. ELECT. PLG. ,MECH.
F D i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
O y - License Class Lic.Number
4 m °w Date Contractor
x
ec a w u OWNIiR-RUILDIiOWNER-BUILDERDECLARATION PERMIT
BUILDING
x ;`m 1 hereby affirm that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
wng reason. VALUATION $/FT.
Fu00J Law orcommywhichre,ciresaermit to
ocness nstructessions pEflM1T ISSUANCE 10.00
fee>f Code:Any city or county which reyuiresn permit toconstruct,allcq
Ii Q C improve,demolish,or repait any SULICture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
LL requires the applicant for Such permit to Ice a signed statement that TOTAL PER
TO
u w m he is licensed pursuant m the provisions of the Contractor's License
r z r
Law(Chapter 9(commencing with Section 7000)of Division 3 of Ore
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES- TYPE CONSTR.
i ; - by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER (EA.) $,00
of not more than five hundred dollars($500).1:
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and tire structure is not _
intended or offered for sale (Sec. 7044, liminess and ProfessionsDRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of -
property who bunds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenetintendedorofferedforsale,If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvenhent is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
ov for purpose of sale.). INDUSTRIAL WASTE INTER30.00 RES IND CON PB Other
I,as owner of the property,am CXClu .sively Contracting with 0 0 0 0
tic nsed cmnolemos 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 dues 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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft 10.00
the Con 's License Law. / TRACT NO. PARCEL N0,
C1 I aarn m pexeempt under Sec..,b.&P.C.for this WATER HEATER W/VENT 6.00
reason I
Owner Date - WATER SYSTEM 5.00
ACC.GATE ACC FILE NO.
WORK ERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, -
or a certificate of Workers'Compensation Insurance,oZONING r a certified ENG.SITE NO.
copy thereof(See.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-y4
Z Z ❑ CertiRed copy is fled with the city inspection division. FIRE
O Applicant MISC.- REFER TO ORD. v N
N v
� N CERTIFICATE OP EXIiMPTION PROM WORKERS' PERMIT ISSUANCE 10. OFLOOD ZONE A.L.U.C.
LU > COMPFNSATION INSURANCE PLG.CONTR. LIC.NO. I.G.P6) U
d O (This section need not be completed if the permit is for one TOTAL G v N Y N
Z hundred dollars IS 100)or less.)
U O 1 certify that inthe performance of the work for which this per QTY. MECHANICAL PERMIT E �1n FEE SUMMARY
LL F mit is issued, I shall not employ any person in any manner so as to
O W become subject to the Workers'Co epens:dion Laws of California. O`
Date Applicant BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.
emption,you should become subject to the Workers'Compensatimh APPLIANCE 5.00 - PLAN CHECK
Provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10SMC.F.M.) 4.00
CONS'fRUCT10N LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work I'or which this permit is issued(See. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,CN.C.).
Lender's Name H EATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that 1 leve read this application and Sete that the above VENTILATION FAN (SINGLE) 4.00
Information is CODPCCL I agree to comply Willi all city a11d COUIlly PLUMBING
ordinances and stare laws relating to building construction, and BOILER-COMP(3 H.P.of 100,000 B.T.U.) 6.00
hereby authorize representatives forms inspection
on city es enter upon tlhe BOILER-COMP Over 100,000 STU)SEE FEE SCH. MECHANICAL 0
r above-mentioned property forinsp of this
purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX
nay in any way accrue against said City in consequence of the
re/n�ting�sl1of this permit
� J MECH.CONT. LIC.NO. MECH'
Z,6Y I(LyU-L{i'L i YLA p '.LO �F{8 TOTAL O'er/v' TOTAL
hgnatureol'A pphcaAfiCon tractor Date
OFFICE COPY