16831 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 16831
INSPECTION DIVISION
JOB IMSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESSuT S',a'fi�G C-rUNIT# _`LOT#
PERMIT EXPIRES IF WORK
�i,z —0' ��-O U CONTRACTOR L`1�Z c/z'� 7� IS NOT STARTED WITHIN
OWNER C<-� Q./
INSPECTION D TE INSPECTOR INSPECTION RECORD180 DAYS OF PERMIT ISSU-
FOUNDATION — ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE.INSTALLED
PREGUNITE TO COMPLY WITH THE.APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS _
POUR•NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -y'
PLUMBING - •Dl
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECTPLC MECH
,o El a ❑ 1 ❑
DO NOT POUR FLOOR UNTIL AAGVt HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR . q81%9jINFORMATION
VALUATION $IFT.
PLUMBING - , ' v e#;1o0
MECHANICAL ` O` Q
ELECTRICAL /r,^.• PERMIT rU
FRAMING r "�J i zz- cr�
INSULATION - STO ES TYPE CONSTR
I
OCC GROUP RES UNITS
'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED a.FT FUIOH gREA TOTALACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
�1 DIAPHRAGM THE CONSTRUCTION TAX IS PAID
null-DING USE
ROOF SHEATHING Z HES 'NO CON PB om,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E] 0 0 E]
ASSESSORS PgRCE
I- ROUGH SAN.k L NO
PLUMBING 'Z ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO
MECHANICAL MECH.ENERGY
•ACC.OATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
_ ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T-74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N Y ❑ No
ZONE' A.L U C.
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y'❑ NI]
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH < TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPAINCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM
w ELECTRIC ARRANGE FOR INSPECTION BY PHONING 252-4505, ' --�
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE I I TOTAL - moi
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
H3UI LDING PROJECT I DENTI FICATI ON 'PERMIT NUMBER
BUILDING e a APPLICATION & PERMITADDRESS /,
gxUI LDING - ELECTRICAL-PLUMBING-MECHANICAL C$ 16831
OWNER'S PLAN CHECK VALIDATION
t..� - NAME OTY. ELECTRIC PERMIT FEE
L/A14 PHONE .e
S
,. NAME'7 OUTLETS-SWITCHES-RECEP 10.00/1.00
CONTRACT
4 C.
LIGHTING FIXTURES 10,00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
RA2AooREss .�n
�W PHONE PANELS 10.00 DATE OF APPLICATION
ARc. ECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3,00
ARCH.
oo Ess ENG' SPECIAL CIRCUI I 5.00 PERMIT VALIDATION
ZIP EMP.METE OR'POLE INS. 20.00
AMOTORS SEE FEE SCH.
ADDRESSPP
APPLICANT
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
FE,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.
,., w i Professions Co and license is N full for -'pd LC- O❑ ❑ ❑
o 10
i a o License Clay- �Lie.NumberO
H m H j Daley/(/./ Conlmao ,I \
m M a OWNER-BUILDER DECLARATION - _ Y +� BUILDING PERMIT
BE rc w u ,} 0 INFORMATION
F
° A H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
3 w a y P
w0¢ Law fertile following reason.(Sea 7031.5,Business and Professions PERMIT ISSUANCE 10 VALUATION SIFT.
wtri 4 Code:Any city or county which requires a permit to construct,alter,
ELEC.CONTE. LIC.NO.
2 Be ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC. ��
¢ requires IIIe applicant for such permit to file a signed statement that TOTAL PERMIT TO
w m y he is licensed pursuant to the provisions of the Contractor's liccnsc r.
Law(Chupter9(coal me tic iilg wi l It Sect ion 7000)o f Division 3 of t he
fi o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
re H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant too civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than Ove hundred dollars($5001.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or offered for Sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
y Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
\ himself or through his own employees,provided that such improve
{I ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the own'
builder will have the burden of proving that he did not build or imr- GAS•EA.SYSTEM-OVER 4(EA.) 2.00. BUILDING USE
RES IND CON PS Other
_ _ prove 11,aso nee of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑.
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS•1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
and Professions Code:The who
Contractor's License Law does not apply
to contracts
owner of property who builds tr improves Hereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
the Con 6 for such projects with a contranor(sl licensed purnl5nn m
the Contractor's License Law. SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under See. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
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' ZONING ENG.SITE NO.
or a certificate of Workers'Compen 'tion Insurance,or a`certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Com pan
❑ Certified copy is he re .fumes ed. (� FIRE SPRINK ENERGY T24
Z Z '�Cerlifie eft' III tt• ci y 'Is eti n division.
O AZ,licant t MISC. REFER TO ORD. Y N❑ Y N❑
I- H 'ATPERMIT ISSUANCE 10.00
W CIiR'IIPI MPENEAIION INS FRONC17 F.RS' FLOOD 20rvE A.L.U.c.
W � COMPENSATION INSURANCIi PLG.CONTE. LIC.NO. PLG.
CL Z( This section need not he•completed if the'Pernit is foe ane TOTAL Y❑ N❑ Y ❑. No
hundred dollms IS 100)or less.)
U O 1 cert By that in the performance of the work For which nh is Per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner So us to
O W become subject to the Workers'Compensation Laws of California. BUILDING
M Date Applicant ALTER OR ADD TO MECH. 5.00
>_ N NOTIC17'1'0 APPLICANT:V,after making this Certificate of lix-
♦- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the.Labor Code, you must forthwith comply with FEE
U sych provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11C.F.M,) 4.00
CONSTRUC'T'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10SWC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
thq performance of the work for which this permit is issued(Sea MICROFILM
31A7,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
ordina ccs is correct. I agree to comply with all city and C0011fy PLUMBING
ordinances unit state laws relating to building construction, unA BOILER•COMPI3 H.P.or 100,000 B.T.U.) 6.00
hereby auHorite reprcsentm eves of this city to eater upon the BOILER-COMP IDver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposs•s.
agree to save, indemnify and keep If
the City of MISC.- REFER TO ORD.
Cupertino against iiayres,judgmems, costs and expenses which CONST.TAX
may in any way Ecrac agSinst said City in consequence of the PERMIT ISSUANCE 10.00
ranting o'ti • yet.� MECH.CONT. LIC.NO. MECH.TOTAL TOTAL ad' dv
Sign I of Applicant Contractor ate
OFFICE COPY