16131 POST THIS CARD NEAR FRONT OF BU'ILDING PERMIT NUMBER
CITY OF CUPERTINO 16131
INSPECTION DIVISION ' I
r/f1, '^ ''II/�I/' JryLO'B INSPECTION RECORD '
JOB ADDRESS—103 V Vn+ hlt C4 PERMIT EXPIRATION
UNIT# - _LOT#
C V PERMIT EXPIRES IF WORK
- OWNER CONTRACTOR I� G IS NOT STARTED WITHIN
INSPECTION ATE I INSPECTOR INSPECTION RECORD 1BBDAYSOFPERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
. NOTE: LASTCALLED INSPECTION.
LIFERALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE' TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLASS. - -
MUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /'SLAB r•
PLUMBING ii T
ELECTRICAL Atio }! ISSUANCE DATE
MECHANICAL ". BI.D ELECT I PLc. MECR
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 9tv Of CuDartimrBUILDING PERMIT
INFORMATION
WOOD FLOOR " VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING I ' I j'+ I I•!�
STORIES TYPE CONSTR.
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE so PT ELooR AREA ,TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB Sm.•,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL. MECH.ENERGY t
ELECTRICAL BUILDING ENERGY ACC DATE . ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL
FIRE SPRINK ENERGY T.)4
L
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y ❑ NL Y ❑ N
,
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE A.L.0C.
INTERIOR SHEAR FIRE DEPT.
L NL L NL
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATHTEMPORARY APPROVALS .9uILDING
SCRATCH COAT ELECTRIC FEEN CHECK 7 _
GAS i - I.,...
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED DccuPnNcv SEISMIC FEE
L.
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM.
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
' o�. 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 a;
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APP1ICANT-TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
6� BUI LOI NG PROJECT IDENTIFICATION PERMIT NUMBER
t.
WLR'55 APPLICATION & PERMIT16131
/0,7(, BUILDING-ELECTRICAL-PLUMBING -MECHANICAL �"
OWNER'S PLAN CHECK VALIDATION
NAME g
S�.NU(rLWVU DTV. ELECTRIC PERMIT FEE
NONE
CONTRACTOR'S
NAME 9G UTLETS-SWITCHES-RECEP 10.00/1.00
COAJ-J U�J7"f� sec.No. / LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
/' ZL / f(//L�II�Ci�aRONE `7�O �OS,J PANELS 10.00 DATE OF APPLICATION '
OR
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.:NO.
ENGINEER
LIC.u0, SIGNS TRANS- 3.00
ADDRESS ENO. SPECIAL CIRCUIT 5.OB, PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 20.00 _ ( '
APPLICANTS MOTORS SEE FEE SCH. �N��I
ADDRESS p/y 4
J• I�1'1� SERVICE CHANGE 20.00
'02
0o LICENSED CON"r RACTORS DECLARATION
a u u I hereby affirm that I am licensed under provistmis or Chapter 9 ISSUANCE DATE
y< w (commencing with Section 7000)of Division 3 of the Business and B DG ELECT. PLG. MECH.
r w 2 Professions Cole d ly license is in full for a d efC c D_ ❑ ❑ ❑
oimW License Cln's_ .. Lic.NumberlSi: r�
_ W H Dulc / Contractor
ar >: f , BUILDING PERMIT
o re U re < OWNCR-BUILDER DECLARATION MISC.- REF I INFORMATION
X ;,� H I hereby affent that T am exempt from the Contractors License
FuoJ Law for the following reason, 7031.5,Businessand Professions PERMIT ISSUANCE (VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter, n 11/1
ac a: ¢ 2O 1
Improve,demolish,or repair any structure,prior to Its lssuaroc,also ELEC.CONTR. LIC.NO. ELEC.
, requires the applicant for such permit to file a signed Stalemenl that TOTAL
n K as he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
FZQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a; by any applicant for a permit subjects the applicant o a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($5001):
❑ I,as owner of the property,or my employees wills wagon as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUPRES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who bullas or Improves thereon,End who floes such work FIXTURES-PER TRAP 5.00 SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees.Provided that such improve-
mentsarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of Proving that he did not build or int- BUILDING USE
RES IND CON PB ONer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,ant exclusively contracting with
licensed contractors 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 does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts I'or such projects with a contractmos)licensed pursuant to
the Comractor',s License Law. SEWER-SANITARY-STORM EA.200ft/10.00
TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dare WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
" WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to selr-insurc,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is Ned with the city inspection division. - MISC.- REFER TO ORD.
O Applicant Y ❑ N Y E] N[]
p: y PERMIT ISSUANCE 10.00
LU :CfiRTIFICCC' IENSAEMPTINS FROM WORKERS' FLOOD ZONE A.L.U.C.
' UJ >_ COMPENSATION INSURANCE PLG,courR, sec.No. vkc.
d 0 (Chis section need not be completed if the permit is for one TOTAL Y❑ N� Y ❑ N[]
Z h Undred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
Iy F mit is issued,I shall not employ any PerSnn n an manner so as to
U become e 1 the Workers' on -Osali IL sof Ca�s'(onsia.
0 0. Date o f� April icum I I ALTER OR ADD TO MECH. 5.00 BUILDING 3,M
} to NOTICE'I'O APPLICANT': If,after aking this Cerl if, He of Ex
F ? emotion,you should become subject io the Workers'Compensation APPLIANCE 5.00 PLAN CHECK ID l
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)"C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.F.M.) 6.00 SEISMIC FEE 415D
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
lire performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lendei s Address ELECTRIC
. I certify that I have read(his application and state Ilia,Ihu aboveVENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply With all city send county BOILER COMP13 H.P.or 100,000 B.T.U.1 6.00 PLUMBING
ordinances and state laws relating In building construction, and
hereby entio ed representatives of this city to enter upon the BOILER-COMP (Over 100,00D BTUI SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purr oxs.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uper.ino against liabilitiee,'j tognlenls, costs and -11-1-which CONST.TAX
)
ay in any way accrue agams Said City in consequence of the PERMIT ISSUANCE 10.00
Inoting of is TOTAL TOTAL
"out.
�0 y,/ MECH.CONT. LIQ NO. MECH.
✓V/jv,_-.. (J �D
Signature ofA plicant/Contractor Date
OFFICE COPY
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' $% f It.+�I'^,6rR�pyl,�x V(S��F� 1 ip l:iY� A'�.t•i, .^i L.d n^'1'CQNTRACTOR,LICENSE 312030 t 4 l� �'� o t tyF.'i kasYi :
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