16921 j •
T • POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMB EB
CITY .' F CUPERTINO, 16921
INSPECTION DIVISION
JOB INSPECTION RECORD
Dr� ( PERMIT EXPIRATION
JOB
JOB ADDRESS V� � V UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER 4Q CONTRACTOR -5 rra t�C' CC1`I IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF, PERMIT ISSU- i
FOUNDATIONANCE.OR 180 DAYS FROM
-� _ NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITIE TO COMPLY-WITH THE APPROVED PLANS AND CITY OF "PIMMIT VAl.mnnGN
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - c1
PLUMBING UNDERGROUND /SLAB - DEC 9 1988
ELECTRICAL o.l OI Cupertino ISSUANCE DATE
MECHANICAL BLDG ELECT, - .PLG MECH,
❑ ❑ ❑ '
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL a
ELECTRICAL PERMIT TO
FRAMING t�[�•�•'F41.
INSULATION _ STORIES TYPE CONS?R,
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO,PT,GLOOP>FEA TOTAL ACREAGE
• - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
BUILDING USE
ROOF SHEATHING RES . IND CON PR all—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ Cl ❑ ❑
ROUGH SAN.N ASSESSORS PARCE L NO
PLUMBING ELECT,ENERGY
,
TUBS&SHOWER PAN PLUMBING ENERGY _ TRACT NOPARCEL NO,.
MECHANICAL MECH.ENERGY
.
ELECTRICAL � BUILDING ENERGY ACC.DATE ACCFILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG,SITE NO.
GAS TEST GAS
MECHANICAL EIRE SPRINR ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ Yl
❑ "❑I
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LOC.
Y
INTERIOR SHEAR �� FIRE DEPT. ❑
Y❑ N❑ N❑.
SHEETROCK GRADE _ FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING 9?,0D
SCRATCH.COAT ELECTRIC PLAN CHECK
GAS• FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING I S NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, r3 ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION.
~� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
O
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST,TAX Gip.
PLEASE READ REVERSE SIDE BEFORE TOTAL l 1(
CALLING FOR FINAL INSPECTION.
OFFICE COPY
-APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
pUl LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION §i PERMIT 69 21
{•
ADDRESS � �.Eq. tJ.1
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'
1 NAME OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
CON ACTOR`S
NAr. /y �•p. OUTLETS-SWITCHES-RECEP 10.00/1.00
L10.NO. 'y/�'y' ✓
JJ t¢ Qa yy 3 �! LIGHTING FIXTURES 10.00/1.00 ! 1•
CONTRACTORS PPLIANCES-RESIDENTIAL4.00
A RESS �
3'32_0
�\1' ^ �A.F�
E�x J � � • r PRONE'/ PVD PANELS 10.00 DATE OF APPLICATION ..
oqARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE p.C.,NO.
ENGINEER -
LIC.NO. SIGNS TRANS. 3.00
ARCH,OR ENG. - PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
APPLICA
SERVICE CHANGE 20.00
0 ¢ i
D o LICENSED CONTRACTORS DECLARATION
a U U I hereby affirm that I am licensed under provisions of Chapter 9 IJEC 2 TIMEISSUANCE DATE
C
z (commencing with Section 7000)of Division 3 of the Business and i a n BLDG. ELECT. PLG. MECH.
I- m z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
oi w o License Class Lic.Number,...,_- my (� SUpertin
F r J Date Conlnlctor
¢ m ¢ a OWNIi R-BUILDER DECLARATION INFORMATION PERMIT
a d O INFORMATION
w ; y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL o a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
� - -' Code:Any city or County which requires a permit to construct,after, (o/
a ¢¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.N0. ELEC.
- O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A F Z he is licensed pursuant In theing provisions of the Contractors License
i
Law(ChapterProfessions
with Section is 00)exemfttherefion oofthe
E 4 o Business and Professions Code)or that he is cion of therefrom and OTV. PLUMBING PERMIT FEE
¢ H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant nor a permit subjects the applicant toa civil penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars(S5001.):
❑ I,as owner of The property,or my en+ployees 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,COND. 5.00
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.
Rents are not intended or offered 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 EASYSTEM-OVER 4(EA) 200
builder will have the burden of proving that h - . . .
e did not build or im- BUILDING USE
prove for purpose ofvale.). INDUSTRIALWASTE INTER. 30.00 RES TND CON pe Omer
❑ 1,as owner of the property,um exclusively contracting with ❑ ❑ ❑ ','ED C]
licensed contractor,, to construct The project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions COrle:The Contractor's Licenx Law does 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 In SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors'License Law. TRACT NO. PARCEL NO.
O I am exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 6.00
Lou
Owner - Date WATER SYSTEM 5.00 ACC.OATE ACC,FILE NO,
WORK ERS'COMPENSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm That I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
1) i y No. Company
O Certified )Py is. famished. FIRE SPRINK ENERGY T-24
Z Z 0 Certifie +y 17.,01 dl�with The ity inspection division.
O ApplicanT__� MISC.- REFER TO ORD. v N v N�
� y CERTI .ICATE OF EXEMPTION.FROM WORK ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U,C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG,
CL
Z (Phis Section need not be completed if the permit is for one TOTAL Y[:] N Y ❑ N 1:1
hundred dollars IS 100)or ICSS3
U O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F alit is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Conimmation Laws of California.
Dam Applicant BUILDING ?
a R ALTER OR ADD TO MECH. 5.00 ( �e ��
} W NOTICE TO should CANT: If,after making this Certificate sa ion
F ? emptiom you should L bor Code,
you to use Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, you must forthwith comply with FEE
U ' such provisions or this permit shall'he deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LIiNDINC AGENCY AIR HANDLING UNIT(OVER 10000C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm 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.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
Leader's Address ELECTRIC '
. 1 certify That I have read this application and slum that the above VENTILATION FAN-(SINGLE) 4.00
s information is correct. I agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COru1P(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes, BOILER-OOMP(Over 100p00BTU)SEE FEE SCH. MECHANICAL
(We) agree In save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
ay any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ra I" gofthi^perm' . x MECH.CONT. LIC.NO. MECH. p
ly 7 P TOTAL TOTAL 7 !�.
Si ,,lure of Appli ant Contractor )at u
OFFICE COPY