16030 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY .0F • CUPERTIN0 16030
INSPECTION DIVISION W
JOB INSPECTION;RECORD
S�E /Qin `PERMIT EXPI RATION
JOB ADDRESS � N l�/o�-+ r. UNIT# '_LOT#'
h - - ,PERMIT EXPIRES IF WORK .
OWNER L. C� CONTRACTOR Sd VS4 -It'LC3C7 IS NOT STARTED,WITHIN '
INSPECTION DATE INSPECTOR INSPECTION RECORD 180.DAYS OFPERMITISSU-•
FOUNDATION • ANCE OR'180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
.LIFER - ALL GRADING AND DRAINAGE SHALL'BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO•STANDARDS. .
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED P ayi K C-7-
UNDERGROUND /,SLAB
UNDERGROUND /BLAB
PLUMBING
ELECTRICALLj_ g ISSUANCE DATE
M - $_Iv_ g coc, ELECT. PLG MECR.,
g-9-ss
MECHANICAL b 4 0 . 0 ❑� El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED rAlw BUILDING PERMIT
WOOD FLOOR'-' INFORMATION
VALUATION' $IFT.
PLUMBING - ASF /..�YV 4„��, M�•yfa •,-.
MECHANICAL
ELECTRICAL. CtV om Inulw PERMIT To ,
FRAMING
INSULATION ., STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
NOTE:NO FINAL)NSP.SHALL BE MADE BEFORE sD.Fr ELgoR AREA TOTAL acRencE
THE CONSTRUCTION'TAX IS PAID
DIAPHRAGM -
ROOF SHEATHING - - RES IND aDCON USE o� .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ ❑ ElEl ' ❑
ASSESSORS PARCEL NO .
ROUGH- - SAN.# -
-• PLUMBING- - + 6 ELECT.ENERGY -
TUBSBSHOWERPAN PLUMBING ENERGY rRACTNo. 'PARCEL No
MECHANICAL" MECH.ENERGY
ACC.DATE ACC.FILE No.
ELECTRICAL BUILDING ENERGY; _
FRAMING ELECT.FINAL TEST
.
INSULATION PLUMBING - " ZONING ENGSITE NO
GAS TEST - GAS -
MECHANICAL FIRE SPRINK ENERGY OZa.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ IN El ❑ N[]
FLOOD ZONE A.L.LLC.
EXTERIOR SHEAR, - ELECTRICALRELEASE
INTERIOR SHEAR _� FIRE DEPT. Y❑�` N❑ v ❑ "❑
SHEET,ROCK - GRADE FEE SUMMARY
EXTERIOR.LATH BUILDING. - -
INTERIOR LATH -' TENIPOR APPROVAL BUILDING.SCRATCH COAT - ELECTRIC - PLAN'CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HASBEEN OCCUPANCY 'SEISMIC FEE
OCCUPANCY OFPSUILDING ISNOT.PERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR.
.MICROFILM ,
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC.
��.` ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z ' PLEASE-GIVE JOB.ADDRESS WHEN PHONING:
SEE,PERMIT FOR EXPIRATION DATE —., MECHANICAL
':IMPORTANT! ,' CONST,TAX .
PLEASE REAP REVERSE SIDE BEFORE TOTAL'
CALLING`'FOR FINAL INSPECTION.
OFFICE COPY
... APPj-ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY "
BUILDING PROJECT IDENTIFICATION ,PERMIT NUMBER
a
In G v APPLICATION & PERMIT 1. 6030.
AOOREss 'VI y
e 12�a BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OwNER'S - PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE '
-_ PHONE
7.1
CONTRACTOR'a
NAME uv /y OUTLETS-SWITCHES-RECEP 10.06tY.00
U uC.No. - LIGHTING FIXTURES 1 0/1.00
ADDRESS DR's � /� 5 0�� PPLIANCES-RESIDENTIAL '4.00
ADDRESS
PHONE / Z•PANELS .10.80 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 ?LAN CHECK FEE P.C.NO. ,
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
AARCH 0.DDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 V ��l. /�f p/
woo LICENSED CONTRACTORS DECLARATION U G -
a i w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and G. ELECT. PLG. MECH.
o Professions Code a �1q license is in full fo��+iI•�Jn yy
z o is� Licens 1 s S�Lic.Number.? L AQ K ❑ ❑
2 I_ aa Date CcntGaGo,_6 .�((.. p
¢ ¢ ¢ a OWNER-BUILDER DECLARATION U7 Cu BUILDING PERMIT
o a sa MISC.- REFER TO ORD INFORMATION
E
;n H 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
.. N¢ Law for the following reason.(Sec.7031,5,Businessand Professions PERMIT ISSUANCE
Code:Any city or county which requires a permit to construct,alter,
re 2 Q Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. '
m¢ requires the applicant for such permit to file a signed statement that TOTAL IS ,Sa PERMIT TO "
n w he is licensed pursuant to the provisions of the Contractor's License
as Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
0C the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjects theapplicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5000.):
❑ I,as owner of the properly,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,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-
ments are not intended or offered for sale.If,howcveq the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have lire burden of proving that he AiJ not build or im- RES IND CON pe Orbe,
prove for purpose of sale.). INDUSTRIAL WASTE INTER, 30.00 - El ❑ ❑. ❑ - 1:1❑ 1,as owner of the property,um exclusively contracting with
licensed contractors to construct lire project(Sea 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-OV ER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00
TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,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
I hereby affirm that I have a certificate oI consent to sell'-insure, ZONING' ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(See.3800,Lab.CJ.
Policy No. - Company -
0 ❑ Ceirifie copyishcrebyfu Ir it FIRE SPRINK ENERGY T-24
Z �Cerl ifi c Is h the city inspcmion division. MISC.- REFER TO ORD. Y❑ IN❑ y ❑ N❑
Applicant
m PERMIT ISSUANCE 10.00 FLOODZONE A.L.u.c.
K CE T E OF IS F-MPTION FROM WORKERS'
LU COMPENSATION INSURANC17 PLG.CONTR. LIC.NO. PLG.
1 O (This section need not be completed if the permit is far one TOTAL Y❑ N❑ Y❑ N❑
0 Z hundred dollars($100)or less.) -
U O I certify that in the performance o('the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY ,
LL I- mi[is issued,1 shall not employ any person in any nmnner so as to
U become subject to the Workers'Compensation Laws of California.
Da Dale ' Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE.TO APPLICANT: If,after making this Certificate of F.x
F ? emplion,you should become subject to the Workers'Compensation 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 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNITIOVER 10f300C.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 for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). H EATI N G UN IT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC X750
..�
1 certify that I hove read this application•and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county .PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU1 SEE FEE SCH, MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino gains[ liabilities,judgments, costs and expenses which CONST.TAX
may in wacme said Cily in consequence of the PERMIT ISSUANCE 10.00
rami of nit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Si atur icon[ o ractor Dale
\\\ OFFICE COPY