16042 ?L
POST THIS CARD NEAR FRONT•OF BUILDING '
f♦ a , '� T' PERMIT NUMBER '
.�;. CITY' OF` CUPERTINO 1602
'INSPECTION'DIVISION,
JOB INSPECTION RECORD
^/ ( U / IFPERMIT'EXPIRATION
JOB ADDRESS ,' LOT#
PERMIT EXPIRES IF WORK �.
OWNER.'. L (Crr! CONTRACTORS NOT STARTED'WITHIN '
INSPECTION DATE INSPECTOR INSPECTION RECORD -180'DAYS OF PERMIT ISSU."
FOUNDATION• - - NOTE: . ANCE'OR 180 DAYS FROM '
.; LASTCALCEDINSPECTION..'
UFER ALL GRADINGAND DRAINAGE SHALL.BE INSTALLED t
PREGUNITE l - TO.COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT,VALmnTION^;',
CUPERTINO STANDARDS:"
GARAGE SLABS;.';
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _w
UNDERGROUND /SLAB " `4
• PLUMBING, t` - �`• +
„ { t
- ELECTRICAL r' . . 'Y " - _ ISSUANCE DATE
MECHANICAL. - BLDG, ELECT, PLG. - MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .. ' - - BUILDING PERMIT
• WOOD FLOOR INFORMATION
PLUMBINGION` SIFT,
MECHANICAL,
r "•S�p. SV,.+ - .7
ELECTRICAL vol PERMIT To. -
FRAMING
- ITOIIES 'TYPE CONSTR.
INSU L"ATION. � � � •� � .,
C.
OCC.GHO UP-,' RES UNITS
PLACE NO SUBFLOOR UNTIL'ABOVE HAS BEEN SIGNED
SD.F i'F L OUR AREA TOTAIACREAGE
- - ROOF NOTE:NO FINAL INSP.SHALL'BE MADE BEFORE, -
DIAPHRAGM t THE CONSTRUCTION TAX IS PAID .I,
BUILDING USE
ROOF SHEATHING - • - ` ' . - . RES IND". CON. PS O , .
APPLY NO ROOFING UNTIL ABOVE'HAS BEEN SIGNED FINALS DATE INSP.'.' " El ❑ ❑ ❑
ROUGH
ASSESSORS PARCEL NO
N
- SAN. ,
,PLUMBING ' ' y; ELECT.ENERGY'
TUBS&SHOWER PAN 'PLUMBING ENERGY - TRACT No. PARCEL NO
MECHANICAL MECH,ENERGY;_
ELECTRICAL •"` -1 BUILDING ENERGY Aca DATE ncc,_P�LE NO.
FRAMINGELECT.FINAL TEST 1..- -
i" -" ZONING G.SITE NO:.q
• INSULATION PLUMBING j ,
• GAS TEST - - GAS,.
MECHANICAL,
FIRE SPRINK ENERGY T'24.'
` 2�� - t
COVER NO WORK UNTILABOVE HAS BEEN SIGNED HEATING ` ❑ "'❑ �Y '"0
'
EXTERIOR SHEAR ELECTRICAL RELEASE
FLOODZONE A.LU,CI
- INTERIOR,SHEAR., FIREDEPT. '- - 7 Y9 N❑ Y ❑ .N❑
L SHEETROCK GRADE - _ - , FEE SUMMARY
EXTERIOR "LATH - BUILDING ,19UILDING'
INTERIOR LATH TEMPORARY APPROVALS —i
SCRATCH COAT, ' ' ELECTRIC PLAN CHECK „
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY •• SEISMIC,FEE
OCCUPANCY,OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM -�—
J.
• ARRANGE FOR INSPECTION BY-PHONING 252-4505,, ELECTRIC
? ONE WORKING'DAY BEFORE REQUIRED°INSPECTION.
PLUMBINGf
z PLEASE"GIVE JOB ADDRESS WHEN'PHONfNG:
SEE"PERMIT FOR EXPIRATION DATE — ,' T MECHANICAL
IMPORTANT. ! Ti'' CONST TAX
PLEASE READ REVERSE SIDE BEFORE w 'a ,k `
CALLING FOR FINAL INSPECTION:I TOTAL
— OFFICE COPY' � • ' _
APPLICANT TO FIi,L IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER i
BUI LDItSG P ChJICT IDENTIFICATION _.- y
ADAPPLICATION & PERMIT
IUaHR6 eING-ELECTRICAL-PLUMBINGM - 1.6042
ADDRESSP�p ID�SpAr KBUILD
fk4tl
DwNE 'B
"AMEPLAN CH ECK VA ATION'
.I�' LE�Ij OTY. ELECTRIC PERMIT FEE
yLAIIIIJ61 eKt4 PHONE
NAME c7Ons UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
MICt4AEL POL'PA uc.No�Sb LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S - APPLIANCES-RESIDENTIAL 4.00
ADDRESS ., r-( (^//l,y//. �" - '
W,v I-`V PHONE f9$''_3t � PANELS 10.00 DATE OF APPLICATION '
ARCHITECT
]PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.L.No.
DR
ENGINEER�t,�r�c,)�s,7 �,p�,�
7 " ICx *oft`UC.rvD. SIGNS TRANS.. 3.00 -
ARCH,ORENG. - 5.00 PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT ,
x EMP.METER OR POLE INS. 20.00. -
Ars MOTORS SEE FEE SCH. .....--/
ADDRESS ODREss
SERVICE CHANGE 20.00
w O o LICENSED CONTRACTORS DECLARATION
¢ U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE - e
y zw (commencing with Section 7000)of Division 3 of the Business and - BLD ELECT, PLG. MECH.at ,
H D z Professions Code,IR my license is in full fore;sndlfhclL ❑ �' ❑,
z o'�- License Class G Lic.Number 7�'fT�T
Date
ahlJ�fz -Contractor�j{d-
a'" % ING PERMIT
¢ ¢w OWNER-BUILDER DECLARATION RMATION
A.
3 A. y 1 herebyaffirm that Pant exempt from the Contractor's License MISC.- REFER TO ORD
P - VALUNS�LJ $/FT.
H
a-00 Law for the following reason.(See.7031.5.Business and Professions PERMIT ISSUANCE 10.00 l�sllrt• 0.V
Code:Any city or county which requiresa permit to construct,alter,
, R G 0 improve,demolish,of repair any structure,prior to its issuance,also ELEL:CONTR. LIC.NO. ELEC. o4�a➢ -
te O ¢ requfreS the applicant for such permit In file a signed statement that TOTAL PERMIT TO'
A w m a- he is licensed pursuant to lire provisions of the Contractor's License
rzi Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r m the basis for the alleged exemption.Any violation of Section 7031.5 _ ,STORIES TYPE CONSTR.
to of noimorellthan fiveahmount unslred do)Ilafs(550ects the 0)P)ianl toacivil penalty ALTER-DRAIN&VENT-WATER (EA,) 5.00
❑ I,as owner of the'property,or my empltiyces with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP .RES.UNITS
their sole compensation„will do the work,and the Structure is not
intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law does not apply to an owner of - = -
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
. men's are not
hdis or offewd forsle.If,
however,
the
improve- GAS-EA.SVSTEM-1.INC.40UTLETS 6.00
mems are not intended or employees,
for sale.If•ed that s the building L
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im. RES IND CON PB Other
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-1511C
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
Iy
contracts for such projects with a contractoAs)licensed punuanl to - - SEWER-SANITARY-STORM EA.200ftI10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec,-,K&P.C.for this WATER HEATER W/VENT 6.00 _
Ow on
Owner [)are WATER SYSTEM 5.00 ACC.DATE -ACC.FILE NO.
WORKIiRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a Certificate of consent to self-insure, - .ZONING ENG.SITE NO.
or a certificate of Workers Compensation Insurance,or a certified
copy thereof(See.3800,Lah.C.
Policy No. Company � � �'
Q ❑ Certified copy is hereby furnished. 1 FIRE$PRINK ENERGY TYO
Z Z ❑ Certified o y is/�Flled ve!l Ity inspection division. MISC.- REFER TO ORD. y❑ N❑ Y ❑ r.No
Fp ApPli<anl�1 Y"'"IiPJ'A c .
N CIiRTII4CATC OF li%IiMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
cc:IL >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 'V❑ N� V❑ N❑
11'0 TOTAL(This section need not be completed if the permit is for one
0 1 hundred dollars IS 100)or less.) - s
0"0 1 certify thatin lire performunaa of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ mit is issued,I slmll not employ any person in any manner so as to
OW become Subject to the Workers'Compensation Laws of California. - BUILDING
W Date Applicant ALTER OR ADD TO MECH. 5.00 7
} N NOTICE TO APPLICANT: If.-after making IN.,Certificate of Gx
F Z emption,you should become atiblect to the Workers'Compensation APPLIANCE 5.00 - 'PLAN CHECK
provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO t0,000C.F.M1' 4.00 FEE
V such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOC.F.M.) 6.00 SEISMIC FEE 9 0 0
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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's NameHEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
,
Lender's Address - _
I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) ' 4.00
information is correct.1 agree to comply with all city and countyPLUMBING
ordinances and stile laws relating tohudding construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter rupon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. -
IWe) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities',judgments osts and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
- may in any ayNe agai s ity in consequence of the
rawe
!DMECH.CONT. - LIC.NO. MECH.I( I' 4. I,pQ TOTAL TOTALf Applicant/Contractor Date
OFFICE COPY