16058 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
-� 16056
INSPECTION DIVISION
JOB INSPECTION.RECORD j •, .-7 C7J
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-1 � ` ' r ,\{1{•�� PERMIT EXPIRATION
2
JOB ADDRESS -:1 g-- w 0 -(� UNIT# LOT# PERMIT EXPIRES IF,WORK
OWNER �O_ "GONTRaCTOR `( Cp CD IS NOT STARTED WITHIN
INSPECTION ATE INSPECTOR INSPECTION RECORD 180 DAYS OFTERMIT ISSU. '
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER., - .. ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - ,3
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1
UNDERGROUND /SLAB. - U
PLUMBING - - )AA9 -
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELEcr. PLc. MECR ^
❑ ❑ ❑ '1'
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION
PLUMBING
MECHANICAL
ELECTRICAL - PERMIT TO
FRAMING
INSULATION
STORIES TYPE C NSTR
-
- - • - OCC GROUP - RES.UNITS '
Ilrl PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'SO,FT^I LOOR AREA TOTAL ACREAGL
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM BUILDING USE THE CONSTRUCTION TAX IS PAID -
ROOF SHEATHING RES IND DON PB 011—
' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ El 11
ASSESSORS PARCEL NO
ROUGH SAN.p
PLUMBING ELECT.ENERGY
TRACT No. PARCELNo
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
Acc.DATE ACC FILE NO
ELECTRICAL
BUILDING ENERGY
FRAMING ELECT.FINAL TEST - ZONING ENG SITE NO. .
INSULATION PLUMBING
GAS TEST GAS -
' - MECHANICALFIRE SPRINK, ENERGY T.Za ,
r•� Y ❑ N❑ Y E] N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONI: Arc UC
INTERIOR SHEAR FIRE DEPT. - Y❑ N❑ Y ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING
INTERIOR LATH_ TEMPORARY APPROVAL sulLowG
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
TONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z E GIVE JOB ADDRESS WHEN PHONING.
'I PLEAS— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
.CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REO LINES - USE BALL POINT PEN ONLY
BUI LDI N&PROJECT I DENTI FICATION .PERMIT NUMBER
PI
ULDI APPLICATION & PERMIT ' " 1 `+0[ p
_un TSI'�OI(< ,-- Z A BUILDING -ELECTRICAL-PLUMBING-MECHANICAL .. I U 58
NER'a PL4A�N CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE 1'w� 1.U3
ecV1 PHONE
CONTRACTOR SOUTLETS-SWITCHES-RECEP 10.00/1.00 _
A1 LIC,No!� O S LIGHTING FIXTURES 10.00/1.00 fOAe
ADDRESSTDRs -OL,s-<' C-L.L&0,4G PPLIANCES-RESIDENTIAL 4.00 -
/1/r�'� ln' I ^ stx
O' IaAyn "tftk✓Lek PHONEPANELS 10.00 DATE OF APPLICATION !
°RRCHrtECT PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE CTO
,NG I ER '' 1�
llW f1 LIC.No SIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 q --1T
APPLICANT MOTORS SEE FEE SCH. •! ( G
ADDRESS `
SERVICE CHANGE 20.00
O¢ z 0 e- A�Tct lxotL;
Foo LICENSED CON"rRACfORS DECLARATION '�Y 1
a t u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
I" (commencing with Section 7000)of[)is siun 3 of the Rusin sunt
G - BLDG. ELECT, PLG. MECH.
O'6^ Professions Co v m lieppAse is in full forCC.`, ❑ ❑ ❑
i o,' License Class y a.l! Lic.Numb Y MAR
9 m H' Dam Contmcm
Q y 2 _, BUILDING PERMIT
¢ as OWNER-BUILDER DECLARATION
o s v INFORMATION
wg LL N I hereby affirm that I am exempt from the Contractor's License MISC.-
H u o J Lew for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 n VALUATION S/FT.
,Ar Code!Any city or county whichrequiresa permit to construct,alter,
¢a ¢IS improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
n O ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT Tp ,
R
mhe is licensed pursuant to the provisions of the Contractor's License
�2 > Law(Chapter 9(Commencing with Section 7000)of Division 3 of the -
< Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
X $=the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR
w by any applicant for a permit subjects the applicant 10 a Civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($5000.):
❑ I,as owner of the property,or my employees with wagnsas BACK FLOW PROTECT. DEVICE 4.00 OCE.GROUP RES.UNITS
their Sole com peasation,will Jo the work,and the structure is not
intended or offered for sole(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 S°.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsamCutintendednrofferedf..sole.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 IEA1 200 BUILDING USE
builder will have the burden of proving that h . . .
e did not build or im- RES ' IND CON PB Other
for purpose of soled. INDUSTRIAL WASTE INTER, 30.00
Cl 1,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 NO.
and Professions Code The Contractor's License Law does not apply
tr)an owner of property who builds.r improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ 1 can exempt under Sec. ,B.&1•.C.for this
WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORKERS'COMPENSATION D17CLARATION 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'Compensltion
copy they��-��((��yyrP��,,,�ii$$QQpp...11aaqq�y�.,,�.. /
Policy NoW ....... a E9(OS -L/)EY
0 ❑ Certified copy is hereby fufNSlmed. FIRE SPRINK ENERGY T 24
Z Z ❑ Cenif Coy y fit it withthe-city inspersion division.
FO ApplicanMISC.- REFER TO ORD. Y ❑ N❑ Y❑ N❑
W CI'RTI F I CATE OF 17 EM PTI ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.M.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z CI his section need not he completed if the permit is for One TOTAL Y❑ N❑ Y ❑ ❑
N
hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which Dmfs per- GTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H - mit is issued,I shall not employ any person in any manner so as to .
QU become subject to the Workers'Ccun,cosati.n Laws of California.
WDale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �Q V.in
} rn NOTICE TO APPLICANT: If,after making this Certificate of Ex-
p. ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you nmst forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F:M.) 4.00 (�x
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10)"C.EM.) 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.). uh HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name f f P,
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information correct I agree tcomply with all city and county PLUMBING
ordinances and state laws relating to building construction, and 130ILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
. . above-mentioned property for inspection purposes.
(We) agree to Save, indemnify unit keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMITISSUANCE 10.00 CONST.TAX
may in any way accnre against mid City in consequence of the
ti0gul this permit MECH.CONT. LIC.NO. MECH.
a
IT-4- � TOTAL TOTAL ��(D
Signature.f Applicant/Contractor Date
II OFFICE COPY