16077 POST THIS CARD NEAR FRONT,OF BUILDING PERMITNUMBER "
9. CITY OF CUPERTINO 16077
INSPECTION DIVISION
•JOB INSPECTION RECORD
f I ( .
'All
// �+PERM17 EXPIRIATION'
JOB ADDRESS ' 101 a3 NI _LOT# -
PERMIT EXPIRES IF.WORK
OWNER gIN4' (t�t CONTRACTOR IS NOT STARTED WITHIN '
INSPECTION I DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: . •
UFER � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS. 1
,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB� pNit- ~
PLUMBING '.r �'"l •. ( '
ELECTRICAL 13,lg* ISSUANCE DATE
MECHANICAL BLDG ELECT SLG. . MEC..
dy °I Cune�l ° ❑ ❑ ❑ ❑ ;
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
vv Rn rc rD
ELECTRICAL n-,5_88 Cc cr O.Yl'l�t 5C 1' b _
FRAMING
1 .
INSULATION - - ��. f T yC 7A- „r,,.7 OWES 1 ,TYPE c STR
per.
OCC.GROUPRES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 FT.PI.00Ii AREA TOTAL ALR EA(iE
\ ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
�( ROOF SHEATHING RES IND BUILDING pa 00—
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 •
ELECTRICAL - ACC DATE ACC,FILEN%.'
- BUILDING ENERGY
FRAMING ELECT,FINAL TEST
INSULATION PLUMBING
ZONING ENG,SITE NO.
' -''J
GAS TEST GAS
MECHANICAL
FIRE$PRINK ENERGY T 24 -
� ..( � v
-COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑, Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD IONS I A L U.C,
INTERIOR SHEAR FIRE DEPT.
Y❑ Nol Y N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COATELECTRIC PLAN CHECK '
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING J
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Y
z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL.
CALLING FOR FINAL INSPECTION.'
1 OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -
BLIILDINGPROJECTIDENTIFICATION -PERMIT NUMBER -.
UILDING L1030 APPLICATION & PERMIT
• RD`RE55I� . I _� fa
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 1.607.7
JOANPN a'S /�I) PLAN CHECK VALIDATION
� M� C 1' O7V. ELECTRIC PERMIT FEE 7�G '�/,f_ r7Q
NAMECONTRAcroas OUTLETS-SWITCHES-RECEP 10.00/1.00 -
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS - PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION' -
ARCHITECT PLAN CHECK FEE P.C.NO.
on PANELS (OVER 200 AMP) - 20.00 ,.
ENGINES _V
hf l(_ 4) K LI NO, SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
A rJ7�, zIP TEMP.METER OR POLE INS. 20.00
noD ICANT's U MOTORS SEE FEE SCH.
• p �B I SERVICE CHANGE 20.00 n
woo LRIENSED CONTRACTORS DECLARATION
c i¢ w I hereby affirm a
that 1 m licensed under provisions of Chapter 9 . ISSUANCE DATE
H (commencing with Section 7000)of Division 3 of the Business'and
w yMECH.
BtZFJ ELECT. PLG.
w z Professions Code,and my license is in full force and effect ❑ ❑
Z i a W License Class Lic.Number ,
Date Contractor
¢ Y
¢ ¢ ¢ OWNER-BUILDER DECI.ARA1'ION Of UILDING PERMIT
A o d U INFORMATION
m ;LL N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
r u o 4 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION 5/FT.
Code.Any city of county which requires a permit to construct,alter, /\
m en¢p improve,demolish,or repair any Structure,prior to its issuance.also ELEC.CONTR. LIC.NO. ELEC. V
d E m¢ requires the applicant for Ruch permit to file a signed statement that TOTAL PERMITTO
is he is licensed pursuant to the provisions of the Contractor's License
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
E i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
the basis for lire alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ; m by any applicant for a permit subjects the applicant too civil Penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S500)J:
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do Nle work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: ROOF,AREA,CON D. 5.00
Code',The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-l1NC.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 am- BUILDING USE
povel'or purpose of sale.). RES IND CON PB Omer
I,as owner of the property,am exclusively contracting with INDUSTRIAL'WASTE INTER. 30.00 ❑ 0
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00ABBESSORSPARCEL NO.
and Professions Corte:The Contractors License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft 10,00
the Cantmctoi s License Law. / TRACT NO. PARCEL NO.
❑ I an exempt under Sec.-,R&P.C.In,fill, WATER HEATER W/VENT 6.00
reason
Owner Date , WgTER15YSTEM 5.00 .ACC.DATE ALC.FILE NO.
w Rk.ERS'COMP.NSAT NDEC RATIO WATER TREATING EQUIP. 5.00
1 hereby affirm that I have o certificate of consent tosell-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished RE SPRINK ENERGYTY4
Z Z ❑ Certified copy is bled with the city inspection division.
O Applicant i MISC.- REFER TO ORD. YE] NE] Y ❑ NC]
CCy Cf:RTIFICA1E OIr EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
d > COMPENSATION INSURANCE PLC.CONTR, LIC.NO. PLG:
0. Z (This section need nal be Completed if the permit is for one TOTAL Y N� Y [:] N�
hundred dollars IS 100)or less.)
L) O ' 1 certify that in the performance of the work for which this per-
QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall not employ any person in any manner so as to
O W bemmo Subject to the Workers'Compensation Laws of California. -
Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
a
} ril NOTICE TO APPLICANT: If.after making this'Certificate of
Ex-emption,you Should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
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=11F.M.) 4.00
CONSFRUCT1ON LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE 44
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,Cie C.). HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lenders Address
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building comtrud ion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city Io enter upon the BOILER-COMP(Over 100,000STU1 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.
uperiino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way ac a against said City in consequence of the PERMIT ISSUANCE. 10.00
ra f ibis perm' . MECH.CONT. LIC.NO. MECH,
TOTAL TOTAL
Signa re of Appheretic ntract • Date
OFFICE COPY