16099 POSTTHIS RD NEAR FRONT OF BUILDING ' PERMIT NUMBER
C14OF CUPERTINO 16099.
INSPECTION DIVISION
JOB INSPECTION
(�RECORD
V I11� `,5p IVO&A PERMIT EXPIRATION
JOB ADDRESS_ �tpQQ Y UNIT# _LOT# pERMIT.EXPIRES IF WORK
OWNER - V CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTIONLNECORD 180 DAYS OF PERMIT ISSU�'
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
_ CUPERTINO STANDARDS.
GARAGE SLABS - {
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - .3 �';i•) lUT I �
UNDERGROUND /SLAB PAID
PLUMBING Q e
ELECTRICAL - - AUG N - 1GP
ISSUANCE DATE
MECHANICAL RLoc ELECT PLG. MECR
City of Cuperfi � ❑
DO NOT POUR FLOOR UNTIL" ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATJON .SIFT.
MECHANICAL C
ELECTRICAL tt PERMIT TO
FRAMING - 1 �L I✓�
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' so.FT FLOUR AnuA roTAL Aca encE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING I RES No CON Pe owr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q ❑ ❑ ❑ ❑
ROUGH SAN.H ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY -
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCELNO
MECHANICAL MECH.ENERGY '
ACC.DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING -
ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY.T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N Y ❑ N0
EXTERIOR SHEAR � ELECTRICAL RELEASE FLOGDZONE AL.D C.
INTERIOR SHEAR FIRE DEPT. v❑ N❑ ° L-1 NO
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING ' SII BUILDING
INTERIOR LATH TEMPORARY APPROVALS' '
SCRATCH COAT ELECTRIC PLAN CHECK '
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE `
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM.
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 7 .
~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. Y,'
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! ;,; CONST.TAX
PLEASE READ REVERSE SIDE BEFORE . +P
CALLING FOR FINAL INSPECTION. " " TOTAL 7d +tit J
OFFICE COPY
APP• ICANT TO FILL IN INFOPeL
PeLMATION WITHIN RED LINES - USE LL POINT PEN ONLY
BU LDING PROJECT I DENTI FIC PERMIT NUMBER
BO1LO1N0l; LCo AS /a APPLICATION & P IT ' 16099
ADDRESS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL t
OWNEP'S PLAN CHECK VALIDATION
V
NAME / C OTY. ELECTRIC PERMIT FEE
4 /' C read( PHDNE
Co
UTLETS-SWITCHES-RECEP 10.00/1.00 e
- -;IIAL �..p�p� LIC.No. LIGHTING FIXTURES 10.00/1.00
ADDREACTOR'S/(/OSSIQ/G/P'r� T
CONTEAC OCG G �r PPLIANC ES-RESIDENTIA L 4.00
PHONE .PANELS 10.00 DATE OF APPLICATION
OR
RCRITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
Lie.NO. SIGNS TRANS. 3.00
ARCH.OR ADDRESS FNG, I SPECIAL CIRCUIT 5.00 PERMIT VAOIDATION
/p ZIP EMP.METER OR POLE INS. 20.00APPLICAN ,1�'(�
ADDRESSTSIpp OS.s/E/QACA GT MOTORS SEE FEE SCH. �•M IU�I.C-E.il
W CoQ e �lpp SERVICE CHANGE 20.00
'02 L LICENSED CONTRACTORS DECLARATION
tow I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H < (commencing with Section 7000)of Division 3 of the Business and1388-
h D-a PwfessianS C = 1?li sc is in full furropp� O BLDG. ELECT. PLG. MECH.
Z O v, - License CI s �Lic.Number.
ow r w Date Contractor �j
¢ Y s¢ OWNER-BUILDIiR DECLARATICSN r47 city of Cu - 'oa BUILDING PERMIT
m a,O INFORMATION
Axu ;a-y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
u O ¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
E - m PERMIT ISSUANCE 48.'00
Ew0I Code:Any city orcounly which requires a permit to construct,alter,
¢ IS ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIG NO. ELEC.
L
0
K
a, requirestheapplicantfor such permit to file a signed Statement that TOTAL
PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License MI
H i Law(Chapter 9(commencingwith Section 7000)uf Division 3 Orlin,¢ I -�11
4 4 O Business and Professions Code)or llmt he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
Cut not more than five hundred dollars 0500).);
❑ I,as owner of the property,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,GOND. 5.00
Code:The Contractor's License Law does not apply to un owner of
property who builds or ln.proves 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 ate not
mprove-mentsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
. .
❑ 1,as owner of the property,am exclusively contracting with 0 ❑ 0 ❑ ❑
licensed contractors to construct the 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-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuont 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.
WORK f:RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, ZONING
or d certificate of}W}o�y�rke.rrsjsp}"{PC�oormpensation Insurance,or a certified ENG.SITE NO.
copy therep(�f$eix`Gr�i/fsINSPJ). L v�lf
Policy NrX�/(///// _
❑ CCrtll' pylshe,b famished. FIRE SPRINK ENERGY T]4
Z 2 Cert opY.is 1 s ith the ci pection division.
App ic;un MISC.- REFER TO ORD. v �' N v El EI
� Lo CERTI FICAT P EXEMPTION FR M WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > CO PENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
IL Z (This section need not be Completed if the permit is for one TOTAL V❑ N❑ Y❑ N❑
hundred dollars(8100)orless.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1mit is issued,I shall not employ any person in any manner so as to
O L) become subject to the Workers'Compensal ion Laws of California.
Q. Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: II',after making this Certiflcmc of Ex-'
F ? 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=C.F.M.) 4.00
CONSTRUCTION LENDING AGI7NCY AIR HANDLING UNIT(OVER 10,000C.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.). �/E HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name /If HEATING UNIT 100,000 B.T.U.)9.50 FJ�
Lenders AJdmss ELECTRIC
I certify that I have,cad 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-COMPI3H.P,or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)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.
per against liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay In a y ve ac a against .ity in consequence of the
m [Ing Ithis,pe MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
I atureofA lican Contmctor Date
OFFICE COPY