16110 POST THIS RD NEAR FRONT OF BUILDING
PERMIT NUMBER
CI1 OF ZUPERT:INO
_16110
' , • ! '•'" -' ° INSPEC'fION 'DIVISfON't.. ' '. � '
JOB INSPECTION"RECORD 9
.
Al" y^lU PERMIT EXPIRATION 'L
JOB ADDR ESS' �4I A �O L.Ao 1\43; 'x: '
UNIT# -LO
T# -
_ - - PERMIT EXPIRES IF WORK
'OWNER p /7 1 _�r' ! d CONTRn_c*oR ' A o rs; "�L(:f71 ' ' ' IS- NOT-STARTED.WITHIN
INSPECTjbN DATE, INSPECTOR, - INSPECTION RECORD ".100,13AYS OF PERMIT ISSU'( .
FOUNDATION .7,1 _ _ ANCE OR 180 DAYS TROM'
NOTE:, ` LAST CALLED INSPECTION.,
UFER ' ALL GRADING AND DRAINAGE'SHALL BE INSTALLED
PREGUNITE : TO COMPLY WITH THE APPROVED PLANS AND CIT/OF PERMIT VALIDATION
GARAGE SLABS CUPERTINO STANDARDS. .. i,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB'.
' PLUMBING..
., ELECTRICAL A�,G 1•0 ^'j�T5 41
�" ISSUANCE DATE'
MECHANICAL " - , - FLECL ,;;PLc MECRa
P19f t �. ❑ . ❑
DO NOT POUR FLO OR
IE HAS BEEN SIGNED ,; ty D® IRM4TIONPERMIT
WOOD F LOO IN O
'IVALUATION $/FT.
',PLUMBING r - '
MECHANICAL `j .i: -
_ 'oo . +
ELECTRICAL
PERMIT To
FRAMING - •. .IIV„ kF;(Ix� !M , LNQ.VG
INSULATION': - , ''-'S STORIES rvPE corvsTR '
OCC.GROUP - RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED +1 as
• - ROOF 'NOTE:NO FINALINS, SO ET:EEOOR AREa TO ACRIACE
SHALL BE MADE BEFORE +
DIAPHRAGM THE CONSTRUCTION FAX IS PAID ' ,J
ROOF SHEATHING -F• . S' BUILDING USE
RE . IND ' CON PB O'l—,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS . DATE, INSP: ❑ ❑ El ❑' T ED
ROUGH SAN.q .„,,� As§essoRS PARCEL
NO
PLUMBING. ELECT,ENERGY -” S
.TRACT NOPARCELNO,
TUBSA SHOWER PAN - PLUMBING ENERGY a '
MECHANICAL, MECH.ENERGY
ELECTRICAL BUILDING'ENERGY ' ACC.DATE ACc.FaE No. 1 ''
I, FRAMING ELECT.FINAL TEST - _
- ZONING' ;ENG SITE NO,�
INSULATION • PLUMBING.' .p „
GAS TEST. GAS - - -
MECHANICAL - FIRE SPRINK ENERGVT-aa
COVER NO WORK UNTIL ABOVE HAS-BEEN SIGNED HEATING ❑ No ` ❑� "❑
' . EXTERIOR SHEAR- ELECTRICAL RELEASE ��� FLOOD ZONE - A.L.0 C. 1
INTERIOR SHEAR ` ” y FIRE'DEPT.- ;`.❑.:-,N❑' y ❑ N❑.
SHEETROCK •,I GRADE FEE SUMMARY w
EXTERIOR LATH BUILDING`
5:57
_ r . ILI -'I
INTERIOR LATI'i. - � TEMPORARY APPROVALS : 'v BUDNG
SCRATCH COAT ELECTRIC• - PLAN CHECK I ,
GAS FEE' ij..
NO TAPE OR PLASTER UNTIL ABOVE.HAS BEEN SIGNED OCCUPANCY SEISMIC FEE a -
OCCUP,ANCYOF BUILDING ISNOTPERMITTEDUNTIL BUILDING F.INALISSIGNED.BY BUI LDING INSPECTOR. 'MICROFILM
ARRANGE FOR'INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING .
Z PLEASE GIVE JOB'ADDRESS,WHEN PHONING.
+ MECHANICA'L.
• — SEE±;PERMIT'FOR,EXPIRATION DATE,- . ' �I '
iv {.
.IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE'. mN rr
°
TOTAL
CALLING FOR FINAL INSPECTION a (�,
.OFFICE COPY,
APPLICANT TO FILL,IN INF ATION WITHIN RED LINES - USE L POINT P,EN ONLY
I .BUILDINGPROJECT IDENTI FIC PERMIT NUMBER
9AUILDE5G , » ,APPLICATION &,PE T ^ 6 1' I O
�' �. 9�(.✓��` BUILDING -ELECTRICAL-PLUMBING `MECHANICAL I I
NANEN a', PLAN CHECK VALIDATION ,
\/n ` ECTRIC PERMIT ,FEE .1 I
�. \CA.�IQi✓r. �1 ✓V� "PHONE.' 7 QTY. EL
•
CONTRACTORS.,
I OUTLETS-SWITCHES-'RECEP -10.00/1.00 _
AK1a JJS-"nL ua NG537 ?9 LIGHTING FIXTURES 10.00/1.00
) rADDFI-DNTRacroR's '@awr54/Ctat�lwi t7 • PPLIANCES-RESIDENTIAL 4.00' ' - r
'2 - PHONEass'-pSp PANELS 10.00 .OATE 6F APPLICATION;
ARCHITECT - PLAN CHECK FEE P.C.NO
OR (
�f� � - I 'PANELS (OVER 200 AMP) 20=
ENGINEER
y- uc.No. ' 121 SIGNS.TRANS." 3.00
ARCH OR ENG.• ` ', PERMIT VALIDATION -
AODR sS _ SPECIAL CIRCUIT 5.00
' Z Y-6,4 ti-A-4 ZIP clej7jr TEMP.METER OR POLE INS: 20.00j-
avvucarvrs MOTORS SEE FEE SCH. //�� �•/
ADDRESS 6YK[ / [y" • U.QJ/. Ai' e•�a..a,.J • '
- ES' SERVICE CHANGE " 20.00 l///JI- VIN.
r02 T;" .YIa-1 hNSYD ON CTORS DECLAR TIONler
< u I'hapeby affirm that I am licensed under provisions of Chapter 9 ISS PNCE DATE '.
(commencing with Section 7000)of Division 3 of the Business and - LOG.„ ELECT. PLG MECH.
H m zT' Professions Code nd"my license is in full fo eft ❑ ❑ ❑
License Qlas� Lic.Number - _
O � H Dale'P/RX -- Cnnhacto s - '•
a a,s -+- - - - •' •' UILDING'PERMIT
¢:¢ w OWNf:RBUILDER DECLARATION ' \`�� ',•INFORMATION'
K ; LL y I hereby,off
m that 1 am exempt from the Contractor's License MISC. REFER TO Q VALUATION
0�ia4 Law foethe tollowing reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE• 10.110 Q / $/FT.
0 Code:Any city or countywhlch recuiresapermit to construct,alter,
- I�,`{, l•l�
rt Q, Improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTE. �• LIC.NO. r• ELEC-
0¢' requires the applicant for such permit to file a signed statement that ' TOTAL
a W m LL he Is licensed pnrsnant to the provisions Of lire Contracto!s License _ - PERMIT TO
Law(Chapter 9(eommencing with Section 7000)of Division of the - ?
f i,o Business and Professions Code)or that he is exempt therefrom and LUMBING PERMIT - FEE ��
¢r o [he basis for the alleged exemption.Any violation of Section 7QTY. P
031.5 .STORIES TYPE CONSTR.
aEm by any applicanCfora permit subjects the applicant to a civil penalty' ALTER-DRAIN (EA.) 5.00 !
of not mom than five hre
undd,dollms($5000.) _
' ❑ 1,as owner of the property,or my employees with wages as .ggCK FLOW PROTECT.DEVICE .4.00 p '
their sole compensation,will do the work,and the'stmcture is no[' OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code:The Contractor's License Law docs 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-
mentsare not intended oroffered for sale,If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 '
or improvement is sold�withln one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.1 2.00 BUILDING USEy�
builder will have the burden of proving that he,did not build or im- - - RES IND CON E Omer
ov or
purpose
.ofsale I INDUSTRIAL WASTE INTER. 30.00 ,•-'O ❑ 1:1
❑ ❑
,as owner of the property,am exclusively contracting with
r, e J 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
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.)- 1.00
' - concocts for such projectswith a contmctons)licensed parsumn io
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 .TRACT NO. " PARCEL NO,
❑ Iain exempt under Sec. ,B.&P,C.flit this WATER HEATER W/VENT 6.00
reason
Owner - - Dare WATER SYSTEM 5.00
ACC.DATE - ACC.PILE NO.
WORKERS'COMPF-NSATION DECLARATION WATER TREATING EOUIP. 5.00 , i
1 hembyaffirm that 1 have a certificate of consent to selbinsure. 20NING ENG.SITE N0.
ora certificate of Workers'Compensation Insurance,or a certified - ,
copy thereof(Sec.3800,Lab.0) -
"' ^�
Policy No Company 1 '
011 ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
z'Z ❑ Ci,, copy s file) with uty inspection division.
p Applicant _��e.. r�'Iy,� .S:-;•9_� MISC.- " REFER TO ORD. Y ❑" 'N.❑ •._J ❑` "•N❑
~ m - -
LU - CERTIFICATE E M EXEMPTION FROWORKERS' PERMIT ISSUANCE 10.00 4000 ZONE a.L.u.c.
,• W'� � COMPENSATION-INSURANCE - PLG.CONTE. .LIC.NO. 'PLG. '
I Z( This section need emw be coninleted'if the permit is,for one - TOTAL• Y❑ N E] Y ❑ N❑-
. hundred dollars IS 100)or less.)
L),0 I certify that in the performance.of the work for which this per- CIM MECHANICAL PERMIT •'FEE FEE SUMMARY
r LL,H mit is issued,1 shall not employ any person in any manna,so as ro
O•w become subject to the Workers'Compensalion Laws of California. PBUILDING.Uate Applicant - - ALTER OR ADD TO MECH. 5.00N NOTICE7TO APPLICANT: If,after making ths Certificate of Ex-emption,you should become subject to the Workers'Compensation APPLIANCE ` 5.00prvisions of the Lalior Code, you_mus[ forthwith comply with -uch provisions or this permit shall be deemed'rev.ked.,' , AIR HANDLING UNIT(TO 10=C.F:M.) 4.00 .CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 ' /,77.d
I hereby affrm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00the performance of the work for which.lhis permit is issued(Sec.3097,Civ.C.). HEATING UNIT(TO 100;000B.T.U.) 8.00
Lender's Name• H EATINGUNIT(OVER�100,000 B.T.U.)9.50 -
' Lender's Address
. --I certify that I have 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 BO ILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 .
hereby authorize representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-rumtioned property for inspection purposes.
(We) agree to save, indemii an 'keep harmless the City of, MISC.- "' REFER TO ORD.
`•." upertino
agaimirt liabil' dgments, costs and expenses which CONST.TAX
_ay in`pn way ue dust said.City in conseq rice of the PERMIT ISSUANCE 10.00 _
1 r tin ih' it. MECH.CONT. LIC.NO. ' iMECH. 1 '
TOTAL " TOTAL 7.7, 0 910
i ature of Appli i/Contractor'. U e -
'' OFFICE COPY