16132 POST THIS CARD NEAQ FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO. 16132
INSPECTION DIVISION
JOB INSPECTION RECORD .
11 C PERMIT EXPIRATION
JOBADDRESS n/ •.IODJ .UNIT# '_LOT#
- pi .�j(� - :PERMIT EXPIRES IF WORK �
OWNER h{ � coNraacroR f1,L(A'W G/yy,LO[/v IS NOT STARTED WITHIN .
INSPECTION TE INSPECTOR ONSPECTION RECO "186 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED 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
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE.
MECHANICAL .FLOG FTTECT. PLG. . MECH ,
❑ 1 ,01 ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR PAID' INFORMATION
PLUMBING VALUATION s/PT.
- AUG q �i '
MECHANICAL AUG 11 19io'
ELECTRICAL - - PERNRI rO
FRAMING YIV Of CIIp6ru,in
INSULATION s*aRIEs TYPE CONSTR.
` , • OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEO I
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.FT EiooR AREA tOiAl ACREAGE
. DIAPHRAGM THE CONSTRUCTION TAXIS PAID
BUILDING USE
ROOF SHEATHING R❑ 11 ❑ND N 11 El
NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Assessoas PARCEL No
ROUGH SAN.p
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN - PLUMBING ENERGY - TRACT NoPARCEL No
.
MECHANICAL MECH.ENERGY,
ELECTRICAL BUILDING ENERGY ACC.DATE ACC.PILE No
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG,SITE NO.
GASTEST GAS _
MECHANICAL FIRE SPRINK ENERGY T 2
❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E E] NEI°
EXTERIOR SHEAR ELECTRICAL RELEASE PLooO zoNe AU C,
INTERIOR SHEAR FIRE DEPT. T❑ N❑ v ❑. NEISHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING ,
INTERIOR LATH TEMPORARY APPROVALS . .BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE'OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING. -
MECHANICAL
PERMIT OR X SEE P F EXPIRATION DATE —
-
IMPORTANT! coNsr.TAX
PLEASE READ REVERSE SIDE BEFORE i' '
CALLING FOR FINAL INSPECTION: TOTAL L
OFFICE COPY.
APPLICANT TO FILL IN INFORMATION-WITHIN RED LINES -.USE BALL POINT,PEN ONLY,
BUILDING PR0PROJECT.1 ENTI FICA710N PERMITNUMSEA
APPLICATION & PERMIT '-
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ' .161,32 .
OWNER'S - _ • • PLAN CHECK VALIDATION
NAME - QTY. ELECTRIC PERMIT i FEE i
�_.�V ��/ - •��,. . .,CONTRACTORPHONE'S •' - n
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
14. uc.No, LIGHTING FIXTURES 10.00/1.00
CTa R's
ADDRESS - ��'] - PPLIANCES-'RESIDENTIAL 4.00 . '
CONTRACTOR
OREs
' P„DNE �DZ^/ PANELS' 10100 , DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P,C:.NO.
on PANELS (OVER 200 AMP) 20.00 - ,
ENGINEER' ,t `• '
LIC.NO. SIGNS TRANS. 3.00 '
ADDREOR SS ENG. - - _ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP, 40,00EMP.METER POLE INS. BO O '�{'' ,..j� �7ry,����
- i APPLICANT'S - , MOTORS SEE FEE SCH. 4,}' /,�I1�1�1 �
t ADDRESS ,
SERVICE CHANGE -' , 20.00 _
.woo LICENSED CONTRACTORS DECLARATION i '" (� l
Q U U 1'hereby afOrm Thal 1 am licensed under provisions of Chapin[') ..- ISSUANCE DATE .•�-
N z a (emitmencin with Section 7000)of Division 3 of the Business and
Q B BLDG. ELECT. PL❑G.^ MECH.
•H N i Professions Cod it Y Iaense is a full Orce'�'1 e
c i h W Date
�.Q_ Llc Number�,7
0 H Date �'/.7/ Contractor., _'( '
a x -�+ - - • BUILDING PERMIT
ac IS OWNER-BUILDER DECLARATION -
o a o INFORMATION
w g; ,I- I hereby attnm that I am exempt from the Contractor's License MISC,-- RE IID
w VALUATION $/FT,
FuOj, Law for the following reason.(Sec.703 1.5,Business and Professions "PERMIT ISSUANCE - 4AiBg '
Code.Any city or county,which requires a permit to comstruct.alter,
,a, ¢Q improve,demolish,or repair any structure,prior To'its issuance,also ELEC.CONTR. LIC.NO. - ELEC.'
wO tr• requires the applicant for such permit to file a signed statement that - ,•'• TOTAL 01e�Tdf � PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License "' '•i •.F'�T
z<
Law(Chapter 9',(commencing with Section 700()of Division3ofthe
f i,o Business and Professions Code)or that lie is exempt therefrom and QTY. PLUMBING PERMIT + FEE . .
a,r � the basis for the alleged exemption.Any violation orSection 7031.5 - - STORIES TYPE CONSTR.
n 3- by any applicant for a permit Subjectsthe applicant to'a civil penally
of not more than five hundred dollars(my em: e
ALTER-DRAIN&VENT-WATER.IEA.) 5.00
❑ I,as owner at the properly,lar work,
employees structure
is not BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
ince sole compensation,will(S the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF;'AREA;COND. 5.00 r
Code:The Contractor's License Law does not apply to an owner of -
properlywthroughhisrwnem byes,provided
whodoessuch Work FIXTURES-PER TRAP "" ' 5,00 SO.FT.FLOOR AREA , TOTAL ACREAGE'
• himself re through his own employees,Provided[hat such improves
mems are not intended or oTl'ered for sale.If;however,the building GAS'-EA:SVSTEM-1INC.4OUTLETS 6.00 ;
or improvement is sold within one year of completion,the owner- GAS-'EA.SYSTEM-OVER 4(EA'.) 2.00 I
builder will have the burden of proving that he did not.build or ino, BUILDING USE
prove for purpose of sale.)., „_;. INDUSTRIAL WASTE INTER. ' 30.00 - RES IND - CON- PB 'CNet
❑ I,as owner of the property,am exclusively conlractin,with ❑ ❑ ❑ .•❑ ❑
licensed contraclors'to construct the project(Sec. 7044,Business LAWN SPRINKLERS:1 INC 5 V.B. 6.00 t• A$$ESSORSPARCEL NO. i
and Piofewions Code:The Contractor'sLicense Law does not apply.
to an owner of propeity who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 S
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft110,00 TRACT NO. PARCEL NO. •.
0 am exempt under Sec. ,BAII.C.for this WATER HEATER W/VENT. 6.00
reason I'
Owner' 'Uate' WATER SYSTEM - > 5.00 -,
' ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION,' .WATER TREATING EQUIP. 5.00 ,• ;
I hereby affirm that I have a certificate of consent m sel&insure. '
or a certificate of Workers'Compensation Insurance,or a certified ZONING - ENO.SITE NO.
copy thereof(Sic.3800,Lab.C.). {
Policy No.-Company' -
0 ❑ Certified�j�Qpy is Item by f ishit • ,. FIRE SPRINK ENERGY T-24
Z Z Cerlifrersl�/cpy, is,fled 'h' it
city insjaction JiOi' -
O Aicunt_(-J MISC.- J REFER TO ORD. YE] IN C] v ❑ No .
F T - PERMIT ISSUANCE -10.00
. CERTIFICATE OF EXEMPTION PROhI-WORKIiR$' : - FLOOD ZONE A.L.0 C. - {„
LU > COMPENSATION INSURANCE .' 'a PLG.CONTR..' ,r.�, ' LIC.NO. PLG. -
1 IThis'sectlon need not be completed if the,perinit is for one - TOTAL Y❑, IN '•Y ❑. N❑
.D Z hundred dollars IS 100)or lessJ J +- -
U O 1 certify that in The performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARV
UL F mit is issued,I shall not employ any person in any manner So as to
U become subject to the Workers Compensation Laws of California. -
III Date - 'Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
}
CO NOTICE TO APPLICANT:,IL after making this Certificate of Ex-
F.
x-F Z e,.v.si ,you should become subject to the Workers Compensation APPLIANCE 5.00 .4 PLAN CHECK
• - such pone io the Lobar Code, you d.eemeorevoke comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000QF.M) '4.00
CONSTRUCTION LEN61NCAOHNCY� - AIR HANDLING UNIT(OVER IO,OWC.RM.),6.00 ,SEISMIC FEE
s
I hereby affirm that there is d construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 _
the performance of the work far which this permit is issued(Sec.' - - - MICROFILM 4
3097,CN.C.I. .. _ HEATING,UNIT(TO 100,000 B.T.U.) 8_.00 ' '
Lender's Name s, -Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC .a�}CID
I certify that I have read this application and state that the above' VENTILATION FAN (SINGLE) 4.00
'
if
lormalion is correct. I agree To comply with all city and county, t PLUMBING
ordinances und'siate laws relating to building construction and BOILER-CUMP,(3 H.P.or 100,000 B.T.U.) 6.00
_. hereby authorize representatives of this city to enter upon'the - gOILER-OOMP IOvar'100,000 BTU)SEE'FEE SCH. ;MECHANICAL ,
above-mentioned property for inspection purposes.
(We)agree'ib save, indemnify and keep harmless the City of MISC.- REFER TO ORD. '
upertii against liabilities,judgments, costs and expenses which CONST.TAX
may in y way a true against said City in consequence of him PERMIT ISSUANCE; 10.00
i flhis per L r MECH.LONT. LIC.NO: MECH. -
�// TOTAL . , t TOTAL �Cp
Igne are of Appl¢ant/Contractor Ute
I
OFFICE COPY " �\