16136 POST THIS RD NEAR FRONT OF BUILDING
PERMIT NUMBER
CI1T OF' CUPERTINO 16136 '
INSPECTION DIVISION'
JOB INSPECTION RECORD
[p
• IV{ ,1, PERMIT EXPIRATION
JOBADDRESS U nl �f�' (CU UNIT t/k LOT 4t
• Q PERMIT EXPIRES IF WORK
OWNER LQ�..S CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE-1 INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED 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
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL D ISSUANCE DATE
MECHANICAL BLOC ELECT PLc. I MECy.
❑ ❑ I ❑ JZ
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED su1LDwD PERMIT
INFORMATION
WOOD FLOOR CU VALUATION SIFT.
PLUMBING -
MECHANICAL -
PERMIT TO
ELECTRICAL -
FRAMING
STORIES LUPE CONSTR
INSULATION '
DCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SOFT FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
a UI LDING USE
ROOF SHEATHING I I RES No CON PB OMv,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El 1:1 El
ASSESSORS PARCEL NO
I
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ELECTRICAL - ACC DATE ACC.FILE NO.
BUILDING•ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENO.SITE NO.
INSULATION PLUMBING
GAS TEST - GAS
FIRE SPRINK ENERGY T 24
MECHANICAL - Y N� Y E No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLoo❑zONE A.L uc
INTERIOR SHEAR - FIRE DEPT.
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS (BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
- - GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDI NG FINAL ISSIGNED BY BUILDINGINSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.'
Z
- SEE PERMIT'FORI EXPIRATION DATE '- MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE °
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE PiLLL POINT PEN ONLY
BUX121NG ROJ CTI NTI FICWN PERMITNUMBER !
' , ILDIN APPLICATION & PEWIT 16136
i 3
M BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNEH'S PLAN CHECK VALIDATION
NAME
•
l•N.lr(, PHONE
QTY. ELECTRIC PERMIT FEE µ
�O1C
cACTORs t UTLETS-SWITCHES-RECEP 10.00/1.00
FIM tido.r /({ LIGHTING FIXTURES 10,00/1.00
ADDDRESSTOps - 'A PPLIANCES-RESIDENTIAL 4.00
AY�HONE_/��y `I � PANELS IO,DD DATE OF APPLICATION.
aRRCHITECT a PANELS (OVER 200 AMP) - 20.00 PLAN CHECK FEE P.O.NO.
ENGI EER
Llc.No, SIGNS TRANS. 3.00
ADC.
ESS Enc. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlv EMP.METER OR POLE INS. 20.00 n
ADDRESS s MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
o i UI 1 `L-CJ
F0o LICENSED CONTRACTORS DECLARATION - ,
a U w I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE GATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MEL
r z Professions Code,��and my license is in full fort a fey.. / ❑ ❑ ❑
oz 2 o, Lie. las / --Lie.Num bcr y _�1-/_
F y f j Date J Contractor
Q M E J {
X OWNER-B UILDIik DECLARATION 1�1 Of COO BUILDING PERMIT
w3 06.h I hereby affirm thin I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
o er Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
LLL J PERMIT ISSUANCE 10.00
Cope:Any miry or county which requirese permit to construct,,also
<0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
i w m u requires the applicant for such permit In file a signed statement that TOTAL PERMIT TO
hews(Chapter
pursuantto enthe provisions of the ).fDivision License
zi the
Business
si(Chand Professions
Codeng )or Section is exempt therefrom
and IK-111-kF `J_
4 Business and Professions Cope)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
a t' the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; _ by any applicant for a permit subjects lire applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).):
❑ 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 Jo Ole work,and the structure is not
intended or offered for sale(Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 SD.FT.FLOOR AREA TOTAL ACREAGE
• himself or Omagh his own employees,provided that such improve:
ments are not intended or offered for sale.If,however,Ore building GAS-EA.SYSTEM-11NC.4OUTLETS 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 he did not build or im- - . - . .
BUILDING USE
prove for purpose of sale.). - RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:Tire Contractor's License Law does not apply
to on owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contraclons)licensed pursuant to SEWER-SANITARY-STORM EA.200N/10.00 ~
the Contmct.r s License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM - 5.00
ACC.GATE ACL.FILE NO,
WORKERS'COMPF:NSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consentto self-insure . ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,Or a certified
copy thereof(Sec.3800,Lab C.).
Policy No. Company
0 O Certified copy is hereby furnished, FIRE SPRINK ENERGY T 24
Z 2 ❑ Certified copy is fled with the city inspection division.p ❑ ❑N v ❑ E]O Applicant MISC.- REFER TO ORD. v N
w PERMIT ISSUANCE � 10.00
cc - CIi R'I'I FICA'1'Ii OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LLI > COh1PENSATION INSURANCE PLG.CONTR. LIC.NO, PLG;
CL Q (This vection need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
D Z hundred doflars($100)or less.)
U O I certify that in the performance of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued.I shall not employ any person in any manner so as to
O U becomes jecy to lie Workers'�p�pen'aJ'On ws of Clifo"rn'La.,
It. D"tc�l.. /¢6y-AI'1'l'°a"t:/-0.`2aV -'-ply cPs_ ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE IU APPLICANT: II,eller making this Certificate
Z emption,you should become subject to the Workers'Compensation JAPPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 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.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and stale 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-COW(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter Inion the 801 LER-COMP IOver 100,000 BTU)SEE FEE SCH.1 I MECHANICAL
-1 above-mentioned property for inspection purposes.
(We) site. to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE ,;gig CONST.TAX
by In any way accrue against said City in Consequence of the
ranting. This permit. - MECH.CONT. LIC.NO. MECH.
TOTAL I Q r TOTAL
Sign• ure of Applicant/ tract to C7 r
OFFICE COPY