16138 POST THIS CARD NEAR'.FRONT OF BUILDING PERMIT NUMBER
V . CITY OF CUPERTINO 16138 '
INSPECTION DIVISION i
JOB INSPECTION RECORD
�i
� P (ERMIT EX R TVON
J08 ADDRESS /0 -3 / WOLF6 (/ UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNERE E'Ly L 'coNrRAcroR o 7 IS NOT STARTED WITHIN I
INSPEC ION DATE INSPECTOR INSPECTION RECORD '180DAYS OFPERMIT'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 CIT'OF PERMIT VALIDATION ,
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING -
�•'
ELECTRICAL P
'SUANCE DATE
MECHANICAL D ELEcr vLc. MECR 1
G�' ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - Of DING PERMIT
INFORMATION
WOOD FLOOR - - `.�`Vt VALUATIONsiET.
PLUMBING
MECHANICAL '0�
ELECTRICAL vee NI I TO
FRAMING - ltnFR 'll 11 U '
INSULATION
STORIES ' TYPE CONSTR.
� -
OCC GROUP RES,UNI TS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO�FI ILOOR AREA TOTALACREACE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE•'
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID -
N
ROOF SHEATHING - - RES INBUILDIG USE
D CON BE . OM.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 El L
ROUGH SAN.p
ASSESSORS PARCEL NO
�
PLUMBING ELECT,ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL - MECH.ENERGY -
ELECTRICAL 0^/Q„_ BUILDING ENERGY ADC DATE Acc FILE NO
FRAMING ELECT.FINAL TEST
zo
INSULATION PLUMBING
ZONING ENG,SrtE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y L "El ` -"D
.FLOOD]ONE A.L U C
EXTERIOR SHEAR ELECTRICAL RELEASE - ?...:.
INTERIOR SHEAR' - FIRE DEPT. M L,r 0' N[:] Y,L NL
SHEETROCK 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 @0
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. 'MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• IW—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
-
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL OfO
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER -
BUILDING PROJECT IDENTIFICATION . APPLICATION & PERMIT
to
16138�[_. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL�+g ` 1 s , f 7.. PLAN CHECK VALIDATION
`1y�11/'/ 1 .I"J, '/ 7» E OTV. ELECTRIC PERMIT FEE FLj1Y -ryas
CONTRACTOR'S 1, F-�1 ,ll l'-'f1-, P�
_� NAME UTLETS-SWITCHES-RECEP 10,00/1,00
�i/orr. m�4�gA uc.N LIGHTING FIXTURES . 10.00/1.00 .
A DRESCTOR's 1,3 W CcLweit PPLIANCES-RESIDENTIAL 4.00
A DRESS 1
/4 PHONEZql& PANELS 10.00 DATEOF APPLICATION
ARRCHITECT PANELS 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
EN I E
LIC.N . O SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
21133 qc6r, EWA S 2JR TEMP. METER OR POLE INS. 2QK
ADDRESS MOTORS SEE rs C.DntlC� a/r.,GA e�11303
APPLICA
SERVICE CHANGE 20.
wo o LICENSED CONTRACTORS DECLARATION V / /[;00
C, 1 hnreb 'Iffinn that 1 ran licensed under rovlslons of Cha t r 9 no
rt u y' p seISSUANCE DATE
(commencing with Suction 7000)of Division 3 of the Business and 9LOC. ELECT. PLG. MECH.
r w i Professions Code d my license is in full for IT t./i ❑ ❑ ❑
O0 yd License ass �'� Lic.Number V
n w Date Contractor
E ¢ w ¢ OWNER-BUILDER DECLARATION
BUILDING PERMIT
°A ° MISC.- REFER TO ORD INFORMATION
X ; LL w I hereby altirnt that 1 am exempt from the CCntrnclor's License N $/FT.
H LL o a Law for the following reason.(Sec.7031.5,Business and ProVALUATIO
fessions
Z1' ot Cade:Any city or county which requiresu permit to construct,alter, PERMIT ISSUANCE 10.00
< 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
I, 0 LL requires the applicant for such permit to file a signed statement that TDTAL PERMIT TO
d w $m he is licensed pursuant to the provisions of the Contractor's License
r• Z r Law(Chapler9(commencing with Section 7000)of Divi,ion ision3 of the
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE `
6 H $ the basis for file alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a
F_ ,. by any applicant for a pentibsuifects the applicant loa civil penalty ALTER-DRAIN (EA.15.00
of not more than five hundred dollars(8500).): -
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE - 4.00
their Sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 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 aO4 FT.FLOOR AREA TOTAL ACREAGE
Consul(or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.It,however,the holding GAS-EA.SYSTEM-1 INC.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
Ll 1,as owner of the property,am exclusively contracting with . .
❑ ❑ ❑ ❑ ❑
licensed 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
contracts for such projects with it contractons)licensed pursuant to
the Contractor's License Law.. - SEWER-SANITARY-STORM EA.2001t/10.00 1 TRACT NO, PARCEL NO.
❑ l am exempt under Sec..,B.&P.C.for this
reason WATER HEATER W/VENT 6.00 1
Owner Dale WATER SYSTEM 5.00 ACC.DATE } ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00 -
hereby affirm that 1 have u certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(se,3800,Lah.C.).�P
Policy No. Company Se
O ❑ Certified copy is hereby forms
�)) -
Z_Z_• ❑ Certified copy is filed with 1 e cTy I n-Ohn1011 FIRE SPRINK ENERGY T-Z<
I--, O App]ica MISC.- REFER TO ORD. Ay.❑ N❑ Y ❑ N❑-
�.T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPHNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y [:] N❑
Z hundred doliars($100)or loss.)
U O 1 certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL mit is issued,I shall not employ any person in any manner SO as to
become subject to the Workers'Compensation Laws of California.
y Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE 10 APPLICANT: If,after making this Certificate of E:x-
? eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions oIthe Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1O=C.F.M.) 6.00 - SEISMIC FEE 30e?s
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,Cw CA HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Address
H EATING UN IT(OVER 100,000 B.T.U.)9.50 `
Lender's Address ELECTRIC
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 iClaim, to building construction, and BOILER-CC3W(3H.P.Or100,000B.T.U.) 6.00
hereby authorize representatives of this city to en ler upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 4
above-mentioned property for inspection purposes.
I(We) agree to Save, indemnify and keep Ilurmless the City of MISC.• REFER TO ORD. r-
Cupertino against Babilitics,judgments, costs and expenses which PERMIT ISSUANCE - 10.00 CONST.TAX
may in any way accrue against said City in Conscy Cance of the
rant of this permit MECH.CONT. LIC.NO. MECH.
��/ TOTAL TOTAL 0/I
Signa ure of Applican/Contractor Datc -
OFFICE COPY