16150 POST THIS CARD NEAR FRONT OF.BUILID I'NG
PERMIT NUMBER
CITY `,F CUPERTINO 16150
INSPECTION DIVISION
JOB INSPECTION RECORD
1w� PERMIT'EXPIRATION. '-
JOB ADDRESS,'�I �- � �I_y.(1 'UNIT# - _LOT#
- a PERMIT EXPIRES IFWORK
.OWNER L) ;$ eUNTRACTOR \J �l, �'.fj A . IS ,NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I INSPECTION RECORD 188 DAYS OF PERMIT IiSU '.
FOUNDATION !INCE OR 180 DAYS.FROM
NOTE: • LAST CALLED INSPECTION.
USER ALL GRADING AND DRAINAGE SHALL BE INSTALLED .
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIE InN >•..
CUPERTINOSTA NDARDS.
GARAGE SLABS.. - - hm
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 7—: 17
UNDERGROUND /SLAB r
PLUMBING - AL
- `Lk �{,L.L f
ELECTRICAL - �VV L SSUANCE DATE•'.
MECHANICAL', • _ cuodm BLOC, ELECT PLe. mecR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
" WOOD FLOOR VALUATION $/FT.
PLUMBING - • -
MECHANICAL
ELECTRICAL PERM VIA �I!
FRAMING .,
eKp
- _ STORIES TYPE CONSTR.
INSULATION � ,
` - OCG.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE yq,�FT F1.00R R A TOTAL ACREAGE
ONSTRUCTION TAX IS PAID
�i DIAPHRAGM -
THE C !/ I
ROOF SHEATHING Rua CO use
Nes INo N PR- Go—
APPLY NO ROOFING-UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN,# AS PARCEL NO
PLUMBING ELECT.ENERGY `
TRACT NQ, PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY' 1
MECHANICAL.,• MECH.ENERGY- - 1
ELECTRICAL. BUILDING ENERGY ACC GATE Acc.FaE.No
.FRAMING ELECT.FINAL TEST
ZONING ENG.;ITE�No.
INSULATION - PLUMBING _
GAS TEST - GAS -
MECHANICAL FIRE SPRINK ENERGY T.YA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ Yl❑ NEI
EXTERIOR SHEAR ELECTRICAL RELEASE FL000 zoNE ALU,C.
INTERIOR SHEAR FIRE DEPT.' °❑ N❑ Y 0 ..NO
SHEETROCK ' GRADE, - FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY,APPROVAL BUILDING _OQ.
SCRATCH COAT .. ELECTRIC ' r PLAN CHECK
GAS - FEE �*........-.�.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ,
OCCUPANCY OFBUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM �—
ARRANGE FOR INSPECTION BY PHONING 252:4505, ELECTRIC
LU ONE'•WORKING DAY BEFORE REQUIRED INSPECTION. PLurtnewc
O �, PLEASE GIVE JOB'ADDRESS WHEN PHONING. y;
Z I MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE
IMPORTANT!: .co NST.TAX
C' PLEASE READ REVERSE SIDE BEFORE'
CALLING FOR FINAL INSPECTION. "` TOTA'C
OFFICE COPY
k APPLICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.i -
BUI LDI NG-PROJECT I DENT[FICATION '. - PERMIT NUMBER '
BUILDING. . . I` - - APPLICATION & PERMIT .q O
ADDRESS # 1 VO I f.1 J
V L.LCLO FASMI _ MALL BUILDING —ELECTRICAL—PLUMBING—MECHANICAL 61 C
OWrvER'B - PLAN CHECK VALIDATI
NAME• HO OTY. ELECTRIC PERMIT FEE q�y�bwfk�o tJ• NE'..
NgMERAcrORs F32v N "PHOUTLETS-SWITCHES-RECEP 10.00/1.00
IqJ CO L1Sf-, LTO.NO.' LIGHTING FIXTURES' 10,00/1.00 '
IDDRCONTRACTOR
(�ss TORS APPLIANCES-RESIDENTIAL 4.00
EJI V`2 vU PHONE )�W PANELS 10,00 DATE OF APPLICATION
ARCHIlecr - - - PLAN CHECK FEE P.C.OR
., PANELS (OVER 200 AMP)- 20.00
ENGINEER ^,� c (1
�n/VICV..+ a rX,1 SIGNS TRANS. 3.00
ARCH,OR ENG, PERMIT VALIDATION
1 ADDRESS C SPECIAL CIRCUIT 5.00
VU EM 6w AVE' ZIP Diorl 17 TEMP.'METIER OR POLE INS.' 20.00
.....'�
- ADDRESS r ; MOTORS � SEE FEE SCH.
�� WhJ SERVICE CHANGE 20.00 I
A
0 o LICENSED CONTRACT RS DECLARATION - �' /1__� UuL�/r
<is v I hereby affirm that I am licensed under provisions of Chapter 9 - ��\VVV �T7/`
2 w ( ISSUANCE DATE
st (commencing with Section 700e)i of Division 3'of the Business and
7� Professions Ca BLDG. ELECT. PLG. MECH.
w z my license is in full Com of
z o y - License - Lic.'Num -
El
m r O Uale_ Contract
it CuRdw M w a OWNER-BUILDER'DECLARATION i BUILDING PERMIT
— o a U INFORMATION
F
3 a- w 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD - -
F O C Law for the following reason.(Sec.7031,5,Business and Professions E VALUATION $-/FT. -
PERMIT ISSUANCE 10.00
Code:Any city or county which requires permit to construct,alter, �°
E
¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. , LIC.NO. ELEC. ^�!
iL 0 a, requires the applicant for such permit to file a signed statement that TOTAL
a
X he is licensed pursuant to the provisions of the Coniractoi s License PERMIT TO -
H.zaLaw(Chapter 9(commencing with Section 7000)of Division 3 oflhe _ rn��� �� oI'�
i O Business and Professions Code)or that he is exemptetherefrom and OTY. PLUMBING PERMIT FEE S Jo� Y
f m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES 'TYPE CONSTR.
La by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).);
❑ 1,as owner of the property,or my,employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.CROUP 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,AR EA,CON D. 5.00
Code:The.Contractor's License Law does not'apply to an owner of
. property who builds orimproves thereon,and who does such work FIXTURES-PER TRAP '.00 sg,FT.EL fl TOTAL ACREAGE.
himself or through his own employees,provided that such improve. 7
meal are not intended or offered for Sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS .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 INTER.- 30.00 RES IND CON pa Other
❑ I,as owner of the property,am exclusively contracting with -
licensed contractors to cor,tmel the project IS,,7044,Business LAWN SPRINKLERS-1 INC 5 00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law'does not apply V.B.. .
to an owner ofTroperty who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No: PARCEL No.
❑ lain exempt under Sec. ,BAP.C.for this
reason WATER HEATER W/VENT 6.00 '
Owner .Date WATER SYSTEM .5.00 ACC.DATE ACC.FILE No.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent In self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Ihereof(Sec.3500,Lab.C.).
Policy No. o n any
0 ❑ erlIhedL yish; h iris d FIRE SPRINK ENERGY T-24
Z Z Certifi o file ay inspection division. ,
,FO p ant MISC.- REFER TO ORD. Y0 N� Y ❑ NE]
cc CERTIFICA EOF EXEMPTIONF OM WORKERS', PERMIT ISSUANCE 10.00 - FLOOD ZONE A.L.0 C.
LU COMPENSATIONJNSU ANCE PLG.CONTR: LIC.NO. PLG.
11 O (This section need not be complete if the permit is for one TOTAL Y 0 N 'Y ❑ N
LD Z hundred dollars($100)or less.)
U O 1 certify that in the performance o tilt work for which this per- TY' MECHANICAL PERMIT FEE FEE SUMMARY
LL {- 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.
w Date ' Applicant - ALTER OR Al
BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex- D TO MECH. 5.00
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 U FEE 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 10=C.RM.) 6.00 SEISMIC FEE 3 30 ,
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.L - - vJ HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address - HEATING UNIT(OVER 100,000 B.T.U:)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLET 4.00
. information is state
I agree to comply buildihh'ng
1c city and county 'BOILER-COMP(3 H.P.or 100,000 B T.U.) 6.00 PLUMBING --�^-'
ordinances.and state laws relating-to coo building construction, and -
above-hereby authorize roperty ladies of this city es enter upon the BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. MEC ICAL
above-mentioned property for insp or
purposes.
(We) agree t save, indemnify and keep harmless the City 0f _MISC.- REFER TO ORD
upertino a>�rhs fiabiliti judgnienis, costs and expenses which s PERMIT ISSUANCE 10,0 CONST.TAX L a
may it ani. w' c o• inat sa' Cit in conaequene of ih
•r I \
gr in f th' e t /� ECH.CONT; _ - LIC.NO. TOTAL
\YV1/ TOTAL
Sig acme of A ca oniractor Da[e '
• OFFICE COPY