16192 _.� POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 1
INSPECTION DIVISION 61
JOB INSPECTION RECORD
T�
Iii • r IOIG 'v . PERMIT EXPIRATION
JOB ADDRESS IO�Zb 1`,, WUl C T'C) UNIT# _LOT*f
'PERMIT EXPIRES IF WORK .
OWNER ^(.\ �' J CONTRACTOR -/-'��IQ'� S �5� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS;FROM
NOTE: ' LASTCALLED 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 .I . . ,I %4 l• I
UNDERGROUND /SLAB PAID
PLUMBING
ELECTRICAL - HAY 2 5 311,
ISSUANCE DATE
MECHANICAL BLDG. ELECT I PLG. MECH
City of
CliperfbnfP ElEl ,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR y. VALUATION $/FT.
PLUMBING' pg�
MECHANICAL- -
ELECTRICAL - PERMIT rO
'.a r .,11 f'• .i
' FRAMING '
INSULATION - STORIES •T VPE CONSTR
- OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE I
49
DIAPHRAGM THE CONSTRUCTION TAX iSPAID
BUILDING USE
ROOF SHEATHING RES IND CDN "PB 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 E 'M El 1
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
TRACI NO. PARCELNO
-
TUBS 8 SHOWER PAN PLUMBING ENERGY'
MECHANICAL MECH.ENERGY '
ELECTRICALBUILDING ENERGY
- ACC DATE ACC,FILE NO
FRAMING ELECT.FINAL TEST '
ZONING ENC.SITE N0.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NY Q' NQ
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOODIONC A,L.0 C.
INTERIOR SHEAR. - FIRE DEPT'. 'Y❑ N� Y.� . N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH ' BUILDING 'I .•
INTERIOR LATH - TEMPORARY APPROVALS B.UILOING .
SCRATCH COAT ELECTRIC 'PLAN CHECK•
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE-HAS SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
�,"I ELECTRIC
ARRANGE FOR INSPECTION BY PHONING 252-4505,
• LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' a, PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING.-
• SEE PERMIT FOR EXPIRATION DATE — `ri" MECHANICAL
_ IMPORTANT! it'd' " corvsr.TAX
PLEASE READ REVERSE SIDE BEFORE ° 3•"
CALLING FOR FINAL INSPECTION. TOTAL" r
OFFICE COPY -
' PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICAT1 N 1019E .PERMIT NUMBER
BOILn)NG I APPLICATION & PERMIT 16192�� ^(,f�
- GOREs `�
UILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'a
Na PLAN CHECK VALIDATION
CONTRACTn_DhjaDR01C) OTA'• ELECTRIC PERMIT VF
'S
PHONE
NAM x•� OUTLETS-SWITCHES,-RECEP 10.00/1.00
L LIGHTING FIXTURES 10.00/1.00
f,ONTRaCTOR'S -
q I PPLIANCES-RESIDENTIAL 4 '
HOrvE PANELS
agCRITECT �` 'OO DATE OF APPLICATION
PANELS (OVER 200 AMP) 20.00 PLANCHECKFEE P.C.NO.
ENGINEER
ARCH.OR ENG, LIC,NO. SIGNS TRANS. 3.00
ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION '
ZIP EMP.METER OR POLE I 20.00 . 1' r/-
nooHessTs MOTORS SEE FE J 4�mf Au y_� 1
SERVICE CHANGE 20.00 11 I `$ SC,
2
0
0 o° LICENSED CONTRACTORS DECLARATION
< I hereby affnn that I am licensed under provisions of Chapter Y ISSUANCE DATE
Z O1 (commencing with ection 7000)of Divisi 3 of t Basin
F 2 Pro@ ns CO 'enu is in full 1 an ' n. ,r BL G. ELECT. PLG. 'MECH.
2 O y Dafen Cas Con No the
w w Late Cont rat
¢ —F
X X w u OWNER-BUILDER DECLARATION BUILDING PERMIT
w°' INFORMATION
3 u y I hereby affirm that I am exempt from the Contractor i License MI — ER TO ORD
u o j Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
A - RMIT ISSUANCE 10.00
my Code: ny city or county whichrequirosa permit loconstnlnLalter,
Q Q ¢Q ImplO demOII5I1,Or repair any StrnCtnre,prlOr IO IIS ISsnanCe,aISO ELE CONTR. - LIC.NO.
o n require the applicant for such permit to file a signcA statement Thal - TOTnL
n w m,G he Is tic seJ pursuant to the provisions of the Contractor s License PERMIT TO
r z a Law(Cha er 9(commencing with Suction 7000)of Livision 3 oC the
s 4 o Business an Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ H m .he basis(ort a alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR.
by any applica for a permit subjums the applicant too civil penalty
of not more tha ivc hundred dollars(55001.1'. ALTER-DRAIN -WATER (EA.) 5.00 '
❑ I,ns owner f the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00
their sole compens �caxr
doot OCC.GROUP RES.UNITS
mended orfferedSns DRAINS-FLOOR,ROOF,AR EA,COND. 5.00Code:TheContractLaw does not apply to an owner ofpropertywho buildsves.hereonvid whodocssuch wk FIXTURES-PER TRAP5 50.FT.FLOOR AREA TOTAL ACREAGEhimself or through hployees,provided.Iwt such improvementsarenotintcndreel far sale.If,however,the building GAS•EA:SYSTEM-1 INC.40UTLETS .00orimprovement is sone year of completion, the owner-
builder will have the burden o roving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA. 2.00 BUILDING USE
prove far purpose of sale). INDUSTRIAL WASTE INTER. 30.00 RES IND Oory O OOr
❑ d as owner of the property, fn exclusively.7044..contracting with ❑ ❑ X11
licensed contractors structl projecl(Sec. 7044,BusppIy LAWN SPRINKLERS-1 IN V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor License Law docs not apply
to an owner of property who builds o 'n.Proves thereon,and who LAWN SPRINKLERS-0
contracts for such Projects with a contra o0licensed pursuant to
the Contractor's License Law. PHANDLING
Efl-SANITARY-S RM EA.200ft/10.00 T-ACTN°. PARCEL NO.
❑ 1amexempt under Sec. BAP.C.for thisreason ER HEATER ENT. 6.00
Owner ER SYSTE 5.00ACC.DATE ACCFILE N0.
' WORKIiRs'COMPIiNSKf10ND1iCLARATION ERTRE ING EQUIP. 5.00 I hereby affirm that 1 have a cerlifica.eof content tosell'-insure,
or a cat' .e f r' GWpypseNq Insurance or a certifiedZONING ENG.SITE NO.
copyy9e CyPolic0 ❑ rtifedcopyishereby'arils)C¢ttcd n y d1, lh t is�.cI n divisionFIRE SPRINK ENERGY R29
O rPlicant-��JLL— C.- - REFER TO ORD. Y NO YO No
OLy CIiRTIFICA EOF EXF:MPI'ION FROM WORKERS' MIT ISSUAN CE10.00 FL00o ZONE A.L.U.C.
LU > COMPENSATION INSURANCE . LIC.NO,D' CI
1 his section need not be completed if the Penni. is for rateY❑ N O Y❑ N2 hen d dollars''100)or less)U O I cert hat in the performance of the work for which this per- MECHANICAL PERMIT FEE FEE SUMMARY
EL mil is issue , all not employ any person in any manner sn as to0become subject to Workers'CompeasationLawsofCalifornia.
IL Date AppER OR ADD TO MECH. 5.00 BUILDING
ZNOTICF.TO APPI(CANT: r making this Ccrtil'icme' Ex_emption,you should become suhire he Workers'CompensationLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you mus rthwilh comply withFEE
such provisions or this permit shall he deemed r ed. HANDLING UNIT(TO 10=11F.M.) 4.00CONSTRUCTION L17NDING AGENCY HANDLINGUNIT(OVERIO=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agencyfarAUST HOOD(WITH DUCT) 5.00.he performance of the work for whi' is permit is issued ISMICROFILM
3097,Civ.C.)./� ��� i /,(�q�. TING UNIT ITO 100,000 B.T.U.) &00
Lender's Namej�/_t�J/JL- �L! r_ _/
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
. 1 certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
honey authorize representatives (
f othis city es enter upon the
above-mentioned property for insp or hi purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL =`
(We) agree to save,.indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.`TAX
may in any way accrue against said City in con peen o the PERMIT ISSUANCE
m 1 gofthlsden it. - MECH.CONT. LIC.NO. MECH.
—
Signntu of Applicant/Com
ntracr to p/r\/[`�1/ TOTAL
OFFICE COPY