16203 'POST THIS CARD NEAR FRONT OF BUILDING
PERMIT;NUMBER' 1
CITY,_OF , CUPERTINO
INSPECTION DIVISION 620 I
JOB INSPECTION RECORD" i
PERMIT EXPIRATION
JOB ADDR ESS'l I�3 ✓� dL �- �/� IT
UNIT# _LOT# '
• � 60"v
� • - 'P,ERMIT•EXPIRES IF'WORK•'
OWNER' S (TG WE= LZ,d' CONTRACTOR •60"vC - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTORI PECT12N RECORD 180 DAYS OF PERMITISSU-,
FOUNDATION," NOTE: . ' �. 'AII OR .180 DAYS:FROM
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO.COMPLY WITH THE APPROVED PLANS AND CIN OE PEHNIIT VALIDATION
CUPERTINO STANDARDS. - ..
GARAGE SLABS - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' -UNDERGROUND /SLAB
PLUMBING r t
ti
' ELECTRICAL -
CE DATE
MECHANICAL ;
MECRELECT LG, .,•
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING -
VALUATION $/FT,
MECHANICAL
D .
ELECTRICAL- . PEaNnr To IF
FRAMING
-T/c/Y, �ZC-7, '«
INSULATION �STO IES TYPE CONSTR.
`M OCL.GROUP RES.UNITS
PLACE NO SUBFLOOR'UNTIL ABOVE HAS BEEN SIGNED
�.
ROOF NOTE:
FT,FLOOR AREA TOTAL ACPEAGE «.
NOTE:NO FINAL INSP:SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE ,
ROOF SHEATHING R'es IND IDN PB• 1;0,,,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS, DATE INSP. ❑, ❑ ❑ ❑: -❑
ROUGH
ASSESSORS PARCEL NO,
SANA "
PLUMBING 'ELECT.ENERGY . 1
TUBS 8 SHOWER PAN - PLUMBING ENERGY TRACT NO. PARCEL NO
` MECHANICAL MECH.ENERGY I
ELECTRICAL. - ACC:GATE ACC,FILE No
BUILDING ENERGY
• FRAMING ., ELECT.FINAL TEST
INSULATION i•ZONING ENG+SITE NO.,
- PLUMBING" _
GAS TEST ' GAS
MECHANICAL - --7,,,l PRINrc-. ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING El "❑ ` ❑ "❑
EXTERIOR SHEAR . ELECTRICAL.RELEASE FLooG ZGNE
INTERIOR SHEAR FIRE DEPT. - ;, 'Y❑ - N❑ ° ❑ N❑
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
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, .MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; E4ECTRIc i
o� « ONE WORKING DAY BEFORE REQUIRED INSPECTION P�umswG
z 1PLEASE GIVE'JOB ADDRESS WHEN PHONINGs
— SEE PERMIT FOR EXPIRATION DATE — . ' MECHANICAL:
IMPORTANT! �q CONST,TAX
PLEASE READ REVERSE SIDE BEFORE {
«
CALLING.FOR FINAL INSPECTION: ' TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Y
J - BUILDING PROJECT IDENTIFICATION PERMIT NUMER -
BUILDING APPLICATION & PERMIT 168203
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATION
NAMER -
TS a��� QTY. ELECTRIC PERMIT FEE
J oN I
CONTRACTOR S UTLETS-SWITCHES-RECEP 10.00/1.00
/ NA kAE �7 /T 9
-Y+ i7 10177r LIC.NG. J LIGHTING FIXTURES 10.00/1.00
r,D as TOq'SOX O C3ou) PPLIANCES-RESIDENTIAL 4.00
�JO ds �3 PHDrvE c/(/- PANELS - 10.00 DATE OF APPLICATION
ACHITECT r PANELSIOVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO SIGNS TRANS. 3.00
ARCR.OR ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ADORFss
ZIP. TEMP.METER OR POLE INS.' 20.00 �1
APPLICANT 5 MOTORS - SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
rD o o LICENSE CONTRACTORS DECLARATION
F
I hereby g wit[Ilial I am licensed under ProvisionsF sm of Chesser 9 ISSUANCE DATE
y Q i7 (commencing with Section 7000)of Division 3 of she Business and - BLDG.. ELECT. PLG. 'MECH.
D Professions Cod%od my license is in full force,rf e ❑ ❑
icengC�gs '✓ Lic Number "0�� aLo
9 �- are O_/ Lic.Number
2 x L Q BUILDING PERMIT
¢ ¢ w¢ OWNCR-BUILDER DECLARATION INFORMATION
oa" MISC.- REFER TO OR
w S ¢r I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
LT
¢ o¢ Law for the following mason.(Sec.703 L5,Businessand Professions PERMIT ISSUANCE 10.00
Em0J Code:Any city or county which requires a permit o construct,alter,
¢¢Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 'vQ
y y D ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w he is licensed pursuant to the provisions of the Contractor's License
rii Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe ��
¢ Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT • E11E
M 11.-o the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES I TYPE CONSTR.
a ;m by any applicant for a permit subjects the applicant foe civil penalty gLTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(55000.):
ID 1,as owner of the property,or my employees with wages as BACK FLOW.PROTECT.DEVICE 4.00 OCC. HOUP RES.UNITS
their sole con'pensalion,will Jo the work,and the structure is not
intended or offemd for .It (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractors 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 56 FT.fLOOR AREA TOTALACREAGE
• himself or through his own employees,provided that such improve- _
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or ,improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im" RES IND DON PS Other
prove for purpose ofsale.). - INDUSTRIAL WASTE INTER. 30.00
0 1,as owner of the property,am exclusively contracting with F] ❑ ❑ E3 ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to.un owner of property who builds or improves Thereon,and wlm. LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such pro)ems with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
_
the Contractor's License Law.
C I am exempt under Sec..,B&P.C.for this WATER HEATER W/VENT 6.00
reason
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 ofconsant to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Commensal n Insurance,yr a i,Rified
copy they9g[}s�p4 80 ). Fr/�f
Policy N6 r^'^'�J tP S� l�
0 ❑ C it it is here unlslh�eepp - FIRE SPRINK ENERGY T 24
Z Z 0 C_ BIC i h
MISC.- REFER TO ORD.
l l6e '1 i pccUon slon. Y ❑ N❑ [:]YNE]
O ' Applicu !
FyPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
j -RTIFICATE OF FX{iMPTION FROM WORK.
UJ COMPENSATION INSURANC17 PLG.CONTR. LIC.NO. PLG. - Y❑ N❑ Y 13 NE)
O (This section need not be completed if the permit is for one TOTAL
=),Z hundred dollars(S 100)or less.)
0 O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner so as to
0U become subject to the workers'Compensation Laws of California. BUILDING
0. pnaApplicant ALTER OR ADD TO MECH. 5.00
} Us NOTICE TO APPLICANT: If,after making this Certificate of Ilx-
f" ? enspilot,yon should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forlhwilh comply with FEE
3 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE
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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name �� � HEATING UNIT(OVER 1100,000B.T.U.)B.50 ELECTRIC �✓
Lenders Address
I certify that I have read this application and state that(he above VENTILATION FAN (SINGLE)' 4.00
information n correct.1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 - PLUMBING
ordinances and conrec laws relating to building construction, and
hereby and 0rlZC representatives of this city to enter upon fire 'BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgments,costs and expenses which pERM1T ISSUANCE 10.00 CONST.TAX
yin y way accrue against said City in sequence of the
r OIIO ,Ihis,ye s4. ECH.CONT. LIC.NO. - MECH.
<' �� r TOTAL ' TOTAL
Ignamm of Applicant ntractor pate
OFFICE COPY -