16226 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 1622,6
INSPECTION DIVISION
e1^\{ JOB INSPECTION RECORD
le! /l/ E^�. PERMIT EXPIRATION
JOB ADDRESS to 3m.4cfe edUI
T tk LOT 4t
PERMIT EXPIRES IF WORK
OWNER 51 Iec� CONTRACTOR rn. (,[��t� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I SPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATIONNOTE: ANCE OR 180 DAYS FROM
'
• LIFER � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED 'LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS,
GARAGE SLABSFw
1/
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED fnl!�;I,` -�•'tl
UNDERGROUND /SLAB AUG 88
PLUMBING
ELECTRICAL ` ISSUANCE DATE
MECHANICAL - G eLecT;CitPLaMECR.
❑ ,� ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
PLUMBING WOOD FLOOR VALQAT�N siFT.
MECHANICAL
ELECTRICAL - -T PER", TO
FRAMING
INSULATION STORIES' TYPE CDN TR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $O IT PLom+AReA TUraL ACRenee
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
RUUSE
. CON
• ROOF SHEATHING � � Res IND CON PR on", +
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El ❑ ❑ ❑
ASSESSORSPARCEL NO
ROUGH SAN.#
PLUMBING ELECT,ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING�ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.'DATE ACC FILE NO, I
FRAMING ELECT,FINAL TEST
INSULATION PLUMBING
ZONING ENC.SITE NO.
' -��
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ NE)
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD 70NE A.L U,C.
INTERIOR SHEAR - FIRE DEPT. -
Y❑ N❑ YL N❑
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC _L PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ,
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC y
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL.
— SEE PERMIT FOR EXPIRATION DATE _ ,
IMPORTANT! CONST.TAX,
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. fi
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED,LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT,I DENTI FICATI ON PERMIT NUMBER
or APPLICATION & PERMIT 16226 .6226 '
DREss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
T� lz v wollrr ad %5�.3A
OWNER'S PLAN CHECK VALIDATION
NAME - QTY. ELECTRIC PERMIT FEE
GrvE
CONTAPaUTORs OUTLETS-SWITCHES-RECEP. 10.00/1.00 ,
G uc.ND. LIGHTING FIXTURES 10.00/1.00 `
CONTRACT R's APPLIANCES-RESIDENTIAL 4,00,
ADDRESS �1- �{ (�L.t.Plr�YI7 E�
2D3 go I r e I NE,2 O$ PANELS - 10.00 DATE OF APPLICATION
ARCHITECT + PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENa. SPECIAL CIRCUIT 5.00 ' - PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20-BB
ADDRESS rs MOTORS SEE FEE SCH. TN�}-e�I
ADDRESS
SERVICE CHANGE 20.00
Woo - LICENSED CONTRACTORS DECLARATION -
Q U u ` 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Z w
(commencing with Section 70001 of Division 3 of the Business and G. ELECT. PLG. MECH.
r H z Professions Code,and my license is in full force and effect. - T ❑ '❑
z o m - License Class Lic.Number
D m F� Date Contractor - C+6r OunB
a w 5VI Y 1' BUILDING PERMIT
E w OWNER-BUILDER DECLARATION INFORMATION '
F
;LL _ I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION
ac
J Law forthe fallowing reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE" 10.00 1
Code,Any city or county which requires u permit to construct,alter, -
improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. /� rro
O LL requires the applicant for such permit to Ole a signed statement that ,, TOTAL I �� PERMIT TO
a
w w he is licensed pursuant to the provisions of the )Contractor'svson License y
F Z Q Busi(Chapterand
Pr000mmenCodewith Section is exempt
therefrom the
E 4 o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
r 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES1 TYPE CONSTR.
aF by any applicant for a permit subjects the applicant to a civil penalty
ALTER-DRAIN&VENT-WATER,IEA.) 5.00
of not mom than five hundred dollar,($5001):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sale 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,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who build,Or Improve,thereon,and who lov,Such work F IXTUR ES-PER TRAP 5.00 50,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- 'GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 auaolNG uSE
builder will have the burden of proving that he did not build or im- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00
O 1,as owner of the property,am exclusively contracting with Cl ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business f 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 ir mRtoctods)licensed Pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner Date WATER SYSTEM - 5.00 ACG DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING.EQUIP, 5.00
hereby affirm that I have a certificate of consent to sell-insure, ZONING ENG-SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z Certil' d �y i�flled th the 1 spclion division.
O Aplicact V k MISQ- - REFER TO ORD. Y❑ N❑ Y ❑ N❑
= rn CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LL > COMPENSATION INSURANCE - PLG.CONTR. - LIC.NO. PLG.
a O (This section need not be completed if the permit is for one TOTAL Y❑ N ElY ❑ N❑
Z hundred dollar,($100)or less)
U O 1 certify that in the performance of the work for which this per- QTV MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner sn as to
U become subject to the Workers'Compensation Laws of California.
0 n Date -Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificate-of Ex-
.FZ emption,you should become subject to the Workers''Compensatlon APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE '
C„1 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
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) - 5.00
the
e3097. o C performance of the work for which this permit is issued(See. EATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM-
Lender'sName HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that l have read this application andslate 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.or100,000 B.T.U.)-6.00
hereby authorize representatives of this city to enter upon The 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.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
PERMIT ISSUANCE 10.00
ay in any way accrue against said City in consequence of the
ting offlus permit. MECH.CONT., LIC.NO. MECH.,
g�3- TOTAL TOTAL
a
L
Signature of Applicant/Contruu Date
OFFICE COPY,