16233 �,POST THIS CARD NEAR FRONT•OF BUILDING
PERMIT NUMBER -.
CITY. OF CUPERTINO ' . , 16233
INSPECTION`DIVISION
'JOB INSPECTLQCORD
PERMIT EXPIRATION
JOB ADDRESS")v - 'V'V_ ?�`"� UNIT# � _LOT#
�n C` - PERMIT' EXPIRES IF'WORK '°
~ OWNER • v l,!v•;i; coNTR ACT'oR VY
THIN
THIN
INSPECTION DATE I INSPECTOR- INSFIECTIONRECORD 160 DAYS OFPERMIT ISS U-
FOUNDATION • ._ ANCECOR 180 DAVS'FROM
'NOTE: ` - 'LAST CALLED INSPECTION.'::
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
TDCOMPLY WITH THE APPROVED PLANS AND CITY OF PE RMI r VALIDATON3 ,
PR EGUNITE" - CUPERTINO STANDARDS. { Al
.� GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED-
ew
UNDERGROUND /SLAB
PLUMBING - ry - �+
ELECTRICAL r AUG b ¢< !o', I ISSUANCE DATE
• MECHANICAL - - - BLDG ' ELECT PLG.. . MECR.•
` f4ty Of'Cuperh OE p! 0 .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
° INFORMATION
PLUMBING - WOOD FLOOR - .VALLAIIo .. siF;T.
MECHANICAL .. _ u,^ (i,-•
ELECTRICAL - PERMrt o
. FRAMING I
INSULATION � � - � - ;STORIES `TYPE CONSTF•,'•
1 Q• .. e �` OCC.GROUP ' RESIUNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-ROOF .NOTE:NO FINAL INSP.SHALL BEVADE BEFORE so Er.EyooB AREA _roTAL ACREAce
- I
. DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING L RES` NO CON PB dm�^
APPLY:NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS' DATE INSP. E 0 '::E]+: 0, El
,., ASSESSORS PARCEL NO.-• i
•ROUGH SANA
PLUMBING ELECT:ENERGY
'TRACT NO. PARCEL NO.
TUBS&SHOWER PAN - - PLUMBING'ENERGY. i 1. -
MECHANICAL' MECH.ENERGY
ELECTRICAL - BUILDING ENERGY -ACC.DATE ACC,PILE No.
FRAMING '- - _ ELECT.FINAL TEST ZONING - ENG SITE No
INSULATION - PLUMBING , -
GAS'TEST _ - GAS. .
MECHANICAL ' ., EWE SPRINK ENERGYT24
COVER NO WORK UNTIL`ABOVE HAS BEEN SIGNED HEATING " ' ❑ N ❑
•
EXTERIOR-SHEAR ELECTRICAL RELEASE EL000;zorvE, A.L,u.a:
dNTERIOR-SHEAR FIRE DEPT. El - "O Y ❑ ;°"❑°
SHEETROCK i'' GRADE FEE SUMMARY
EXTERIOR,LATH - ' - BUILDING
INTERIOR.LATH : - - TEMPORARY APPROVALS eulLDwc
SCRATCH COAT ELECTRIC ,2 PLAN CHECK
_ ' GAS "FEE"
,4
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED' OCCUPANCY - SEISMIC FEE
^, u OCCUPANCY OF'BUILDING-IS NOT PERMITTED DNTI L BUI LANG FINALS SIGNED BY.BUILDING INSPECTOR 'MICROFILM
ARRANGE FOR. INSPECTION BY PHONING 252-4505 N ELECTRIC
ONE WORKING DAY BEFORE REQUIRED,INSPECTION
G� F
PLUMBING
0 PLEASE GIVE'JOB ADDRESS WHEN PHONING.
z
SEE PERMIT FOR EXPIRATION DATE - u' MECHANICAL
IMPORTANT., ! ' . CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ;e•;
CALLING FOR,FINAL INSPECTION. TOTAL"
`' OFFICE COOLY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
r BUILDING PROJECT I DENTI FICATI ON - - _ ,PERMIT NUMBER
BUILDING 'APPLICATION & PERMIT 1,623,3
BADD
UILLDD n �fqs 1 �� .. Peel[ BUILDING -ELECTRICAL-PLUMBING-MECHANICALPLAN CHECK VALIDATION
/��I 04 ONE L53 IIO3 DTV ELECTRIC PERMIT FEEORS _
NAM 1 q UTLETS-SWITCHES-RECEP 10.00/1.00
L��J-Q �1 LIC,NO. H LIGHTING FIXTURES 10,00/1.00
Ano/n'e's')sTaR's // APPLIANCES-RESIDENTIAL 4.00
p ( PHONE Z U PANELS 10.00 DATE OF APPLICATION
AOR RCHITECT DATE
PANELS (OVER 200 AMP) 20.00 ' PLAN CHEDK FEE P.C.NO.
ENGINEER f 1e-'£ia l+i 5P _ -
YJ IAJypL',pC.r uc NO, SIGNS TRANS.. 3.00
l✓� ARLH.OR ENG. _ PERMIT VALIDATION
6 ADDRESS s SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS, r -29.80' - ' - -
noon ssTs MOTORS SEE FEE SCH. -
s �N�trl(�(
Q a - SERVICE CHANGE 20.00 s
wo o LICENSED CONTRACTORS UECL ION -
a U i, 1 hereby affirm that 1 am licensed under provisions.(Clmpter9 L �•
z w -
¢ u (commencing with Section 700 0)of Division 3 of the Business and ISSUANCE DATE
B
r w i Professions Code,and my license s in full force and effect LDG. ELECT. PLG. MECH.- ❑ •❑
0 Z m W License Class Lia Number - f11Pf 1'
Date Contractor O�
¢ u � aBUILDING PERMIT
¢ e w ¢ OWNER-BUILDER DECLARATION
wO a LiINFORMATION
; N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO
w o¢- Law for the following reason,(Sec.7031.5,Business and Professions VALUATION $/FT.
I- - g PERMIT ISSUANCE
� M�� Code:Any city or county whichtequiresa permit to construct.alter, 40700 I'
rt c ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEG �]. -
0¢ requires the applicant for such permit to file a signed slaterneut that TOTAL, a(f -��
PERMIT TO
e w m y he is licensed pursuant to the provisions of the Contractor's License
_FZ Law(Chapter 9(commencing with Section 7000)of Division 3ofthe L-v
E4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
M$_S the basis for the alleged exemption.Any violation of Section 7031.$ 1 STORIES TYPE CONSTR.
n; � by any applicant fora permit subjects the applicant toacivil penally ALTER-GRAIN&VENT-WATER IEA.) 5.00
of not more than five hundred dollars($500)J: -
❑ 1,as owner of-the properly,or my employees will'wages as BACK F LOW 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,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES,PER TRAP ` 5.00 So.PT.FLOOR AREA TOTAL AcflEAGE
himself or through his own employees,provided that such improve-
mentsarenotintended or offered fofsale.if,however,the building ' GAS-EA.SYSTEM-11NC.40UTLETS 8.00
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 -
provefor purposeofsale.). INDUSTRIAL WASTE INTER. 30.D0 RES IND CON. PB Omer
❑ 1,as owner of the property,ant exclusively contracting with [3 0
licensed contractors to construct the Pr(tj.t IS". 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
toanowner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 '
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0.
WORKF'RS'COMPI:NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconscri to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
ropy there f,,(($$pp Lab C.1. ..1.^ . '
Policy,No.�Zmpan y�(
❑ Certified copy is hereby fumisheil'
Z Z Cerl ifiFIRE SPRINK ENERGY T-24eJ copy is file) w' he city inspection Jivision�
O plicum��E_ �.-- MISE.- REFER TO ORD. N Y [] N�
T CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. .
d O (This section need not be completed if the permit is for one TOTAL
Z hundred dollars($100).,]...,1
L) O I certify that in the performance of the work for which this per- DTV MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manners.as to
become subject to the Workeri Compensation Laws of California.
Go y Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: II',after making this Certificate of Ex-
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 FEE
U 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 10MC.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'Narn
Lender's Address HEATING UNIT(OVER 100,990 B.T.U.)9.50 ELECTRIC da•oo
�~ 1 certify that I hove read this application and state that the above VENTILATION FAN (SINGLE) 4.00 .-
0 information is correct. 1 agree to comply with all city and county BOILER-DOMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances inances and slate laws relating to building construction, and
zj `�ye hereby authorize representatives of this city to enter upon the COMP'IOver t00,W0 BTU)BEE FEE SEH.
t r above-mentioned property for inspection purposes. BOILER- MECHANICAL
(Wo) agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORD. -
Cupertino against liabilities,judgments, costs and expenses which - - CONST.TAX
may in any yJ y Ie unit said City in co uence of the PERMIT ISSUANCE 10.00
ranting t is
MECH.CONT. - LIC.NO. MECH.
TOTAL
SigmUllreof AOpfkadlC tor/ V Date b - TOTAL o0
OFFICE COPY