16248 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER'CITY OF CUPERTINO
INSPECTION DIVISION :•{ - 16248
JOB INSPECTION RECORD '
.' sp, /OoZol U PERMIT EXPIRATION
JOB ADDRESS � a UNIT# COT#
PERMIT'EXPIRES IFIWOR-
K
OR. L co n/OWNER' I <,r E $ CONTRACT
- IS-NOT STARTED WITHIN
INSPECTION DATE INSPECTOR - INSPECTION RECORD. 'laooaysoFPEgMirlssu-
"
FOUNDATION . ANCE OR 180 DAYS FROM
'NOTE: ' ' ' LAST CALLED INSPECTION.
LIFER'', � ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE, - ' TO COMPLY WITH THE APPROVED PLANS AND CIT'OF PERMIT VALIDATION -
CUPERTINO STANDARDS.
GARAGE SLABS - - •
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1 -±. I'"""'""
�UNDERGRUUND /SLAB
PLUMBING
- ELECTRICAL ' _ ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLO. MECH.
t • - ❑' ❑, ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $/FT,
I. PLUMBING. _ - - r - -
MECHANICAL
�.,. ., PERMIT T '
ELECTRICAL
FRAMING
STORI TYPE CONSTIR ."
- INSULATION _ �.\ �
VCC YG_ROUP RES UNITS
PLACE NO SUBFL000 UNTIL ABOVE HAS BEEN SIGNED
SD.FT FLOOR AREA TOTALACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '
�. DIAPHRAGM.'. THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING ' RES IND CON Pe oma,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' FINALS 'DATE INSP. • ❑ [-1 ❑ ❑
ASSESSORSPARCELNO
ROUGH SAN.# -
. PLUMBING' ELECT.ENERGY
TRACING PARCEL.NO.
TUBS&-SHOWER:PAN - PLUMBING ENERGY
MECHANICAL - A MECH.ENERGY
ELECTRICAL' BUILDING ENERGY ACC;DATE ACC FlLE NO.
'
FRAMING ELECT.FINAL TEST '
ZONING ENG.SITE NO.
INSULATION PLUMBING.
GAS TEST - . GAS ' -
'FIRE.SPRINK ENERGY L 2 -,
MECHANICAL v.[:] NE] -. v ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -
. '.
EXTERIORSHEAR • ELECTRICAL RELEASE FLOOD ZONE A.LUc. '.
INTERIOR'SHEAR FIRE DEPT. - rY 01 N❑I
SHEETROCK GRADE FEE SUMMARY
' EXTERIOR LATH IBUILDING - . .
INTERIOR.LATH TEMPORARY APPROVALS BUILDING
SCRATCH,COAT ELECTRIC PLAN CHECK .
GAS FEE a
!' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE•
,i OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR: MICROFILM .
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I" ONE WORKING DAY BEFORE,R'EQUIRED INSPECTION.
- PLUMBING:' ••
�� PLEASE GIVE JOB ADDRESS WHEN PHONING. `ar
Z MECHANICAL '
— SEE PERMIT FOR EXPIRATION DATE -'
IMPORTANT!' I , CONST. TAX
:PLEASE READ REVERSE SIDE BEFORE ki ° ""'' TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION .PERMITNUMBER
• eDILDING P . APPLICATION & PERMIT 1. 6248
ADDRESS
07 BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S 8l/TUv4-I S PLAN CHECK VALIDATION
""
PHONE - OTV. ELECTRIC PERMIT FEE
C NTH OTOR' UTLETS-SWITCHES•RECEP 10.00/1.00
C r.NA
1� Ic.No.—1 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS p
k .PHONE 4ppp OO PANELS 10.00 DATE OF APPLICATION ...
ARCHITECT PANELS IOVER ZOO AMP) 20.00
OR PLAN CHECK FEE C.NO.
ENGINEER - -
LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG. 5.00 PERMIT VALIDATION
ADDRESSSPECIAL CIRCUIT
ZIP EMP,METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
AOOREss
SERVICE CHANGE 20,00 /
w O O LICIINSBD CONTRACTORS DECLARATION �I� C
Q U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
<U. (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT.- PLG. MECH.
F 7 Z Professions C e license is in full for tett. �1
o
0- W UcensrCl ss Lie.Number ❑, ❑ ❑ 14,1
H Dale �/�Contractor_.\
a y— -' g '�.• BUILDING PERMIT
¢ ¢w¢
OWNER-BUILDER DECLARATION NFORMATION
o U MISC.— REFER TO ORD
X LL H I hereby affirm That I am exempt from "he Contractor's License ATION $/FT.
u O a - Law for the following reason.(Bee.7031.5,Business and Pro Possions PERMIT ISSUANCE 10.0 uQ0
Code:Anycity orcounly which requires a permit to construct.alter,
QpQQ ImproVe,dennolis1,ormpalrany structure,prinrtO its lsSuanCe,also ELEG.CONTR. LIC.NO. ELEC. - �x$O
DLL requires the applicant for such permit to filo a signal statement that TOTAL Caw - pERMITT
N w$ he is licensed pursuant to the provisions of the Contractor's License - ,tv'6
H z a Law,(Chapter 9(commencing with Section 7000)of Division 3 of the
4 O ow
Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 by any applicant for A permit subjects the applicant loo civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than live hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP 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,AREA,COND. 5.00
Code:The Contractor's 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 SO.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.SVSTEM-11NC.40UTLETS 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 CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conlractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lain exempt under Sec. ,B.&P.C.I'or Ihis WATER HEATER W/VENT 6.00
reason
Owner Data WATERSYSTEM5.00 ACC,DATE ACC.FILE NO.
WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to set6insum, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,LuKC.)._ _y \Xy Tg_ V
Policy No. Company_ .�•+
O ❑ Cetlilied Copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O Applicant Y N Y N
~ oa PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C.
LU j CERTIFICATE OF EXEMPTION FROM WORKERS'
UJ _ COMI'IiNSAT10N INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Q (This section need not be completed if the permit is for One TOTAL Y O N❑ V ❑ N❑
:) Z hundred dollars 1S 100)or less.)
U O I certify that in the performance of the work for which"his per OTV. MECHANICAL PERMIT - FEE FEE SUMMARY
LL f mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. �. BUILDING
Dam Applicant ALTER OR ADD TO MECH. 6.00
} tan NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? ca ption.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 10)WOCF,M-) ,^,400
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVERIQOODCEM.) 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.CJ. HEATING UNIT(TO 100,000 B.T.U.)' 8.00
Lender's Name H EATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) S
. information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U,P 6,00 PLUMBING
ordinances and slate laws relating to building construction, and �ya
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,)00 BTU)SEE FEE SCH. MECHANICAL ( S�
above-mentioned property for inspection purposes. r
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
pertino against kabiftie judgments, costs and expenses which' CONST.TAX
ls�,
w cr a iost said City in consequence of the PERMIT ISSUANCE this L MECH.CONT. LIC.NO. MECH. -TOTA3(0,5"0 TOTALnature ofA icanl raclo ate b
OFFICE COPY