16268 POST THIS CARD NEAR FRONT'OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 1628
INSPECTION DIVISION_'
'•' JOB INSPECTION RECORD
7.
'� 4^ �' ^ ��� '. PERMIT EXPIRATION
JOB ADDRESS 1r)/�_3- A/= U LFC- - LOT# -,
/ PERMIT EXPIRES IF WORK
OWNER fL '.co"tRAcroR' (2,�-n/j 7; `IS NOT STARTED WITHIN'�
INSPECTION DATE INSPECTOR INSPECTION RECORD- ieo,DAYSOFPERMIT'ISSU-'
'ANCE OR 180 DAYS'FROM
FOUNDATION � � - .• �: � � � - -
NOTE: LAST CALLED INSPECTION.;
UFER•,'- - `ALL GRADING-AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE .TO COMPLY WITH THE APPROVED PLANS AND CITYOFPERn+Ir vALlDnnoN,
CUPERTINO STANDARDS. *' • ..
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND SLAB •' �"
i
PLUMBING.
ELECTRICAL ` (> ISSun�cE unr2
.MECHANICAL �' •S - , BLDG; EcecT. ,PLC MECN �
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Q BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION SIFT.
PLUMBING � �� � _ - - '
MECHANICAL'
ELECTRICAL " M1,,,t. - PERMIT TO
'FRAMING �` ��/ O
INSULATION - - ORIES . TYPE Co"STR. 4
OCC.GROUP -„ ,RES`,UPUIl • I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ASO FT,FLOOR AREA TOTAL ACREAGE,
ROOF' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE +
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID _
BUILDING USE
ROOF SHEATHINGo
• Res± IND cON PB o„a'„
APPLY NO;ROOFING UNTIL ABOVE HAS BEEN SIGNED `FINALS DATE INSP.,. ❑` ❑ - ❑ ❑ ❑
ASSESSORS PARCELNO.
ROUGH SAN.N
PLUMBING .ELECT.ENERGY” - -
TUBS&SHOWER PAN" PLUMBING ENERGY ' - TRACT NO. ,PARCEL NO. I
MECHANICAL' MECH.ENERGY
@
.' ELECTRICAL - -. . � BUILDING ENERGY: .� - a«''!FILE N0. f'
,.'•_.. . '
FRAMING ELECT,FINAL TEST
INSULATION _ PLUMBING. ' :ACC,ZONING " `DATE ACC'ENG.SITE NO.
GAS TEST - - GAS
MECHANICAL',
FIRE SPRINK ENERGY T 24
- . . ' - • •' '' " ,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ ^ NE]
ELECTRICAL RELEASE. : '. FLOOD ZONE AO u.c:
EXTERIOR SHEAR , _i '^ O
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ ° ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH; - BUILDING �•'�y
INTERIOR'L'ATH ' TEMPORARY APPROVALS BUILDING631
SCRATCHrCOAT • _ ELECTRIC ' - PLAN CHECK
- ' GAS FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE CQ
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDINGFINAL ISSIGNED BY BUILDING INSPECTOR; MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC
F ONE WORKING DAY'BEFORE'REQUIRED INSPECTION ". P�UMewc,
I- PLEASE GIVE JOB ADDRESS WHEN PHONING.
ZMECH ANICAL ,
—,SEE PERMIT FOR EXPIRATION DATE
IMPORTANT' �y p coNST.,TAx
' Fif a
PLEASE READ REVERSE SIDE BEFORE j C ,
CALLING FOR FINAL-INSPECTION. TOTAL .,
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE,BALL POINT-PEN ONLY
-
BUILDING PROJECT IDENTI FICATION PERMITNUMBER- .APPLICATION & PERMIT AAA I�AAA
�,
eu TIDING ,p /,
J , AD[�,EES
BUILDIN1fG vh
G-ELECTRICAL-PLUMBING-MECHANICAL -..
' OW
E. - ,
NAME., I PLAN CHECK VALIDATION
CITY. ELECTRICPERMIT FEE
E�' ,PHONE
CONTRA TORTOR'S -
N A1Q7,� OUTLETS-SWITCHES-RECEP 10.00/1.00
1�1'-nuc.N7a`" LIGHTING FIXTURES .10.00/1.00
\ roNTRAcroas -
cl - APPLIANCES-RESIDENTIAL 4.00
I� �r1 6.5.f*
PHONE (JOT PANELS 10.00 DATE OF APPLICATION'
ARCHITECT - PLAN CHECK FEE P.C.NO,
OR - . 1 * PANELS (OVER 200 AMP) 20.00
ENGINEER - "
uc.rvo. - SIGNS TRANS. 3.00
ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS - - SPECIAL CIRCUIT '5.00
'
ZIP TEMP.METER OR POLE INS.. 20.00 ' /` �_'• �.�
ADDRESS" MOTORS .
- •- aoDREss' SEE FEE S
' SERVICE CHANGE 2 .00 � FiIA�a
O¢'z ���/// (l
F O'O *LICENSED CONTRACTORS DECLARATION - )�� y
W
i'w 1 hereby affirm that I am licensed under provisions of Chapter 9 J ISSUANCE DATE
a n (comtnenCing with$ `lion 7000)of Division oC the Business and BLDG. ELECT. PLG. MECH.
H_N'^ Professions Code, ny license is in full for fiM!/ 0
o i w" License ClanLia Number ✓✓✓✓LLLLLL���DVV '' 77El
Dale .pG_Co ntrachn
a m a =1 P BUILDING PERMIT,
w a O NCR-BUILDER DECLARATION ,
o n" INFORMATION
w ; n'� I hereby attain that I am exempt the Contractor's License MISC.- REFER TO ORD
n O e, Law for the following reason.(Sec.703 L5,Businessand Professions VALUATION $/FT.
r - .PERMIT ISSUANCE 70.00
Code:Any city or county which requirese permit m wnsuact,,d q,
¢'0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. ELEC.
y w m u requires the applicant for such permit to file a signed statement that TOTAL PERMIT _
he is licensed pursuant to the provisions of the Contractor's License'
z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe. . �
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ rm the basis for the alleged exemption.Any violation ofSeclion 7031.5 STORIES TYPECONSTR.
d3 _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500)):
0 I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4:00 OCG GROUP RES.UNITS
their sole compensation,will do the work,and t .he structure is not -
intendedor 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-
Plains are not intended oroffered for sale.if,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 200
builder will have the burden of proving that h - . - . .
e did not build or im- BUILDING USE
prove for purpose of sale.), I INDUSTRIAL WASTE INTER3000 RES IND_ CON PB Other
. .
❑ I,as owner of the property,am exclusively contractirig,with' -❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(See.,7044,Business _ LAWN SPRINKLERS-i INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs 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 contractors)licensed pursuant to
the Contractor's License Law. - SEWER-SANITARY-STORM EA..200ft/10.00 - TRACT NO. PARCELNO.
❑ lam exempt under Sec. ,B.&P.C.for Wis ' WATER HEATER 6.00 '
reason
Owner Date WATER SYSTEM 5.00 jACC.DATE ACC_.FILE NO.
WORKERS:COMPENSATION DECLARATION . WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure
or a certificate of Workers'Compensation'Insurance,or a certified ZONING, ENG.SITE NO.
copy thereof(Sec.3500,Lab.C.). 1. . ' -
' Policy No. - Company
0 ❑ copy is hereby frod fed. - _ FIRE SPRINK ENERGY T-30
Z 2 Crtified �I� is BI d ith if ity inspection division. MISC:- REFER TO ORD.
APPlicanl _ �� Y [3 [7] Y ❑ N[3'
UJ CERTIFICATE EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
W � COMPENSATION
PERMIT ISSUANCE 10.00 INSURANCE PLG.CONTR. UC.NO. PLG.
CL.
(This section need not be completed If the permit is for one TOTAL Y❑ ' N❑ Y❑ N❑
hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the work for which this per- CITU. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to
0 U become subject to the Workers'Compensation Laws of California. {Z
C. Date LEx
Applicant BUILDING
ALTER OR ADD TO MECH. 5.00 rv�.+
>_ N NOTICE TO APPLICANT: If,after making this Certificate o -
? emption,you should become subject to the Workers`Compensation APPLIANCE 5.00 VELECTRIC
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=C.F.M.) 4.00 /
CONSTRUCTION LENDING AGENCY - AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 kP0
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 -
3097,CN.C.)' _ r HEATING UNIT„(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address - - -I certify that 1 have read this applicationand state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
ordinances and state'laws relating to building construction, and BOILER-COME(3 H.P.Or 100,000 B.T.U.) '6.00
hereby authorize representatives of this city to enter upon Bic BOILER-COMP(Over 100,000 BTU)SEE FEE$CH. 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"
ay 'n any evio accrue avinst said City in consequence of the PERMIT ISSUANCE 10.00
of ! re sermiL MECH. T.CON -LIC.NO MECH. -�
\X/ r �/� _ _ TOTAL TOTAL
' Sign are of pplicant/ ontractor o Dage
OFFICE COPY