16320 POST THIS CARD NEAR FRONT OF BUILDING
' PF.RAIIT NUMBER
CITY OF. CUPERTINO 16320
INSPECTION DIVISION
JOB INSPECTION RECORD.
q � �� oy - PERM I7'EXPIRATION
• JOB ADDR ESS_/O�^�J i_LA!y`�d � UN _ _LOT#k PERMIT EXPIRES-IF WORK-
OWNER S' -le'lLi- V CONTRACTOR L a +IS;NOT STARTED WITHIN
INSPE ION ATE INSPECTOR INMPECTION RECORD 'leo DAYS OF PERMIT iSSU-
ANCE OR 180 DAYS FROM.
,
FOUNDATION NOTE:,LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.'
PREGUNITE., TO COMPLY WITH THE APPROVED PLANS AND CITY OF _ PERMIT VALIDATION
CUPERTINO STANDARDS. - .. L
GARAGE SLABS -
' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (l-1 - H/y�
UNDERGROUND /SLAB - "V -
PLUMBING •i �7 {^
ELECTRICAL - ' I.SSUANC EI DATE
MECHANICAL - BLDG ELECT PLG. MECH ,
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION !JET.
PLUMBING
MECHANICAL ',
PERMIT TO
' 'ELECTRICAL LB
FRAMING PAI
INSULATION , - sT RIES TYPECONSTR,-
OCC.GNOUP 'RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED nity 01 CU OR
SO.GT.FLOOR AREA TOTAL ACREAGE .
• ROOF . NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAXIS-PAID
BUILDING USE
ROOF SHEATHING RES NO CON- PR Dm.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ - ❑ 0-
ROUGH SAN
ROUGHSANASSESSORS PARCELNO
.k
PLUMBING- ELECT.ENERGY
TUBS&SHOW ER PAN PLUMBINGENERGY TRACT NO, PARCEL NO.
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST ZONING ,ENG,SITE NO.
INSULATION,! - PLUMBING,
GAS TEST GAS '
MECHANICAL FIRE SPRINK -EN ERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ❑ N
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE A u.cEEI .
INTERIOR SHEAR FIRE DEPT., Y ❑• "❑ Y ❑ NE]
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING -
p INTERIOR. LATH
TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING — r
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE — a ,,,�;
IMPORTANT! ,'' coNST.Tnx
PLEASE READ REVERSE SIDE BEFORE1G, TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION .PERMIT NUMBER
BUILDING , APPLICATION & PERMIT', ^ ^O
ADDRESS `/ - b (�
o�02 N1 141. �� 6 BUILDING- ELECTRICAL-PLUMBING-MECHANICAL ,..
OWNER'S - PLAN CHECK VALIDATION
NAME r QTY. ELECTRIC PERMIT FEE '
/D SPHONP
CONTRACT fl'S
NAME - OUTLETS-SWITCHES-RECEP 10.00/1.00
} 1✓� uc.NO. LIGHTING FIXTURES 10,00/1.00 - -
noo ESS TOR's' PPLIANCES-RESIDENTIAL 4.00 ;
lNf P„ONE' 36 4 PANELS 10.00 DATE OF APPLICATION
ORc„rrscr - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,c.No. {
ENGINEER
LIC.NO, SIGNS TRANS. - - 3.00
ARCH.ORENG. ,- - .' - PERMIT VALIDATION '
ADDRESS SPECIAL CIRCUIT 5,00
ZIP EMP.METER 08 POLE INS. 20.00 l/•-+'�~”
APPLICANT s IMOTORS ' ' SEE FEE SCH.
ADDRESS
„g SERVICE CHANGE 20.00 /'�
wo o LICENSED CONTRACTORS DECLARATION r/
a u u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
a z w (commencing with Section 7000)of Division 3 of Ilse Business and
¢ n g BLDG. ELECT; PLG. MECH_
r y e Professions Code and my 'cense is in full force aid�-f t.
O w- License Class_ Lic.Number G_3
z _
mH� Date y —�Contractor -
a
¢ ¢ a a OWNER-BUILDER ABUILDING PERMIT
RATION
w— u INFORMATION
a-a LL r 1 hereby'afl 'irm that I am exempt from.the Contractor's License MISC.- REFER TO ORD
LL O Law for the following reason.(Sec.7031.5,Business and ProfessionsPERMIT ISSUANCE 10.00 VALUATION $/FT.
� - -' Code:Anycilyorcounty which requires a permit toconstrucl.alter, _
QQ Q�� Improve,demolish.Or repair any structure,prior to Its Issuance,also FLED.CONTR. LIC.NO. ELEC.
— O S, requires the applicant for such permit to file a signet)statement that TOTAL PERMIT TO
K
he is licensed pursuant to the provisions of the Contractor's License - `
rzi Law(Chapter 9(commencing with Section 7000)cul-Division 3 oflhe �4_i
- a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
F_- any applicant for a permit subjects the applicanttoacivil penally ALTER-DRAIN -WATER (EA.) v
of not more than five 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,.Buslness and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5,00
Code:The Contractor's License Law does not apply to an owner of I
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 56 FT.FLOOR AREA TOTAL ACREAGE
• himselfor 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 IEA.)
builder will have the burden of proving that he did not build or am- BUILDING USE
prove for purpose of sale.). RES. IND CON PS Other
❑ 1,as owner of lire property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑' ❑ ❑ O ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B.�00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds nr improves thereon,and who LAWN SPRINKLERS-OVER 5(contracts for such projects with a contractors)licensed pursuant toSEWER-SANITARY-STORM EA. O
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. " ,B.&P.C.for this WATER HEATER W/VENT
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WOR KF-RS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00 ,
I hereby affirm that I have a certifi4ale of consent In mlf-insure, ZONING
or a certificate oF.Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,
L,Lab.
Policy Nany
No. C ..,S -
0 ❑ C ifed copy is hereby furnished FIRE SPRINK ENERGY T-24
O_ APPlicanlllfl copy is Filed Ih ty. ' 'peclion'division. MISC.- REFER TO ORD. Y N Y ry
PERMIT ISSUANCE
N 1'IFICA'I'E OF ExEMP'rION FROM WORKERS' -_74 FLOOD ZONE A.L.U.C.
UJ > COMPENSATION INSURANCE PLG.CONT LIC.NO PLG.
CIL O (This section need not be completed if the permit is for one ♦ TOTAL d0-- Y❑ N❑ Y❑ N❑
Z hundred dollars($100)or less.) -
U O 1 certify,that in the performance of the work for which this per- QTY MECHANICAL PERMIT' FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
U become subject to Ore Workers'Compensation Laws of California.
w Date - Applicant ALTER OR ADD TO MECH. 5.00 'BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- -
H ? comfort,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of,the Labor Code, you must forthwith comply with AIR HANDLING UNIT ITO IO FEE
U such provisions or this permit shall be deemed revoked. .000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of,lhe work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 .
Lender's NamActio
Lender's Address HEATING UNIT(OVER 100,000 B.T.0-)9.50
ELECTRIC
I certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
. information is correct. I agree to comply with all city and countyPLUMBING f�
ordinances and state laws relating to building construction.,and BOILER-OOMP(3 H.P.ol-100,000B.T.U.) 6.00 0
hereby authorize representatives of this city to enter upon the BOILER-COMP(O4er 100,0008TUI 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.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue agai said City in consequence of the PERMIT ISSUANCE. 10.00
rant of this permit ” MECH.CONT. LIC.NO. MECH1-7 .
TOTAL TOTAL
nature pplicaht ontraclor .Date -
OFFICE COPY Is