16331 POST THIS RD NEAR FRONT OF BUILDING . PE EMIT NUMBER r
CI1TOF CUPERTINO : 16331 .
INSPECTION DIVISION
JOB INSPECTION RECORD
,•, _ , / •�./ �J�� - - - PERMIT EXPIRATION
JOB ADDRESS �Q.�d3 N, Wd C.fcT I� UNIT# -LOT#
PERMIT EXPIRES IF WORK
OWNER '0/� /Q� '�� .CONTRACTORS Ce_41e_' � - IS. NOT STARTED WITHIN -'
INSPECTION DATE INSPECTOR INSPECTION RECORD 10 DAYS OF PERMIT ISSU 11
FOUNDATION. . ^ ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.'^ `
UFER. - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINOSTANDARDS. -
GARAGE SLABS +
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
• UNDERGROUND /SLAB;.
PLUMBING... ^+w A,
ELECTRICAL
ISSUANCE DATE
MECHANICAL - aLEG, ELECT. PLc. mECH,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED auao PERMIT
WOOD FLOOR INFORRM MATION
VALUATION
PLUMBING
MECHANICAL "
ELECTRICAL - - . PERMIT To
FRAMING-
INSULATION - + STORIES I 11 comsrR,
sty
a no
p OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE . sr.FLooR ARE.. TOTAL ACREAGE
DIAPHRAGM _ - THE CONSTRUCTION TAX IS PAIDIII
.... - - - -
BUILDING USE
ROOF SHEATHING '' RES IND CON AT,El o,�+
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 1:1 '
ASS :
LSSUHSPAHCELNO. .
ROUGH SAN.#
PLUMBING ELECT.ENERGY 1 -
.
-' TUBS 8 SHOWER PAN - � PLUMBING ENERGY THACTNOPARCEL NO
MECHANICAL -- MECH.ENERGY '
A C
_ DATE 'ACC.FILE NO .
ELECTRICAL BUILDING ENERGY:
FRAMING - ELECT.FINAL TEST
ZONING ENG,SITE No.
INSULATION PLUMBING _
GAS TEST'- GAS
FIRE SPRINK ENERGY T.24
MECHANICAL / .
` - - • ,S -
kEXTEERIOR
NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. - Y ❑ NEI "�I
SHEAR,,, - ELECTRICAL RELEASE - FLoou zorvE .A.L.u.c.'
SHEAR FIRE.DEPT. " - 10 NE v0 N❑.
CK - GRADE FEESUMMARY
LATH BUILDING *LATH TEMPORARY APPROVALS sulLDwcOAT ELECTRIC PLAN CHECK
. .. GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505; "° ELECTRIC
LU ONE.WORKING DAY BEFORE-REQUIRED INSPECTION.
z� . PLEASE'GIVE.JOB.ADDRESSWHENPHONING. , PLUMBING'
• — SEE PERMIT FOR EXPIRATION DATE,— MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE 1 Y TOTAL
CALLING FOR FINAL INSPECTION.,
OFFICE COPY
.y. .. .. a _.
APPLICANT TO FILL IN INFO,JWIAATION WITHIN RED LINES - USE' L POINT PEN ONLY .
+, BU/LDING PROJECT IDENTIFIC 'pERMIr NUMBER
BUILDING APPLICATION & PE T 1'6331 ..
ADDRESS• '
BUILDING'- ELECTRICAL-PLUMBING-MECHANICAL '
D R PLAN CHECK VALIDATIOW
A - QTY. ELECTRIC PERMIT FEE
PRONE
C NTRACTOR'S
E , OUTLETS-SWITCHES-RECEP, 10.00/1.00
-� LIC.No, LIGHTING FIXTURES 10.00/1.00
NTRACTT`OORR's APPLIANCES-RESIDENTIAL 4.00 1
-\ PXOxE PANELS - 10.00 DATE OF APPLICATION-
ORRCNITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
EOR erva. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METEWOR POLE INS. - 20.00 _
APPLICANTS - MOTORS. SEE FEE SCH. �,
ADDRESS
SERVICE CHANGE 20.00 ` iJ`A' p�
V 7 p .�
woo LICENSED CONTRACTORS DECLARATION
I //
a i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUAN"CE DATE
a T (commencing with Section 7000)of Division 3 of the Business and _ BLDG. ELECT. PLG. MECH.
F O z Professions C my license is in full -
, 0.- ' Licen Flits, _Lia NnI11M1l ., 'El '' ❑' .
¢ m¢a OWNER•BUILDER DECLARATION - BUILDING PERMIT
o d v INFORMATION
. 0.
; LL I- I hereby affum that 1 am exempt from the Contractor's License MISC._ REFER TO ORD
w VALUATION $/FT.
F u o J Law for the following reason.(Sea 7031.5,Business and Professions PERMIT ISSUANCE 10.00 _
Code:Anycityorcoumy which requires a permit to construct,alter,
¢ 2 Q 0 improve,demolish,or repair any structure,prior to its issuance also ELEC.CONTU ,-LIC.10. ELEC,
A. w m M requires the applicant for such permit to file a signed statement that '• TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License ,
•H i'Q Law(Chapter 9(commencingwith Section 7000)ofDivision 3 tribe
i D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation t ofSection malt ' STORIES TYPE CONSTR.
by any applicant fora permit subjects $5000.licant toacivil penalty - ALTER-DRAIN&VENT-WATER (EA.)i 5.00
of not more than flue hundred property,
o fmy Bur: _ ^
❑ I,as owner of the property,or my employees witll 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-FLOOA,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of - t
' 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
mems arc not intended or offered for sale,If,however,the building GAS-EA.SVSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year oIcompletion,the owner " GAS EASYSTEM-OVER 4(EAP "200 BULLOING USE - -
builder will have.the'burden of proving that he did not build or im- - . . .
RES IND CON PB Omer
prove for purpose of sale.). - INDUSTRIALWASTEINTER. 3
❑ 1,as owner of the property,am exclusively contracting with 11 [1 C1 13 1:1licensed contractors to construct the project(Sec.7044,Business LAWN SPR INKLERS-1 INC 5 V.B. ASSESSORS PARCEL NO.
and Professions Code:1'he Contractor's License Law does not apply r
- to an owner of property who builds or improvesthereon,and who. LAWN:SPRINKLERS-OVER 5(EA.) .00 -
contracts for such projects with a mrGractor(s)licensed pursuont to SEWER-SANITARY-STORM EA /1 .00
the Contractor's License Law, ' TRACT NO, PARCEL NO.
. ❑ Iamexemptunder Se c._,B.&P.C.for this WATER HEATER W/VENT
reason �QD
Owner Date WATER SYSTEM - ACC.DATE ACC.FILE NO.
wORKFRS'COMPENSATR)N DECLARATION WATER TREATING EQUIP. 5.00
.I hereby affirm that I have a certificate of consent to self-insum, - ZONING ENG.SITE N0.
_ ar a certificate of Workers'Compensation Insurance,or a certified -
copy thereof ISec.3 0,Lab.y �<�-
Policy a Cm y r"
❑ er fie y Is at y furnished. FIRE SPRINK ENERGY T 24
Z'ZO Cerh s led i the city inspection division. - MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ .
Applican Y N V N
~ w PERMIT ISSUANCE' FLOOD ZONE A.L.u.C.
Cr f,CRTIFICA'fli OP I PT ION PROM WORKIiRS'
CL COMPENSATION'INSURANCE PAG.•COr+LR. Lj�N PLG, d.Q ❑ ❑ ❑ ❑
1 Q This section need not be completed if the permit is for one I J TOTAL Y N Y N
Z hundred dollars IS 100)or less)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
ly F mit is issued,I shall not employ any person in any nmnner sous to
O Ubecome subject to the Workers'Compensation Laws of California.
LAU,d Dam Applicant ' ALTER OR ADD TO MECH. r 5.00 - BUILDING
}'(n NOTICE TO APPLICANT'. If,after making this Certificate of Ez- _
F ? enmtion,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 1000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE '
T 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 Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have read INS application and state Ih.1 the above VENTILATION FAN (SINGLE) 4.00
information is correct, I agree to comply with all city and,:vounfy PLUMBING
• ordinances and state laws relating to building'conslruct ion, and BOILER-COMP.(3 H.P:OF 100,000 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 properly for inspection purposes.
(We) agree to save indemnify and keep harmless'the City of MISC.- REFER TO ORD.
Cupertino acus[ I lies,juds-Sots, costs and expenses which - CONST.TAX
a wa acer a against Said City im consequence o the - PERMIT ISSUANCE 10.00
tr (this ermit `,V 1. MECH.CONT., LIC.NO. MECH. ,
TOTAL TOTAL
I nota of Applicant/Contractor Date
OFFICE COPY