16344 'POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER 4 "
r : , CITY OF CUPERTINO 1634' "
INSPECTION DIVISION .
)' JOB INSPECTION RECOR S T Z®� {l
'
PERMIT-EXPIRATION; ,
JOB ADDRESS U`�Z3-- /' ll� �• C'�� f—� UNI _LOT# .pERM1T EXPIRES,•}F WORK '
OWr ER �� ( V. CONTRACTOR S 0-. (e I� f��07/STA'RTEtj WITHIN,
INSPE TION DA INSPECTOR INSPE IONR CORD t ODAYS OF PERMIT ISSU-7;
' FOUNDATION .. - - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION..
UFER . . .ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF pl PERMIT VALIDATION
PR EGUNITE - CUPERTINO STANDARDS. _ ....•�`�� `
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB trCL
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL • BLDG. ELECT 1, PLGMECR;
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
-WOOD FLOOR INFORMATION
PLUMBING - VALUATION /FT. I
l-ODO
- MECHANICAL - ` - • - _2
ELECTRICAL-
FRAMING,
LECTRICAL FRAMING pAUD -
STORIES, r PECONSTR.
INSULATION •,
NOV 161998
OCC,GROUPRES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED clty'Df, CUp61t100 -
':- . ROOFS - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sU.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM . THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - Res' INO CON PB ' .on,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ ❑ [1 El I-0
ASSESSORS FARCE L NO,
ROUGH SAN.a
PLUMBING - 'ELECT.ENERGY
TUBS&SHOWER PAN - - PLUMBING ENERGY - TRACT NO PARCEL No.
MECHANICAL - MECK ENERGY -
III; •. ELECTRICAL BUILDING ENERGY ACC.DATE ACC,FILE NO,
FRAMING - ELECT.FINAL TEST
ZONING ENG.SITE N0. '
INSULATION - PLUMBING -
GAS TEST - GAS
' FIRE SPRINK ENERGY T 24'
' MECHANICAL Y ❑ N❑ v ❑ NE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOOD zCNE AL,U,C.
INTERIOR SHEAR - FIRE DEPT. - ❑. N❑ Y ❑ `N❑
SHEETROCK - GRADE _ - FEE SUMMARY
EXTERIOR LATH ' BUILDING
INTERIOR LATH, - TEMPORARY APPROVAL BUILDING
SCRATCH COAT ELECTRIC . PLAN CHECK
GAS. .FEE, - ..':�....
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE-
.
OCCUPANCY OF:BUILDINGIS NOT PERMITTEDUNTILBUILDING FI,NALISSIGNED BY BUILDING INSPECTOR, MICROFILM '
ELECTRIC
LU ' ARRANGE, FOR INSPECTION BY PHONING 252-4505,
'� ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING_ --=-
z 'PLEASE GIVE JOB,ADDRESS WHEN PHONING:
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL E3
4
IMPORTANT! CONST.TAX _
PLEASE READ REVERSE SIDE'BEFORE -
CALLING FOR FINAL INSPECTION. TOTAL A
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMITNUMBER
ODRE516344
Dias APPLICATION & PERMIT
�
p 3 k) - �E, � a060 BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S
NAME , J1 PLAN CHECK VALIDATION
MT Ctca) w(A 1'�J' I DTV• ELECTRIC PERMIT FEE r
PHONE _tet / ` q
OrvTRACTORs UTLETS-SWITCHES=RECEP 10.00/1.00 r04 �
AME pppp �Y
(R Lic.ry IOJZ LIGHTING FIXTURES 10.00/1.00 Q
Y CONTRACTOR'S
AOD/REs } II�1
APPLIANCES-RESIDENTIAL 4.00 /
tG7 r1Y1W' 'PI'Q PHONE rLla 6 PANELS - 10.00 - 11DATE OF APPLICATION
ARCHITECT �J
\ • OR PANELS (OVER 200 AMP) 20.00 2 rP PLAN CNECK FEE P.C.NO.
X EN 516
AENGuC. SIGNS TRANS. 3.00
,
ADDRESS
DREss SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
S• EMP.METER OR POLE INS. 20.00
ADDSS MOTORS
SEE FEE SCH.
SERVICE CHANGE 20.00Lie
,•
O i
F0o LICENSED CONTRACTORS DECLARATION PAIn =
a U u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
w Q e. (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r y.z Professions Cosle,�pJ my license is in Ildl fryyy{{k..e��a�yyy if ❑ Vr
p i w o LICL'n asx_L J'1 Lic.Nmnbe
PC I
xi
L H w Dale_ '1+{ugt=Contractor p
w -
OWNER-BUILDER DECLARATION CI BUILDING PERMIT
X ;LL w I hereby affirm that I am exempt from the Contractor's License
MISC.— REFER TO ORD INFORMATION
u o j Law for the fallowing reason.(Sec.7031,5,Businessand Professions - VALUATION $/FT,
t — m p PERMIT ISSUANCE 10.00 e0 3d'o-d-a
8w � Code Any ymYsh cormfywhnystruturep prior
ots issuance,
ED W ao 0 improve,demolish,or repair any structure,prim l0 its issuance,also ELEC.CONTE. LIC.N0. ELEC. l V
$LL requires the applicant for such permit to file a signed statement thus TOTAL V PERMIT TO '
w he is license)pursuant to the provisions of the Contractor's s License
r 2 a Law(Chapwr9(commencingwith Section7000)of Divisian3ofllie �N•rte /edl�C
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE A1�
I the basis for the allege)exemption.Any violation of Section en L5 STORIES TYPE CONSTR.
n 3 by any applicant fora undue dollars ow applicant too civil penalty ALTER-DRAIN VENT-WATER (EA.) 5.00
of not more than five hundred dollars(my con)
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole mm pensation,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
Coda:The Contractor's License Law docs not apply to an owner of
Property who builds or improves thereon,and who docs 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.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
' builder will have the burden of proving oma he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2,00 BUILDING USE
prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00 REB IND CON PB Omn
❑ I,as owner of the properly,am exclusively contracting with 11licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS1 INC 5 V.B. 6.00 ASSESSORS PARCEL 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 contractors)licensed pursuant to
the Contractor's Licclue Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No,
CII am exempt under See...BAP.C.for this
reason WATER HEATER W/VENT 6.00
Owner Ume WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO,
WORKERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm film I have a certificule of consent to self-insure,
or u certificate of Workers'Conpensalion Insurance,Ora certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company��-f'
0 O Certif r py is It rebyf (shed. FIRE SPRINK ENERGY T-24
Z Z ❑ Cc fit I 1 he city inspection division,
t— O Applicant - MISC.- REFER TO ORD. N Y ❑ NQ
CcN CERTIFICATE OF EXEMPTION I7ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG,CONTE, LIC.No. PLG.
CL O ('Phis section need not be complete) i(the permit is for one TOTAL Y N Y E] NE]0 2 hundred dollars($100)or be
U O I certify that in the performmnee of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- 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.
El. Date Applicant ALTER OR ADD TO MECH500 BUILDING ? d'Q
>- W NOTICE TO APPLICANT: If,after makig . .
nthis Certificate of Fx- J
eniption,you should become subject to the Workers'Compensation APPLIANCE 5.00 - PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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(tie work in,which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 3'7 �D
I certify 11,11 1 have read this application unit saute teal the above VENTILATION FAN (SINGLE) 4,00
BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
hereby authorize s representativveec this BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly tar inspection of city to enter upon the
hipurposes. L
(Perfli& to save, indemnify and keep harmless the City of MISC.r REFER TO ORD.
ertin a ainst liabilities,ju ent( costs and expenses which pERM1T ISSUANCE CONST.TAX
y in way ac' a aqui t aid i in consequence of the 10.00
nti f Iris erm' MECH.CONT, LIC.NO, MECH.
TOTAL TOTAL 3
ig re o pelican[Cont a ate
1
OFFICE COPY