16379 POST THIS CARD NEAR.FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 16379.
INSPECTION DIVISION
JOB INSPECTION RECORD
L • y' 16 - PERMIT EXPIRATION
' JOB ADDRESS �Q�'Z-3N' �OG"�� >�� UNIT# - _LOT# -
PERMIT EXPIRES IF WORK
OWNER' L(//f-F�,/� ILS CONTRACTOR _j e—A/�y 6-L AS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOR Teo DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR,180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO,COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALUATION
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE,UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - - ,'•''L�'"
PLUMBING
ELECTRICAL', " ISSUANCE DATE
CA
MECHANIL BLDG. ELECT. PLG. MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
I, WOOD•FLOOR .INFORMATION
PLUMBING -
VAWATIDN $/F T.
-
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING -
INSULATION - - STORIES TYPE co"srR
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO FT.FLOORGREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
•' DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUO-DiNG USE
ROOF SHEATHING RES mo CON PB on...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ El ❑ 1:1
ASSESSORS PARCEL NO.
ROUGH SAN.N
PLUMBINGELECT.ENERGY '
TUBS&SHOWER PAN' PLUMBING ENERGY - TRACT No. PARCEL No.
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC,DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONINGENG.SITE NO. '.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� ❑ N
EXTERIOR.SHEAR " ELECTRICAL RELEASE '1np.000ZONE ALU.0
INTERIOR SHEAR- - FIRE DEPT. Y ❑ N❑ v ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN.CHECI I
.. GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC '
O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. b ' PLUMBING '
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL'
T: \
LMPORTANT! .: CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
M I i
CALLING FOR FINAL INSPECTION. TOTAL '
OFFICE COPY
APPLICANT,.TO'FIL'L IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY . (fid 87'
BUILDINGPROJECT IDENTIFICATION - PERMIT NUMBER . -
RUILDING APPLICATION &`PERMIT
aooREss 1079
• O � q! D BUILDING - ELECTRICAL=PLUMBING-MECHANICAL � 54:P
OWN ER'S��" �- PLAN CHECKVALIDATION
NAME yToVVARn r �'Its A OTU- ELECTRIC PERMIT FEE
�I' Uiss"f-trio/ l.lLr'h!L aHONEQ,6f-- 5.1-87s ,
^ NgMErsacroRs OUTLETS-SWITCHES-RECEP -10.00/1,00
L' MB LPD NC. FIXTURES 10.00/1.00
/CONTRACTORS PPLIANCES-RESIDENTIAL, 4.00
_
f S ONE — -1 41 PANELS 10.00 GATE OF APPLICATION. -i�
ARCHITECT PLAN CHECK FEE P,C.NO.
OR - PANELS (OVER 200 AMP) - 20.00
ENGIgEER
MA L. . B TTS LIC.NO.G O SIGNS TRANS. 3.00
ARCH OR
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMITVALIDATI ON
- CAA)6 GA CAI ZIP EMP.METER OR POLE INS. 20.00
APPLICANT'S . . , -
ADDRESS ''' ��-
- - MOTORS SEE FEE SCH. '\/�,`}kp
Z LDO vim, S4174 LL SERVICE CHANGE - 20.00
o O LICENSED CONTRACTORS DECLARATION
1 u sa I hereby affirm that I am licensed under provisions of Chapter 9 ..
¢ w ISS CE DATE
¢ w (Commencing with Section ]000)of Division 3 of the BneineW and - ,BLDG. ELECT. PLO. MECH.
r w z Professions Code,and my license Is m full r nd eft ..
z O m - License lass O LicNumber) ,5.._/ - - EJ,, 0,'
O r Data Co.ntuietorl�LL�Maill _
¢ ¢
in Is OWNER-BUILDER DECLARATION `
BUILDING PERMIT
- o a " INFORMATION
E
; w y I hereby affirm diet 1 am exempt hm. the Contractor's License MISC.- - REFER TO ORD
u O ¢ Law for the following reason.(Sec.]031.5,Business and Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00
Code: e,dem y Or county it any structur e permit ro is issuance,also alter, -
aa ¢ ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
m u he is tic ns dp pursuant
t the permit to f to signed statement i that TOTAL PERMIT TQ
E
he is licensed pursuant to Ing provisions of the Contractor's License _
r i-4 Law(Chard r(coCode)orSuction-is exempt therefrom
of the .
M 4 o Business and hensed Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE `
ILH $ thebasis the ora exemption.tstheaplicnt to action exalt STORIES TYPE CONSTR.
by any applicant fora permit subjectsthe0H.). anttoacivil penu0y ALTER-DRAIN VENYWATER (EA.) 5.00
of not more than five hundred dollars($$00).):
❑- I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.`DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP AES.UNITS
1 intended or Offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law floes not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ 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-I1NC.40UTLETS 6,00
or improvement is sold within one year of completion,the owner- '
• builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). RES IND CON PO Orha,
❑ 1,as owner of(lie property,am exclusively contracting with, INDUSTRIAL WASTE INTER. 30.00 -
licensed Contractors to construct the project(Sec.7044,Business ' LAWN SPRINKLERS-1 INC 5 00 1:1 ❑ASSESSORS 1:1
1 ❑ 1:1NO. ,
and Professions Code:The Contractor's License Law does not apply V.B.. . PARCEL
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS_ -OVER 5(EA.) 1.00
contracts for such projects with a contractoos)licensed pursuant to - -
theContractor'sLicenseLaw. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. 'PARCEL No.
❑. I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT '6,00 -
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 _
I hereby affirm that I have a certificate of consent to self-insure.
or..certificate.(Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. -
- ,A copy thereof(Sec.3800,Lab.C.). . -
Policy No. - Company _
O ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T-24
z Z Cerf ificp copy is 61ed with he city inspection division. - ❑ ❑ ❑ ❑
Applicant Tlrl- —h=6si �l1 A,.! MISC.- REFER TO ORD. v N Y N
to CERTIF-ICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C..
LU COMPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG. '
Q. o .(This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
hundred dyneat($100)pe Iform FEE SUMMARY
UO 1certify that h the te mploynanyftheworkfor which this per. D MECHANICAL PERMIT ' F �e
U. L) mil is issued,I shall not employ any person in any manner so is m
O W become subject to the Workers'Compensation Laws of Calii'ornia:
y Date—Applicant- Applicant ALTER OR ADD TO MECH. %UILDING
} rn NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z emption,you should become subject to the Workers Compensation APPLIANCE .00 8 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE "
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.)
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I n—, FM.) 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 HEATING UNIT(OVER 100,000 B.T.0-)9.50
Lender's Address ELECTRIC
. 'I certify that I have read this application and statethat the above VENTILATION FAN (SINGLE) 4.00
information is correct:1 agree to comply with all city and county BOILEfl-COMP13 H.P.Cr 100,000 B.T.U.) 6.00 -PLUMBING
ordinances and state laws relating to l6uilding constr.
ction, and
hereby authorize representatives of this city In enter upon [he BOILER'-COMP (Over 100,000 BTU)SEE FEE SCM. MECHANICAL
above-mentioned property for inspection purposes.
(We);agree to save, indemnify.and k harmless the City of MISC.- - REFER TO ORD. '
upertino ag 'oat liab" ,judgment osis and expenses which CONST.TAX .
ay in a way e'again sa' City in consequence of the PERMIT ISSUANCE
antin this - MECH.CONT. LIC.NO. MECH. ,
TOTAL TOTAL'
Si atur pplic CbWctor Date
OFFICE COPY