16412 POST THIS CARD NEAR FRONT OF BUILDING
` 7 B PERMIT NUMBER
CITY ' OF CUPERTINO . 1641 Z
INSPECTION DIVISION
JOB INSPECTION RECORD
• WO
' ' ''J•J 'ZU PERMIT EXPIRATION
JOBADDRESS l0�a.3' N WOLF - UNIT#* _'LOT# -
PERMIT EXPIRES IF WORK
OWNER C�Z 7' CONTRACTOR Tc, IS NOT STARTED WITHIN '
INSPECTION D#TE INSPECTOR INSPECTION RECORD IUUDAYSOFPERMITISSU-
ANCE OR 100 DAYS FROM
FOUNDATION NOTE: - -
LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY-OF Penn+IT VAI lDn TION
CUPERTINO STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED y - _ yrirJ fb C A
UNDERGROUND /SLABf
PLUMBING dl/,>f GL- — ooh
q ti
ELECTRICAL Tv K �M ..E {$SUANCE DATE'
MECHANICAL Bi ELecr. PLC. MECR._
❑ ❑'
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDDING PERMIT
WOOD FLOOR. . Q O INFORMATION
VALUATION
PLUMBING
MECHANICAL• '
ELECTRICAL _ MIT TO
PEF.g 0
FRAMING
INSULATION - STORIES TYPE CONST.
-OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ,so,ET,ELDOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CDN PB O{n.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED. FINALS DATE INSP. Q ❑ - Q ❑ 1:1
ROUGH SAN.a ASSESSORS PARCEL NO'
-
PLUMBING ELECT.'ENERGY
TRACT NO FARCE NO
TUBS&SHOWER PAN PLUMBING ENERGY -.
MECHANICAL MECH.ENERGY -
- ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO. .
GAS TEST - - - GAS -
MECHANICAL FIRE SPRINK ENERGY T 24 '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, Y "� HARY
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE
INTERIOR.SHEAR FIRE DEPT. Y ❑ N
SHEETROCK - GRADE FEE SUMM
EXTERIOR LATH BUILDING - y—�f'j'INTERIOR LATH TEMPORARY APPROVALBUILDwG
SCRATCH COAT ELECTRIC PLAN CHECKGASNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILMARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE-WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - MECHANICAL
— SEE PERMITYOR EXPIRATION DATE —
IMPORTANT! conisT.TAX
PLEASE READ REVERSE.SIDE BEFORE ?, `' TOTAL
` CALLING FOR FINAL INSPECTION-:
OFFICE COPY,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BIII-UILDING PROJECT IDENTIFICATION -PERMIT NUMBER
.I".ING �&p APP.LICATIONA PERMIT
ADDRESS ^�
IO w9 f� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 16 /n41 2+
oWNEn'S 11 L�" PLAN CHECK VALIDATION
y OTY. ELECTRIC PERMIT FEE
/ . -13C.12TS PHONE
mNrRAcroRs _• } 2 OUTLETS-SWITCHES-RECEP TWOO/1.00 r/0
Ju/ N� V L'� ��--iLlc,��S�J� LIGHTING FIXTURES 10.00/1,00
CONTRACTOR'S
ADDRE$$XjSS�3� APPLIANCES-RESIDENTIAL 4.00
rr ..
CXJ�I J 040Nf44/-VC)DO ' PANELS 10.00 JA110. DATE OF APPLI CATION � I
4H1...ell PLAN CHECK FEE P.C_NO.
oR IPANELS (OVER 200 AMP) 20.00
ENGINEER
LIC,NO, SIGNS TRANS. 3.00
ADDRESS E"O' SPECIALCIRCUIT ' 5.00 PERMIT VALIDATION ' S
ZIP EMP.METER OR POLE INS. 20.00
ADDDRDREESSSS
AMOTORS SEE FEE SCH.
AM
,� SERVICE CHANGE 20.00 ,
Woo LICIiNSED CONTRACTORS DECLARATION. V•MrL F 4 p -
< u• 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
w (Commencing with Section 7000)of Dision 3 of the Business and BLDG. ELECT. PLC. MECH.
Professions Co my license is m f ❑ e f
i m o Lim Clasc t c.N Cr py,� - \. PV21
o Dater= q-� Cnn c t �v
y f BUILDING PERMIT
S,w OWNER-BUILT CLARATION INFORMATION
w ;A y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFERTQPWLV
Foov, Law for the following reason. 7031.5,Business and Professions _ PERMIT ISSUANCE 0 VALUATION $/FT.
Code'.Any city or county wh! lirequiresa permit toconslrmt,aler, ��-! \n0
QQ ¢ 0 Improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. • ELEC. E�❑
m LL requires the applicant for such permit to DIC a signed statement that TOTAL``] �r PERMIT TO.
F
he is licensed pursuant to the provisions of We Contractor's License
F z r
Law(Chapter 9(commencing with Section 7000)of Divisior13ofthe 4 LE�-7;
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for.permit subjects the applicant-toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dullms($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
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 S,DD SQ.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
memSarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA'.1 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- REB IND CON PB Omer
prove 1,as ofor wner
ofsale.), INDUSTRIALWASTE INTER. 30.00 ❑ ❑ 0
❑ d as owner of the property,a.he project
iv Se contracting with
licensed contractors: construct the project(Sea 7044,of apply ; LAWN SPR IN KLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Coop:The Contractor's License Law dour not apply
to anowner of property who builds li improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts far such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200110.00
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 qLL.FILE NO,
-WORKHRS'COMPP.NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate at consent to self-insure, - ZONING
or a certificate of Workers'Compensation Inumanc„ur a crI ified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C�-/ -u�L]
Policy No. _Comp' y� : rT
O ❑ Cerlifi opy is her furnished. FIRE SPRINK ENERGY T24
Z 2 Certif copy is 1 d ��th the city inspection division. -
O A pliwn I9t1LM�: .n MISC.- , REFER TO ORD. Y N� Y ❑ N�
~ rn• � PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.c.
LU > E IPICCO O EXEMPTION FROM WORKERS'
W CON :NSATION INSURANCE: PLG.corvrR. LIC.rv0. PLG.
CL Cl (This section need not be Completed if the permit is for one TOTAL Y C] N� Y E3
hundred dollars IS 100)or less.)
U O, I certify that in the performance of the work far which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL l- Hill is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
a Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} H NOTICE TO APPLICANT: If,after making this Certificate of Ex
F 2 emplion,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 10=11F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10ACC.F.M.) 6.00 SEISMIC FEE '.
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITHDUCT) 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
Lender's Address
HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l have read this application and slate that lho above VENTILATION FAN (SINGLE) 4.00
intbrmation is correct. I agree to comply with.11 city and county PLUMBING
ordinances and state laws rotating to building construction, and BOILER-COMPI3 H.P.Or 100,0008.T,U.) 6.00 -
hcrcby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEEFEE SCH. MECHANICAL
abuve-menliened property for inspection purposes.
011e ree to save indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cuperdnafagarinst Iia hmS,judgments,costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX.
may
ny way ac a against said City in consequence of the
m or this perm MECH.CONT. - LIC.NO. MECH.
� TOTAL TOTAL
S' alure of APp' an/ ommetor Date
OFFICE COPY