16447 POST THIS CARD NEAR FRONT OF BUILDING
• PERMIT NUMBER,
CITY OF, CUPERTINO . 16447
INSPECTION DIVISION
JOB INSPECTION RECORD S p ZU 6
' ` ' /' (J PERMIT EXPIRATION
JOB ADDRESS �- vV UNITtk LOT*t
41&7 PERMIT EXPIRES IF WORK
OWNER r coNTRAcrOFi p Lr (�g.,�� IS NOT STARTED WITHIN ^
`� -S ECTION DATE SPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ,
FOUNDATION ANCE OR 180 DAYS FROM •I
NOTE: - LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EG UNITE TO COMPLY WITH THE APPROVEDP.Ui yD CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. 1
GARAGE SLABS. �
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (�,q�(,Ty�4'Y„f..•C—
UNDERGROUND /SLAB
PLUMBING AMY Of upe i o
ELECTRICAL - ISSUANCE DATE
MECHANICAL - Bwc. ELECT. Pul. MECR,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING
VALUATION •$/FT.
• � - � - I AA
MECHANICAL. . - - I•r1•! 7�S'V
ELECTRICAL - - PERMIT To
FRAMING' l
INSULATION STORIES TYPE CONSTR.
- - UCC GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE S. IT.ELooB AREA TOTAL ACREAGE
DIAPHRAGM
THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND' CON PB Omr•
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 11 1 E ❑ 1:1 1 El
ROUGH SAN.N ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY '
TUBS B SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.onrE ACE.PILE No.
It
FRAMING - ELECT.FINAL TEST
ZONING ENO.SITE N0.
INSULATION - PLUMBING
GAS TEST . GAS
_ MECHANICAL FIRE SPRINK ENERGY T 14
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ N ''[] NO
F LOGO ZONE A,L U C.
EXTERIOR SHEAR ELECTRICAL flELETEE �'j.� I
INTERIOR SHEAR FIRE DEPT. - v❑ N[D Y ❑ N�
SHEETROCK GRADE • - FEE SUMMARY
EXTERIOR LATH BUILDING Z.
,INTERIOR-LATH IFMPORARYAPPROVAL S4v BUILDING ` QD
SCRATCH COAT ELECTRIC PLAN'CHECK /
GAS FEE C
NO TAPEOR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE L 7�
OCCUPANCY.OF BUILDINGISNOTPERMITTEO UNTILBUILDING FINAL ISSIGNED BY BUILDING,INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. F ONE WORKING DAY,BEFORE REQUIRED INSPECTION. PLUMBING '
O PLEASE GIVE'JOB ADDRESS WHEN PHONING.
Z MECHANICAL
•— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! ' coNsr.rnx
PLEASE READ REVERSE SIDE BEFORE Y TOTAL, Z.
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
i/1" ,BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
aUILOIN OL (� APPLICATION & PERMIT
YID- BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 16447
OWNER'S ,y �..
PLAN CHECK VALIDATION
NAm`E
\'(VVQ LJaVK ELECTRIC PERMIT FEE
PHONE U7
CONTRACTORS
NAME I - OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. 2Z LIGHTING FIXTURES 10.00/1.00 r O
nooaiss roR's PPLIANCES-RESIDENTIAL 4.00 _
PHONE PANELS 10.00 DATE OF APPLICATION ::I
ARCHITECT PLAN CHECK FEE P.C..NO.
onPANELS (OVER 200 AMP) 20.00
.S
ENGINEER
4eUe- ok LIC.rvo.C,"q flat SIGNS TRANS, 3.00
ARCDHd
SS ervo. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
z.IP EMP.METER OR POLE INS. 20.00 .x
ADDRESSTS 1}Q rD N /' MOTORS SEE FEE SCH. 1 't.•+
Qf t �4 SERVICE CHANGE
woo LICENSED CONTRALTO S DECLARATION. k O V
¢z I hereby from Ilett I am licensed under provisions of Chapter 9 ISSUANCE DATE
G a w (commencing with Section 7000)of Division 3 of the Business and SEP V RLDG. ELECT. PLG. MECH.
H w z Professions Code,and my license is in full force and effect ❑ El
iw c License Class Lic.Number '1Hy'I
Date-Contractor
a K City Of CU 8�If1. BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
¢o a 0 INFORMATION
E
g LL I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
IL 0 a Law for the followin reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
H - g PERMIT ISSUANCE
Code:Any city orcounty which requires a permit to construct,alter, -
¢s- p improve,demolish,or repair any 51¢mture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. D D 0
0¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License /) '
Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe e/
z er Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 4
¢ F m the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects Ilia applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
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 lire work,and Ilia structure is not
intended or 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 5.00 SG.FT,FLOOR AREA TOTAL ACREAGE
•' himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4 (EA.) 200 BUILDING USE
builder will have the burden of proving that he did not build or im . . .
' RES IND CON PB DIM1er
pre,�0,1,as owner
of sale.). INDUSTRIAL WASTE INTER. •30.00
P-I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. -
end Professions Code:The Contractor's License Law dues 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 contractor(s)licensed pursba it to SEWER-SANITARY-STORM EA.200h/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sec ,BAPWATER HEATER W/VENT 6.00 -
reason
Owner ate.Cfrlhis DWATER SYSTEM 5.00
ALC.DATE ACC:FILE NO.
WORKERS'COMPENSA'fION DfiCLARA'1'ION WATER TREATING EQUIP. 15.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK' ENERGY T-24
Z Z -❑ Certified copy is filed with the city inspection division
p: SC.-
MI ' - REFER TO ORD.
Y❑ N❑ Y ❑ N❑
Q Applicant wPERMIT ISSUANCE 0.00
1
K - CERTIFICAT'E OF Ex EsarrION FROM WORKERS' FLOOD ZONE a.L.U.C.
W > AT
_ COMPENSION INSURANCE PLG.CONTR. LIC.NO. PLD, Y❑ N❑ YO NEI
O Cflds section need not he completed if the permit L
is for ome TOTA
Z) Z hundreddollars IS 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 f mil 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-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING d0
} W NOTICE TO APPLICANT: If,eller making this Certificate of fix. A
emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK ) //
provisions of the Labor Code, you must forthwith comply with FEE �`w0`
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C,F.M.) 6.00 SEISMIC FEE `fo
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.1. HEATING UNIT(TO 100,000 B:T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 6
Lender's Address ELECTRIC 1 Q
• 1 certify that 1 have read thisapplicalion and slate that Ilia above VENTILATION FAN (SINGLET 4,00
Information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction,.and BOILER-OOMPI3 H.P.Or lOQ,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes. BOILER-COMP (Over t00,000BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of 'MISC.- REFER TO ORD. -
upertino against liabilities,judgments, costs and expenses which CONST.TAX
ay in y w y ac rue against said City in copse ence of the
PERMIT ISSUANCE' - 10.00
rano f per I[. ,•s - / MECH.CONT. - LIC.NO. MECH. -
G TOTAL TOTAL
Ignalure of Applicant/Con[mctor Date '
OFFICE COPY