16462 POST THIRD NEAR" FRONT OF BUILDING .; PERMIT NUMBER
C11 OF CUPERTINO 1.6462
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS /o/a3 dG �Uo✓ "a "�� - UNIT# _LOT# f
- PERMIT EXPIRES IF WORK:
OWNER �` Q U QS CONTRACTOR E-LL G IS NOT STARTED WITHIN
INSPECTION DA E INSPECTOR INSPECTION RECORD 180 onus of PERMIT ISSu- j
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE - CUPERTINO STANDARDS. ,
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �• "( . - -�
UNDERGROUND /SLAB - • ' '.
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - - BLDG ELEcr. .?Lc. MFCH.:
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR 1 ppa INFORMATION
F �OaLDaTIDN $,FT.
PLUMBING - � �
MECHANICAL OCT ,
ELECTRICALPERnuT TO
City of Peltin
FRAMING. — "•'LT"
INSULATION. ST RIES TYPE CONSTR.
OCC GROUP RES:UNRS,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.FT PLooR ARea .royal acR eACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES-' IND CON -PB Umr:
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ El "❑ El'
ASSESSORS PARCEL NO,
ROUGH SAN.k
PLUMBING .ELECT.ENERGY
TRACT NO. PARCEL NO
TUBSBSHOWERPAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY - -
ELECTRICAL BUILDING ENERGY Acc.UnrE Acc:FILE NO
FRAMING - ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEE GNED HEATING " E] NE]
EXTERIOR SHEAR - ELECTRICAL RELEASE FOOD ZONE ILL UC. ,
INTERIOR SHEAR FIRE DEPT. v ❑ N❑ Y ❑ NQ '
SHEETROCK -" GRADE FEE SUMMARY
EXTERIOR. LATH BUILDING - -
INTERIOR-LATHTEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK'- „I
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE j
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL19SIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION'BY PHONING 252-4505, ELECTRIC
' F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUM61NG
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR„EXPIRATION DATE - MECHANICAL
. .IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE , , ', .
CALLING FOR FINAL INSPECTION. TOTAL.
OFFICE COPY
M•APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFI N PERMIT NUMBER
BUILDING [CATION & P IT 16462
ADDR u
O UILD -ELECTRICAL-PLUMBING-MECHANICAL +.
OWNER's PLAN CHECK VALIDATION
E x !�L dU7��,rj' OTY. ELECTRIC PERMIT FEE
• ONE
corvrnacrOns UTLETS-SWITCHES-RECEP 10.00!1.00
uc.rvo.� LIGHTING FIXTURES 10.00/1.00 -
ro DR 1 PPLIANCES-RESIDENTIAL 4.00
ADD E _
PRONE 'PANELS 10.00 DATE OF APPLICATION "
OR
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.
ENGINEER
LIc.No. SIGNS TRANS. 3.00
ADDRESS esc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
As MOTORS SEE FEE SCH.
ADDR DDR ST
' SERVICE CHANGE 20.00 /p
�oo LICENSED CONTRACTORS DECLARATION la�
a U I hereby affirm that 1 am licensed under provisions of Chapter 9 "Jul
DATE
2 m (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
Hi Professions C y license is in full fore a e eM M 0
F o rA- Licen Classy Lin.Numb S`-' LD
9 m H w Datce " `�Confraaor v
m f 4 BUILDING PERMIT
tc w OWNIi RBUILUFiR DECLARATION INFORMATION
Wo
se ; P.ar I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO VALUATION $/FT.
H _ o J Law for the following reason.(Sec.7031.5,Businessund Professions PERMIT ISSUANCE 10.00
w Code:Any city or county which requires a permit to consimcl,alter, _
aa, ¢ FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. -
a n O M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License - _
H z Q Law(Chapter 9(comme acing with Section 7000)of Division 3 oft he L
4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE Q
X H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
T by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more titan 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 the work,and the structure is not
intended or offered for sale (See. 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 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
ments are notnt intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
or improvemeis sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING 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,), INDUSTRIAL WASTE INTER. 30.00
❑ 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.BL 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
con tracts for such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM A.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.-
❑ tum exempt under Sec. ,B,&P.C.for Ibis WATER HEATER tl4UftIT 6.00 •�'
reason
OwnerDate WATER SYSTEM 5.00
ACC.GATE ACG FILE NO.
WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
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 ❑ Ce fied copy is herebl fumishe FIRE SPRINK ENERGY T 24
iter h ti ity i
Z Z Ce copy coon division.
MISC.- REFER TO ORD. Q' C] C] ❑
O pp
V. IN V N
� y CERTIFICATEOFFXEMI'TION FROM WORKERS' PERMIT ISSU N E 4.919 FLOOD ZONE A.L.U.C.
IJJ > COMPENSATION INSURANCE 7AIR
C. PLG.G. O (This section need not be completed if the Permit is for one TOTAL V❑ N❑ Y� Z hundred dollars($1001 or less.)L) O 1 certify that in the performance of the work forwhichthisper- HANICAL PERMIT FEEFEE SUMMARY
IL F- mil is issued,I shall not employ any person in any manner so as m become subject to the Workers'Compensation Laws of California.IL Date Applicant TER OR ADD TO MECH. 5.00BUILDING
W NOTICE TO APPLICANT: If,after making this Certificate of Ex-emption,you should become subject to the WorkersCompensationLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
such provisions or this permit shall be deemed revoked HANDLING UNIT(TO 1Op000.F.M.) 4.00
CONSTRUCTION LENDING AGENCY HANDLING UNIT(OVER IQODOC.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sea _ HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.1.119.50 - ELECTRIC
Lender's Address
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING pZ
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU[SEE FEE$CH. MECHANICAL
(We) agree to Save, indemnify and keep harmless the City of misc.- REFER TO ORD.
uperline against liabilities,judgments, costs and expenses whi'h CONST.TAX
a i any way ace 'gain said Ci in F,Cc�Sasequence o t e PERMIT ISSUANCE 10.00
of this unit x.� 'Y 17^ MECH.CONT. LIC.NO. MECH.
/ OC 1 TOTAL TOTAL.
Signa are of App cant/Contractor Date
OFFICE COPY