16474 POST THIS CARD NEAR FRONT OF BUILDING
, .•;., PERMIT NUMBER
CITY OF CUPERTINO 164,7�
:INSPECTION""DIVISION
JOB INSPECTION RECORD ' J
!PERMIT EXPIRATION
JOB ADDRESS UNIT# _LOT#
�+— PERMIT EXPIRES IF WORK
�L�c7iCt v
OWNER:. � . CONTRACTOR LCL IS",NOT STARTED WITHIN.
-
INSPECTION DATE INSPECTOR INSPECTION RECORD - '180 DAYS OF PERMITASSIJ ._
FOUNDATIONNOTE:
�ANCE OR'180 DAYS.FROM
• . ..
UFER - ._ � � � .� ALL GRADING•AND,DRAINAGE SHALL BE INSTALLED LAST CALLED INSPEC,T,ION.-
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION 11
CUPERTINO STANDARDS.
GARAGESLABS - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED-
UNDERGROUND /SLAB
IGNEDUNDERGROUND /SLAB
PLUMBING
ELECTRICAL 1-:I. X17 ,'k issuANCE unrE
` MECHANICAL Cu-. BLoc ELECT .. vLcMECR
of ❑ Q. ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' " euaolNc PERMIT
NFORMATION
I
WOOD FLOOR
PLUMBING VALUATION SIFT,
� �.
MECHANICAL
ELECTRICAL ' PERFIIT TO
FRAMING
INSULATION" STORIES TYPE CONSTR:-�
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50,FT FLOOR ARLA TOTAL ACREAGE '.
• _ ROOF NOTE:NOFINAL INSP:SHALL BE MADE BEFORE_ , • ,
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -
BUILDING USE'
ROOFSHEATHING _ RES IND,. CON PB GL.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS • DATE INSP.. ❑ ❑' El ❑ ❑ •I
ASSESSORS PARCEL NO
ROUGH SAN.N I
PLUMBING ELECT.ENERGY ",♦ - '
TRACT NO,, PARCEL NO.
TUBS&SHOWER PAN - PLUMBING ENERGY "
MECHANICAL - MECH.ENERGY '
ELECTRICAL ACC.DATE ACC.FILE NO,
,'BUILDING ENERGY .
FRAMING. • - ELECT.FINAL TEST
ZONING ENG.SITE NO. I
INSULATIONS . � - PLUMBING
,GAS TEST •" GAS '
MECHANICAL - FIRESPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING •• Y ❑ N❑ ❑ " "❑
FLOOD ZONE A.L.0 C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT, YE] No .❑. N❑.
SHEETROCK GRADE FEESUMMARY
' EXTE RI OR'LATH ' BUILDING BUILDING '
INTERIOR LATH .TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC . PLAN CHECK -
- GAS FEE ,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ELECTRIC• OZ ,
• w ARRANGE FOR INSPECTION BY PHONING-252-4505, " , � � 1
' I-� ONE WORKING DAY BEFORE.REQUIRED INSPECTION., PLUMBING
O ' PLEASE GIVE JOB ADDRESS.WHEN PHONING. '
" Z MEC• -SEE PERMIT FOR EXPIRATION DATE_ HANICAL
.` ,♦ - C -
'
IMPORTANT! CONST.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,
+'Y
BUILDINGPRO CT IDENTIFICATION -PERMIT NUMBER
GINGf. APPLICATION &.PERMIT 1 C A A
ADDRESS I U�F °}
r
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNE 'S
NAME - PLAN CHECK VALIDATION,.
_ OTY. ELECTRIC PERMIT FEE
-PRONE
corvrRAcrORs OUTLETS-SWITCHES-RECEP '10.00/1.00
NAME
Lc LID NO.a7p(o'20LIGHTING FIXTURES 1 10.00/1.00 -O
CONTRACTOR'S ,
' ADDflfss APPLIANCES-RESIDENTIAL - 4.00 _
HON
ARCHITECT PANELS 10.00 DATE OF APPLICATION':f':1
OR - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER -.
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG.
ADDRESS - '' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP-. TEMP.METER OR POLE INS. 20.00 /( a/-y✓
ADDRESSTs MOTORS
SEE FEE SCH.
SERVICE CHANGE 20.00
Dai //J 00
0o LICENSED CONTRACTORSDECLARATION '
¢ H ih_410
w ,
Q 2 w 1 herby affirm that I am licensed under provisions of Chapter 9
< e (commencing with Section 7000)of Division 3 of the BISSUANCE DATEusiness and RLOO. . ELECT. PLG. MECH.
r w z rofessions Code d my license is in full fore and effec
a t.
zo i m . icense ss Lie.Number
Contractor C, - ❑ ❑ ❑
ec ¢_w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
E
o: s- w 'I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO OR INFORMATION
F LL o j Law for the following reason.(See.7031.5,B usiness and Professions pERM1T ISSUANCE VALUATION $/FT.
w Le Cade:Any city or county which requires a permit to construct,alteq 1
T ac Q D Improve,demobs',Of repair any alrnet orC,prior IO itS l]snance,aIn ELEC.CONTE. LIC.NO. ELEC. '
o M requires lire applicant for such permit to file"S
statement that TOTAL - -
o, w $ he is licensed pursuant to the provisions of the Contrnctor'S License `� PERMIT TO
t z a Law(Chapter9(Commehcing with Section 7000)of Division3 of tine
Business and Professians Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT -
$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
v3 by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.0
of not more than five hundred dollars(S 500).):
6.
❑ I,as owner of the proper[,,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will IS the work,add
the structure is not DCe.GROUP- RES.UNITS
intended ar of
for sale IS
7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law docs not apply to an owner of '
Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00
himself or through his awn employees,provided that such improve-
SG.FT.FLOOR AREA TOTAL ACREAGE
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS'6.00 '
or improvement is soldwithin one year of completion, file owner-
builder will have the burden of proving that lie did not build or am- GAS-EA.SYSTEM-OVER 4(EA.). 2.00 BUILDING USE
Prove for purpose of Sale.). INDUSTRIAL WASTE INTER. 30.00 ° RES IND CON PB ' Omer
❑ I,as owner of the property,am exclusively contracting with �'
licensed contractors to construct the project(Sec. 7044,BusinessMWATER
KLE M
6.00
and Professions Code:The Contractor s License Law does not apply ASSESSORS PARCEL NO,
to an owner of property who builds or improves thereon,and whoKLE .) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. ITAR0ft/10.00 TRACT No. PARCEL NO.
reason am exempt render Sec. -,B.&P.C.for thisTER 6.00OwnerDate TEM5.00ACC.DATE ACC.FILENOWORKERS'COMPENSATION DECLARATION ATIN5.00
1 hereby affirm that I have a certificate of consent to velf-mame,
or a certificate of Workers'Compensation Insurance,or a certified ZONING I ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). �
Policy No._CompanY I�etU� ..
0 ❑ Cerlifiedcopyisloreby( tisI it FIRE SPRINK 'ENERGY T-24'
z Z 0 Certified Copy is file h I cit inspection division. - e
APPlicunt� /� MISC.- REFER TO ORD. V E] �,� vi N�
stn C E RTI F I CATE OF EX PT ION F ROM WO R K F.RS'' PERMIT ISSUANCE 10.00 - �:
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.N0. PLG. FLOOD ZONE :A.L.U.C.
_
D1 (This section-need Awl be completed if die'permit is for one TOTAL - Y O N❑ Y❑ N❑
Z hundred dollars IS 100)or less.)
U O - 1 certify that in the performance of the work for which this per-
LL Y MECHANICAL PERMIT FEE FEE SUMMARY
LL O mil is issued,I shall not employ any person in any inamer so as to
O ul become subject to the Workers'Compensation Laws Of California.
L Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} Z NOT NOTICE-TO APPLICANT'. If,after making[itis Certificate of Iix-
I- _ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of tine Labor Code, you must forthwith comply with U FEE 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 tOl000GF.M.) 6.00 'SEISMIC FEE' "
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT)' 500
the performance of the work for which this permit is issued d .
See. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000.B.T.U.) 8.00
Lender's Name - - -
Lender'sAddress HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC ,3 S�
-I certify that l have read this application unit state that the above VENTILATION FAN (SINGLE) '4.00 , n
information is correcr.l agree to comply with all city and county - I^ _PLUMBING, -'
Ordinances and state laws relating m building construction, and BOILER
-COMPOH.P.or100,000B.T.U.) 6.00
W.
�• hereby authorize representatives of this city t0 enter upon the
above=mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTUI SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and,keep harmless the City of MISC.- REFER.TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
i ranting of this permit. MECH.CONT. LIC.NO. MECH. -
TOTAL. TOTAL
..� Sign of Appiicanl/Comm r Date -
OFFICE COPY