16537 Pt)STTHISJJRD NEAR FRONT OF BU I LD ING , • PERMIT NUMBER
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DITOF CUPERTINO 16537
INSPECTION DIVISION
JOB INSPECTION RECORD '
f[�J ' PERMIT EXPIRATION !
' JOB ADDRESS ��PL3 'I/I �OLFt y�,b - UNIT# _LOT# � • ' '
PERMIT EXPIRES IF.WORK
owNER �F�' CONTRACTOR IS NOT STARTED WITHIN
I SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - NOTE: ,, ANCE OR 180 DAYS-FROM `
,-
LIFER - - ALL GRADING'AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH.THE APPROVED PLANS AND CITY OF PERMIT VALIDATION,
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING '
ELECTRICAL - - ISSUANCE'DATE
MECHANICAL - BLDG ELECT. PLG.. ME CH
-
❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
INFORMATION
. - WOOD FLOOR - 47� vnwAnoN siEc,
PLUMBING- - -
MECHANICAL - Oki }
ELECTRICAL
FRAMING L3G-
INSULATION STORIES TYPE CONSTR..
OCC-GROUP RES.UNITS
PLACE NO'SUBFLOOR UNTIL-ABOVE HAS BEEN SIGNED
SO.FT FLOOR AREA TOTAL ACREAGE
• _ ROOF NOTE:NO FINALSHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTIONION TAXIS PAID ,
BUILDING USE
ROOF SHEATHING des IND CON PB On..•.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 10 ❑
ROUGH SAN.# - ASSESSORS PARCEL NO.
PLUMBING - ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL NO
MECHANICAL' MECH.ENERGY '.
ELECTRICAL .. BUILDING ENERGY ACC DATE ACC FILE NO, i
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 BEEN SIGNED HEATING Y ❑ N ❑ NO'
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOODZONE A.Luc. i
INTERIOR�SHEAR FIRE DEPT, Y❑ N❑ Y❑• N❑�;
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING `
.INTERIOR LATH. . TEMPORARY APPROVALS BUILDING `!
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 ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Iw—� .ONE WORKING DAY BEFORE REQUIRED INSPECTION. , ;': PLUMBING*PLUMBING*z0 PLEASE GIVE JOB ADDRESS WHEN PHONING. ;, r
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! y CONST,TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO PIL'L'IN INFOMATION V1IITHIN'RED'LINES - USE LL POINT PEN ONLY
BU I LDINGPROJECT I DENTIFIC •PERMIT NUMBER .
a LpWG APPLICATION & PE IT
ADDRESS '
/p ' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 16537
OWrvER' -/. !rv' PLAN CHECK VALIDATION
rvA ' ,lips / r8Y oNESf=a`f QTY. ELECTRIC PERMIT - FEE
NAME ADTDRs - UTLETS-SWITCHES'-RECEP 10.00/1.00 ,
LIC,ND, LIGHTING FIXTURES •10.00/1.00
ACTORS
ADDRESSAPPLIANCES-RESIDENTIAL 4.00 .
ADDRESS
.PHONE PANEL$ 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE - 7,,N?_GINEER
OR PANELS (OVER 200 AMP) 20.00 ,
EN -LIC,NO. SIGNS TRANS:_ ' 3.00
ARCH.OR ENG. 5.00 •PERMIT VALIDATION I
ADDRESS„ • - - SPECIAL CIRCUIT -
iIP' EMP.METER OR POLE INS.„ 20.00
ADDRESS I
ADOREss - MOTORS. '_- SEE FEE SCH.
• .h I SERVICE CHANGE, 20.00 /"
o O .LICENSED CONTRACTORS'DECLARATION ' - ( O/J � �
tc �etHj I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANC ATE
a
y Q y (commencing with Section 70000-or Division 3 of the Business and .. BLDG. ELECT. PLG. MECH.
I- < i Professions Code,and my license is in full force and effect. ❑ ' ❑ ❑
z_vOi License Class" Lic.Number - _
Date Contractor - -
¢ y s BUILDING PERMIT
Ix,Q w ¢
OWNER-BUILDER DECLARATION INFORMATION
MISC.- . REFER TO ORD
w 3 A'�- 1 hereby,affirm that I am exempt from lire Contractor's License _ , VALUATION S/FT.
u o¢ Law for the following reason.(Sea 7031.5,Business and Professions PERMIT ISSUANCE 10.00
y�,4 Code Any city or county which requires o permit to construct,alter,
¢ ¢ a,O improve,demolish,or'repair any structure,prior to its issuance, ELEC.CONTR. LIG NO. - ELEC. �'N .
a w m¢ requires the applicant for such permlLto file a signed Statement that - TOTAL t�T.Rl
IT TO
he is licensed pursuant to lite provisions of the Contractor's License ,
h z r Law(Chapter 9(commencingwith Section 7000)of Division 3 of the¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT PF Etit¢ r $ the basis forthealleged exemption.•Any violation of8ecUon703L5 �3 TYPE CONSTR.
a ; by any applicant for a permitsubjects the applicant to a civil penaltygLTER-DRAIN&VENT-WATER (EA.) 5AB=of not more than five hundred dollars(8500).):❑ 1,as'owner'of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE RES,UNITS
their sle compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR„ROOF,AREA,COND. 5.00Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 50.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,Provided that such improve-
ments are not Intended or offered for sale,11,however,the building GAS-EA.SVSTEM-PINC.40UTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS-EA:SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder,will have the burden of proving that he did not build or air- - RES IND- CON PB 9 Otber
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - -
❑ I,as owner of the property,am exclusively contracting with ''❑ ❑ '❑ ❑, ❑
. licensed contractors to construct lire project(Sec. 7044,Business LAWN,$PRIN KLE RS-1 INC 5 V.B. 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
contracts for such projects with a contractor(s)licensed pursuant to - I-
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. - PARCEL NO.
❑ l am exempt under Sec. _ ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason'
-X 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 eonsenl to sel Finsure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING, ENG'.SITE NO.
copy thereof fSec.3800,Lab.CJ. "
Policy No. � Company
O / ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
ZZ '❑ Certified copy is.filed with the city inspection division. -- REFER TO ORD.
O Applicant MISC. Y'❑ N❑ Y ❑ N❑ -
~ rn- PERMIT ISSUANCE 19.90 - FLOOD ZONE A.L.U.C.
Cr--2 ..CF-RTIFICATF.OP EXEMPTION FROM WORKERS`
W COMPENSATION INSURANCE PLG.CONTR, UC.NO. PLG. Y❑ N 0 V❑ +N❑
D. O '•(This section need not he co catered if the permit is ITOTAL
'or one _
^0'Z hundred dollars IS 100)atlas -
•U O I certify that in the performance of the work for which this per, OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to _
U become subject to the Workers`Compensation Laws of California.
� w Data Applicant - ALTER OR*ADD TO MECH.' 5.00 - BUILDING
} y " NOTICE TO APPLICANT: If,after making this Certificate of Ex- '
•F Z 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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC,FEE '
Thereby 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.). HEATING UNIT(TO 100,000,8.T.U.). 8.00
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have read Ihis application and state that the above VENTILATION FAN (SINGLE) 4.00
information'is correct. I agree to comply with all city and county PLUMBING 0 ..
ordinances and state laws relating to building construction;and BOILER-COMP(3H.P.or1OO,000B.T.U.I 6.00
hereby'authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. ' MECHANICAL
above-mentioned property for inspection purposes. .
'agree to save, indemnify and keep harmless.the City of 'MISC.- REFER TO ORD.perlino against liabilities,judgments, costs,and expenses which CONST.TAX
y in any way accrue ago' t said City in consequence of thePERMIT ISSUANCE 10.00,.(We)
anting of per MECH.CONT. LIG NO. MECH.
TOTAL TOTAL
` ign ur plic t '9 Date., - - '
✓ OFFICE COPY t
- ,