16548 POSTPOST T ARD NEAR FRONT OF BUILDING PERMIT NUMBER
C'IW OF CUPERTINO 16548
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB.ADDRESS OI N YC UNIT#- • LOT*f
,-7VA'U(s .—P L�OdLW� TOR ��j PERMIT EXPIRES IF WORK ,
OWNER �' L T-86 IS NOT STARTED WITHIN
INSPECTION DA INSPECTOR INSPECTION RECORD 180 DAYS'OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE'INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS _ -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -UNDERGROUND /SLAB
PLUMBING -
r
ELECTRICAL '
ISSUANCE DATE
MECHANICAL - —TIFE7T777777G. I MECR
• ❑. El ❑ El I
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
WOOD FLOOR Pity INFORMATION
PLUMBING ATION S/FT.
MECHANICAL
ELECTRICAL \ ERMITTO
FRAMING ?Z-6G—
�, INSULATION _ STORIES TYPE CONSTR. ,
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
.$p,FT,FLOOR AREA TOTAL ACR EAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
I . DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB •0,11,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH SAN.# '
PLUMBING ..ELECT.ENERGY '
I . PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC.DATE ACC.FILE NO.
FRAMING - ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PL"UMBING
GAS TEST- GAS
MECHANICAL FIRE SPRINN ENERGY.T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE
FLOOD zorvE A.L u.c.
INTERIOR SHEAR FIRE DEPT, `" ❑ "❑ '" ❑ "❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING ,
INTERIOR LATH TEMPORARY APPROVALS BUILDwG
SCRATCH'COAT ELECTRIC, PLAN CHECK .
_ GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, p� ELECTRIC
UJI
F-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
zo PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE MECHAwcaL
IMPORTANT!
coNST.rAx
PLEASE READ REVERSE SIDE BEFOREr� �
TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY
APPLICANT TO FILL IN INF RMATION'WITHIN'RED-LINES - USE ALL POINT.PEN ONLY
BUI LDI NG PROJECT I DENTI FI N j .PEfiMIT NUMBER „4 1
ADLDING - - . APPLICATION & P It. 1 ^h A
._� BUILDING - ELECTRICAL-PLUMBING,-MECHANICAL 1_V 5 T 8,
s r
'PLAN CHECK,V ALIDATION .-•
• "A E �/ A4�f�'• . QTY. ELECTRIC PERMIT FEE I
�/ PHONE
IGUNTRACTOR. ... I
Na E OUTLETS-SWITCHES-RECEP '•10.00/1.00
�7Bw/�N.No ✓Q D LIGHTING FIXTURES ,10.00/1.00
CONTRACTOR S APPLIANCES RESIDENTIAL 4.00
H Q PANEL$, 10.00DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C:-NO.
OR - PANELS (OVER 200,AMP) 20.00 - ,N
ENGINEER LIC,NO. u 'SIGNS TRANS'. 3.00 i
ARCH.OR ENG. , PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. •. 20.00 -
APPLICANT'S , I
ADDRESS MOTORS SEE FEE SCR.
a " SERVICE CHANGE - 2000 � 1� per/
w o o LICENSED CONTRACTORS DECLARATION
< u I hereby at thaLl am licensed under provisions of Chapter 9 ISSUANCE GATE. .
z w (commencing with Section 7000)of Division 3 of the Business and ,
rri a ,Di• .. BLDG. ELECT. PLG. MECH,
r 7 z Professions Cod}}•.�an license is in full fore i t -
i o'� - Licenx Class_(,�._ i Lm.Number i ❑ ❑ �'
0 w H w Datc�tl-�OWNE c�CryMr�lq� _ .'
�^d `Ii�L'j � ,14, s BUILDING PERMIT -
¢ o owNE:RBUILDe n• LnRn to - :y ; INFORMATION
E:
3 H I hereby affirm that I am exempt from the Contractor's License MISC.-- ' REFER. O ORD a
u o¢ Law for the following reason (Sec 7031 5,Busmessand Professors VALUATION
H _ - - PERMIT ISSUANCE • 10.00
Code Any city or county which regwres a permit to construct alter, _
rc rt ¢ 2 improve,demolish_or,repair any structure,prior to its issuance,also ELEC.CONTR. ' LIC.NO. ELEC. - d
wO u requires the applicant for such permit 10 file a signed statement that - TOTAL PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License
i Law(Chapter 9(commencing with Section 7000)of Division 3 of the Ld'�
o Business,and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT �EE.k
¢I- $ the basis for the alleged exemption.Any violation of Section 7031.5 Qa IES - TYPE CONSTR.
n3 � by any applicant forapermit subjects the applicant loacivil penalty ALTER-DRAIN&'VENT-WATER (EA.) 5.00 1+
of not more than five hundred dollars($500).):
❑,I,as owner of tiro property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.0 OCC. 0uP HES.uNR$
their sole compensation,will do the work,and the structure is not - t�F� _ "I
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,A_REA,COND.' 5.0.0
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 50.FT.FLOOR AREA TOTAL ACREAGE
himself 6r through his own employees,provided that such improve- ` - -
mentsarenot intended oroffered for sale.If,however,the building GAS-EA.SYSTEM=1'INC.40UTLETS 6.00 f '•
•I or improvement is sold withm'one year of completion.(lie.owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did.not build or im. BUILDING USE
Prove to,purpose ofsale.).. , .s INDUSTRIAL WASTE INTER. ' ,30.00 -HES IND CON P8 'Omer
❑ 1,as owner of the properly,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.,
- and Professions Code:The Contractor'sLicense Law does not apply I
to an owner of property who builds or improves thereon.and who 1 LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pmsumit to - SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO, ..
O lam exempt under Sec. ,B.&PC.for, WATER HEATER W/VENT -
reason
I'OwiiC! _ Dmc _ y (!ATER SYSTEM-.., '5.00 ,ACC.DATE •'ACC.FILE NO. 9 .Y
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. t 5.00
r. 1 hereby affirm that I have a certificate of consent lu self-insure, - x ZONING ENG.SITE NO.:.
or u certificate of Workers'Compe ryyvi t yL,,or'p�vyII'i• it
copy thereof(See.3800.Lab.C.). v
Policy No. Company
O Certified copy is hcrebyfippnissc FIRE SPRINK ENERGYT-24 .
Z Z - O Certifiuy,co is filed OM1, the 't •cHan-division..
0 Applicant <-J,•�(N7-' G�.I � ' MISC.- REFER TO ORD. YQ- N❑ Y ❑ N❑,
~ rn - ��_ PERMIT ISSUANCE .FLOOD ZONE A.L.u.C.
CL CER 'IFICATEPE F,XEMPTINS PROM WORK ERS'
W ��' . COMPIiNSA1'ION INSURANCE PLG.CONTR. LIC.No. PLG.
(This section need not be completed if9he Permit ie for-Roc ` TOTAL +Y❑' IN Y,❑ N❑'
Z hundred dollars($100)or less.)
U 0 1 certify that in the performance of tiro work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is.issued, I shall not employ any,person in any manner so as to
Qw" become subject to the Workc.,Cosiipensation Lucas of California.
y DateApplicant - ALTER.OR ADD'TOMECH. 5.00 BUILDING
} 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex-
L.. Z emption;you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions o1the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10,000C.F.M:) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p000.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD,(WITH'DUCT) 5.00 i7
the performance of the work for which this permit is issued(Seca HEATING UNIT(TO 100,000 B.T.U.) 6'00 MICROFILM "
3097,Civ.C.). _
r Lender's Name i HEATING UNIT[OVER 100,000 B.T.U.)9.50
a. Lender's Address ' -ELECTRIC
I certify that 1 have read this application and state that the ebove VENTILATION'FAN (SINGLE), A00 +•• - sAem�,,
. _ information is correct.'I agree to comply with all city and countyPLUMBING 4 V
ordinances-and state laws'.relatmg to building construction and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 600 -
hereby authorize representatives of this city to enter,upon the gOICER-COMP (Over 100,000.BTU1'SEE FEE$CH MECHANICAL
above-mentioned property for inspection purposes. - - -
"(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
may in any way,accrue against sai C' PERMIT ISSUANCE 10.00 ''
yin consequence the - - t I
- rami of hi permit ECH.CO NT. LIQ NO. MECH." -
�� 8 I . TOTAL TOTAL
_ to Ap is /Conlr for • Date I -
0. ..,
A• -
OFFICE COPY