16599 • _ _
POST THIS CARD NEAR FRONT OF BUILDING
' PfRMIT NUMBER
v �. CITY OF CUPERTINO 16599
INSPECTION DIVISION
JOB INSPECTION RECORD
i
PERMIT'EXPIRATION j
JOB ADDRESS,/O/°Z3 A wOCFt-- - UNIT# _LOT#
PERMIT EXPIRES IF WORK%;
owNER 0 .x - CONTRACTOR � N(-7 � IS NOT STARTED WITHIN
INSP CTION DATE INSPECTOR INSPECTION RECORD. 180DAYS OFPERMIT ISSU-
FOUNDATION - - -ANCE OR 180 DAYS FROM
NOTE: - LAST CALLED INSPECTION. .!
UFER ALL GRADING AND DRAINAGE,SI-I&IDf 04STALLED
` PR EGUNITE TO COMPLY WITH THE APPROVED FLANS AND Cf�l'jOF,-PERMIT VALIDATION
CUPERTINO STANDARDS I
GARAGE SLABS
POUR NO CONCRETEUNDERGROUND /SLAB E HAS BEEN SIGNED tolkvOCAN
PLUMBING - ) '•
ELECTRICAL ISSUANCE DATE
MECHANICAL -" - - BLDG ELECT- P c MECH.
11 El . .,❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR . '-- INFORMATION
VALUATION
PLUMBING" �y- �f •• :�
MECHANICAL ' ' e 0"
ELECTRICAL aeRMITJO
FRAMING ' 'UTG�R/O,e /il•/ 0{!E' i
INSULATION' - - - STORIES TYPE CONSTR.
• - , :I, OCC,GHOUP RES,UNITS.,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO.FT.FLOOR AREA .TOTALACREAGE• ,
• , ROOF - ,NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
ROOF SHEATHING - + - RES IND TCDDN . PS 00", .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ El'
`
+ ROUGH SAN.N ASSESSORS PARCEL NO.
PLUMBING - ELECT.ENERGY
. TRACT NO. PARCEL NO. I
' TUBS&SHOWER PAN Y'' + - - PLUMBING'ENERGY � +'
MECHANICAL , MECH.ENERGY _
ELECTRICAL I BUILDING ENERGY ACC.DATE Acc:PILE rvo
FRAMING ELECT.FINAL TEST -
INSULATION PLUMBING , ZONING END.SITE N0.
GAS TEST GAS ,
- .'EIRE SPRINrc ENERGY T 2
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING : - Y ❑ "❑ ` ❑ "❑
EXTERIOR SHEAR - ELECTRICAL RELEASE ROOD ZONE A.L U C.
INTERIOR SHEAR FIRE DEPT. _ I Y❑ N❑ ° ❑ N❑
SHEETROCK - GRADE ' FEE SUMMARY
EXTERIOR LATH _• BUILDING _
INTERIOR LATH TEMPORAAPPROVALS BUILDING
RY t3b�
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS .. - FEE + -
NO TAPE OR PLASTER UNTILABOVEHAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ,MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
r + w ONE WORKING DAY BEFORE REQUIRED INSPECTION:'
/ * O .
PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
r Z ' = SEE PERMIT FOR EXPIRATION DATE - MECHANICAL "" «•
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE= " TOTAL. 41)
CALLING FOR FINAL INSPECTION.
OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - PERMITNUMBER -
BUILDING
A �/s APPLICATION & PERMIT
BUILDING—ELECTRICAL—PLUMBING—ME. CHANICAL . 6[ J9
WNER'B - PLAN CHECK VAL ATON'
• " / / DTV. ELECTRIC PERMIT FEE
ONE 1 V/_ +—
\ ONTRA ORS - OUTLETS-SWITCHES-RECEP '10,00/1.00 ( C14
LIC.No, ILIGHTING FIXTURES 10.00/1.00
JIREA TDR s YY1�/YJ�L_ PPLIANCES-RESIDENTRIAL 4.00
'
I7 -{Ii/f/✓- PONE Q PANELS, 10.00 DAT E O F APP LICA YJ O N`�.'
ARCHci PLAN CHECK FEE P.C.NO.
DR PANELS`(OV ER 200 AMP) 20,00 ,..
ENGI vY
uc.N PERMIT VALIDATION
ARCHOR ENSIGNS TRANS. 3.00• y
, G
AM � � Ni �,' � SPECIAL CIRCUIT •5.00 � -
47
EMP.METER OR POLE INS. 20.00
1APPLICANTS - MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 /
wo o LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that I am licensed under provisions of Chapter 9, ISS ANCE DATE .i
G a N (commencing with Section 7000)of Division 3 of th Rosiness and s - BLDG. ELECT. PLG. MECH.
z Professions Code d my license is in full'
z o y� / License Clss� Lic.Numbel`7Y -71
❑ ❑ .❑
0 N H J
,at
�� ConDietor�Jl�/� f'
rc Y a a ,v '(/ WN DER'DECLAARTATT110�N r ''" BUILDING PERMIT
_ O w FORMATION
X3: MISC.— REFER TO ORD
w 3 u N I hereby affirm that I so exempt from the Contractor's r'e License ION $/FT.
F u_ o ¢ Law for the following reason.(Sec.7031.5,Businessland Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
2 ¢ Q improve,demolish,orrepair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. TE LEC.
w y 0 ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO -
n wAs" he is licensed pursuant to the provisions of the Contractor's License _ ,
H z Pilot
i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /I/ e".CLO( //y,Will I/rt
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES, TYPE CONSTR:
a3 - by any applicant for a permit subjects the applicant loo civil penalty gLTER-DRAIN -WATER (EA.) 5.00
of not mom than five hundred dollars(S500).): -
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 14.00 - OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for Sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
merits are net hrough
ownemployees,for
provided hat ever,the
improve- GAS-EA.SYSTEM-1 6.00
meats are not intended or thin one
for sale.If,however,the budding
or improvement is sold within one year of
arcompletion,the owner- GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving that he did not build or in,. . . .
- RES IND CON PB Other
prove fors owner of theJ. INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ - ❑ ❑
❑ d as owner of the property,he exclusively.contracting with
licensed contractors: construct the project(Sec. does Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
and Professions Code:The Contractor's improv Law docs not apply -
to owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 r
he Co contracts for such projects with a contracmrtsl IiccnscA @'ramal to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL No.
❑ I am exempt under Sec.—,B.&P.C.tie thisWATER HEATER W/VENT 6.00 1 '
reason
owner Date WATER SYSTEM 5.00
- ACC.GATE ACC,FILE NO,
WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a ce,fficalcofconsent tuself-insure, - - ZONING ENG.SITE NO.
or A certificate of Workers'Compensation Insurance,or a certified
7tl copy thereof tSec.3800,Lab,C ` NN/r 0 '
Policy No. Compan
O ❑ err fled cop is ereb nished. FIRE SPRINK ENERGY T-24
IT
I ith the city inspect n division. MISC.- REFER TO ORD.
Z p Applicant
st Y❑ N❑ Y ❑ N❑
CCin - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.G.
— CC tTI FICATIi OI'IS
FROM WORKIiRS'
LU 1 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y[:] N❑
CL 0 1'This section need not be completed if the permit is for one TOTAL
0 Z hundred dollars(S 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 M mil is issued,1 shall.not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
W Dnte ,00- Applicant - ALTER OR ADD TO MECH. 5BUILDING � Lo
>_ m NOTICE TO APPLICANT, If,after making this Certificate OTE x --
♦— ? emotion,you should become subject to the Workers'Coinpens.1wo APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you_must forthwith comply will' FEE
V' 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 10MC.EM.) 6.00 SEISMIC FEE' 7
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(See. MICROFILM
3097,CieCT. IHEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify 11,311 have read this application and stale that the above VENTILATION FAN (SINGLEI 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-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby author" representatives of this city to enter upon the BOILER-COMP(Over 100,000BTUI SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. '
up rtino against liabilities,judgments, costs and expenses whichCONST.TAX'
may in any w accrue against said City in consequcnc of the PERMIT ISSUANCE 10.00
n fill ermlt. MECH.CONT. LIC,NO. ."MECH.
TOTAL TOTAL /
Sigitturel6fApplicanl/Contractor - Dal
OFFICE COPY