16603 POST THIS CARD NEAR FRONT OF BUILDING
PERMITNUMBER'
'
-CITY. OF. CUPERTINO` r: 16603 :1
INSPECTION DIVISION
JOB INSPECTION RECORD .' . .
' . / a-OSU PERMIT EXPIRATION
JOB ADDRESS )01,23 fV A/0�-F�-s ,�Q UNIT# LOT
PERMITEXPIRES IF WORK
OWNER C7 �S _ CONTRACTOR W/j WE'iQ 7 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOPM 780 DAYS OF PERMIT ISSU-
FOUNDATION • ANCE OR_180 DAYS FROM
NOTE: LASTCALLED 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 /SLABi /
PLUMBING
ELECTRICAL ` . - - ISSUANCE DATE
MECHANICAL' - BLOO, ELECT PLG. MECR,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
.WOOD FLOOR - INFORMATION
- VALUATION $/FT..
PLUMBING � � � � .-• \ � eQ - --
MECHANICAL:
ELECTRICAL - PERMIT To
FRAMING ® - QQ®(Hl\0 . & C-r
INSULATION
STORIES TYPE CONSTR
-
C
v OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 6AFT.FLOOR AREA TOTAL ACREAGE .
- DIAPHRAGM - - THE CONSTRUCTION TAX IS PAID . .. I
BUILDING USE ..
ROOF SHEATHING - RES IND CON PB :om�l4
APPLY NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED FINALS DATE- INSP. ❑ El El ❑ ❑
'ASSESSORS PARCEL NO
ROUGH SAN.k
PLUMBING U O D" %r3.� ELECT.ENERGY U -
- TRACT NO PARCEL NO.
TUBS&,SHOWE PAN PLUMBING-ENERGY
MECHANICAL - MECH.ENERGY -
AC FILE No
ELECTRICAL BUILDING ENERGY .DATE Acc
FRAMING ELECT.FINAL TEST
INSULATION
ENG.srtENo!.
' INSUL•ATION - PLUMBING �� ,
GAS TEST GAS
MECHANICAL FIRESPRwrc - ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ •"�' ` "0
EXTERIOR,SHEAW - ELECTRICAL.RELEASE FLooD ZONE A u.c.
V❑ "❑ YID
INTERIOR SHEAR FIRE DEPT. L.: NE)
SHEETROCK, GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR. LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
L GAS .. .FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE '
CCUPANCV OF BUILDING NOT PERMITTED UNTIL BUI LDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMBING (o
PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
L ;CALLING FOR FINAL INSPECTION.
OFFICE COPY
iAPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICAT[O PERMITNUMBER
BUILDING d APPLICATION&'PERMIT 1,6603
ADORES O UIL
BUILDING—ELECTRICAL—'PLUMBING—MECHANICAL
OW E., PLAN CHECK VALIDATION
NAM
QTY• ELECTRIC PERMIT FEE `-
PHONE
NAM RAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00
Pn- UC.No. Q LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S '
ADDRESS APPLIANCES-RESIDENTIAL 4.00 ,.
[�JP IONE �7^J3 PANELS 10.00 DATE OF APPLICATION '-
ORCH ECT PANELS (OVER 200 AMP) 20.00 PLAN CHECKFEE P.C.NO.
ENGINEER
- LIC.NO. SIGNS TRANS, 3.00
ARCH.OR ADDRESS ENG SPECIAL CIRCUIT 5.0U PERMIT VALIDATION
ZIP EMP.METER OR POLE INS.,. 20.00
APPLICANT'S -
ADOREss �n MOTORS SEE FEE SCH.
(.J�, SERVICE CHANGE 1 20.00
O o LICENSED CONTRACTORS DECLARATION
a u u
2 1 hereby affirm that I am licensed under provisions of Chapter 9 ..I,
iy '¢ w (commencing with Section]000)of DIVlalnn 3 of BnSlneaa and ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
r w z Professions Cod d y license is in lull fore d feet.
o i m o License s�Lic.Number O/
F w r J Date Contractor -
a m M BUILDING PERMIT
¢ ¢ w a "OWNER-BUILDER DECLARATION
o d" - INFORMATION
E
3 u w I hereby affirm that I am exempt from the Contractor s License MISC.— REFER TO ORD s
u.o ¢ Law for the following reason.(Sec.7031.5,Business and Professions 'VALUATION
Cod. An cit or count PERMIT ISSUANCE 10.00 '
Y Y Y it my structure,
prior
to construct, also
Le M Q improve,demolish,or repair any structuro,prior to its issuance,also ELEC.CONTR. LIC.NO. ELED,
¢ requires the applicant for such permit to file a signed statement that TOTAL
PERMIT TO
a w m�` he is licensed pursuant en the provisions of 700 )mfDb,lor's License n
Hz: ¢
Law(Chapter ndPr(cosions Codeng)or Section is exempt therefrom
of he
and
LSJ�
E 4 o Business and Professions Code)or that he IS ezempt therefrom and QTY. PLUMBING PERMIT- FEE
¢ H o¢ the basis for the alleged exemption.Any violation of Section 703STORIES TYPE CONSTR.
u ;•- by any applicant for a permit subjects the applicant loacivil penalty
ALTER-DRAIN&VENTWATER (EA) 5.00
' of not more than five hundred dollars($500)J -
' - � - . '
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not Oce.GROUP RES.UNITS
intended or offered for sale•(See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
- Cade:The Contractor's License Law does not apply to an owner of
properly who builds or'improves thereon,and who does such work FIXTURES-PER TRAP SO.FT,FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improveIrP—L-
,+•, menta are not intended or offered for sale.If,however,the building GAS EA.SYSTEM-1 IN .4 OUT LETS
or improvemem is sold within one.year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) .00
builder will have the burden of proving that lie did not build or im- - BUILDING USE
prove for purpose of sale.): INDUSTRIAL WASTE INTER. 3 RES . IND CON PB Omer
0 I;as owner of the property,am exclusively contracting with - -
licensed contractors to construct the project(Sec. 7044,Business LAWN SPR INKLERS-1 INC 5 V. 6. 0 \ 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(E .) 1.0
contracts for such projects with a conlraetorls)licenied pursuant to
the Contractor's License Law. SEWER-SAN ITARY-STORM I 200fthoo TRACT NO. PARCEL NO.
❑ 'I am ezempt under Sea ,B.&P.C.for,Orisreas -
on WATER HEATER W/VENT - .6.00
-• Owner ' Dam 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 ofconsent to self-in sure,
or a certificate of Workers'Compensation Insurance,.or n certified ZONING ENG.SITE NO.
copy'thereof(Sec.3800,Lab.C.). -
Poll Company_ .,
G :iJ tertltiedcopyisherebyfurnished. FIRE SPOINK ENERGY F]6
••Z Z ❑ Certified copy tiled c y Imam ion division.
O Applicants (L MISC.- " REFER TO ORD. Y [] N Y ❑ NO
cr rn CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE CPI— FLOOD ZONE A.L.U.C.
LU CL 0 (This section n Od notJ bAi•TcompjION NSetea RAif;CI' pcnni[ is for one PLG.CONTR. - LIC.NO.1 TOTAL W VA�— V N
D Z hundred dollars 1$100)or less.) -
U O "1 certify that in the perform aIcc'of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY '
LL H mit is issued,I shall not employ any person in any manner so as to
O L) become subject to the Workers Compensation Laws of California. -
y Date Applicant BUILDING
�- N NOTICE: TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. � 5.00
Z emption,you should become subject to the Workers'Compensation APPLIANCE
F - - 5.00 PLAN CHECK -
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10,000GF.M.) '4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER'10=QF.M.).6.00 SEISMIC FEE
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 IS". MICROFILM'
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
Lender's Nunn "HEATING UN IT(OV ER 100,000 B.T.U.) _ _
Lender's Address ELECTRIC -
I certify that 1 have read this application and state that the above V.ENTILAT.ION FAN (SINGLE) _-4.00 . ' q�
id.nnation is correctA agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-
COMP
H.P.or 100,000 B.T.U.) 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.'
(We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which - PERMIT ISSUANCE 10.00 CONST.TAX
may In any wa aecme against said City 1n consequence of the
ranting o is nniL l MECH.CONT. - LIC.NO. MECH.
TOTAL TOTAL
/\ SigByly pplrcant Contractor ale
OFFICE COPY