16608 • " ' " , POST THIS CARD NEAR FRONT:OF BUILDING
PERMIT NUMBER.
CITY OFCUPERTINO 1'608
INSPECTION DIVISION.
JOB INWyCTION RECORD
.yr— t y PERMIT EXPIRATION
JOB ADDRESSF — -S UNIT#` -_LOT d
PE7RMIT,'�XPIAR -IF-WORK
OWNER . _ •CONTRACTOR eC,- ;�SJNOTy$TAR7IED WITHIN "
INSPECTION DATE INSPECTOR INSPECTION RECORD •180 DAYS OF PERMIT ISSU-'
FOUNDATION L ANCE OR 180 DAYS FROM
_ NOTE: a" "+ ;L�ASTCALLED INSPECTION.
UFER ALL GRADING AND'ORAINAGE��SHALL BE INSTALLED
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF, PERMIT VALIDATION _
- - CUPERTINO.STANDARDS.
GARAGE SLABS � � -� �� '-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ;
UNDERGROUND,/SLAB
PLUMBING'S
ELECTRICAL' `" S ISSUANCE DATE
MECHANICALI, ',BLDG. ELECT.I PLO. MECH,r
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED• BUILDING PERMIT
INFORMATION
WOOD FLOOR - - VALUATION -$/FT.•
PLUMBING. "
MECHANICAL -
ELECTRICAL - ;•PERMIT rO . ,
FAIT
FRAMING 1,4 v-
INSULATION STORIES TV PE CDNSTR
CT.13 1988
OCC GROUP RES,UNITS
City of Cupertino
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
5[].FT.,FLOOq AREA TOTALAC REAGE ..
ROOF N FINAL BE MADEREFORE
DIAPHRAGM
THE CONSTRUCTION TAXIS PAID T -_
BUILDING USE
ROOF SHEATHING - I HES . IN CON PB 7.Omr, '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.# - ASSESSORS PARCEL NO_
t
PLUMBING ELECT.ENERGY
TUBS&SHOWER PANPLUMBING ENERGY - TRACT No.- - PnRceLNo.
MECHANICAL MECH.ENERGY p
ACC.DATE ACC<F ILE NO
ELECTRICAL BUILDING ENERGY - -
FRAMING., - - ELECT.FI NAC TEST - ZONING,,. ENG.SITE No. f
INSULATION , PLUMBING -
- GAS TEST', ., - GAS
MECHANICAL FIRE SPRINK ENERGY'T.ZE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y:�. "� ❑ ";NE]
F LOCO ZONE 'A L U;C..
EXTERIOR SHEAR ELECTRICAL RELEASE i '
INTERIOR,SHEAR FIRE DEPT. Y N❑' . Y ❑_.?N❑,
SHEETROCK. - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR'-LATH - TEMPORARY'APPROVALS BUILDING ,
l '. 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; ELECTRICLU
ONE'.WORKING DAY BEFORE REQUIRED INSPECTION PwMBING
0�. PLEASE GIVE JOB ADDRESS WHEN PHONING. '
I Z50- MECHANICAL
- SEE PERMIT FOR,EXPIRATION DATE
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE �'4
� y .
CALLING FOR FINAL INSPECTIONTOTAL
.. • . iOFFICECOPV '
-
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
r' BUILDING PROJECT IDENTIFICATION - ^PERMIT.NUMBER
aUHQisG '^1 APPLICATION PERMIT -
ADDRESS ,V I �� 166'08
UI„ BUILDING.—ELECTRICAL=PLUMBING—MECHANICAL
0wNER'5 `l PLAN CHECK VALIDATION
—�' "AME — C ELECTRIC PERMIT FEE
E
CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1:00 .D
NAME' //� ��n
0911" `-s Tue.NO. V �' LIGHTING FIXTURES 10.00/1.00 3�
CONTRACTOR'S [APPLIANCES RESIDENTIAL 4.00
ADDRESS X11 n ./ /1 I 7
21--)—,}_W// PHONE PANELS 10.00 Z. DATEOFAPPLICATION'r-
ARCHITECT� / '` PLAN CHECK FEE P.C.NO..
OR 4 PANELS (OVER 200 AMP) 20.00 f
ENGINEER '
uC.NO. SIGNS TRANS. 3.00
ARC H.OR ENG. S.Of3 - PERMIT VALIDATION APOGEES SPECIAL CIRCUIT
ZIP TEMP.METER OR POLE INS. 20.00 '-
APPLICANTS PRECHANGE
SEE FEE SCH.ADDRESS
20.00
o o LICENSED CONTRACTORS DECLARATION
ISSUANCE DATE
w hrey affirthat Iumlicensed under provisions of Chapter 9 �� I< encing with Section70001ofDivision 3 of the Business nd BLDG. ELECT. PLG. MECH.
i Professions Code ndG licenu is in full fort a e ❑
zD w — License Llss Lic.NumberO Dale — Contractor -
M rBUILDING PERMIT
¢ wOWNER-BUILDER DECLARATION INFORMATION
w ;LL nI hereby af0rm that I am exempt from the Contractor's LicenseREFER TO ORD
g PERMIT ISSUANCE 10.00 .vALunraoN S/Fr.
F LL O a Law for the following reason.(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,
¢< 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. EOTA p��
n a C u requires the applicant for such permit to file a signed slarement that TOTAL 4.J.,�O PERMIT TO
w$ he is licensed purimet.to the provisions of the Contractor's License
r z> Law(Chapter 9(commencingwith Section 7000)cd[Dwisicro of the
i o Business and Professions Code)or that hicisexempt therefrom and OTY. PLUMBING PERMIT FEE
¢ I_ a the basis for the alleged exemption.Any violation of Section 703 LS STOR ES TYPE CONSTR.
i 5—: m by any applicant fora permit subjects the applicant t0acivil penalty gLTERDRAIN&VENT-WATEfl IEA.) 5.00
error more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4,00 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,AREA,COND. 5.00
Code:The Contractor's License Law does not apply 10 an owner of -
property-who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SG.F.T.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
mems are not intended or offered for sale.If,however,the budding
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that h .e did trot build or int- RES IND CON PB ONar
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00
C1 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PAHDEL NO.
and Professions Code:The Contractor's License Law docs not amply ,
LAWN SPRINKLERS-OVER 5(EA.) 1.00
to an owner of property who builds or improves thereon,and who
contracts for such projects with a contraclntsl licensed pursuant to
the Contractor's License Law. z SEWER-SANITARY-STORM EA.200Tt/10.00 TRACT NO, PARCEL No.
O lam exempt under Sec. ,B.&P.C.Norther WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ALC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that l have a certificate of Conserv to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compens' ' n Insurance,or' cer Tied -
copy thereof(Sec.3800,Lab.C.). r -'
Policy No, pony
O ❑ Certified CD her y aGmS FIRE SPRINK ENERGY T-Z9
Z 2 ❑ Certified is 1 city inspection division. MISC.- REFER TO ORD, y N y D N11
Applicant
N, CGR'TI FICA' EDI'E J PTION PROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.0 C.
U ,COMPENS TION INSURANCE: PLG.CorvTR. LIC.NO: PLG. y� N� v � N�
CL O t (This section need not be completed if the permit is for one - _ TOTAL
0 2- hundred dollars($100)or less.).
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F— mit is issued,I shall not employ any person in any manner sa as to v
O W become subject to the Workers''Compensation Laws of California. ' BUILDING
Dale Applicant - ALTER OR ADD TO MECH. 5.00 _
} m NOTICE TO APPLICANT: If,after cooing this Certificate 0f Ex-
F ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 - FEE
V such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000OF.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5'00 MICROFILM
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
3097,Civ.C.l. 3F 0
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC , E�
Lender's Address -
Icertifythatlhivereadthisapplicationandstatethattheabove VENTILATION PAN (SINGLE) 4.00 PLUMBING
information is correct. I agree to comply with all city end county BOILER-COMP(3 H.P.or 100,000 B.T.U.) ,6.00
ordinances and state Taws relating to•building construction, and
.•' hereby authorize representatives Of this city to enter upon the BOILER-COMP (Over IM,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes. ,
(We) agree to save, 'ndem y and k hat nless the City of MISC.- REFER TO ORD. CONST.TAX
upertino g ' t liab' ties, Jgment cost J expenses which .PERMIT ISSUANCE 10.00
Day in.a ay a Ie ainsl s" Cit consequence of the
anling o is pe IL �,/ MECH.CONT. LIC.NO. MECH.
/_/ TOTAL TOTAL 4/2,40
SiMat reof Applicant/Contmcto / Date
OFFICE COPY