16635 POST THIS'CARD.NEA,R FRONT OF BUILDING
PERMIT NUMBER
CITY -OF CUPERT
IN0 16635
INSPECTION DIVISION
JOB INSPECTION. GQR D
p PERMIT EXPIRATION
JOB ADDRESS Z7C`d��� N. GVOLFL ' UNIT# _LOT#
PERMIT EXPIRES IFOWORK .
OWNER e .' CONTRACTOR_ N,' �Y sG71e j IS NOT'STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU: ,
FOUNDATION., I .. I ANCE OR 180 DAYS FROM
+NOTE: LASTCALLED INSPECTION.
LIFER 'ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITETO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS:
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ✓'` . 1j
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL IssuANCE unTE
MECHANICAL po ELECr PLG. mECH'I
El
OD NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - • RUILDI G PERMIT
WOOD FLOOR . INFORMATION 1
VALUATION. $IFT.
PLUMBING
MECHANICAL - - -
ELECTRICAL - - PERMIT TO
FRAMING - ' 'x( •
- INSULATION STORIES TYPE CONSTR. I
'
DEC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOR AREA TOTAL ACREAGE, r
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM , THE CONSTRUCTION TAX IS PAID'
BUILDING USE
ROOF SHEATHING'' - RES aND CON PB DO-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DATE INSP. 111 , 1_1 ❑ ❑ ❑'
ROUGH SAN.# ASSESSORS PARCEL No..
^ PLUMBING .ELECT.ENERGY' '
TRACT NO: PARCEL NO
TUBS&SHOWER PAN - .PLUMBING ENERGY.
MECHANICAL - - MECH.ENERGY" '
ELECTRICAL BUILDING ENERGY
Acc.DATE Acc.FILE No
FRAMING e ELECT.FI NAL TEST
ZONING„ ENG.SITE NO.
INSULATION' PLUMBING 1
GAS TEST - GAS -
MECHANICAL FIRE SPRINK ENERGY T 2
COVERAO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 7 ` ❑ N❑ Y ❑ N❑'
/^ F
EXTERIOR SHEAR ` �. ELECTRICAL RELEASE LOOD'ZONE AC:uc.
- INTERIOR SHEAR n ,' FIRE DEPT. v❑ N❑ '' Y ❑ -NO
SHEETROCK GRADE - FEE SUMMARY
'• EXTERIOR. LATH BUILDING ` '
INTERIOR LATH' TEMPORARY APPROVALS • BUILDING'
SCRATCH COAT - ELECTRIC - -/S" PLAN CHECK
GAS - FEE' _
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY "SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, . MICROFILM
ELECTRIC
uU ARRA'NGE' . .
FOR INSPECTION«BYPHONING 252-4505, . G .
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.'
- SEE PERMIT,FOR EXPIRATION DATE.- :MECHANICAL
IMPORTANT!.
CONST. rnx
PLEASE READ REVERSE SIDE BEFORE+"'• a«
CALLING FOR FINAL INSPECTION. TOTAL sirF,
`OFFICE COPY. . a w '-
PPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FIC ION PERMIT NUMBER
mIILDINc O OLFg APPLICATION & PERMIT 16635
'70 ADOREss I BUILDING—ELECTRICAL—PLUMBING—MECHANICAL � '"
2a o Yf9-0 C6 r',l}' A/
PLAN CHECK VALIDATION
OWNER'S
L oPC --z--.--� TIPWSIGNSTRANS.
LECTRIC PERMIT FEE
�_ PHONEL:
cOr TRActo RB ITCHES-RECEP 1Q.00L7-00
NAMES
(g � L,c,NO, f{'G g$QIXTURES 5688/1.00
` CONTflACTOR'S` -RESIDENTIAL 4.00
, . y6�('3 f Z`J•QI SIJ///WJPROxE 2A6-06 pz-So DATE OF APPLICATION
PLAN CHECK FEE PC.NO.
ARCHITECT ER 200 AMP) 20.00
ORENGI"EER rS. 3.00
LIC.NO.
ARCH.OR ENG. $PEDIAL DIRDU IT 5,00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
APPucaxrs - MOTORS SEE FEE SCH
ADDRESS
SERVICE CHANGE !/ p
w /1,a
oo LICENSED CONTRACTORS DIiCLARATION
rt U U 1 hereby affirm that 1 am licensed under provisions of Chapter 9 d1 ISSUANCE DATE
y Z N be with Section 7000)of Division 3 of the Business and - `pV. BLDG. ELECT. PLG. 'MECH.
r O Z Professions Code,and my license is in full t'orce and cheat. ❑ ❑
Z O uu'i icense Class C-' �Z+ Lic.Number�(- y
El
Q Z — 0 ale —�F-�—'Contractor t
H w �\
r " - BUIL ING PERMIT
w¢ OWNER-BUILDER DECLARATION INFORMATION
u REFER TO ORD
F.
3 LL N I hereby affirm that I am exempt from the Contractor's License MISC.—. VALUATION $/FT.
w 0¢ Low for 1110 fOIIOwmf;1eaamL ISG,.1031.5,Businussund P...lession, PERMIT ISSUANCE "10:00
H WCode:Any city or county which requires a permit to construct,alter,
Q 2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.LONTR. LIC.NO. ELEC. rjQ
— O u requires the applicant for such permit to file a signed statevmnt that TOTAL &0 PERMIT TO
w m he is licensed pursuant to file provisions of the Contractor's License -
�Ltz
>,Z >
Business
w(Chand Profession,
(commencingwithSection 7000)of therefrom the ,
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
E. the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR.
n by any applicant lot a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the properly,or my employees will'wages its BACK F LOW 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 to an owner of "
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
. himself or through his own employees,provided that such improve. GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
,cuts arc not intended or offered for sale.If,however,the building
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 int- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with El El 0 El 0
licensed contractors to construct the project(Sec.7044;Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCELNO.
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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft110.00 TRACT No. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec.—,BAP.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSAT'ION D17CLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to su l Einsum. I ZONING ENG.SITE NO.
or a certificate of Workers'Compensation`Insurance,or a certified
copy lhereof(Sec.3800,Lab.C.)¢¢/-L>r4
.� Policy No. Companyy, �'EINd�
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T.24
_Z Z ❑ Certified cop is Bled wi�l' tho-cify jnspection division. MISC.- REFER TO ORD. y NO y NO
HyApplicant,
PERMIT ISSUANCE 10.00 FLOOD ZONE - A.LU.C.
— C17RTIFICATE OI'EXEMPTION PROM WORKERS'
LU > COMPISNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. y❑ No YO No
IL Cl (This section need not be complcicJ if file permit is' for one TOTAL
Z hundred dollars(SI00)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
F mit is issued,I shall not employ any person in any manner m as to
O tU become subject to the Workers'Compensation Laws of California. BUILDING -
Date Applicant I ALTER OR ADD TO MECH. 5.00
} m
NOTICE TO APPLICANT'. If,after making this Certificate of Rx-
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will' FEE
U such provisions or this per it sh ill be dcemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY . AIR HANDLING UNIT(OVER IQOOOC.F.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.) 8r
00
3097,Civ.CJ.
Lender's Name HEATING UNIT 100,000 B.T.U. ELECTRIC l)
Lender's Address
I certily that l have read this application and state that the above VENTILATION FAN (SINGLE) PLUMBING
information n correct I agree to comply with all city and county BOILER H.P.Or 100,000 B.T.U.)ordinances and nate laws relating Io building construction, andhereby authmrue representatives of this city to enter upon the BOILER-COMP(Over 100,0008TU1 SEE FEMECHANICAL
above-mentioned property for inspection purposes.
(we) agree to save, indemnify.and keep harmless the City of MISC.- REFER TO CONST.TAX
Cupertino against liabilities,judgments, costs and expenses which pER MIT'ISSUAN CE
may in any ay accrue ago' sl said City in consequence of the
ranlingofl -Y --con MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
i nt re of Applicant/Contractor Date
OFFICE COPY