16642 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER i
CITY OF CUPERTINO � 664Z
INSPECTION DIVISION
JOB INSPECTION RECORD
•, ,F' // ,/qJ' .' /O3 0 PERMIT EXPIRATION
JOB ADDRESS . 01d3A �O � 'V - UNIT# _LOT#*
PERMIT EXPIRES IF,WORK
OWNER'. (� /)- CONTRACTOR IS NOT. STARTED WITHIN''
—INSPECTION DA E INSPECTOR INSPE TION RECDAD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM '
NOTE:
UFER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAL DArl0N
GARAGE SLABS
CUPERTINO STANDARDS.
'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE DAZE
MECHANICAL - RLDc ELECT PLc. . MECH ,
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT♦
MECHANICAL
ELECTRICALPERM T TO
FRAMING L�'V
INSULATION ` STORIES TYPE CONSTR
' O OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED C�
O.Fi V
. ROOF NOTE:NO FINAL INSP.SHALL BE M Q� PFm>d LOOR AREA TOTAL ACRE ACBE
,
DIAPHRAGM THE CONSTRUCTION TAX IS PAID '��Y
BUILDING USE
ROOF SHEATHING - RES IND CON PB 0'0,•, ;
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP- L 0 L L
ROUGH SAN.q . ASSE55ORS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO,
MECHANICAL MECH.ENERGY
'
ELECTRICAL - BUILDING ENERGY ACC.DATE ACC.FILE NO
I
FRAMING - ELECT.FINAL TEST tr
INSULATION PLUMBING ZONING ENG SITE NO.
GAS TEST GAS12—��.-ys� -
MECHANICAL FIRE SPRINK ENERGY.T.24
'2 „ Y L N v N L
COVER NO WORK UNTICABOVE HAS BEEN SIGNED HEATING -
EXTERIOR SHEAR ELECTRICAL RELEASE " FLoODZONE A.L.UC
INTERIOR SHEAR FIRE DEPT. Y❑ NL ,Y L ".❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - - BUILDING -
INTERIOR LATH TEMPORARY APPROVALS Bu1LDFNG j
SCRATCH COAT ELECTRIC - PLAN CHECK j
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING.252-4505, ELECTRIC
0 j ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 / PLEASE GIVE JOB ADDRESS WHEN PHONING.
zMECHANICAL
-'SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST:TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL / F
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.-'USE BALL POINT PEN ONLY
BUILD[NG PROJECT IDENTIFICATION -PERMIT NUMBER
�'. ILmNG APPLICATION & PERMIT 1 L+ C %I
\/ ADDRESS- Q I U U 4}
/Y I6 I L 3 N` W 0'L_ Fe h BUILDING —ELECTRICAL—PLUMBING—*MECHANICAL
OWNER'S PLAN CHECK VALIDATION
'AME OTY. ELECTRIC PERMIT FEE -
f A- �v Press=RONE
corvr acroR's UTLETS-SWITCHES-RECEP 10.00/1.00
'/ f— m.-rvo. G-9L LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S - PPLIANCES-RESIDENTIAL 4.00 -
_ ADDRESS p ZL3&90
yy ..r
�E 5 L4. _' Y-ePHONF&90_Slyj ' 1PANELS 10.00 DATE OF APPLICATION IF,
ARCHITECTweW, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE PC NO
oR .,
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG.. 5.00 PERMIT VALIDATION
ADDRESS, � SPECIAL CIRCUIT -
ZIP EMP.METER OR POLE INS. . 20.00
APPLICANT'5 MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE
o o LICENSED CONTRACTORS DECLARATION
c U 1 hereby affirm that I am licensed underprovisionsof Chapter9 ISSUANCE DATE
w (commencing with Section 7000)of Division 3 of the Business and _ BLDG- ELECT. PLG. MECH.
zProfessions Code,5ds1 Ijeense is in full f r t3 ❑ ❑ ❑
z 0 w — Llcens Class C< Ica Bic.Nomb•
9 r O ate Contract0 !1111 or
a x • , BUILDING PERMIT
le rc w OWNER-BUILDER DEC ARATION INFORMATION
E:
1.0 .1 hereby affirm that I am exem t from the Contractor's License MISC.— REFER TO ORD
Y P VALUATION
F .. 0 J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
2 G o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w he Is licensed pursuant to the provisions of the Contractor's License
w
pza Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the
S x a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
M r$ the basis for the alleged exemption.Any violation of Section7031.$ STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant toa civil penaltygLTER-DRAIN&VENT-WATER (EA.)•
of not more than five hundred dollars(5500).:
❑ I,as owner of property,or my employees with wages as BACK FLOW PROTECT. DEVICE 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,GOND. fS80 '
Code:The Contractor's License Law does not apply to an owner of r -
property who builds or improves thereon,and who does such work L FIXTURES-PER TRAP _r-ee SG.FT.FLOOR APEA TOTAL ACREAGE,--
• himself or through his own employees,provided that such improve-
, meets are not intended or offered for sale.If,however,the building / GAS-EA:SYSTEM-11NC.4 OUTLETS 4:60
or improvement is sold within one year of completion,the owner- yy GAS-EA.SYSTEM-OVER 4(EA.) 2:60 '� BUILDING USE
builder will have the burden of proving that he did not build or ire- l� IN CON CON PB Other
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3980 AK-�' E] C] ❑ ❑ ' ❑
❑ 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 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(EA.)
can tracts
for such projects with u contractor(s)licensedpursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2 t 1 .00 TRACT NO. PARCEL NO.
❑ WATER HEATER W/VENT
reason kRR
Owner _ Date WATER SYSTEM 11.00 Q ACC.DATE ACC.FILE NO.
WORKP.RS'COMPENSATION DECLARATION WATER TREATING EQUIP,
I hereby affirm that I have a certificate of consent to self-insure. •� ZONING ENG.SITE N0.
r o certificate of Workers'Compensation Insurance,or a certified _
copy thereof(Sec.3800,Leb.C.).
Policy No. Company -
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z' ❑ 'Certified copy is filed with the city inspection division. MISC.- REFER TO ORD, y ❑ N❑ y [:] N❑
O Applicant - -
ccy CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE FLOODZONE - A.L.U.C.
W >_- COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. �}p
n• 0 (This section need not be completed if the permit is for one TOTAL 3 V❑ N❑ Y ❑ N❑'
:).Z hundred dollars IS 100)or less.
V O 1 certify that in the performance of the work for which this Per- CITY MECHANICAL PERMIT FEE -FEE SUMMARY
LL I. mit is issued,1 shel�l pppp�j..chiplo u y p-rsan in any manner o as Ur
U becom ub1 toQB�(V/orker C saner sof Ca' rnia.
O w Date r� vA plicant ALTER OR ADD TO MECH. 5.00 BUILDING
} y ' NOTICE TO APPLICANT: H, er making OR CeO'Diial• :x-
♦— ? emplion,you should become s jeer to the Workers;Comp n it APPLIANCE rA` 5.00 PLAN CHECK
provisions of the Labor Co , you must forthwith comp y with FEE
(.� Such provisions or this permit hall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE,
1 hereby affirm that there is u construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is Issued(Sec. MICROFILM -
3097,CwCJ1 HEATING 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 that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ,Lar
information is correct.1 agree to comply with all city and county BOILER-COMP H.P.or 100,000 B.T.U.) 6.00 PLUMBING'
ordinances and state laws relaling'to building construction, and �-�
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. -
i - (we) agree to save, indemnify and keep harmless the City of - MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which' CONST.TAX
in y way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ra ing fthis peI MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
QVIllibutts of Appllca Contrac 'Date
OFFICE COPY -