16653 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 16652
INSPECTION DIVISION "
JOB INSPECTION RECORD
7�L I D 3 PERMIT EXPIRATION
JOB ADDRESS 'VT V✓tl(.:. Cs �r� UNIT# _LOT#"
PERMIT EXPIRES IF WORK
OWNER L�,(/CT CONTRACTOR S Ems �, IS NOT STARTED WITHIN i
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-:
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALL ED INSPECTION. I
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 /SLAB
PLUMBING '
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLuc. ELECT, PLG. MECH.,
❑ ❑ ❑ ❑ .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
no INFORMATION
eelWOOD FLOOR VALUATION SIFT.
PLUMBING � � -
MECHANICAL
ELECTRICAL - PERMIT TO ..
FRAMING CM - gec
- INSULATION STORIES/-,, TYPE CON TR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
i� ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE s0FT FLOOR AREA TOTAL ACREAGE
,
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HES No CON AS
0-1....APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E) ElEl El ❑ I
ASSESSORS PAHCEL NO
ROUGH SAN,#
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ACC DATE ACC.FILE NC.
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST zoNlNc ENc.sIrENo.
-
INSULATION - PLUMBING
GAS TEST GAS
MECHANICAL EIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v "� v "o
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE AL UC.
INTERIOR SHEAR FIRE DEPT..• YD ND IQ NE]
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC �- � '' PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 2=9�;
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
.
'00 PLEASE GIVE JOB ADDRESS WHEN PHONING.
-'SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST,TAX
PLEASE READ REVERSE SIDE BEFORE- TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY "
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - -PERMIT NUMBER
_41 ADoAEss !p - APPLICATION & PERMIT 4� L+ [ rj
�co ' P4� •• BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I U 52
�
NAME $�" NAME- PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
PHONE
°
iameflA�°Tj°Rs OUTLETS-SWITCHES-RECEP . 10.00/1.00
r 1 LIC.NO, 2 �p LIGHTING FIXTURES 10.00/1.00
ADDRESST0R5 APPLIANCES-RESIDENTIAL 4.00
yJ J� PHONE ` PANELS 10.00 DATE OF APPLICATION
ARCHITECT
OR
OOPANELS (OVER 200 AMP) 20.00 - PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO: ISIGNS TRANS. 3.00
Roo Ess ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
APZIP- EMP.METER OR POLE INS. �29, 0
ArDRrSS - ,
IR
ss
sOa
I MOTORS SEE FEE SCH.
SERVICE CHANGE 20.0 ,
D
at i
r O o LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that 1 am licensed under provisions of Chapter 9 IS/6UAMrJ/CE DATE
H<h (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
y z
Professions Code,and my license is in lull farce and effect ,0 Vpeo ❑ ❑ ❑
Z a m- License Clas Lie.Number
P
w F w a[e P�Contractor
Q w a OWNER-BUILDER UILDIiR DECLARATION BUILDING PERMIT
w-O A " INFORMATION
g LL H I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
r u 0< Law for the following reason.(Sec.7031.5,Businussamd Professions _ VALUATION E/FT.
Code:An cit PERMIT ISSUANCE
E M 4 f y y sh county it any structur e permit t o consuance,also
SE
-0 O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �� 0
n c u requires the applicant for such permit to file a signed statement that TOTAL
A w m - he is licensed pursuant to the provisions of the Contrnetco s License PER MIT TO
Fza Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a 3 by any applicant for a permit subjects the applicantto o civil penally
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do Ilse work,and the structure is not
intended or offered for sale(Sea 7044, Business and ProfessionsDRAINS-FLOORROOFAR D500 '
Code:The Contractor's License Law does not apply to an owner of , , , D. .
property wlio builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
_• himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale,If,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner,
builder will have the burden of proving that he did not build or all. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of e.). RES INDUSTRIALWASTE INTER. 30.00 13 El
❑ry ❑ Omar
❑ L th
as owner of the property,am exclusively.contracting704with
licensed contractors to construct the project(Sec. ]044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codc: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
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec,.,BAP.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE - ACC.FILE NO.
WORKHRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that I have a certifieale of consent toself-insure,
or a ecRiflcate=of Workers'Compensation Insurunw,or a certified ZONING ENG.SITE NO.
Copy thereof(See.3800,Lab.C.), -
Policy No. Company tWJC, 1NX&nJ1V)77
4 Certified Copy is hereby furnished. FIRE SPRINK ENERGVT44.-
Z Z ❑ Cerlifl fled i'tlI 0 t ci y ation division.
O Alen cant in cMISC.- REFER TO ORD. Y ❑ N 0 Y ❑ N[
!r w CERTIFICATE OP EXEMPTION FROM ORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONER. LIC.NO. PLG.
Q' O (This section peed not be completed if the permit is for One TOTAL Y❑ NE1 Y ❑ NE]
Zhundred dollars 1$100)or less.)
V O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I shall not employ any person in any manner so as Io
Q Qbecome subject to the Workers'Compensation Laws of California.
.a DateApplicant ALTER OR ADD TO MECH. 5.00 BUILDING
} 0 NOTIC17 1'0 A1113LICAN'1': IL after making this Certificate of rix-
F" ? cranium,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
prr)Uuoss of the Labor Code, you must forthwith comply wit
3 suh FEE
Such provisions or this permit Shall be deemed revoked AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00 '
CONSTRUCTION LENDING AGI7NCY AIRHANDLING UNIT(OVER 10=C.F.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(See. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8,00 q �
Lender's Name-• H EATI N G LIN IT(OVER 100,000 B.T.U.)9.50 dQ
Lender's Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
informatioordinances n correct I agree to comply with all oily and eorintd BOILER-COMP(3 H.P.or 100,000 R.T.U.) 6,00 - PLUMBING
ordinances and slate laws reeling to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP IOvar 100,000 BTU)SEE FEE SCH. MECHANICAL
herebymautioriz properly for inspection i purposes.
(We) agree to save, indemnify and keep harmless rhe City of MISC.- REFER TO ORD. '
Cupertino against liabilities,judgments casts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against Said ity in consequence of the
mmllmg this permit. MECH.CONT. LIC.N0, MECH.
D'•'-' ✓O TOTAL TOTAL
IgA tut a 6 pp Icanf/Con raclor Dare '
OFFICE COPY